Asthma, Rhinitis, Other Respiratory Diseases: Brief Communication
The effect of omalizumab on nasal allergic inflammation,☆☆

https://doi.org/10.1067/mai.2002.125488Get rights and content

Abstract

Background: In sensitized patients, coupling between IgE and FcϵRI receptors on mast cells leads to release of proinflammatory mediators and a subsequent influx of inflammatory cells to the affected organ. Omalizumab (Xolair; formerly rhuMAb-E25) binds to circulating IgE, thus preventing induction of the allergic process. Objective: We investigated the effect of treatment with omalizumab on seasonal allergic rhinitis and related changes in inflammatory cell numbers in nasal biopsy specimens. Methods: Patients were randomized to treatment with omalizumab or placebo before the pollen season; the treatment was started and continued during season. Symptoms and use of medication were recorded, and blood samples and nasal biopsy specimens were obtained before and during season. Immunocytochemistry was performed on biopsy sections through use of the following antibodies: anti-CD4, CD8 (T lymphocytes), EG2, and anti-eosinophil peroxidase (eosinophils), anti-tryptase (mast cells), human neutrophil lipocalin (neutrophils), and antibodies against IgE and FcϵRI. Results: During the season, blood eosinophils increased in placebo-treated patients but not in omalizumab-treated patients (P = .01); the difference between the treatment groups was significant (P = .04). Free IgE in serum decreased significantly (P = .0002) in omalizumab-treated patients but not in placebo-treated patients; the difference between the groups was significant (P = .0001). In nasal biopsy specimens, the number of eosinophil peroxidase-positive staining cells increased in the placebo-treated patients (P = .003) but not in the actively treated patients during the season; the difference between the groups was significant (P = .0001). The number of IgE+ staining cells decreased significantly in the omalizumab group during the season in comparison with the placebo group (P = .04). Conclusion: The clinical benefit of treatment with omalizumab is associated with an anti-inflammatory effect on cellular markers in blood and nasal tissue. (J Allergy Clin Immunol 2002;110:68-71.)

Section snippets

Methods

Blood samples were obtained for eosinophil counts and measurement of serum IgE levels before and during the pollen season. Nasal mucosa specimens were obtained in randomized order from either the right or the left inferior turbinate twice during the study: outside the pollen season (before trial treatment) and at the peak of the season (during trial treatment). Local anesthesia of the inferior nasal turbinate was achieved by means of topical application of 1 mL of a solution of 4% cocaine and

Clinical symptoms

Thirty patients from 2 centers participating in a multicenter Scandinavian trial were included in this nasal biopsy study. Nineteen patients (9 male and 10 female) were randomized to the omalizumab treatment; 11 patients (5 male and 6 female) were randomized to the placebo group. The patients ranged in age from 20 to 48 years (mean, 31.6 years).

In both treatment groups, significant seasonal increases in all symptoms variables were noted. In addition, use of rescue medication increased

Discussion

The results confirm that in birch-sensitized patients, seasonal pollen exposure is associated with inflammation of the nasal tissues, notably in markers reflecting eosinophil activity.1 Omalizumab appeared to exert an anti-inflammatory effect in preventing allergen-induced tissue eosinophilia, with a corresponding effect on blood eosinophilia.

The results of a statistical analysis performed on the clinical symptoms of the 30 participating patients did not agree with the findings of the original

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Supported by Novartis Pharma AG, Basel, Switzerland, and Genentech Inc, San Francisco, Calif.

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Reprint requests: Sabina Rak, MD, PhD, Asthma and Allergy Research Group, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, 413 45 Göteborg, Sweden.

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