Omalizumab, the blockbuster monoclonal antibody anti-IgE that revolutionized the market by the disruptive innovation that supposed more than 20 years ago. This biological drug changed the paradigm of the treatment of allergic diseases, particularly severe allergic asthma and chronic spontaneous urticaria. It opened up a new alternative world of possible treatments, covering the clinical unmet needs of asthmatic patients and creating value for patients who do not respond well to traditional medicines (small-molecules). Its efficacy and safety have been demonstrated in numerous clinical trials and Real-World Evidence. These observations have favoured the life cycle management of the product for new applications, including nasal polyposis and food allergies. However, it is no longer the only biological on the market for the treatment of these pathologies, so how is it possible that after so many years it is still a blue ocean product?