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Smell improvement by anti-IgE and anti-IL 5 biologics in patients with CRSwNP and severe asthma. A real life study

Barroso B1,2*, Valverde-Monge M1,2*, Alobid I2,3,4, Olaguibel JM2,5, Rial MJ2,6, Quirce S2,7, Arismendi E2,8, Barranco P2,7, Betancor D1,2, Bobolea I2,8, Cárdaba B2,9, Cruz Carmona MJ2,10, Curto E2,17, Domínguez-Ortega J2,7, González-Barcala FJ2,11, Martínez-Rivera C2,12, Mahíllo-Fernández I13, Muñoz X2,14,15, Picado C2,4,8, Plaza V2,17, Rodrigo Muñoz JM2,9, Soto-Retes L2,17, Valero A2,8, del Pozo V2,9, Mullol J2,16**, Sastre J1,2**.
1Allergy Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
2CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
3Rhinology Unit & Smell Clinic, ENT Department, Hospital Clinic Barcelona, Universitat de Barcelona, Barcelona, Spain
4Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, Barcelona, Spain
5Allergy Department, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
6Allergy Department, Hospital Juan Canalejo, A Coruña, Spain
7Department of Allergy, La Paz University Hospital, IdiPAZ, Madrid, Spain
8Allergy Unit & Severe Asthma Unit, Pneumonology and Allergy Department, Hospital Clínic; IDIBAPS; Universitat de Barcelona. Barcelona, Spain
9Immunology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz-Universidad Autónoma de Madrid, Madrid, Spain
10Pulmonology Service, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
11Pulmonology Department, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, La Coruña, Spain
12Pulmonology Department, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona Badalona, Barcelona, Spain
13Epidemiology, Fundación Jiménez Díaz, Madrid. Department of Medicine, Universidad Autónoma de Madrid
14Pulmonology Department, Hospital Vall d’Hebron, Barcelona, Spain
15Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Barcelona, Spain
16Rhinology Unit & Smell Clinic, ENT Department; Clinical and Experimental Respiratory Immunoallergy (IDIBAPS); Universitat de Barcelona. Barcelona, Spain
17Pulmonology and Allergy Department, Hospital de la Santa Creu i Sant Pau, Instituto de investigación biomédica Sant Pau (IIB Sant Pau), Universidad Autónoma de Barcelona. Barcelona, Spain

*Blanca Barroso and Marcela Valverde-Monge contributed equally as the main authors.
**Joaquín Sastre and Joaquim Mullol contributed equally with senior responsibilities.

J Investig Allergol Clin Immunol 2023; Vol. 33(1)
doi: 10.18176/jiaci.0812

Background. Chronic rhinosinusitis with nasal polyps (CRSwNP), characterized by partial (hyposmia) or total (anosmia) loss of smell, is commonly associated with asthma and/or nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD), worsens disease severity and quality of life.
Objectives. The objective of this study was to determine whether, in real-life conditions, biological treatments prescribed for severe asthma can improve olfaction in patients with CRSwNP. A further objective was to compare smell improvement in N-ERD and non-N-ERD subgroups.
Methods. A multicenter, non-interventional, retrospective, observational study was performed, including 206 patients with severe asthma undergoing biological treatment (omalizumab, mepolizumab, benralizumab, or reslizumab) with CRSwNP.
Results. Improved olfaction was found after treatment with all monoclonal antibodies: omalizumab (35.8%), mepolizumab (35.4%), reslizumab (35.7%), and benralizumab (39.1%), with no differences between groups. Patients with atopy, greater use of short course systemic corticosteroids, and larger polyp size were more likely to experience improvement in smell. The proportion of patients experiencing smell improvement was similar between the N-ERD (37%) and non-N-ERD (35.7%) groups.
Conclusions. This is the first study to compare real-life improvement in sense of smell among patients undergoing long-term treatment with omalizumab, mepolizumab, reslizumab, or benralizumab for severe asthma and associated CRSwNP. Approximately 4 out of 10 patients reported a subjective improvement in sense of smell (with non-significant differences between biologic drugs). No differences were found in smell improvement between the N-ERD and non-N-ERD group.

Key words: Benralizumab, CRSwNP, Mepolizumab, Nasal polyps, Olfaction, Omalizumab, Reslizumab, Smell