TY - JOUR
T1 - Omalizumab-Induced Aspirin Tolerance in Nonsteroidal Anti-Inflammatory Drug–Exacerbated Respiratory Disease Patients Is Independent of Atopic Sensitization
AU - Quint, Tamara
AU - Dahm, Valerie
AU - Ramazanova, Dariga
AU - Arnoldner, Michael A.
AU - Kurz, Harald
AU - Janik, Stefan
AU - Brunner, Patrick M.
AU - Knerer-Schally, Birgit
AU - Weninger, Wolfgang
AU - Griss, Johannes
AU - Ristl, Robin
AU - Schneider, Sven
AU - Bangert, Christine
N1 - Funding Information:
This article was reviewed and approved by the Ethics Committee of the Medical University of Vienna approval #1732/2017, registration at the European Union Drug Regulating Authorities Clinical Trials Database (EudraCT 2017-003119-21).
Publisher Copyright:
© 2021 American Academy of Allergy, Asthma & Immunology
PY - 2022/2
Y1 - 2022/2
N2 - 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.
AB - 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.
KW - Aspirin hypersensitivity
KW - Asthma
KW - CRSwNP
KW - Nonsteroidal anti-inflammatory drug exacerbated respiratory disease
KW - Omalizumab
UR - http://www.scopus.com/inward/record.url?scp=85121001919&partnerID=8YFLogxK
U2 - 10.1016/j.jaip.2021.09.050
DO - 10.1016/j.jaip.2021.09.050
M3 - Article
C2 - 34678497
AN - SCOPUS:85121001919
VL - 10
SP - 506-516.e6
JO - Journal of Allergy and Clinical Immunology: In Practice
JF - Journal of Allergy and Clinical Immunology: In Practice
SN - 2213-2198
IS - 2
ER -