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Improvement in Olfaction in Patients With CRSwNP and Severe Asthma Taking Anti-IgE and Anti–IL-5 Biologics: A Real-Life Study

Barroso B1,2*, Valverde-Monge M1,2*, Alobid I2,3,4, Olaguibel JM2,5, Rial MJ2,6, Quirce S2,7,8, Arismendi E2,4,9, Barranco P2,7,8, Betancor D1,2, Bobolea I2,4,9, Cárdaba B2,10, Cruz Carmona MJ2,11, Curto E2,12,13, Domínguez-Ortega J2,7,8, González-Barcala FJ2,14, Martínez-Rivera C2,15, Mahíllo-Fernández I16, Muñoz X2,11,17, Picado C2,4,9, Plaza V2,12,13, Rodrigo Muñoz JM2,10, Soto-Retes L2,12,13, Valero A2,4,9, del Pozo V2,10, Mullol J2,3,4**, Sastre J1,2**

1Allergy Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
2CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
3Rhinology Unit and Smell Clinic, ENT Department, Hospital Clinic, Barcelona, Spain
4Clinical and 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, Madrid, Spain
8Hospital La Paz Institute for Health Research (IDIPAZ), Madrid, Spain
9Allergy Unit and Severe Asthma Unit, Pulmonology and Allergy Department, Hospital Clínic, Barcelona, Spain
10Immunology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
11Pulmonology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
12Pulmonology and Allergy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
13Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Universidad Autónoma de Barcelona, Barcelona, Spain
14Pulmonology Department, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, La Coruña, Spain
15Pulmonology Department, Hospital Germans Trias i Pujol, Badalona, Spain
16Department of Epidemiology, Fundación Jiménez Díaz, Madrid, Spain
17Department of Cell Biology, Physiology and Immunology, Universitat Autònoma 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) : 37-44
doi: 10.18176/jiaci.0812

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP), which is characterized by partial loss of smell (hyposmia) or total loss of smell (anosmia), is commonly associated with asthma and/or nonsteroidal anti-inflammatory drug–exacerbated respiratory disease (N-ERD). CRSwNP worsens disease severity and quality of life.
Objectives: The objective of this real-world study was to determine whether biological treatments prescribed for severe asthma can improve olfaction in patients with CRSwNP. A further objective was to compare the improvement in in olfaction in N-ERD and non–N-ERD subgroups.
Methods: We performed a multicenter, noninterventional, retrospective, observational study of 206 patients with severe asthma and CRSwNP undergoing biological treatment (omalizumab, mepolizumab, benralizumab, or reslizumab).
Results: Olfaction improved after treatment with all 4 monoclonal antibodies (omalizumab [35.8%], mepolizumab [35.4%], reslizumab [35.7%], and benralizumab [39.1%]), with no differences between the groups. Olfaction was more likely to improve in patients with atopy, more frequent use of short-course systemic corticosteroids, and larger polyp size. The proportion of patients whose olfaction improved was similar between the N-ERD (37%) and non–N-ERD (35.7%) groups.
Conclusions: This is the first real-world study to compare improvement in olfaction 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 olfaction (with nonsignificant differences between biologic drugs). No differences were found for improved olfaction between the N-ERD and non–N-ERD groups.

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