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Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a type‑2 inflammatory disease of the upper airways, with severe impairment of quality of life. Persons affected by NSAID-exacerbated respiratory disease (NERD) usually present with highly dynamic recurrence of polyps and disease despite prior treatment with sinus surgeries, oral corticosteroids, and aspirin desensitization (ATAD). Biologic therapy has fundamentally changed the choice of therapeutic concept; however, limited data exist on subgroups such as NERD patients. The aim of the current article is to report on a multicenter retrospective study on add-on therapy with dupilumab, omalizumab, and mepolizumab in patients with NERD., Methods: This is a retrospective cohort study of patients (NERD+, status after ATAD) in three reference centers in Germany (Munich, Mainz, Berlin). Subjective and objective parameters were collected at 4, 8, and 12 months after biologic therapy initiation in accordance with current EPOS/EUFOREA (European Position Paper on Rhinosinusitis and Nasal Polyps/European Forum for Research and Education in Allergy and Airway Diseases) guidelines. Biologic agents were chosen depending on availability and patient characteristics., Results: Treatment was commenced in 122 patients meeting the criteria for CRSwNP and NERD. The endoscopic polyp score, SNOT-22 questionnaire score, visual analogue scoring of total symptoms/severity of disease, and sense of smell (psychophysical testing with Sniffin'Sticks/Brief Smell Identification Test, B‑SIT; Sensonics, Inc., Haddon Heights, NJ, USA) improved significantly after 4 and 12 months of add-on therapy (p < 0.0001). All three biologic agents significantly improved one or more disease parameter. Adverse events were not life threatening but led to change of biologic agent in 4 cases. Patients rated biologic therapy significantly better than ATAD, with improved long-term disease control., Conclusion: Add-on biologic therapy is effective, safe, and widely accepted among CRSwNP + NERD patients. Future studies might allow for personalized algorithms with sequential surgery, ATAD, and/or biologic therapy., (© 2024. The Author(s).)

International guidelines for the treatment of chronic spontaneous urticaria support the updosing of second-generation antihistamines to four times of the approved dose when adequate symptom control cannot be achieved with the standard dosage. However, this recommendation is primarily based on expert opinions, and there is a lack of large, well-designed, double-blind clinical trials. Most the existing trials provide insufficient data, and due to the heterogeneity of the conducted trials on antihistamine effects (definition of control, design, quality, lack of an active comparator, no placebo arm, small sample size, outcomes) and their short duration, comparative analysis is challenging. However, it can be concluded that the use of modern second-generation antihistamines is both effective and safe based on the available data and our own long-term experiences in the specialized outpatient clinic of a university dermatology department, even though increased dosages (up to fourfold as per the current international guidelines) may be necessary for symptom control. Another therapeutic option for refractory symptoms in chronic spontaneous urticaria is subcutaneous administration of omalizumab at a dosage of 300 mg at 4‑week intervals as a very safe and effective treatment., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

We conducted a retrospective data analysis of 26 patients with chronic spontaneous urticaria (CSU), 12 of whom had been treated with anti-IgE therapy (omalizumab). The subcohort of patients treated with omalizumab displayed more severe and prolonged courses of disease. In addition, they had often undergone various inpatient therapies, frequently presenting with concomitant angioedema. Collecting the Urticaria Activity Scores from the seven daily values for wheals and itching (UAS7) proved an important and suitable instrument for the determination and assessment of the course of therapy in the dermatological office. Elaborate laboratory screenings, however, seem far less indicative of the severity, prognosis and course of the disease. Omalizumab proved to be a viable and well-tolerated treatment option. One third of the patients were completely free of all symptoms, another third showed very good improvement, whereas the last third showed no improvement at all, even when omalizumab and/or concomitant therapies were escalated., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Our 21-year-old woman presented with symptoms of chronic spontaneous urticaria with angioedema and of cholinergic urticaria as well as of atopic dermatitis. Treatment with the IgE antibody omalizumab resulted in an improvement of urticaria; however, relapses of the atopic dermatitis occurred. The use of the monoclonal IL-4/13 receptor antibody dupilumab resulted in complete healing of the atopic dermatitis, complete remission of the chronic spontaneous urticaria with angioedema, and the satisfactory control of cholinergic flare ups over a follow-up period of 26 weeks.

Biologicals are a therapeutic option for patients with severe asthma. Difficult asthma in patients with untreated comorbidities or persistent trigger factors is much more common than severe refractory asthma. Optimized medical treatment, adherence to medication, elimination of trigger factors and treatment of comorbidities are essential before escalating the therapy with a biological. A careful phenotyping of patient with severe asthma is necessary because all available biological are only effective in certain phenotypes of the disease. For patients with severe allergic asthma an antibody against IgE (Omalizumab) is available. For patients with severe asthma and eosinophilic inflammation the Interleukin (IL)-5 Antibodies Mepolizumab and Reslizumab have recently been approved. The most prominent effect of biological treatment is the reduction of acute exacerbations in these patients. Further antibodies against IL-5 receptor (Benralizumab) or against the IL-4 receptor alpha chain (Dupilumab) are in advanced clinical development., Competing Interests: Interessenkonflikt: Dr. med. Ina Haasler erhielt Erstattung von Fortbildungskosten und Kongresskosten von den Firmen TEVA, ALK und Boehringer Ingelheim Pharma.Prof. Dr. med. Christian Taube erhielt Honorare für Vortrags- und Beratertätigkeiten von Boehringer Ingelheim, Astra-Zeneca, Novartis, TEVA, Glaxo, Chiesi und ALK. Forschungsunterstützung erfolgte durch Novartis und Boehringer-Ingelheim., (© Georg Thieme Verlag KG Stuttgart · New York.)

Chronic urticaria (CU) is defined by episodes of urticaria with or without angioedema, which recur daily or nearly daily over more than 6 weeks. Sudden manifestations of CU with or without known causes are termed chronic spontaneous urticaria, which is differentiated from chronic inducible urticaria. The differential diagnoses of CU in childhood range from self-limiting dermatoses to severe systemic diseases. Further targeted steps are taken to detect potential trigger factors or underlying illnesses only if suspicion arises on anamnestic grounds and CU is best treated in accordance with international guidelines. First-line therapy consists of non-sedating H 1 -antihistamines at approved or even higher doses. If symptoms persist, additional treatment with omalizumab, cyclosporine or montelukast can be initiated after careful individual consideration.

Current guidelines of the global initiative for asthma (GINA) recommend the addition of biologics in step 5 of the stepwise asthma treatment approach. This review gives an overview on the effects and the clinical role of antibodies targeting immunoglobulin E, IgE (Omalizumab), Interleukin-5, IL-5 (Mepolizumab, Reslizumab) or the IL-5 receptor (Benralizumab). In addition, potential future treatment options of refractory asthma with antibodies (for instance Dupilumab) are discussed., (© Georg Thieme Verlag KG Stuttgart · New York.)