Despite the advanced and increasing understanding of the pathophysiology of asthma and other allergic diseases, current treatment remains unspecific and targets late events within the allergic cascade. Therefore, a novel and promising approach to treat allergic asthma is antagonizing IgE by anti-IgE antibodies. This review analyzes the role of IgE for the pathology of asthma, summarize the current data about action, safety and efficacy of anti-IgE therapy, and tries to give a rational approach for future indications and directions of treatment with anti-IgE antibodies.