One randomized controlled trial examined the efficacy of immunotherapy with or without concurrent omalizumab in adolescents with moderate to severe AR; the combination treatment led to significant improvements in symptom reduction and a decreased need for rescue medication (J Allergy Clin Immunol. 2002;109:274-280). Another study found that administering omalizumab with immunotherapy resulted in prolonged inhibition of allergen-IgE binding as compared with either treatment alone (J Allergy Clin Immunol. 2007;120:688-695). Additional research has also suggested that administering omalizumab prior to rush immunotherapy may decrease anaphylactic reactions (J Allergy Clin Immunol. 2006;117:134-140).
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September 2022
Omalizumab studies have found that [the biologic] is helpful in reducing nasal symptoms and improving quality of life. —Christine Franzese, MD
This can have profound impact on patient treatment outcomes. “Anaphylactic reactions can be deadly, so we’re talking about saving lives here,” said Mohamad Chaaban, MD, MSCR, MBA, associate professor of otolaryngology–head and neck surgery at the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University in Cleveland, Ohio.
At least four trials have assessed the impact of combined biologic treatment and immunotherapy, and evidence to date suggests that the combination of omalizumab and immunotherapy is superior to immunotherapy alone, according to the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis.
Biologics for Cat and Birch Pollen Allergies
Researchers are currently studying various biologics to determine their effectiveness in managing symptoms resulting from exposure to specific allergens. Previous studies have shown that omalizumab treatment can decrease nasal ocular symptom scores (and decrease chest symptom scores and skin sensitivity) in cat-allergic people. Those treated with omalizumab tolerated a median of 50 minutes in a room containing cat allergen versus 22 minutes for the placebo group (J Allergy Clin Immunol. 2011;127:398-405).
A phase 2, randomized, double-blind study that examined the impact of an investigational antibody cocktail of two monoclonal IgG antibodies in cat-allergic patients with mild asthma found that antibody administration prevented early asthma reactions and increased the amount of cat allergen patients could tolerate. Phase 3 clinical trials are currently underway, according to Dr. Franzese. “We’re enrolling patients who are allergic to cats but live with their cat and don’t want to get rid of them,” she added. “They’re getting one injection every three months to treat their cat allergies.”
Scientists have also targeted birch pollen allergies. A phase 1, randomized, double-blind study of a Bet v 1-specific antibody cocktail found that administration of the cocktail significantly reduced total nasal symptom scores (relative to baseline) following birch nasal allergen challenge. Significant improvement was noted after just one week of treatment, and reduction in allergy symptoms persisted at least two months (J Allergy Clin Immunol. 2022;149:189-199). An ongoing clinical trial is assessing the safety and efficacy of low-dose IL-2 in birch pollen allergy; the estimated study completion date is March 2024.