Role of Systemic Omalizumab in Management of Allergic Fungal Rhinosinusitis

Abstract

Background: Allergic fungal rhinosinusitis (AFRS) is due to the continuous exposure of fungal antigens to an atopic individual. It is caused by type I, IgE mediated (and possibly type III) hypersensitivity reaction to an extramucosal fungal antigen. Medical treatment following the surgery is the standard protocol of management. Steroids (systemic/topical) have been considered as the standard medical treatment for control of the disease despite high recurrence rate and their serious side effects. Instead, omalizumab, a humanized monoclonal anti-IgE antibody, can be tried as a new treatment modality with less side effects to control symptoms and decrease the recurrence rate in AFRS patients. It acts by aborting the immunological reaction to sinonasal fungi through preventing the release of inflammatory mediators that cause allergic signs and symptoms. Aim: To evaluate the role of omalizumab for postoperative management of AFRS patients in comparison to topical steroids as regarding symptom free interval and side effects. Patients and methods: A total of 20 patients with AFRS were included in the study. Patients were divided randomly into two equal groups: group A used local steroid and group B used single dose of subcutaneous omalizumab. Clinical parameters were compared at 4,8,12 and 24 weeks. Results: Although there was no statistical significant difference between both groups as regards endoscopic nasal examination post-treatment, patients of group B were statistically better as regards clinical and subjective parameters. Conclusion: We suggest that omalizumab has more superior effect than local steroids in controlling nasal symptoms in AFRS patients despite the same endoscopic scores post-treatment. More well-designed large prospective randomized controlled trials to determine the effects and optimal dosage and duration of omalizumab therapy in patients with AFRS will be necessary. Keywords: Nasal polyps, hypersensitivity, sinusitis, Aspergillosis, steroids, omalizumab, Anti-Immunoglobulin E