Progress in anti-IgE monoclonal antibody targeting therapy for allergic bronchial asthma: a review

Allergic bronchial asthma is a prevalent chronic airway disease characterized by immunoglobulin E (IgE)-mediated inflammation. For patients with moderate-to-severe diseases that remain inadequately controlled despite conventional therapies, anti-IgE monoclonal antibodies (mAbs) represent an important targeted treatment strategy. This review summarizes the mechanistic basis, clinical efficacy, safety, heterogeneity in treatment response, predictive biomarkers, and future directions of anti-IgE therapy for allergic asthma. Omalizumab, the first approved anti-IgE mAb, reduces circulating free IgE, downregulates FcεRI expression, and attenuates downstream inflammatory cascades. Evidence from clinical trials and real-world studies indicates that omalizumab reduces asthma exacerbations, emergency department visits, hospitalizations, and systemic corticosteroid use while improving disease control and health-related quality of life. Clinical benefits have also been reported in selected patients with allergic bronchopulmonary aspergillosis and when omalizumab is used in combination with allergen immunotherapy. Omalizumab is generally well tolerated; however, rare cases of anaphylaxis and remaining uncertainties regarding its long-term safety warrant continued pharmacovigilance. Emerging agents such as ligelizumab exhibit greater IgE-binding affinity than omalizumab, but their clinical superiority in allergic asthma has not yet been established. The current evidence base is limited by substantial heterogeneity in study populations, treatment regimens, follow-up durations, and outcome definitions; a scarcity of head-to-head comparisons; and insufficient long-term asthma-specific data on newer agents. Future studies should validate biomarker-guided approaches to patient selection and further evaluate long-term safety, comparative effectiveness, and cost-effectiveness.