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].