Omalizumab can inhibit respiratory reaction during aspirin desensitization

Publication date: Available online 16 May 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): David M. Lang, Mark A. Aronica, Elizabeth S. Maierson, Xiao-Feng Wang, Dorothy C. Vasas, Stanley L. Hazen
BackgroundAspirin desensitization has been associated with benefit in management of aspirin exacerbated respiratory disease (AERD). An intervention that would encourage aspirin desensitization to be performed more frequently has substantial potential for improving outcomes and quality of life in patients with AERD.ObjectiveWe investigated whether omalizumab administration would be associated with attenuation of aspirin-provoked bronchospasm in patients with AERD undergoing aspirin desensitization.MethodsWe carried out a randomized, double-blind, placebo-controlled study in which subjects with AERD who fulfilled label criteria for omalizumab received omalizumab or placebo for 16 weeks, and then underwent aspirin desensitization.ResultsEleven subjects completed aspirin desensitization. Of the seven who were randomized to omalizumab, 5 had no respiratory reaction during aspirin desensitization. Compared with placebo, omalizumab was associated with a significantly greater likelihood for subjects with AERD to have no respiratory reaction during desensitization (p=0.04, Fisher Exact Test). There was an overall difference in urinary LTE4 levels in subjects who received omalizumab and did not have respiratory reaction during desensitization compared to subjects randomized to placebo (p = 0.035, mixed model with interaction). Urinary LTE4 levels were significantly higher with respiratory reaction in placebo subjects compared with levels obtained after the 100 mg dose in AERD subjects who had no respiratory reaction (p < 0.001, mixed model with interaction).ConclusionIn atopic AERD subjects, omalizumab administration for 16 weeks was associated with "clinically silent" desensitization. Further studies to investigate the therapeutic utility of omalizumab in patients with AERD who are candidates for aspirin desensitization are warranted based on these findings.



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