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Effectiveness of Omalizumab in Severe Allergic Asthma and Nasal Polyposis: A Real-Life Study

Tiotiu A1,2, Oster JP3, Roux PR4, Nguyen Thi PL5, Peiffer G6, Bonniaud P7-9, Dalphin JC4,10, de Blay F11,12

1Department of Pulmonology, University Hospital of Nancy, Nancy, France
2EA 3450 DevAH - Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, University of Lorraine, Nancy, France
3Department of Pulmonology, Hospital of Colmar, Colmar, France
4Department of Pulmonology, University Hospital of Besançon, Besançon, France
5Centre hospitalier universitaire de Nancy, Plateforme d’aide à la recherche clinique, Nancy, France
6Department of Pulmonology, Hospital of Metz-Thionville, Thionville, France
7Department of Pulmonary Medicine and Intensive Care Unit, University Hospital, Dijon, France
8Inserm, LNC UMR866, LipSTIC LabEx team, Dijon, France
9Bourgogne Franche-Comté University, Dijon, France
10Franche-Comté University, Besançon, France
11Department of Pulmonology-Allergology, University Hospital of Strasbourg, Strasbourg, France
12University of Strasbourg, Strasbourg, France

J Investig Allergol Clin Immunol 2020; Vol 30(1) : 49-57
doi: 10.18176/jiaci.0391

Background: Omalizumab is a human anti-IgE antibody approved for the treatment of severe allergic asthma (SAA). However, its effectiveness in SAA associated with chronic rhinosinusitis with nasal polyposis (CRSNP+) is less well documented.
Objective: The aim of this study was to evaluate the real-life effectiveness of omalizumab in patients with SAA and CRSNP+ who tolerated and did not tolerate aspirin.
Methods: We performed a retrospective, observational, multicenter, real-life study of patients with SAA and CRSNP+ treated with omalizumab for 6 months. Asthma outcome parameters (symptoms, number of salbutamol rescues/wk, number of moderate/severe exacerbations, Asthma Control Test score, and lung function), sinonasal outcome parameters (symptoms, number of episodes of acute rhinosinusitis, sinus computed tomography images, nasal polyps endoscopy score), and serum eosinophil levels were analyzed 6 months before and after treatment with omalizumab.
Results: Twenty-four adult patients were included (9 with documented aspirin intolerance). All respiratory parameters were significantly improved by the treatment. In parallel, a significant improvement was observed in sinonasal clinical outcomes and sinus computed tomography images, with no major effect on the nasal polyps endoscopy score. The serum eosinophil count decreased significantly after 6 months of treatment with omalizumab.
Conclusion: Treatment of SAA with omalizumab improves the outcome of associated CRSNP+, thus supporting the concept of a “one airway disease”.

Key words: Severe allergic asthma, CRSNP+, Effectiveness of omalizumab