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Am J Respir Crit Care Med. 2017 Oct 15;196(8):985-992. doi: 10.1164/rccm.201701-0120OC.

Effects of Omalizumab on Rhinovirus Infections, Illnesses, and Exacerbations of Asthma.

Author information

1
1 University of Wisconsin, Madison, Madison, Wisconsin.
2
2 Rho Inc. Federal Systems Division, Chapel Hill, North Carolina.
3
3 National Institute of Allergy and Infectious Diseases, Rockville, Maryland.
4
4 University of Texas Southwestern Medical Center, Dallas, Texas.
5
5 Columbia University Medical Center, New York, New York.
6
6 Cincinnati Children's Hospital, Cincinnati, Ohio.
7
7 Henry Ford Health System, Detroit, Michigan.
8
8 National Jewish Health, Denver, Colorado.
9
9 Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado.
10
10 Children's National Health System, Washington, DC.
11
11 Boston University School of Medicine, Boston, Massachussetts; and.
12
12 Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.

Abstract

RATIONALE:

Allergic inflammation has been linked to increased susceptibility to viral illnesses, but it is unclear whether this association is causal.

OBJECTIVES:

To test whether omalizumab treatment to reduce IgE would shorten the frequency and duration of rhinovirus (RV) illnesses in children with allergic asthma.

METHODS:

In the PROSE (Preventative Omalizumab or Step-up Therapy for Severe Fall Exacerbations) study, we examined children with allergic asthma (aged 6-17 yr; n = 478) from low-income census tracts in eight U.S. cities, and we analyzed virology for the groups randomized to treatment with guidelines-based asthma care (n = 89) or add-on omalizumab (n = 259). Weekly nasal mucus samples were analyzed for RVs, and respiratory symptoms and asthma exacerbations were recorded over a 90-day period during the fall seasons of 2012 or 2013. Adjusted illness rates (illnesses per sample) by treatment arm were calculated using Poisson regression.

MEASUREMENTS AND MAIN RESULTS:

RVs were detected in 97 (57%) of 171 exacerbation samples and 2,150 (36%) of 5,959 nonexacerbation samples (OR, 2.32; P < 0.001). Exacerbations were significantly associated with detection of rhinovirus C (OR, 2.85; P < 0.001) and rhinovirus A (OR, 2.92; P < 0.001), as well as, to a lesser extent, rhinovirus B (OR, 1.98; P = 0.019). Omalizumab decreased the duration of RV infection (11.2 d vs. 12.4 d; P = 0.03) and reduced peak RV shedding by 0.4 log units (95% confidence interval, -0.77 to -0.02; P = 0.04). Finally, omalizumab decreased the frequency of RV illnesses (risk ratio, 0.64; 95% confidence interval, 0.49-0.84).

CONCLUSIONS:

In children with allergic asthma, treatment with omalizumab decreased the duration of RV infections, viral shedding, and the risk of RV illnesses. These findings provide direct evidence that blocking IgE decreases susceptibility to RV infections and illness. Clinical trial registered with www.clinicaltrials.gov (NCT01430403).

KEYWORDS:

IgE; asthma; omalizumab; rhinovirus

PMID:
28608756
PMCID:
PMC5649984
DOI:
10.1164/rccm.201701-0120OC
[Indexed for MEDLINE]
Free PMC Article

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