Impact of omalizumab therapy on medication requirements for chronic rhinosinusitis

Chandra, Rakesh K.; Clavenna, Matthew; Samuelson, Madeleine; Tanner, S. Bobo; Turner, Justin H.

doi:10.1002/alr.21685

Cited by 23 publications

(20 citation statements)

References 14 publications

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“…Targeted treatment of CRS patients with atopy is important in improving patients’ control of their symptoms and overall QoL. Omalizumab is an anti‐IgE monoclonal antibody that has been investigated in CRS with nasal polyps; although it has been shown to be effective in both atopic and nonatopic patients (n = 24), further data with a larger study sample are required to more accurately assess its usefulness in CRS with atopy and other upper airway diseases in the future …”

Section: Discussionmentioning

confidence: 99%

Atopy in chronic rhinosinusitis: impact on quality of life outcomes

Alvarado

Rimmer

et al. 2019

Int Forum Allergy Rhinol

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Background: Chronic rhinosinusitis (CRS), in particular with nasal polyps (CRSwNP), has been linked with skewed T-helper 2 and immunoglobulin E (IgE)-mediated allergic responses. The role of atopy in CRS, however, remains unclear. Correlations between immunological allergic markers and patient-reported outcomes measures (PROMs) were investigated. Methods:A cross-sectional study of adult patients with CRS undergoing endoscopic sinus surgery was conducted. Immunological allergic markers included automated immunoassay testing for serum-specific IgE to common allergens (house dust mite, grass, mold, animal epithelia) and total IgE. PROMs were assessed using the 22-item Sino-Nasal Outcome Test (SNOT-22). Patients were defined as atopic based on either a positive specific IgE or elevated total IgE (>160 kU/L). Results:A total of 446 patients (45.7% female, age 49.05 ± 14.96 years) were recruited, of which 42.8% had asthma, 51.6% had CRSwNP, and 63.0% had eosinophilic CRS. Positive allergen sensitization was detected in 52.9% patients. Total IgE levels were elevated in 28.0% with mean IgE level of 161 ± 269 kU/L. Atopy was associated with younger age at the time of surgery, CRSwNP, asthma, and eosinophilic CRS (eCRS). Atopy was also associated with increased severity in nasal symptom score (13.1 ± 6.4 vs 11.9 ± 6.0, p = 0.04), as well as worse scores in the loss of smell/taste (χ 2 (1) = 5.97, p = 0.02) and need to blow nose (χ 2 (1) = 4.26, p = 0.04) questions in the CRS population. In the CRSwNP population, there was no significant association between atopy and PROMs. Conclusion:Comorbid atopy in CRS is associated with additional symptom burden, reflected mainly within the nasal symptom quality of life markers. Atopy assessment in CRS is important to ensure appropriate and successful treatment of the disease. C 2018 ARS-AAOA, LLC.

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Section: Discussionmentioning

confidence: 99%

Atopy in chronic rhinosinusitis: impact on quality of life outcomes

Alvarado

Rimmer

et al. 2019

Int Forum Allergy Rhinol

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“…Significant reduction of nasal polyps by 16 weeks in conjunction with concurrent reduction of corticosteroid use of approximately 50% at the end of therapy have been reported . In another study in patients with asthma and CRS there was a 60% reduction in antibiotic use and a 42% reduction in systemic steroid use …”

Section: Discussionmentioning

confidence: 92%

“…13 In another study in patients with asthma and CRS there was a 60% reduction in antibiotic use and a 42 % reduction in systemic steroid use. 13,57 IL-5 has been found to be elevated in nasal polyp tissue compared to normal controls, and the highest concentrations were detected in patients with comorbid nonallergic asthma or AERD. 58,59 Anti-IL-5 antibodies such as reslizumab and mepolizumab, which have been used to treat severe eosinophilic asthma, have also been considered for the treatment of CRS.…”

Section: Chronic Rhinosinusitismentioning

confidence: 99%

The use of biologics in children with allergic rhinitis and chronic rhinosinusitis: Current updates

Shinee¹,

Sutikno

Abdullah

2019

Pediatric Investigation

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The therapeutic goals of the treatment of allergic rhinitis (AR) and chronic rhinosinusitis (CRS) are symptom relief, avoiding complications, and improving quality of life. In the treatment of AR and CRS, several limitations of currently prescribed medicines have been identified. Antihistamine administration (both oral and topical) together with intranasal corticosteroids bring relief to the majority of patients, but their dependency on the medications and a necessity to maintain strict compliance with regular medication regimes pose a challenge. Immunotherapeutic agents are an option in some patients, but polysensitized patients, the risk of anaphylaxis, and the need for daily administration for years are limiting it from becoming the main therapy modality. Immunotherapy in any form requires commitment by the patient, which renders adherence and compliance issues particularly relevant. The procedure involved are generally time‐consuming and entail an associated risk of severe adverse reactions. The use of biologics could overcome the limitations of other therapeutic modalities. They could be used as a monotherapy or combined with pre‐existing medications. The benefits of targeted therapy include less adverse effects and optimal efficacy. The aim of the present review was to investigate the collective literature to date pertaining to the role of biologics in managing children with AR and CRS.

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“…Omalizumab, the anti‐IgE antibody, has shown a considerable efficacy in reducing the sensitivity of DCs to allergens by decreasing IgE levels . For CRS patients, omalizumab has been shown to reduce the inflammation on imaging, and overall antibiotic use and steroid dependence . It is possible that the therapeutic effect of omalizumab on CRS is partially due to its regulatory effects on DCs.…”

Section: As a Potential Therapeutic Target For Inflammatory Sinonamentioning

confidence: 99%

Dendritic cells in inflammatory sinonasal diseases

Cao

Shi

et al. 2016

Clin Experimental Allergy

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Dendritic cells (DCs) are critical in linking the innate and adaptive immune responses, which have been implicated in the pathogenesis of many immune and inflammatory diseases as well as the development of tumours. The role of DCs in the pathophysiology of lung diseases has been widely studied. However, the phenotype, subset and function of DCs in upper airways under physiological or pathological conditions remain largely undefined. Allergic rhinitis (AR) and chronic rhinosinusitis (CRS) are two important upper airway diseases with a high worldwide prevalence. Aberrant innate and adaptive immune responses have been considered to play an important role in the pathogenesis of AR and CRS. To this end, understanding the function of DCs in shaping the immune responses in sinonasal mucosa is critical in exploring the pathogenic mechanisms underlying AR and CRS as well as in developing novel therapeutic strategies. This review summarizes the phenotype, subset, function and regulation of DCs in sinonasal mucosa, particularly in the setting of AR and CRS. Furthermore, this review discusses the perspectives for future research and potential clinical utility focusing on DC pathways in the context of AR and CRS.

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Impact of omalizumab therapy on medication requirements for chronic rhinosinusitis

Abstract: Omalizumab therapy is associated with a decrease in overall antibiotic use for CRS. A subset of patients also experience significant reduction in steroid dependence. Further study is necessary to determine factors predictive of response.

Cited by 23 publications

References 14 publications

Atopy in chronic rhinosinusitis: impact on quality of life outcomes

Atopy in chronic rhinosinusitis: impact on quality of life outcomes

The use of biologics in children with allergic rhinitis and chronic rhinosinusitis: Current updates

Dendritic cells in inflammatory sinonasal diseases

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