Former AAOA Heads Take on Allergic Rhinitis

Some IgE levels are so high it would cost too much to make this work effectively, she said. Of course you can give steroids to lessen those levels…and you would need to have them come in twice per month. Those with low levels can come in once per month.

Dr. Ferguson pointed out that there have been four randomized clinical trials in which omalazumab showed a benefit-reducing asthma symptoms and patients’ need for corticosteroids.

With regard to monitoring patients while on omalazumab, Dr. Ferguson suggested that everything be done on a clinical basis, because no commercial assay exists for looking at free IgE.

Remember that [omalazumab] is complexing with this IgE molecule, so when you assay [subjects’] serum with normal patients, IgE is going to be elevated because [the test] is going to be seeing this complex, she said. It won’t be able to distinguish whether it is free IGE or a complex that is there as a result of the [omalazumab].

Ninety percent of patients respond to the drug within 12 weeks and most within 16 weeks, Dr. Ferguson said. No studies have been done concerning the duration of the effect after discontinuation.

Zileuton is indicated for the treatment of asthma. According to Dr. Ferguson, the drug became nonprofitable for Abbott Laboratories, so the company discontinued its manufacture several years ago. Two years ago Clinical Therapeutics started marketing the drug again for a small subgroup of patients, and it has been successful.

This is a good drug, but you must monitor liver function, she said. Because you’re using it for asthma and upper airway, if it is not working within a month, I move on to something else.

Zileuton is an enzyme blocker that has undergone double-blind trials regarding its efficacy on asthma. Dr. Ferguson said one study done in her office showed great promise.

The drug had a clinical response in three of our seven patients, she said, one of whom had their polyps go from Stage IV to Stage II obstructing.

Sublingual Immunotherapy

With better elucidation of the immunology underlying type 1 hypersensitivity disease, therapy is increasingly being directed at disease modulation rather than solely confined to symptom control. This involves not only traditional injection-based immunotherapy, but potentially more cost-effective and less morbid approaches, such as sublingual delivery of antigens.

Dr. Derebery detailed the pros and cons of sublingual immunotherapy, stressing that doctors must inform patients that it is an investigational technique.