Single omalizumab dose before pollen season may counter seasonal allergic rhinitis
Click Here to Manage Email Alerts
A dose of omalizumab administered before pollen season improved symptom control and quality of life compared with standard medication among patients with seasonal allergic rhinitis, according to a study in Clinical and Translational Allergy.
Yuan Zhang, MD, an ENT doctor in the department of allergy at Beijing TongRen Hospital at Capital Medical University in Beijing, and colleagues conducted the prospective randomized controlled open-label single-center trial between July and September 2020.
Researchers randomly assigned 16 patients (mean age, 34.75 years ± 1.75; 62.5% women) to receive a 300 mg subcutaneous dose of omalizumab (Xolair; Genentech, Novartis), a recombinant humanized anti-IgE antibody, about 2 weeks before the start of the autumn pollen period in Beijing, defined as Aug. 15.
Fifteen participants (mean age, 36.93 years ± 2.55; 66.7% women) received control standard medication. Typical treatment for seasonal allergic rhinitis includes guideline-based antihistamines and corticosteroids, protective measures to reduce pollen inhalation or adhesion, and allergen immunotherapy.
All of the participants completed daily questionnaires about their nasal and ocular symptoms and use of antihistamines and intranasal or oral corticosteroids, as well as their quality of life based on activities, sleep, practical problems, nose and eye symptoms and emotional function, over the 6 weeks spanning the start of the pollen period through 1 week after it ended.
Patients assigned omalizumab demonstrated significantly reduced changes of mean daily combined symptom and medication score (CSMS) for the nose during the pollen period (P < .001), the peak pollen period and remainder of the pollen season (P = .002), and a week after the end of the pollen period (P = .009) compared with those assigned the control standard medication.
Omalizumab also significantly decreased changes in CSMS for the eye during the pollen period (P < .001), peak pollen period and shortly thereafter (P < .001) and post pollen period (P = .003) compared with control standard medication.
The participants who received omalizumab further saw a significantly higher proportion of days that did not require medication to relieve their allergy symptoms compared with control standard medication (76.2%; 95% CI, 16.7-98.8 vs. 19%; 95% CI, 0-71.4; P = .03).
Omalizumab provided the same nasal symptom control assessed via total nasal symptom score during the entire pollen season as the control standard medication and better results in the total eye symptom score during the pollen period (P = .046) and peak pollen period and shortly thereafter (P = .004).
The participants who received omalizumab also saw significantly greater improvement in quality of life over the entire pollen season (pollen period, P = .037; peak, P = .004) than the control group.
Additionally, a greater proportion of those assigned omalizumab than control medication said they achieved total control (18.75% vs. 6.67%) or substantial control (56.25% vs. 46.67%) of their symptoms.
Finally, seven of the patients who received omalizumab received doses considered to be adequate based on baseline serum total IgE level and weight. However, there was no significant difference between their improvements in symptoms and the improvements experienced by those who were considered to have received an insufficient dose.
Only one (6.25%) of the patients who received omalizumab experienced local adverse events — in this case, local itching and wind masses at the injection site that subsided within a half-hour after the injection.
Noting the expense of omalizumab treatment, the researchers said the single dose achieved equal or greater efficacy of treatment for seasonal allergic rhinitis than pharmacotherapy while minimizing costs, which may be particularly advantageous among patients who exercise low adherence to standard pharmacotherapy.
Perspective
Back to Top
The results of this study are significant, but not surprising. It is not surprising that blocking IgE can help alleviate symptoms of allergic rhinitis. But due to the cost of omalizumab and the lack of on-label indication, it has always been very difficult to obtain it for use in allergic rhinitis.
The findings of this study also are significant in that they provide further evidence that even a single pre-seasonal dose of omalizumab may be beneficial for patients who have severe seasonal symptoms, while providing some support for intermittent or once-a-year use of the therapy for these patients.
I have not personally used omalizumab solely for the purpose of allergic rhinitis, but I have considered it for patients who were refractory to immunotherapy. However, I have noticed that for my asthmatic patients who are on omalizumab, their comorbid allergic rhinitis symptoms seem to improve.
Physicians can consider using a single dose or a few doses of omalizumab pre-seasonally for seasonal allergic rhinitis patients. These findings suggest that omalizumab may be beneficial for individuals who are not eligible or who do not wish to be on immunotherapy.
The next steps would be to conduct a double-blind randomized control study on a much larger group of patients. In addition, this study only looked at seasonal allergic rhinitis, but future studies should examine perennial allergic rhinitis patients using longer term omalizumab therapy. Furthermore, future studies should examine the benefit of combining omalizumab plus subcutaneous or sublingual immunotherapy.
Overall, I feel that this is a helpful contribution to our field and to patients, and the findings have significant clinical relevance to improve the management of patients with severe allergic rhinitis.
Collapse
Zhang Y, et al. Clin Transl Allergy. 2022;doi:10.1002/clt2.12094.
Read more about
Click Here to Manage Email Alerts