Omalizumab Inhibits Respiratory Reactions During Aspirin Desensitization

Omalizumab therapy resulted in “clinically silent” aspirin desensitization in patients with aspirin exacerbated respiratory disease (AERD) according to the results of a study published in the Annals of Allergy, Asthma & Immunology.

Approximately 7% of adult asthmatics experience AERD. These patients typically have chronic rhinosinusitis, nasal polyposis, asthma, and respiratory reaction after exposure to aspirin and nonsteroidal anti-inflammatory drugs. Aspirin desensitization has been associated with significant reductions in emergency department visits, hospitalization rates, outpatient visits, episodes of sinusitis, use of antibiotics, and the need for polypectomy and sinus surgeries.

David M. Lang, MD, of the Respiratory Institute, Department of Allergy and Clinical Immunology at the Cleveland Clinic Foundation in Ohio, and colleagues conducted a randomized double-blind placebo-controlled study (ClinicalTrials.gov Identifier: NCT00555971) to determine whether omalizumab would reduce aspirin-provoked bronchospasm in patients undergoing aspirin desensitization for AERD. Patients who fulfilled the label criteria for omalizumab and anti-immunoglobulin E therapy were randomly assigned to receive either omalizumab or placebo for 16 weeks followed by aspirin desensitization.

A total of 11 patients completed aspirin desensitization: 7 received omalizumab and 4 received placebo. All patients had moderate to severe persistent asthma and were receiving inhaled corticosteroids with long-acting beta agonists and montelukast, with the exception of one patient whose asthma was controlled on medium-dose inhaled steroids combined with montelukast.

Of the participants who received omalizumab, 5 experienced no respiratory reaction during aspirin desensitization, while 2 had an isolated upper airway reaction. Of the patients in the placebo group, 2 had an isolated upper airway reaction and 2 had combined upper and lower airway reactions with declines in FEV₁ exceeding 20% of baseline. Participants who had no reaction to aspirin had a lower mean level of urinary LTE4 compared with participants who reacted, although this was not statistically significant.

Study limitations included the significantly higher baseline mean immunoglobulin E levels in participants randomly assigned to receive omalizumab and a gender imbalance in the intervention group.

The investigators asserted that given these data, omalizumab has substantial potential for managing patients with AERD who fulfill the label criteria for anti-immunoglobulin E therapy.

Reference

Lang DM, Aronic MA, Maierson ES, Wang X-F, Vasas DC, Hazen SL. Omalizumab can inhibit respiratory reaction during aspirin desensitization [published online May 17, 2018]. Ann Allergy Asthma Immunol. doi:10.1016/j.anai.2018.05.007