What is the role of anti-immunoglobulin (IgE) in the treatment of anaphylaxis?

Updated: May 16, 2018
  • Author: S Shahzad Mustafa, MD; Chief Editor: Michael A Kaliner, MD  more...
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Answer

Anti-IgE (eg, omalizumab) complexes circulating (but not receptor-bound) IgE and keeps it from binding to its receptors. It does not remove IgE bound to receptors and can take several weeks to months to have a substantial effect. It should not be used in an acute setting and would not be expected to influence IgE-independent or nonimmunologic events.

Due to the potential for delayed anaphylaxis after omalizumab (0.09% of recipients in 1 report), observation periods of 2 hours for the first 3 injections and 30 minutes for subsequent injections have been recommended. Patients should also be prescribed an epinephrine autoinjector (see above for epinephrine autoinjector instruction) and advised to carry it before omalizumab injection and for the ensuing 24 hours. [52]


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