Omalizumab treatment for severe allergic asthma also improves co-existent CRSwNP. Further clinical studies of current and emerging biological agents for severe asthma should include upper airway outcomes. These agents may be effective for severe CRSwNP and comparative studies with surgery are warranted.

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Background: Chronic rhinosinusitis with and without nasal polyps (CRSwNP and CRSsNP respectively) can be difficult to treat and biologics offer potential as a future therapeutic intervention. CRS and severe asthma often co-exist. Omalizumab is currently licenced for the treatment of severe allergic asthma. Objective: The aim was to determine which blood biomarkers and treatment variables were associated with clinical response for sinonasal symptoms in patients with allergic CRSsNP and CRSwNP who were treated with omalizumab for severe allergic asthma. Methods: Sinonasal outcome test (SNOT)-22 scores were recorded in a cohort of patients with allergic CRSsNP (n=10) or CRSwNP (n=15) treated with omalizumab for severe asthma according to UK guidelines. Using a linear modelling approach, the improvement in the SNOT-22 score as the treatment variable against several disease and treatment predictor variables was modelled. Results: SNOT-22 significantly decreased with omalizumab treatment. Increased blood eosinophil count and omalizumab dosing every two weeks (as opposed to every 4 weeks) were associated with greater reductions in SNOT-22 after 16 weeks of omalizumab treatment. Conclusion: Our study confirms that omalizumab is an effective treatment for CRS, and suggests that improvements are greater in those with eosinophilic disease. Further studies are required to determine long term efficacy and whether this treatment could reduce the need for surgery.

Background Chronic rhinosinusitis (CRS) has a high prevalence of anxiety and depression. It is currently uncertain if treatment in patients with CRS with or without nasal polyps (CRSwNP and CRSsNP) has any impact on improving mental health outcomes. The aims here were to document anxiety and depression in patients with severe CRS and asthma already treated with appropriate medical therapy. We then evaluated whether further maximal treatment with omalizumab improved anxiety and/or depression alongside improvements in CRS and coassociated asthma. Methods Hospital Anxiety and Depression Scale (HADS) scores along with measures of CRS and asthma severity were recorded according to CRSwNP and CRSsNP status in n = 95 patients with severe CRS and asthma. Of this group, a further n = 23 had omalizumab for associated allergic asthma. Follow‐up measures were collected 16 weeks after omalizumab treatment. Results HADS anxiety and depression prevalence in CRS were 49.47 % and 38.95%, respectively. Within the CRSwNP and CRSsNP group 53.06% and 45.66% had raised HADS‐anxiety scores. Abnormal HADS‐depression scores were present in 40.82% and 36.95% of the CRSwNP and CRSsNP groups, respectively. Correlations for sinonasal outcome test‐22 (SNOT‐22) versus HADS total was r = 0.59 p < 0.0001, HADS‐anxiety r = 0.56 p < 0.0001 and HADS‐depression r = 0.49 p < 0.0001. Omalizumab improved anxiety in CRS (p < 0.0001) regardless of nasal polyp status (CRSwNP p = 0.0042 and CRSsNP p = 0.0078). Depression scores did not improve in either group. SNOT‐22 (p = 0.0006), asthma control questionnaire‐7 (p = 0.0019) and mini‐asthma quality of life questionnaire including emotional function (p = 0.0003 and p = 0.0009, respectively) all improved in both subgroups. Conclusion In CRS and asthma, anxiety scores but not depression improved after omalizumab treatment. Anxiety may be closely related to airway disease severity, but depression may be independent of airway disease itself. If so, a separate mental health care pathway is needed for CRS patients with depression.

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