The anti-immunoglobulin (IgE) monoclonal antibody omalizumab proved beneficial for all patients with severe allergic asthma (SAA) and especially for patients with multiple allergic comorbidities (AC) or atopic dermatitis (AD), according to a post-hoc analysis of the STELLAIR study published in the Journal of Asthma and Allergy. In patients with three or more AC, omalizumab also improved AC outcomes. The study team hypothesized that omalizumab may be particularly beneficial for patients with SAA and multiple AC, including perennial/seasonal rhinitis, conjunctivitis, AD, and food allergy. To test their hypothesis, they classified patients (n = 872, 149 minors and 723 adults) based on the presence of multiple AC (≥3 AC or <3 AC) or AD as assessed by questionnaire. Response to omalizumab was assessed after 4-6 months (T4-6) and after 12 months (T12). Asthma response at T4-6 was based on global evaluation of treatment effectiveness, reduction of 40% or more in annual exacerbation rate, and a combination of both. Asthma response at T12 was based on change in yearly exacerbation and hospitalization rates, and AC improvement at T12 was based on patient perception.
The researchers found that patients with three or more AC demonstrated a higher combined response to omalizumab (74.7% vs 58.3%) at T4-6 and had reduced yearly exacerbation and hospitalization rates (88.9% vs 77.4% and -94.0% vs -70.5%, respectively). Patients with three or more AC were more likely to show an improvement in their AC (85.3% vs 51.9%) at T12. Results were similar in minors and adults. The presence of AD was associated with greater omalizumab effectiveness at T4-6 and a greater AC improvement at T12. Improvement of AD and food allergies at T12 were 73.2% and 38.7%, respectively, in the population overall.