Anti-IgE for the Treatment of Allergic Rhinitis – and Eventually Nasal Polyps?

Abstract

In allergic rhinitis, cross-linking of IgE molecules upon allergen contact induces degranulation of mast cells and basophils within the mucosal tissue and results in the release of typical mediators, which consecutively induce the well-known symptoms. Omalizumab counteracts these interactions by reducing serum levels of free IgE. Therapy targeted at IgE also interferes with its binding to the low-affinity receptors inhibiting the amplification of the Th₂-type response. Treatment of allergic rhinitis with anti-IgE has been shown to be safe and to reduce specific symptoms. Furthermore, the combination of omalizumab with specific immunotherapy may not only increase efficacy but also safety in selected patients. Therefore, we reviewed previously published studies on omalizumab therapy in allergic rhinitis, either as monotherapy or in combination with immunotherapy. In patients with nasal polyps, a local multiclonal IgE response has recently been described, initiated by Staphylococcus aureus-derived enterotoxins, which at least modifies the inflammatory reaction within the tissue. Evidence accumulates that these enterotoxins act as superantigens resulting in a multiclonal T- and B-cell activation with massive IgE formation within the airways. Because of the multiclonality, a range of allergens could possibly maintain a constant degranulation of mast cells present in the polyp tissue, which may contribute to disease severity. We here discuss a proof-of-concept treatment trial with omalizumab in nasal polyposis, which – in case of a positive therapeutic response – would also pave the way for anti-IgE treatment approaches for severe non-atopic lower airway disease.

Forkhead box P3+ T cells express interleukin-17 in nasal mucosa of patients with both allergic rhinitis and polyposis

“…It has been noted that a correlation exists between nasal allergy (AR) and nasal polyposis (NP) [1][2][3]; however, the underlying mechanism remains to be further understood. Functional deficiency or decrease in the number of regulatory T cells (Treg) plays a critical role in allergic diseases [4].…”

Hydroxypropylmethylcellulose gel application delays Der p 1 diffusion in vitro

“…An ideal allergy treatment would inhibit the establishment of an allergic reaction altogether. Anti-IgE prevents binding of allergen to IgE antibodies and so inhibits a reaction while the allergens are already inside the epithelium [19]. HPMC might work at an earlier stage by preventing allergens from entering the mucosa in the first place by the generation of a mechanical gel barrier.…”

Anticuerpo monoclonal anti-inmunoglobulina E en el tratamiento de la rinitis alérgica

“…Con relación al perfil de seguridad es también similar al observado en los adultos 11,21,25 . Baez y cols 10,11,25,26 publicaron un estudio donde se evaluó el efecto combinado de la inmunoterapia específica (ITE) y Omalizumab sobre la liberación de la proteína catiónica eosinofílica (PCE), triptasa, IL-6, y IL-8 en la secreción nasal; 225 niños (6-17 años) con antecedentes de RAE inducida por polen de abedul y gramíneas se asignaron al azar en cuatro grupos: ITE de abedul o gramínea en combinación con anti-IgE o placebo. Se tomaron muestras de la secreción nasal de 53 pacientes antes del tratamiento Visita 1 (V1), estación de polen de abedul (V2) temporada de polen de gramínea (V3) y después de la estación de polínica (V4).…”

“…Otro estudio en niños realizado por RolinckWerninghaus y cols 11,24,26 que incluyó pacientes entre 6 y 17 años con RAE a polen de abedul y pasto, analizó la asociación entre las concentraciones de IgE con la severidad de los síntomas y uso de medicación de rescate. El grupo A recibió placebo y el grupo B Omalizumab antes y durante la estación polínica.…”