Omalizumab in the severe exacerbations of seasonal allergic rhinitis

Abstract

Background: according to the Federal Clinical Guidelines (FCG), patients with severe persistent allergic rhinitis (AR) and/or severe exacerbation and with the ineffectiveness of the 3rd line pharmacotherapy (antihistamines, leukotriene receptor antagonists, nasal corticosteroids) are recommended to consider the appointment of the omalizumab, but there aren`t practical recommendations on the regimens and duration of the omalizumab therapy in the severe exacerbation of seasonal AR. Aim: omalizumab additional therapy in patients with severe exacerbation of AR during the pollen season to assess the efficacy and to determine the optimal regimen and duration of treatment. Materials and methods: this is an open observational uncontrolled prospective single-center study. 10 adult patients with severe exacerbation of seasonal AR due to birch pollen were selected to study. All of them received the 3rd line of therapy according to FCG and had absence or incomplete control: TNSS (Total nasal symptom score) 2. All of them were treated with the omalizumab, dose and regime were prescribed according to instruction take into account the overall IgE level and the patient's weight. Daily symptom diaries and need for rescue medication were evaluated. The primary endpoint was a decrease in the Combined medical and symptom score (CMSS) mean. Results: the additional omalizumab treatment has improved AR control for all patients and has reduced the rescue medication (TNSS 1.8 [95% CI 1.562.04]; p0.001 and CMSS 2.12 [95% CI 1.742.5]; p0.001 by the end of 1 wk after the first omalizumab injection; TNSS 2.53 [95% CI 2.053.01]; p0.0001 and CMSS 5.22 [95% CI 4.74-5.7]; p0.001 by the end of 4 wk, respectively) . It was noted that the omalizumab effect realization occurs for some time (from 3 to 7 days). Due to short season pollen for birch (1-2 month) the duration of treatment in our study did not exceed 1 month, so we managed to achieve complete control over the symptoms in all patients by the omalizumab with a small multiplicity of injections (1-2). No adverse events were registered during study. Conclusion: omalizumab additional therapy in patients with severe exacerbation of AR allows to achieving the whole symptoms control. Taking into account the mechanism omalizumab should be administered at least a week before the expected pollen season in patients with severe exacerbation (according to the previous seasons) which did not complete the allergen-specific immunotherapy in a timely manner, and continue therapy for the end of the pollen season.