Perspective from Bob Geng, MD
Source:

Zhang Y, et al. Clin Transl Allergy. 2022;doi:10.1002/clt2.12094.

Disclosures: The authors report no relevant financial disclosures.
February 17, 2022
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Single omalizumab dose before pollen season may counter seasonal allergic rhinitis

Perspective from Bob Geng, MD
Source:

Zhang Y, et al. Clin Transl Allergy. 2022;doi:10.1002/clt2.12094.

Disclosures: The authors report no relevant financial disclosures.
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A dose of omalizumab administered before pollen season improved symptom control and quality of life compared with standard medication among patients with seasonal allergic rhinitis, according to a study in Clinical and Translational Allergy.

Yuan Zhang, MD, an ENT doctor in the department of allergy at Beijing TongRen Hospital at Capital Medical University in Beijing, and colleagues conducted the prospective randomized controlled open-label single-center trial between July and September 2020.

18.75% of participants on omalizumab achieved total control of their symptoms, compared to 6.67% on control standard medication.
Data were derived from Zhang Y, et al. Clin Transl Allergyl. 2022;doi:10.1002/clt2.12094.

Researchers randomly assigned 16 patients (mean age, 34.75 years ± 1.75; 62.5% women) to receive a 300 mg subcutaneous dose of omalizumab (Xolair; Genentech, Novartis), a recombinant humanized anti-IgE antibody, about 2 weeks before the start of the autumn pollen period in Beijing, defined as Aug. 15.

Fifteen participants (mean age, 36.93 years ± 2.55; 66.7% women) received control standard medication. Typical treatment for seasonal allergic rhinitis includes guideline-based antihistamines and corticosteroids, protective measures to reduce pollen inhalation or adhesion, and allergen immunotherapy.

All of the participants completed daily questionnaires about their nasal and ocular symptoms and use of antihistamines and intranasal or oral corticosteroids, as well as their quality of life based on activities, sleep, practical problems, nose and eye symptoms and emotional function, over the 6 weeks spanning the start of the pollen period through 1 week after it ended.

Patients assigned omalizumab demonstrated significantly reduced changes of mean daily combined symptom and medication score (CSMS) for the nose during the pollen period (P < .001), the peak pollen period and remainder of the pollen season (P = .002), and a week after the end of the pollen period (P = .009) compared with those assigned the control standard medication.

Omalizumab also significantly decreased changes in CSMS for the eye during the pollen period (P < .001), peak pollen period and shortly thereafter (P < .001) and post pollen period (P = .003) compared with control standard medication.

The participants who received omalizumab further saw a significantly higher proportion of days that did not require medication to relieve their allergy symptoms compared with control standard medication (76.2%; 95% CI, 16.7-98.8 vs. 19%; 95% CI, 0-71.4; P = .03).

Omalizumab provided the same nasal symptom control assessed via total nasal symptom score during the entire pollen season as the control standard medication and better results in the total eye symptom score during the pollen period (P = .046) and peak pollen period and shortly thereafter (P = .004).

The participants who received omalizumab also saw significantly greater improvement in quality of life over the entire pollen season (pollen period, P = .037; peak, P = .004) than the control group.

Additionally, a greater proportion of those assigned omalizumab than control medication said they achieved total control (18.75% vs. 6.67%) or substantial control (56.25% vs. 46.67%) of their symptoms.

Finally, seven of the patients who received omalizumab received doses considered to be adequate based on baseline serum total IgE level and weight. However, there was no significant difference between their improvements in symptoms and the improvements experienced by those who were considered to have received an insufficient dose.

Only one (6.25%) of the patients who received omalizumab experienced local adverse events — in this case, local itching and wind masses at the injection site that subsided within a half-hour after the injection.

Noting the expense of omalizumab treatment, the researchers said the single dose achieved equal or greater efficacy of treatment for seasonal allergic rhinitis than pharmacotherapy while minimizing costs, which may be particularly advantageous among patients who exercise low adherence to standard pharmacotherapy.