A new study suggests that Novartis drug Xolair may aid in the treatment of asthma, the leading cause of chronic illness in children, especially for those living in highly polluted inner-city areas. Asthma affects as many as 10% to 12% of children in the United States and for unknown reasons is steadily increasing.

The respiratory ailment can begin at any age, but most children have their first symptoms by age five. Inner-city children with asthma may be particularly vulnerable to air pollution at levels below current air quality standards, but new research suggest that including the drug omalizumab (Xolair) in asthma therapy reduces seasonal attacks and the need for controller medication among inner-city children in particular, regardless of asthma severity.

Suzanne Steinbach, MD, an associate professor of pediatrics at Boston University School of Medicine states:

“We found omalizumab (Xolair, Novartis) to be equally effective at all levels of asthma severity and all ages evaluated.”

She and colleagues enrolled 419 inner-city patients, aged 6 years to 20 years and found that omalizumab reduced asthma symptoms by 25% and asthma exacerbations by 30% compared with placebo.

Those with asthma are at risk of an asthma attack, or exacerbation, when their lungs and airways begin to overreact to certain things that trigger these attacks. During an asthma exacerbation the lining of the airways will suddenly become swollen and inflamed. The muscles of these airways will tighten up and the production of mucus will increase. This combination makes the openings much narrower and can almost close them altogether, making breathing hard. A severe asthma attack can result in death if untreated as the person will eventually be unable to breathe.

In addition, children in the omalizumab group experienced fewer exacerbations between September and November, the peak asthma season. Whereas exacerbations increased more than 100% in the placebo group from summer to fall and inhaled-corticosteroid use went up, rates stayed static in the treatment group.

In recent years, there has been a worldwide increase in the number of children with asthma. This trend has been linked to environmental factors, including air pollution. However, it is important to understand that indoor triggers can play just as much of a role as outdoor triggers in bringing on an asthma attack.

Children’s airways are narrower than those of adults. This means that triggers that may cause only a slight problem in an adult can create more serious problems in children. In children, an asthma attack can appear suddenly with severe symptoms. For this reason, it is important that asthma be diagnosed and treated correctly. Some children may need to take medicine every day to prevent attacks, even when they do not have symptoms.

Omalizumab is a protein that resembles one type of human antibody. Antibodies are proteins produced by the body that recognize foreign substances such as bacteria (that cause infection) and pollens (that cause allergies). Once they recognize a foreign substance, the antibodies attach to receptors on two types of cells in tissues and blood, mast cells and basophils. These cells then release chemicals that cause an allergic reaction that leads to inflammation. Omalizumab blocks the receptors on the surfaces of the mast cells and basophils to which antibodies attach, thereby preventing antibodies from attaching to the cells.

The research finalizes:

“Because omalizumab targets a specific immunologic pathway of major importance in asthma, patients with asthma and allergic sensitizations are obviously the candidates for this treatment. Although our observations will help in the selection of patients for omalizumab, asthma treatments for individual patients will eventually need to consider many aspects of disease management, including cost.”

Source: The New England Journal of Medicine

Written by Sy Kraft, B.A.