Xolair Indications, Side Effects, and Warnings

Xolair (omalizumab) has been shown to decrease the frequency of asthma attacks in moderate to severe asthmatics, and decrease or eliminate the need for other asthma medications.

Woman with asthma using inhaler
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Will I Benefit From Xolair?

Some patients with allergic asthma make too much IgE that may result in a worsening of asthma symptoms such as:

In general, you may benefit from Xolair if you have:

  • Moderate persistent or severe persistent asthma
  • A sensitivity to an allergen and an abnormal allergy test like RAST
  • Not obtained a good response to an inhaled steroid like Flovent or an inhaled steroid plus a long-acting beta agonist like Advair.

Additionally, some patients with occupational asthma who are unable to modify their work environment may benefit from treatment with Xolair. Some insurers like Aetna require certain criteria be met before approving payment for Xolair initially and for its continued use.

How Does It Work?

Xolair acts at a number of different levels related to your asthma pathophysiology including:

Through its action, IgE levels decrease along with the activity of basophils and mast cells. The result is decreased inflammation and airway hyperresponsiveness resulting in the previously mentioned clinical improvements.

Who Can Take Xolair?

You may use Xolair if you are 12 years of age and older.

How Is Xolair Administered?

Your Xolair (omalizumab) dose is based on your:

  • Weight
  • IgE level

Depending on your weight and IgE level, you will receive a subcutaneous (under the skin) injection every 2-4 weeks. You need to receive injections for at least 12 weeks to see if Xolair is effective for you. If you need to stop Xolair due to side effects or some other reason, treatment effects will begin to wear off and will be totally gone in about 6 months. There are no permanent benefits of receiving the injections.

Because of the risk of anaphylaxis, you will receive Xolair injections in your physician's office and will have to remain for up to 2 hours to make sure you do not develop a reaction. Your doctor may also prescribe and educate you about an EpiPen or epinephrine injector to use in case you develop symptoms of anaphylaxis outside of the office.

Adverse Effects

In the clinical studies to get Xolair approved by the FDA, it appears to be very safe. Xolair has been given to more than 2000 adults and adolescents over the age of 12. As of January 2010, this included more than 1600 asthma patients using Xolair for more than 6 months and more than 550 patients using Xolair for a year or more.

Common adverse effects occurred about equally in both patients taking Xolair and those taking a placebo. There are also a number of potentially serious adverse effects that one should be aware of both before beginning treatment with Xolair and to monitor yourself closely for with your asthma care provider. Fortunately, the serious adverse effects appear to occur in less than 1% of patients treated with Xolair.

The Xolair safety information includes a potentially significant Black Box Warning related to anaphylaxis and another warning related to cancer.

Is Xolair Safe?

Many patients often ask questions about whether a particular treatment is safe or not. Since all drugs have adverse effects, this question really boils down to whether you and your doctor think the potential side effects of Xolair are greater or less than your potential benefit. You and your doctor should have a conversation discussing the risks and benefits before you make a decision.

How Much Does It Cost?

Xolair is very expensive, ranging from $500 to $2000 per month. Talk with your doctor about getting insurance coverage for this treatment.

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