Chronic rhinosinusitis and omalizumab: eosinophils not IgE predict treatment response in real-life

Background: Chronic rhinosinusitis with and without nasal polyps (CRSwNP and CRSsNP respectively) can be difficult to treat and biologics offer potential as a future therapeutic intervention. CRS and severe asthma often co-exist. Omalizumab is currently licenced for the treatment of severe allergic asthma. Objective: The aim was to determine which blood biomarkers and treatment variables were associated with clinical response for sinonasal symptoms in patients with allergic CRSsNP and CRSwNP who were treated with omalizumab for severe allergic asthma. Methods: Sinonasal outcome test (SNOT)-22 scores were recorded in a cohort of patients with allergic CRSsNP (n=10) or CRSwNP (n=15) treated with omalizumab for severe asthma according to UK guidelines. Using a linear modelling approach, the improvement in the SNOT-22 score as the treatment variable against several disease and treatment predictor variables was modelled. Results: SNOT-22 significantly decreased with omalizumab treatment. Increased blood eosinophil count and omalizumab dosing every two weeks (as opposed to every 4 weeks) were associated with greater reductions in SNOT-22 after 16 weeks of omalizumab treatment. Conclusion: Our study confirms that omalizumab is an effective treatment for CRS, and suggests that improvements are greater in those with eosinophilic disease. Further studies are required to determine long term efficacy and whether this treatment could reduce the need for surgery.