The effectiveness of anti-IgE therapy for allergic rhinitis in patients with severe atopic bronchial asthma and concomitant allergic rhinitis in real clinical practice

BACKGROUND: Omalizumab, by binding immunoglobulin (Ig) E in patients with atopic asthma, can improve clinical and functional parameters and patients’ quality of life.

AIM: To evaluate the efficacy of anti-IgE therapy in patients with allergic rhinitis treated with omalizumab for concomitant severe atopic asthma in real clinical practice

MATERIALS AND METHODS: This open, non-interventional, prospective, and non-randomized study in real clinical practice was conducted in the Sverdlovsk region in October 2021 based on a regional registry of adult patients with severe asthma with chronic nasal inflammatory diseases and receiving targeted therapy. Dynamics of nasal symptoms were assessed using the Sino-nasal-outcome test 22 (SNOT-22) questionnaire and visual analog scale (VAS) initially and after 4 and 12 months of omalizumab therapy. Peripheral blood eosinophil level was assessed before and after 4 months of omalizumab therapy.

RESULTS: The study included 26 patients. Assessment of nasal symptoms dynamics using the SNOT-22 questionnaire at baseline and after 4 months of omalizumab therapy revealed a decreased severity of symptoms (p <0.001) of 46.85±22.04 points at baseline (95% confidence interval [CI]: 37.94–55.75) and 30.65±14.81 points after 4 months (95% CI: 24.67–36.64). Additionally, improvement in SNOT-22 questionnaire score was revealed in 18 patients treated with omalizumab during 12 months, with 47.5 points before therapy (Q₁–Q₃: 35.7–59.3), 30.4 points after 4 months (Q₁–Q₃: 22.1–38.1), and 24.9 points after 12 months (Q₁–Q₃: 16.9–32.9) (p=0.001). Improvement in rhinitis symptoms control was observed according to the VAS scale, with 8.0 points before therapy (Q₁–Q₃: 6.2–9.0), 5.0 points after 4 months (Q₁–Q₃: 3.2–5.8), and 5.0 points after 12 months of treatment (Q₁–Q₃: 4.0–6.8). The eosinophil levels (n=16) decreased from 510.9±317.9 cells/µl (95% CI: 341.5–680.3) to 327.4±217.7 cells/µl (95% CI: 211.4–443.5) after 4 months of anti-IgE therapy (p <0.041).

CONCLUSIONS: Omalizumab in real clinical practice has demonstrated improvement of rhinitis symptoms and quality of life in patients with allergic rhinitis with concomitant severe atopic asthma. Additionally, a statistically significant decrease in peripheral blood eosinophils level was observed, which largely determines airway inflammation severity and clinical manifestations of allergic rhinitis and bronchial asthma.