Biologicals
Uncontrolled and severe forms of AR with substantial impact on quality
of life, have been considered as a potential target for biologicals
[114]. Recent reports and meta-analysis showed that anti-IgE
(omalizumab) significantly reduces rhinitis morbidity, severity and
rescue medication use and improve quality of life in uncontrolled
adolescents [115, 116]. There are also data indicating that
pre-treatment with anti-IgE in children undergoing seasonal AIT,
significantly decrease severe adverse reactions and improves daily
rhinitis symptoms [117]; nevertheless, Omalizumab is not indicated
in AR due to cost limitation.
Dupilumab is an anti-IL-4 monoclonal antibody currently approved for
uncontrolled atopic dermatitis and asthma [118]. In a Phase IIb
clinical trial dupilumab was efficient in ameliorating rhinitis symptoms
such as postnasal discharge, nasal blockage, runny nose and sneezing, in
patients with uncontrolled asthma and perennial AR [119]. The
results from a clinical study evaluating the efficacy of dupilumab as an
adjuvant therapy in patients undergoing AIT are awaited[120].