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From the Authors

Allergy and Asthma Clinic, Charité, Humboldt University Berlin, Germany

From the authors:

In our recent article, we demonstrated the inhibitory effect of subcutaneously administered monoclonal anti-immunoglobulin-E antibody, omalizumab, on nasal responses to allergen challenge in patients with allergic rhinitis 1. Omalizumab-treated patients showed reduced nasal symptoms, an inhibition of the increase of human serum albumin the nasal lavage fluid after allergen challenge and a decrease in tumour necrosis factor- in basal nasal lavage fluids.

D.K.C. Lee mentioned in his Letter to the Editor, that no exact degree of disease severity and no data with regards to the usual therapy for allergic rhinitis were given in the article. Moreover, D.K.C. Lee missed an exact indication for the use of omalizumab and an estimation of the role of omalizumab in the therapy of allergic rhinitis compared to the conventional therapy. Furthermore, D.K.C. Lee missed detailed data with regards to each individual's aeroallergen and mentioned a possible influence of the pollen season on the results of our study. Finally, D.K.C. Lee stresses the subcutaneous way of application of omalizumab, as this will be a disadvantage against the established therapies for allergic rhinitis.

The target of our study was the effect of omalizumab on the nasal symptoms and the inflammatory markers in nasal lavage fluid before and after allergen challenge of patients with allergic rhinitis. The degree of disease severity and the usual therapy were not a target of our study, moreover the patients had no symptoms at the time-points of allergen challenge. However, we think the influence of severity and usual therapy would be very interesting for further studies.

As our study was a model of allergen provocation, of course it was not possible to get exact results for the indication for omalizumab in the therapy of allergic rhinitis. There are other studies which have investigated the effect of omalizumab on allergic rhinitis during the allergy season 2. Further studies like these may have the possibility to analyse the rank of omalizumab in the therapy of allergic rhinitis. At this time, omlizumab is approved for the additional treatment of severe asthma. From our point of view, omalizumab has its advantage in the treatment of multiple allergic diseases, such as allergic asthma and allergic rhinitis simultaneously.

As mentioned above, all patients who participated in the study were symptom-free at the time-points of allergen-challenge. This includes the seasonal und perenial allergens. Consequently, we had no influence of seasonal effects on the results of our study.

The subcutaneous application of omalizumab was no problem for our patients. Yet we agree with D.K.C. Lee, that we would prefer a different way of administration or a longer period between the injections. However, the route of administration is defined by the pharmacokinetics and pharmacodynamics of the compound.

Over allih the interest of our studies of the effect of omalizumab was mainly the influence on inflammatory processes. As in the recently published article concerning allergic asthma 3, we focused on the description of the effect of omalizumab on allergic inflammation to get a more detailed insight into the reasons of the clinical effect of omalizumab.

References

1. Hanf G, Noga O, O'Connor A, et al. Omalizumab inhibits allergen challenge-induced nasal response. Eur Respir J 2004;23:414–418.[Abstract/Free Full Text]
2. Adelroth E, Rak S, Haahtela T, et al. Recombinant humanized mAb-E25, an anti-IgE mAb, in birch pollen-induced seasonal allergic rhinitis. J Allergy Clin Immunol 2000;106:253–259.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
3. Noga O, Hanf G, Kunkel G. Immunological and clinical changes in allergic asthmatics following treatment with omalizumab. Int Arch Allergy Immunol 2003;131:46–52.[Web of Science][Medline] [Order article via Infotrieve]

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