What Otolaryngologists Need to Know about Biologics and Allergic Rhinitis

Future uses of biologics in otolaryngology may include:

Chronic rhinosinusitis without polyps. To date, biologic agents have not been extensively studied in patients with CRS without polyposis, and available research suggests that most cases of CRS without polyps are not driven by Th-2 type immune response (Otolaryngol Clin N Am. 2021; 54: 709–716); however, approximately 20% to 30% of patients without nasal polyps have an almost identical immunological profile as those with polyps, said Mohamad Chaaban, MD, MSCR, MBA, associate professor at the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University in Cleveland, Ohio. These patients have elevated IF-5 and IF-13 levels, so theoretically, they may benefit from biologics that target those pathways.

Food allergies. More than 70% of individuals with pollen allergy also experience oral allergy syndrome (OAS), or negative reactions to specific foods that may include angioedema of the lips, mouth, and throat (J Allergy Clin Immunol. 2022; 149:189-199). As evidence accumulates that biologics may decrease nasal allergy symptoms and increase tolerance of pollens, researchers are sure to investigate the potential utility of biologics to treat food allergy. At least one study has already found that a patient with a birch allergy and OAS was able to eat apples for several weeks after treatment with a novel antibody cocktail targeting Bet v-1 (J Allergy Clin Immunol. 2022;149:189-199). “That’s very exciting and shows how biologics may eventually be used as a preventive for food allergies,” Dr. Chaaban added.