A prospective study from London, evaluating the response of chronic rhinosinusitis patients with nasal polyposis who were being treated with monoclonal antibody against IgE for severe allergic asthma. Thirteen patients were treated with Omalizumab, according to UK guidelines for their severe asthma and 24 patients with severe asthma underwent endoscopic sinus surgery. CRSwNP was confirmed endoscopically and no patients had Churg-Strauss syndrome or fungal allergic disease. Omalizumab patients had to be sensitive to at least one aero allergen, the drug was administered using total IgE scores and weight to determine dose and frequency of administration. The drug binds IgE and prevents it from binding to the receptor, thereby preventing the allergic cascade. SNOT-22 scores were recorded for both groups at baseline, four and 16 weeks post treatment and also ACQ-7 asthma scores. A SNOT-22 score exceeding 50 defined severe CRSwNP. A mean ACQ-7 score of 1.5 or above represented inadequately controlled asthmatic disease.
Median SNOT-22 in the Omalizumab was 52 which reduced to 24.5 at four weeks and 30 at 16 weeks post treatment. In the surgery group SNOT-22 reduced from 70 to 29.5 post-surgery. Both groups showed a significant difference but there was no difference between them.
Rapid asthma improvement also occurred, with a significantly decreased ACQ-7 at four and 16 weeks. It is noted that the majority of patients with severe late onset asthma and CRSwNP do not have a sensitivity to aero allergens and therefore are precluded, by guidelines, from taking Omalizumab. The cost of the drug together with the estimated disease burden cost of CRS is also mentioned, however only a small group of patients would be within treatment parameters currently, although the drug is expected to be of benefit in non-allergic patients also. It seems that larger cohort studies in this area are needed soon.
