Omalizumab-Induced Aspirin Tolerance in Nonsteroidal Anti-Inflammatory Drug–Exacerbated Respiratory Disease Patients Is Independent of Atopic Sensitization

Tamara Quint, Valerie Dahm, Dariga Ramazanova, Michael A. Arnoldner, Harald Kurz, Stefan Janik, Patrick M. Brunner, Birgit Knerer-Schally, Wolfgang Weninger, Johannes Griss, Robin Ristl, Sven Schneider, Christine Bangert

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Abstract

Background: Nonsteroidal anti-inflammatory drug (NSAID)–exacerbated respiratory disease (N-ERD) comprises the triad of chronic rhinosinusitis with nasal polyps (CRSwNP), asthma, and intolerance to inhibitors of the cyclooxygenase-1 enzyme. The impact of omalizumab on prevention of aspirin-induced hypersensitivity in N-ERD patients with and without atopic sensitization has not been thoroughly addressed. Objective: To investigate the effect of omalizumab treatment on aspirin tolerance in atopic and nonatopic N-ERD patients. Methods: This single-center, prospective trial evaluated overall omalizumab-induced aspirin tolerability in N-ERD patients by performing aspirin challenge testing before and after 6 months of anti–immunoglobulin E (IgE) therapy. The impact of omalizumab on CRSwNP asthma as well as serum and tissue biomarkers in patients with and without comorbid atopic sensitizations was further analyzed. Results: Out of 33 patients included in the study, 56% developed complete aspirin tolerance and 18% tolerated higher dosages after 24 weeks. Polyp size and disease-specific symptoms (nasal polyp score [NPS] –1.9 ± 0.3, P <.001; Sino-Nasal Outcome Test [SNOT]–20 –16.7 ± 3.7, P <.001; Asthma Control Test [ACT] 3.2 ± 0.7, P <.001) improved in all patients irrespective of atopic sensitization. Effectiveness of omalizumab was accompanied by an increase in mean total serum IgE (307.8 ± 42 kU/L; P <.001) and a decrease in eosinophilic cationic protein (–10.6 ± 6.7 μg/L) and in relative eosinophilia (–2.5 ± 0.7%; P <.01). Whereas there was a significant reduction of tissue IgE (P <.05) in all patients after 4 weeks, the number of local eosinophils decreased only in atopic individuals (P <.05). Conclusions: Omalizumab induced complete aspirin tolerance in the majority of patients (56%) independent of atopic sensitization and demonstrated clinical efficacy in the treatment of CRSwNP and asthma. Inhibition of IgE can therefore be a promising treatment option in preventing NSAID hypersensitivity reactions in N-ERD patients.

Original languageEnglish
Pages (from-to)506-516.e6
JournalJournal of Allergy and Clinical Immunology: In Practice
Volume10
Issue number2
DOIs
StatePublished - Feb 2022
Externally publishedYes

Keywords

  • Aspirin hypersensitivity
  • Asthma
  • CRSwNP
  • Nonsteroidal anti-inflammatory drug exacerbated respiratory disease
  • Omalizumab

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