Xolair®-induced recurrent anaphylaxis through sensitization to the excipient polysorbate

Omalizumab is an anti-IgE humanized IgG1 monoclonal antibody, indicated for the treatment of moderate-to-severe allergic and uncontrolled asthma. Anaphylaxis was found to occur in 0.1 to 0.2% of patients taking Xolair®, the commercialized form of omalizumab1, with no known underlying mechanism. Although it has been very difficult to develop a reliable assay to detect clinically significant anti-omalizumab IgE, a recent report suggested that Xolair®-induced anaphylaxis is not mediated by IgE sensitization to the monoclonal antibody (mAb) omalizumab itself2.

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