Evaluation of Rhinological Symptoms and Quality of Life in Patients with Allergic or Eosinophilic Severe Uncontrolled Asthma Treated with Anti-IgE or Anti-IL5 Therapy: A Real-Live Study.

Introduction: Patients with asthma have a higher incidence of allergic or nonallergic persistent rhinitis, and chronic rhinosinusitis with or without nasal polyps. The nasal symptoms significantly reduce quality of life and substantially affect the asthma control among these patients. Because of no complete knowledge of the etiology of rhinological symptoms, in some patients the proposed therapeutic options are still ineffective. Recommended pharmacotherapy, immunotherapy, and surgical treatment do not have the expected therapeutic effect in some patients. More recently, biological treatment based on phenotyping has become a new alternative therapeutic option. Currently, omalizumab, a monoclonal antibody with an anti-IgE effect in patients with allergic phenotypes or mepolizumab, an anti-IL-5 biologic that reduces the number of eosinophils, may be used.

Methods: In this single-center, real-live study, authors analyzed effects of biological treatment on rhinological symptoms in patients over the age of 18 with severe uncontrolled bronchial asthma with coexisting persistent allergic rhinitis treated with omalizumab or uncontrolled bronchial asthma with coexisting chronic rhinosinusitis with nasal polyps treated with mepolizumab. In all patients, the otolaryngologist performed anterior rhinoscopy. Evaluation of rhinological symptoms and quality of life in patients treated with anti-IgE or anti-IL5 therapy before and 6 months after biological treatment was performed using the TNSS and SNOT-22 scales. The sub-analysis of changes in rhinological symptoms was also performed in a group of patients with N-ERD regardless of eosinophilic or allergic asthma phenotype.

Results: A total of 48 patients (9 male, 18%) with severe chronic bronchial asthma treated with biologics were included into the study. Among them, there were 26 (54%) patients with allergic asthma and persistent allergic rhinitis treated with omalizumab, and 22 (46%) with eosinophilic asthma and chronic rhinosinusitis with nasal polyps treated with mepolizumab. In both groups, 6 months of treatment with omalizumab or mepolizumab resulted in significant improvement in relation to all rhinological symptoms assessed with TNSS and SNOT-22 scales. There was a significant increase in the number of patients with smell improvement in the mepolizumab-treated group. Improvements in all rhinitis symptoms and quality of life assessed by TNSS and SNOT-22 scales after 6 months of treatment were comparable in NSAIDs-sensitive versus NSAIDs-tolerant patients regardless of type of monoclonal antibodies used.

Conclusion: Six-month phenotyping-based biological therapy with omalizumab in patients with chronic allergic rhinitis accompanied by several bronchial asthma or with mepolizumab in patients with chronic sinusitis with nasal polyps accompanied by several bronchial asthma showed significant improvement in rhinological symptoms and quality of life.