If your current treatments aren’t working for severe allergic asthma, chronic hives, or nasal polyps, your doctor may suggest trying omalizumab (Xolair). There are a few things you may want to know about this medication.
What Is Omalizumab (Xolair)?
The drug can help prevent and reduce asthma attacks and chronic hives. It can also help shrink the size of nasal polyps. Nasal polyps are noncancerous growths that can affect your nasal drainage, cause pain, and decrease your sense of smell.
Omalizumab is in a newer class of medications called biologics. These drugs are made of cells that come from humans, animals, or microorganisms. Omalizumab is a monoclonal antibody, which means it’s a copy of a living protein. It’s made to function like your natural antibodies, which support your immune system. It’s different from traditional drugs because those aren’t made from living organisms.
This medicine is not made to take when you have a sudden asthma attack. You take it to try and prevent allergic reactions that can cause inflammation. An inflammatory response can lead to serious symptoms like asthma attacks in some people.
It only comes as an injection. You get a shot every 2 or 4 weeks. Your doctor’s prescription will detail the dose and how often you get them.
Omalizumab is approved to treat:
- Asthma in patients 6 years old and older
- Nasal polyps in adults
- Chronic hives in people 12 and older
How Omalizumab (Xolair) Works
When you’re exposed to an allergen, your body makes an antibody known as immunoglobulin E, or IgE. The IgE attaches to the allergen and your body’s inflammatory cells. They can release substances that can cause inflammation. That may lead to symptoms that cause an asthma attack or other reaction. Omalizumab blocks IgE from attaching to your inflammatory cells to prevent inflammation.
Here’s what it can do for each condition it’s approved for:
Allergic asthma. It can decrease symptoms and reduce asthma attacks.
Chronic hives. It can lower the number of hives you get and relieve itching.
Nasal polyps. It can reduce the size of polyps, decrease congestion, and improve your sense of smell.
What to Know Before You Take Omalizumab (Xolair)
Tell your doctor if you have:
- Cancer
- A parasitic infection (now or in the past)
- Had a reaction to the ingredients in the medication, hamster proteins (which are used to make omalizumab), latex, foods, dyes, preservatives, or other medications
- Had sudden breathing problems
- Ever had a very serious allergic reaction or anaphylaxis
Or if you’re:
- Pregnant, trying to get pregnant, or are breastfeeding
- On any other medicines including over-the-counter medications, herbal supplements, or vitamins
Omalizumab (Xolair) Dosing Information
To treat asthma and nasal polyps, the dose of omalizumab depends on how much you weigh and how much of the antibody IgE you have in your bloodstream. Dosing for chronic hives does not depend on how much you weigh or how much IgE you have in your blood.
Asthma. The adult dose is usually 150 milligrams to 375 milligrams every 2 or 4 weeks. Children ages 6 to 12 usually get 75 milligrams to 375 milligrams every 2 or 4 weeks.
Chronic hives. Children over age 12 and adults usually get 150 milligrams to 300 milligrams every 4 weeks.
Nasal polyps. You may get 75 milligrams to 600 milligrams every 2 or 4 weeks.
Children younger than 6 can get this drug. The doctor determines the dosing for them.
What to Expect When You Take Omalizumab (Xolair)
Your doctor will take a blood sample to find your IgE levels if you have asthma or nasal polyps. They’ll also use your weight to figure out the best dosage.
You’ll get a shot in your upper arm, stomach, or thigh. You may need more than one shot if the dose is more than the amount of medicine in the prefilled syringe. If you need more than one shot, they’ll alternate locations to keep it from giving you skin problems.
You may not see improvement in your symptoms right after you take omalizumab, but that doesn’t mean it’s not working.
You’ll know it’s working over time if your symptoms don’t seem as severe or if you have less of them. Track your symptoms so your doctor can tell whether it’s a good choice for you.
How to Take Omalizumab (Xolair)
Depending on how your body reacts to this medication, your doctor may let you give yourself the injection at home. First, take the syringe out of the refrigerator. Let it come to room temperature for about 15 to 30 minutes before you use it. Don’t use the syringe if it’s been left out at room temperature for more than 48 hours. Call your doctor’s office for instructions if you leave it out too long.
Put the used syringe in the proper container marked for sharp objects.
Side Effects of Omalizumab (Xolair)
Some people have side effects, but you may not. Common ones are:
- Fatigue
- Muscle or joint aches
- Injection site reaction (like pain, redness, or swelling)
- Stomach pain
- Headache
- Ear pain
- Nose bleeds
- Nausea
- Swelling in nose, sinuses, or throat
Serious side effects include:
- Shortness of breath
- Fever, rash, muscle aches, or swollen glands within a few days of injection
- Sores on your skin
- Coughing up blood
- Trouble swallowing
- Numbing, tingling, or serious pain in hands and feet
- Swelling
- Swollen lymph nodes
- Loss of appetite
It’s rare to have a serious allergic reaction, but you can get one when you get your shot or within 4 days of it. Some people don’t have a reaction after the first shot but may have a serious reaction later on as they continue on it. This has been seen more than a year after starting treatment. Your doctor will monitor you for about 2 hours to check for any reactions at their office during the first three sessions.
They do this before letting you take the medicine at home to see if you have a reaction. (You may have to keep getting injections in a medical setting for some insurance plans to cover the cost.)
Who Shouldn’t Take Omalizumab (Xolair)?
You shouldn’t take omalizumab if you’re sensitive to any of the ingredients in it. If you’ve had anaphylaxis (a reaction that could be life-threatening) in the past from foods, medications, or other causes, tell your doctor. You’re at a higher risk for having a serious reaction from omalizumab if you’ve had anaphylaxis before.
Call 911 if you have these symptoms:
- Tightening in muscles around your lung area (bronchospasm), causing trouble breathing
- Hives
- Low blood pressure (hypotension)
- Dizziness or fainting
- Swelling in your tongue or throat
Off-Label Uses of Omalizumab (Xolair)
You may get omalizumab on an “off-label” basis. This means it may help with a condition that it’s not FDA-approved to treat.
Your doctor may prescribe it on an off-label basis for conditions like:
- Hay fever
- Food allergy
- Drug allergy
- Swelling
- Non-allergic asthma
- Eczema
- Chronic sinus infections
- Blisters
Omalizumab (Xolair) Drug Interactions
So far, no studies have been done to find out interactions between omalizumab and other prescription medications.
This medicine may interact with:
- Tobacco products
- Alcohol
- Illegal drugs
Tell your health care professional if you use any of them. Also make sure your doctor knows about any prescription and over-the-counter medicines you take, including vitamins and supplements.
How Effective Is Omalizumab (Xolair)
Studies show the drug is generally safe and it works to treat a variety of conditions.
In the studies used for initial approval, researchers found:
- Fewer people with allergic asthma who took omalizumab were hospitalized for worsening asthma compared to those who didn’t take the drug. They treated most issues without a hospital visit.
- People with nasal polyps who took omalizumab had more improvements in postnasal drip, runny nose, and sense of smell compared to those who didn’t take it.
- In trials on those with chronic hives, itch seriousness scores and hive counts went down more in people on three different doses of omalizumab compared to those getting a placebo. The greatest improvements were in those on the highest dose.
What to Do If You Miss a Dose of Omalizumab (Xolair)
Keep your appointments if you get your injection in a medical facility so you can get your medication on time. If you miss an appointment, call right away to reschedule.
If you take the medication at home and miss a dose, call your doctor to see when you should take this dose and when you should take the next one.
