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Omalizumab and Changes in Airway Hyperresponsiveness

We thank Drs. Currie, Saha, and Lee for their thoughtful comments regarding the observations made in our study that anti-IgE treatment does not alter methacholine responsiveness (1). They are right when they say that this treatment might have had an effect on adenosine monophosphate (AMP), mannitol, and cold air/exercise responsiveness, as these reflect, at least in part, mast cell activation. It is, indeed, also possible that responsiveness to other stimuli, such as bradykinin, may have also been reduced. Thus, they are right that the jury is still out as to whether airway responsiveness to stimuli other than methacholine, which we investigated in our study, may be affected by this treatment.

Notwithstanding the above comments, we remain surprised that omalizumab did not have larger effects on methacholine reactivity given its large effects on airway eosinophilia and other markers of airway inflammation. This finding, in our view, is worthy of further study so that we may better understand the relationship between airway inflammation and methacholine airway responsiveness, a key characteristic of asthma.

Ratko Djukanovic^a and John V. Fahy^b

^a University of Southampton Southampton, United Kingdom
^b University of California San Francisco, California

FOOTNOTES

Conflict of Interest Statement: R.D. has been consulting for Aventis and has received payments for lectures sponsored by GlaxoSmithKline and has received sponsorship for basic research from AstraZeneca, Cambridge Antibody Technology, Immunex, GlaxoSmithKline, and Bayer, and in addition has received funding from GlaxoSmithKline for participating in two multicenter studies of the antiinflammatory effects of Advair and is one of the cofounders and paid consultant of Synairgen in which he has shares; J.V.F. received a research grant from Novartis/Genentech for his participation as an investigator in the study examining the effects of omalizumab on airway inflammation in asthma.

REFERENCES

1. Djukanovic R, Wilson SJ, Kraft M, Jarjour NN, Steel M, Chung KF, Bao W, Fowler-Taylor A, Matthews J, Busse WW, et al. Effects of treatment with anti-immunoglobulin E antibody omalizumab on airway inflammation in allergic asthma. Am J Respir Crit Care Med 2004;170:583–593.[Abstract/Free Full Text]

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