However, new research has shown that inpatient treatment is necessary for patients with risk factors such as beta-blocker use and recent myocardial infarction, as well as any other medical condition or drug treatment that would make the management of severe asthma or anaphylactoid reaction difficult. Such conditions would include severe asthma as well as a history of severe or life-threatening reactions to either aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs). Outpatient desensitization is possible if the following conditions are met:
Explore this issue:March 2009
- A physician experienced in the assessment and treatment of patients with acute, severe asthma exacerbations is immediately available.
- Medically qualified personnel with such experience are available to monitor the patient.
- At least one of these personnel can be dedicated solely to the individual patient being treated for the full course of desensitization.
- Resuscitation equipment is available.
The increased availability of aspirin desensitization, with the outpatient setting option, is exciting because this is a way of treating patients that is holistic and systemic, said Dr. Haydon.
Monoclonal Antibodies Show Potential
Monoclonal antibody therapy for allergic disease is an example of a new approach for which high-quality evidence is accumulating, Dr. Haydon said in his own presentation. At this point, there is only one FDA-approved monoclonal antibody of a disease relevant to otolaryngology, he said in reference to omalizumab (Xolair). Omalizumab is an antibody that is specific to immunoglobulin E (IgE), the molecule involved in allergic reactions. The goal is for omalizumab to bind with the body’s IgE before an allergic reaction can develop. Currently, omalizumab is approved only for the treatment of asthma, although high-quality trials are showing that it may also be effective for rhinitis and for peanut allergy.
Dr. Haydon said that other monoclonal antibody therapies may also control allergic disease, including those approved for other indications. Examples are tumor necrosis factor (TNF) inhibitors that are approved for rheumatoid arthritis, such as infliximab (Remicade) and etanercept (Enbrel). Additionally, investigational agents are still in the pipeline. Monoclonal antibodies change the immune system in a natural and nondestructive way, so that we can combat the immunologic disorders that cause allergies and other immunologic disease, Dr. Haydon said in his interview. They interact with proteins and are therefore large molecules. Conventional allergy therapies such as antihistamines are small molecules and are therefore excreted quickly. Monoclonal antibodies recognize an enemy, a specific protein. They recognize a template, and only that template.