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| |  Pretreatment With Omalizumab Can Safely Increase Effectiveness of Rush Immunotherapy: Presented at ACAAI By Sandra Ripley Distelhorst SEATTLE -- November 10, 2008 -- Pretreatment with omalizumab appears to help patients with asthma and allergic rhinitis to achieve their target maintenance immunotherapy (IT) dose and prevent systemic allergic reactions (SARs), according to research presented here at the American College of Allergy, Asthma & Immunology (ACAAI) annual conference. Allergic rhinitis can cause debilitating episodes in patients with asthma, and more than 60% of patients with asthma are believed to have allergic asthma. Desensitisation of patients allergic to specific common household allergens is thought to reduce SARs. However, conventional IT can take weeks, months, or even years to reach maintenance dose. Rush IT compresses the desensitisation process into 1 or 2 days and, in some studies, has been effective in reaching the maintenance therapy; nevertheless, it has some risks, such as anaphylaxis. Recent data, however, demonstrated that pretreatment with omalizumab reduced the rate of anaphylaxis following ragweed-specific rush IT in patients with allergic rhinitis. In a presentation on November 9, Harold S. Nelson, MD, National Jewish Medical and Research Center, Denver, Colorado, presented study results on the use of omalizumab, a nonsteroidal humanised monoclonal anti-IgE antibody to prevent such SARs. The multicentre, double-blind, 26-week study randomised 275 patients who had both asthma and allergic rhinitis to a treatment group and a placebo group. Study patients were aged 18 to 55 years and had at least moderate persistent symptomatic asthma, total serum immunoglobulin E (IgE) levels 30 to <700 IU/mL, and skin test sensitivity to at least 1 of 4 perennial aeroallergens (cat, dog, and house dust mite). Patients received 16 weeks of pretreatment with omalizumab or placebo. IT was begun 12 weeks after pretreatment and titrated to a target dose specific to the allergic allergen (15 mcg Fel d1/Can f1, 5 mcg/3.5 mcg Der f1/p1) using 18 injections at 8 visits over a 4-week period followed by an 8-week period of maintenance therapy. The proportion of patients who experienced a SAR following IT were evaluated using the Cochran-Mantel-Haenszel test, adjusting for dosing regimen (2/4 weeks), perennial allergen sensitivity (single/multiple), and cat sensitivity (yes/no). Treatment and placebo groups had similar baseline IgE, forced expiratory volume at 1 second, inhaled corticosteroid dose, and allergen sensitivity. Dr. Nelson presented results for the 248 patients who received at least 1 dose of IT. Of 126 patients in the omalizumab group, 17 (13.5%) experienced SARs compared with 32 of 122 (26.2%) patients in the placebo group (absolute treatment difference = 0.1274, P = .017). Patients in the omalizumab group also had fewer respiratory related SARs compared with placebo (7 vs 24, respectively). More patients in the omalizumab versus placebo group were able to reach the target maintenance IT dose (87.3% vs 72.1%, respectively, P = .004). No patients had an anaphylactic reaction to omalizumab or rush IT during the study period, Dr. Nelson reported.
[Presentation title: Effect of Pretreatment With Omalizumab on the Tolerability of Specific Immunotherapy in Patients With Persistent Symptomatic Asthma Inadequately Controlled With Inhaled Corticosteroids. Abstract 17]
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