Skip to main content
The Egyptian Journal of Otolaryngology
Download PDF
  • Original article
  • Open access
  • Published:

Anti-immunoglobulin E therapy: is it a valid option for the management of chronic rhinosinusitis with nasal polyposis?

The Egyptian Journal of Otolaryngology volume 35, pages 269–277 (2019)Cite this article

Abstract

Objectives

To evaluate the efficacy of omalizumab (OMA) therapy for patients with chronic rhinosinusitis with nasal polyposis as a sole therapeutic line versus traditional therapy.

Patients and methods

Eighty-six patients were randomly divided into two equal groups: study patients received OMA [0.016 mg/kg/immunoglobulin E (IgE) (IU/ml)] therapy only and control patients received conventional therapy. All patients completed a questionnaire to determine the total subjective score (TSS), who underwent rigid nasal endoscopy for endoscopic scoring according to the Lund-Kennedy scoring system, had paranasal sinuses computed tomographic (CT) imaging for scoring according to the Lund-Mackay scale, and estimation of pretreatment serum IgE levels. Study outcomes included the therapeutic effect determined as more than 50% decrease of TSS with improvement on endoscopic findings, recurrence rate, and frequency of decision; shift to surgery or repeat the trial of OMA therapy.

Results

Serum IgE level positively correlated with TSS and endoscopic and CT scores. Seventeen patients had successful response without recurrence with significantly lower TSS in the study versus control patients. Twenty-seven patients had recurrence after primary successful outcome with significantly lower TSS in study than control patients and significantly longer duration till recurrence with OMA than conventional therapy. Forty-two patients showed no response to the first session of therapy. Nineteen study patients with recurrent manifestations received a second session of OMA therapy; 11 had successful response, five patients had rerecurrence, and three patients failed to respond. Surgery-sparing effect is significantly higher with OMA than conventional therapy (46.5 vs. 18.6%). Endoscopic and CT scores of total patients, at the end of follow-up, were nonsignificantly lower in control while they were significantly lower in the study group.

Conclusion

OMA significantly superiorly improved the outcome of conservative treatment of chronic rhinosinusitis with nasal polyposis than conventional with higher surgery-sparing rate. The second session of OMA minimized the recurrence rate of manifestations.

References

  1. Geißler K, Guntinas-Lichius O. Allergic rhinitis in the context of chronic rhinosinusitis. Laryngorhinootologie 2015; 94:250–269.

    Article  PubMed  Google Scholar 

  2. Bachert C, Zhang L, Gevaert P. Current and future treatment options for adult chronic rhinosinusitis: focus on nasal polyposis. J Allergy Clin Immunol 2015; 136:1431–1440.

    Article  CAS  PubMed  Google Scholar 

  3. Ostovar A, Fokkens WJ, Vahdat K, Raeisi A, Mallahzadeh A, Farrokhi S. Epidemiology of chronic rhinosinusitis in Bushehr, southwestern region of Iran: a GA2LEN study. Rhinology 2019; 57:43–48.

    Article  CAS  PubMed  Google Scholar 

  4. Hopkins C, Surda P, Bast F, Hettige R, Walker A, Hellings PW. Prevention of chronic rhinosinusitis. Rhinology 2018; 56:307–315.

    PubMed  CAS  Google Scholar 

  5. Gurrola J 2nd, Borish L. Chronic rhinosinusitis: endotypes, biomarkers, and treatment response. J Allergy Clin Immunol 2017; 140:1499–1508.

    Article  CAS  PubMed  Google Scholar 

  6. Takeda K, Sakakibara S, Yamashita K, Motooka D, Nakamura S, El Hussien MA, et al. Allergic conversion of protective mucosal immunity against nasal bacteria in chronic rhinosinusitis with nasal polyposis. J Allergy Clin Immunol 2019; 143:1163–1175.

    Article  CAS  PubMed  Google Scholar 

  7. Bachert C, Gevae E. Advances in rhinitis and rhinosinusitis in 2015. J Allergy Clin Immunol 2016; 138:1277–1283.

    Article  PubMed  Google Scholar 

  8. Nakamura T, Fukaya T, Uto T, Takagi H, Arimura K, Tono T, Sato K. Selective depletion of basophils ameliorates immunoglobulin E-mediated anaphylaxis. Biochem Biophys Rep 2016; 9:29–35.

    PubMed  PubMed Central  Google Scholar 

  9. MacGlashan D Jr. FceRI density and spontaneous secretion from human basophils. PLoS One 2017; 12:e0179734.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Jensen RK, Plum M, Tjerrild L, Jakob T, Spillner E, Andersen GR. Structure of the omalizumab fab. Acta Crystallogr F Struct Biol Commun 2015; 71 (Part 4):419–426.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Davies AM, Allan EG, Keeble AH, Delgado J, Cossins BP, Mitropoulou AN, et al. Allosteric mechanism of action of the therapeutic anti-IgE antibody omalizumab. J Biol Chem 2017; 292:9975–9987.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Incorvaia C, Mauro M, Russello M, Formigoni C, Riario-Sforza GG, Ridolo E. Omalizumab, an anti-immunoglobulin E antibody: state of the art. Drug Des Devel Ther 2014; 8:197–207.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. [No authors]. Report of the Rhinosinusitis Task Force Committee Meeti. Alexandria, Virginia, August 17, 1996. Otolaryngol Head Neck Surg 1997; 117 (3 Part 2):S1–S68.

    Google Scholar 

  14. Baudoin T, Kalogjera L, Geber G, Grgić M, Cupić H, Tiljak MK. Correlation of histopathology and symptoms in allergic and non-allergic patients with chronic rhinosinusitis. Eur Arch Otorhinolaryngol 2008; 265:657–661.

    Article  PubMed  Google Scholar 

  15. Zhang T, Chen J, Zhu C, Li G, Xie C, Wang Y, He Z. The clinical relationship between allergic rhinitis and allergic factors and chronic rhinosinusitis with or without nasal polyps. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2014; 28:1278–1281.

    PubMed  Google Scholar 

  16. Lund VJ, Kennedy DW. Quantification for staging sinusitis.International conference on sinus disease: terminology, staging, therapy. Ann Otol Rhinol Laryngol Suppl 1995; 104 (suppl):17–21.

    Article  Google Scholar 

  17. Lund VJ, Mackay IS. Staging in rhinosinusitis. Rhinology 1993; 31:183–184.

    PubMed  CAS  Google Scholar 

  18. Rix I, Håkansson K, Larsen CG, Frendø M, von Buchwald C. Management of chronic rhinosinusitis with nasal polyps and coexisting asthma: a systematic review. Am J Rhinol Allergy 2015; 29:193–201.

    Article  PubMed  Google Scholar 

  19. Bakhshaee M, Jabari F, Ghassemi MM, Hourzad S, Deutscher R, Nahid K. The prevalence of allergic rhinitis in patients with chronic rhinosinusitis. Iran J Otorhinolaryngol 2014; 26:245–249.

    PubMed  PubMed Central  Google Scholar 

  20. Xiu Q, Meng C, Li L, Zhu D, Dong Z. Allergic factors affect on severity of chronic rhinosinusitis and postoperative outcomes. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2015; 29:34–38.

    PubMed  Google Scholar 

  21. Bachert C, Sousa AR, Lund VJ, Scadding GK, Gevaert P, Nasser S, et al. Reduced need for surgery in severe nasal polyposis with mepolizumab: randomized trial. J Allergy Clin Immunol 2017; 140:1024–1031.

    Article  CAS  PubMed  Google Scholar 

  22. Bidder T, Sahota J, Rennie C, Lund VJ, Robinson DS, Kariyawasam HH. Omalizumab treats chronic rhinosinusitis with nasal polyps and asthma together-a real life study. Rhinology 2018; 56:42–45.

    Article  CAS  PubMed  Google Scholar 

  23. Ledford D, Busse W, Trzaskoma B, Omachi TA, Rosén K, Chipps BE, et al. A randomized multicenter study evaluating Xolair persistence of response after long-term therapy. J Allergy Clin Immunol 2017; 140:162–169.

    Article  CAS  PubMed  Google Scholar 

  24. Rivero A, Liang J. Anti-IgE and anti-IL5 biologic therapy in the treatment of nasal polyposis: a systematic review and meta-analysis. Ann Otol Rhinol Laryngol 2017; 126:739–747.

    Article  PubMed  Google Scholar 

  25. Chandra RK, Clavenna M, Samuelson M, Tanner SB, Turner JH. Impact of omalizumab therapy on medication requirements for chronic rhinosinusitis. Int Forum Allergy Rhinol 2016; 6:472–477.

    Article  PubMed  Google Scholar 

  26. Clavenna MJ, Turner JH, Samuelson M, Tanner SB, Duncavage J, Chandra RK. Differential effect of omalizumab on pulmonary function in patients with allergic asthma with and without chronic rhinosinusitis. Allergy Asthma Proc 2016; 37:23–26.

    Article  PubMed  Google Scholar 

  27. Cavaliere C, Begvarfaj E, Frati F, Masieri S. Omalizu mab a new prospective:a nasal polyposis. J Biol Regul Homeost Agents 2018; 32:167–169.

    PubMed  CAS  Google Scholar 

  28. Tsetsos N, Goudakos JK, Daskalakis D, Konstantinidis I, Markou K. Monoclonal antibodies for the treatment of chronic rhinosinusitis with nasal polyposis: a systematic review. Rhinology 2018; 56:11–21.

    Article  CAS  PubMed  Google Scholar 

  29. De Schryver E, Derycke L, Calus L, Holtappels G, Hellings PW, Van Zele T, et al. The effect of systemic treatments on periostin expression reflects their interference with the eosinophilic inflammation in chronic rhinosinusitis with nasal polyps. Rhinology 2017; 55:152–160.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University, Damietta Branch, Cairo, Egypt

    Ashraf A. Wahba

  2. Department of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

    Ahmed M. Abdelfattah MD

Authors
  1. Ashraf A. Wahba
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ahmed M. Abdelfattah MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ahmed M. Abdelfattah MD.

Additional information

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wahba, A.A., Abdelfattah, A.M. Anti-immunoglobulin E therapy: is it a valid option for the management of chronic rhinosinusitis with nasal polyposis?. Egypt J Otolaryngol 35, 269–277 (2019). https://doi.org/10.4103/ejo.ejo_19_19

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/ejo.ejo_19_19

Keywords