To date, no biologic medications have received FDA approval to treat AR; some of the research that led to the approval of biologics to manage allergic asthma and CRS with polyposis also reported improvements in AR symptoms, however.
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September 2022Omalizumab, the first biologic approved to treat asthma, probably has the most robust evidence base to support its potential use as a treatment for allergic asthma. “Omalizumab studies have found that [the biologic] is helpful in reducing nasal symptoms and improving quality of life,” said Christine Franzese, MD, professor of otolaryngology at the University of Missouri in Columbia and a past president of the American Academy of Otolaryngic Allergy. “The dupilumab trials also looked at allergic rhinitis-associated symptoms and found improvement, as did studies of mepolizumab.”
However, she noted that there isn’t a lot of data to support using biologics to treat allergic rhinitis. “I don’t know if it’s enough to really justify their use,” Dr. Franzese said. “Patient-reported data and a few small studies show they help, but not a huge amount.”
The Role of Biologics: Comorbid AR, Asthma, CRS, and Atopic Dermatitis
Although no biologic medication has yet received FDA-approval to treat AR, biologics are worth consideration if a patient has AR and another inflammatory condition, such as asthma, CRS, or atopic dermatitis.
Evidence dating back to the early 2000s has found that omalizumab, which is generally safe and well tolerated in patients 12 years of age and older, and can improve asthma and AR symptoms and quality of life in people with both conditions (Allergy. 2004;59:709-717; Ann Allergy Asthma Immunol. 2003;91:160-167). Many patients with CRS and AR also experienced improved AR symptoms when treated with omalizumab (Otolaryngol Clin North Am. 2017;50:1135-1151).
“If you have someone who has really severe allergic rhinitis and can’t seem to get it under control, my suspicion is that they may have one or more of the other comorbid diseases that are often associated with it,” Dr. Luong said. “For that person, you may want to think about biologics not only to manage their allergic rhinitis but also their other comorbid disease.”
Biologics Plus Immunotherapy for AR
Immunotherapy can reduce AR symptoms and improve allergen tolerance in many patients who are unable to find relief with over the counter or prescription medication. But immunotherapy can also trigger serious adverse reactions, and some people do not experience a significant reduction in symptoms with immunotherapy treatment. Adjuvant administration of biologic medication may help. “There is some evidence that using a biologic in conjunction with immunotherapy can decrease the number of systemic reactions and also decrease symptoms overall,” Dr. Brook said.