Omalizumab Decreases Rates of Cold Symptoms in Inner-City Children with Allergic Asthma
Saturday, March 5, 2016: 3:00 PM
Room 502B (Convention Center)
Ann T. Esquivel, MD, , , , , , , , , , , , , , , , ,
Rationale: Omalizumab can reduce virus-induced asthma exacerbations, however little is known about its effects on colds. Our previous data show that omalizumab treatment reduces duration of viral detection, and that omalizumab can improve interferon/antiviral responses. Thus, we hypothesized that omalizumab treatment would decrease weeks with symptomatic upper respiratory illnesses.

Methods: The Preventative Omalizumab or Step-up Therapy for Severe Fall Exacerbations (PROSE) study was a randomized trial of guidelines-based asthma care vs. add-on fluticasone boost vs. add-on omalizumab in 478 asthmatic children (6-17 years) from low-income census tracts. Cold symptom scoring sheets were collected weekly over the 4-month treatment period during the fall seasons of 2012 or 2013. Colds were identified as increased symptoms (runny nose, stuffy nose, sneezing, cough, sore throat) compared to baseline. Adjusted illness rates (colds per sample) by treatment arm were calculated using an over-dispersed Poisson regression.

Results: In total, 5873 cold assessments were completed and 1034 (18%) symptomatic illnesses were detected. Rates of colds (per sample) were significantly reduced (p=0.01) in participants treated with add-on omalizumab (0.15, n=259) compared to guidelines-based asthma care alone (0.20, n= 89), a decrease of 27%. Interestingly, this reduction was seen across asthma treatment steps, with the same rate of reduction observed in children with moderate vs. severe persistent asthma. Fluticasone boost had no significant effect on cold rates (0.17, n=130).

Conclusions: Omalizumab significantly decreases rates of cold symptoms in children with allergic asthma. These findings indicate that IgE contributes to the frequency and/or duration of upper respiratory illnesses in this population.