The effectiveness of anti-IgE therapy for allergic rhinitis in patients with severe atopic bronchial asthma and concomitant allergic rhinitis in real clinical practice

BACKGROUND: Omalizumab, by binding IgE in atopic patients, can improve clinical and functional parameters and patients' quality of life. AIMS: to evaluate efficacy of anti-IgE-therapy in patients with allergic rhinitis treated with omalizumab for concomitant severe atopic asthma in real clinical practice. MATERIALS AND METHODS: An open, non-interventional, prospective and non-randomized study in a real clinical practice. The study was conducted in the Sverdlovsk region in October 2021 based on a regional registry of adult patients with severe asthma with chronic nasal inflammatory diseases and receiving targeted therapy. Dynamics of nasal symptoms was assessed using SNOT-22 questionnaire and visual analogue scale initially, after 4 and 12 months of omalizumab therapy. Peripheral blood eosinophils level was also assessed before and after 4 months of omalizumab therapy. RESULTS: The study included 26 patients. Assessment of nasal symptoms dynamics using the SNOT22 questionnaire at baseline and after 4 months on omalizumab therapy revealed decrease in the severity of symptoms (p 0.001): baseline - 46.8522.04 points (95% CI 37.94-55.75), after 4 months - 30.6514.81 points (95% CI 24.67-36.64). Also improvement in SNOT22 questionnaire score was revealed in 18 patients treated with omalizumab during 12 month: before therapy - 47.5 points (Q₁ -Q₃: 35.7-59.3), after 4 months - 30.4 points (Q₁- Q₃: 22.1-38.1), after 12 months - 24.9 points (Q₁ -Q₃: 16.9-32.9) (p = 0.001). Improvement in rhinitis symptoms control was observed according to the VAS scale: VAS before therapy - 8.0 points (Q₁-Q₃: 6.2-9.0), after 4 months - 5.0 points (Q₁- Q₃: 3.2-5, 8), after 12 months of treatment - 5.0 points (Q₁-Q₃: 4.0-6.8). The level of eosinophils (n=16) decreased from 510.9317.9 (95% CI 341.5680.3) cells /l to 327.4217.7 (95% CI 211.4443.5) cells /l after 4 months of anti-IgE-therapy (p0.041). CONCLUSIONS: Omalizumab in real clinical practice has demonstrated improvement of rhinitis symptoms control and quality of life in patients with allergic rhinitis with concomitant severe atopic asthma. It was accompanied by a statistically significant decrease in peripheral blood eosinophils level, that largely determines airway inflammation severity and clinical manifestations of allergic rhinitis and bronchial asthma.