Effect of anti‐immunoglobulin E on nasal inflammation in patients with seasonal allergic rhinoconjunctivitis

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Abstract
Summary: Background Binding of allergens to IgE on mast cells and basophils causes release of inflammatory mediators in nasal secretions.Objective The combined effect of specific immunotherapy (SIT) and omalizumab, a humanized monoclonal anti‐IgE antibody, on release of eosinophilic cationic protein (ECP), tryptase, IL‐6, and IL‐8 in nasal secretion was evaluated.Methods Two hundred and twenty five children (aged 6–17 years) with a history of seasonal allergic rhinoconjunctivitis induced by birch and grass pollen were randomized into four groups: either birch‐ or grass‐pollen SIT in combination with either anti‐IgE or placebo. Complete sets of nasal secretion samples before treatment Visit 1 (V1), during birch‐ (V2) and grass (V3)‐pollen season and after the pollen season (V4) were collected from 53 patients.Results A significant reduction in tryptase only was seen in the anti‐IgE‐treated group at V2 (PPP< 0.005; V4: +79.0 μg/L, P< 0.05), and stable levels of tryptase, IL‐6 and IL‐8. Treatment with anti‐IgE resulted in stable ECP values and a significant decrease of tryptase compared with V1 (baseline): V2: −80.0 μg/L (P< 0.05); V3: −56.3 μg/L, which persisted after the pollen season with V4: −71.6 μg/L (P< 0.05). After the pollen season, a decrease of IL‐6 was observed in both groups (V4 placebo group: −37.5 ng/L; V4 anti‐IgE group: −42.9 ng/L, P< 0.01).Conclusion The combination of SIT and anti‐IgE is associated with prevention of nasal ECP increase and decreased tryptase levels in nasal secretions.