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Wise et al.

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AR, but reported no significant adverse events associated with omalizumab. 1396 A second study randomized birch pollen-induced SAR patients to receive either 300 mg of omalizumab (originally named rhumAb-E25) or placebo given 2 or 3 times over the season, depending on baseline IgE levels. RhemAB-E25 treatment significantly reduced nasal symptom severity scores, the average number of tablets of rescue antihistamines per day, the proportion of days with any SAR medication use, and all domains of QOL. 1392 A third study applied omalizumab, 50 mg, 150 mg, or 300 mg, vs placebo subcutaneously prior to ragweed season and repeated every 3 to 4 weeks during the pollen season dependent on the patient’s base-line serum IgE. 1393 At the highest dose studied, 300 mg of omalizumab significantly reduced nasal symptom severity scores and rhinitis-specific QOL scores. A significant association was observed between IgE reduction and nasal symptoms and rescue antihistamine use. The frequency of adverse events was not significantly different between omalizumab and placebo groups. subcutaneously every 4 weeks for 16 weeks. 1394 Omalizumab therapy was well tolerated. Similarly, effectiveness and safety of subcutaneously injected omalizumab was shown in the treatment of Japanese cedar pollen-induced SAR. 1395 Omalizumab treatment markedly reduced serum free IgE and the clinical response to nasal allergen challenge in an open study, but did not affect IgE-secreting B cells and epsilon mRNA in nasal lavage fluid, suggesting that treatment for 6 months does not significantly modulate synthesis of nasal IgE. 1397 The biologic also suppressed tryptase and ECP levels in nasal secretions in seasonal allergy. 1398 Omalizumab showed significantly greater improvements than suplatast tosilate, a selective T-helper type 2 cytokine inhibitor, in the treatment of SAR induced by Japanese cedar pollens. 1399 In 4 trials, a combination of omalizumab with AIT was studied to determine whether combined therapy could provide better efficacy and lower adverse events than AIT alone. In children and adolescents with SAR to birch or grass pollen, combination therapy significantly reduced symptom load over AIT alone independent of the allergen. 1400 Anti IgE monotherapy alone significantly diminished rescue medication use and reduced the number of symptomatic days. The combined treatment with AIT and anti-IgE showed superior efficacy on symptom severity compared with anti-IgE alone. 1401 Combination therapy may, therefore, be useful for the treatment of AR, particularly for polysensitized patients. Patients receiving omalizumab and rush ragweed AIT showed a significant improvement in severity scores during season compared with AIT alone. 1402 Although omalizumab carries some risk of anaphylaxis itself, addition of omalizumab resulted in a significant decrease in risk of anaphylaxis caused by AIT. Combination therapy also significantly reduced the symptom load in HDM-allergic subjects better than AIT monotherapy, and improved asthma control and QOL with respect to asthma and AR. 1403 These effects were limited to the combined treatment period. 1404 Omalizumab was also studied in the treatment of PAR, significantly reducing the mean daily nasal severity score and the rescue medication, and improving QOL when given

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There are no other published studies evaluating other biologics (anti-IL5, anti-IL4, or IL-4R) as monotherapy for AR. A combination therapy of anti-IL4 with suboptimal AIT provided

Int Forum Allergy Rhinol . Author manuscript; available in PMC 2020 June 10.