Editorial
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 21, 2016; 22(43): 9451-9456
Published online Nov 21, 2016. doi: 10.3748/wjg.v22.i43.9451
Possible therapeutic role of IgE blockade in irritable bowel syndrome
Eli Magen, Tinatin Chikovani
Eli Magen, Medicine C Department, Allergy and Clinical Immunology Unit, Barzilai Medical Center, Ben Gurion University of Negev, Ashkelon 78100, Israel
Tinatin Chikovani, Department of Microbiology and Immunology, Tbilisi State Medical University, Tbilisi 0177, Georgia
Author contributions: Magen E and Chikovani T contributed equally to all aspects of this article.
Conflict-of-interest statement: The authors declare no conflicts of interest related to this publication.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Eli Magen, MD, Medicine C Department, Allergy and Clinical Immunology Unit, Barzilai Medical Center, Ben Gurion University of Negev, Ashkelon 78100, Israel. allergologycom@gmail.com
Telephone: +972-8-6745710 Fax: +972-8-6745712
Received: July 19, 2016
Peer-review started: July 21, 2016
First decision: September 5, 2016
Revised: September 23, 2016
Accepted: October 27, 2016
Article in press: October 27, 2016
Published online: November 21, 2016
Abstract

Omalizumab is a humanized monoclonal antibody that binds to the high-affinity type-I IgE Fc receptors on mast cells (MCs) and basophils, inhibiting the IgE immune pathway. Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder, and dysregulation of the immune system likely contributes to its etiology and/or symptomatology. Colonic biopsies from patients with IBS demonstrate considerable increase in the number of degranulating MCs releasing histamine in proximity to nerves, and this event may underlie the common IBS symptom of abdominal pain. Pharmacologic control of MC activation and mediator release is a current area of active interest in the field of IBS research. Recently, we and Pearson et al described 2 cases of patients with IBS with diarrhea (IBS-D) showing positive clinical response to omalizumab. In both cases, the female patients had severe, long-lasting IBS-D and achieved an almost complete resolution of IBS symptoms. Both patients were also able to discontinue all IBS medications after commencing the anti-IgE therapy. For both patients, the omalizumab treatment showed a relatively rapid onset of action, resembling the efficacy observed in and previously reported for patients with chronic spontaneous urticaria. In this Editorial, we discuss the possible biological mechanisms that may underlie the clinical efficacy of omalizumab in IBS. We suggest that there is a need for a well-designed prospective study to investigate the therapeutic effects of anti-IgE in IBS.

Keywords: IgE, Omalizumab, Irritable bowel syndrome, Anti-inflammatory, Irritable bowel syndrome with diarrhea

Core tip: Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder diagnosed. A growing body of research suggests that mast cells (MCs) releasing histamine in the colonic mucosa might contribute to the etiology and/or symptomatology of IBS. Blockade of the high-affinity type-I IgE Fc receptors on MCs by omalizumab has been observed as an effective therapy in 2 patients with IBS. We suggest that anti-IgE antibody therapy might be an attractive therapeutic option for functional bowel disorders.