Omalizumab is a recombinant humanized monoclonal antibody. Use of omalizumab is reported to benefit significantly a subset of asthmatics patients with inadequately controlled moderate-to-severe persistent allergic asthma that is not controlled with high-dose inhaled corticosteroids. However, recent reports and patents suggest wider applications in asthma and related diseases. In this review unmet needs and future directions regarding the use of omalizumab in asthma are discussed. Better understanding of omalizumabs mechanisms of action on one hand and asthma and related pathogenesis on the other hand might contribute to the development of better future guidelines of omalizumab use in asthma patients.