Search

Tomoko Tajiri,1 Motohiko Suzuki,2,3 Takeo Kutsuna,4 Hirono Nishiyama,1 Keima Ito,1 Norihisa Takeda,1 Kensuke Fukumitsu,1 Yoshihiro Kanemitsu,1 Satoshi Fukuda,1 Takehiro Umemura,1 Hirotsugu Ohkubo,1 Ken Maeno,1 Yutaka Ito,1 Tetsuya Oguri,1 Masaya Takemura,1 Kosho Yoshikawa,4 Akio Niimi1 1Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Aichi, Japan; 2Department of Otorhinolaryngology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Aichi, Japan; 3Department of Otorhinolaryngology, Nagoya City East Medical Center, Nagoya, Aichi, Japan; 4Department of Respiratory Medicine, Daido Hospital, Nagoya, Aichi, JapanCorrespondence: Tomoko Tajiri, Department of Respiratory Medicine, Allergy and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan, Tel +81-52-853-8216, Email tomokot@med.nagoya-cu.ac.jpObjective: Omalizumab has demonstrated clinical efficacy in patients with severe allergic asthma sensitized to perennial allergens and/or severe pollinosis through inhibition of IgE-dependent allergic response. When considering the “one airway, one disease” concept, sensitization to pollen could predict responsiveness to omalizumab. This study aimed to assess whether the pretreatment specific IgE response could be a predictor of responsiveness to omalizumab in severe allergic asthma sensitized to perennial allergens.Methods: In this retrospective study, 41 adult patients with severe allergic asthma sensitized to perennial allergens (27 females; mean age 59 years) who had completed 52-week omalizumab treatment were enrolled. The Global Evaluation of Treatment Effectiveness was performed, and demographic characteristics and the positive ratios of specific IgE responses classified into five subgroups (pollen, dust mite, house dust, mold, and animal dander) were compared between responders and non-responders. Multivariate logistic regression analyses were performed to identify predictors of responsiveness to omalizumab.Results: Thirty-one patients (76%) were identified as responders. The number of sensitized aeroallergen subgroups and sensitization to pollens were significantly higher in responders than in non-responders (both p< 0.05). Multivariate logistic regression analysis showed that sensitization to pollen (OR = 8.41, p = 0.02) was independently associated with the effectiveness of omalizumab.Conclusion: Pretreatment serum pollen-specific IgE could be a predictor of responsiveness to omalizumab.Keywords: omalizumab, antigen-specific IgE, pollen, allergic rhinitis, allergic asthma

Keima Ito,1 Tomoko Tajiri,1 Hirono Nishiyama,1 Ryota Kurokawa,1 Jenifer Maries Go Yap,1 Norihisa Takeda,1 Kensuke Fukumitsu,1 Yoshihiro Kanemitsu,1 Satoshi Fukuda,1 Takehiro Uemura,1 Hirotsugu Ohkubo,1 Ken Maeno,1 Yutaka Ito,1 Tetsuya Oguri,1,2 Masaya Takemura,1,2 Akio Niimi1 1Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; 2Department of Education and Research Center for Community Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, JapanCorrespondence: Tomoko Tajiri, Email tomokot@med.nagoya-cu.ac.jpPurpose: Recently, single-inhaler triple therapy (SITT) has demonstrated efficacy in patients with uncontrolled asthma who were symptomatic despite treatment with inhaled corticosteroids/long-acting β 2 agonists. However, the characteristics of patients who benefit from SITT remain unclear in the real-world. The aim of this study was to examine the predictors of responsiveness to SITT in patients with asthma.Patients and Methods: A total of 45 patients with asthma who had regularly visited our respiratory clinic and were started on SITT from March 2019 to March 2021 were retrospectively analyzed. Patients’ demographic characteristics, residual respiratory symptoms, type 2 biomarkers, and lung function before SITT were assessed from the patients’ medical records. Predictors of responsiveness to four-week SITT were evaluated in these patients. The definition of responders was based on the physician-assessed global evaluation of treatment effectiveness.Results: Thirty-four (75%) of 45 patients were identified as responders to SITT. Non-responders showed significantly lower forced vital capacity (FVC) (%predicted) values, and complained of dyspnea more frequently than responders before SITT (p = 0.01 and p = 0.02, respectively). There were no significant differences in demographic characteristics and type 2 biomarkers between responders and non-responders. Clinical predictors of poor response to SITT were residual dyspnea (OR = 0.14, p = 0.02), low FVC (%predicted) values (OR = 1.05, p = 0.01), and FVC (%predicted) < 80% (OR = 0.11, p = 0.02). Multivariate analysis showed that poor response to SITT was associated with residual dyspnea before SITT (OR = 0.14, p = 0.02). On the other hand, patients with residual dyspnea had significantly lower FEF25– 75 (%predicted) values than patients without residual dyspnea before SITT (p = 0.04).Conclusion: Residual dyspnea, reflecting small airways dysfunction, may predict poor responsiveness to short-term SITT in patients with asthma.Keywords: single-inhaler triple therapy, long-acting muscarinic antagonists, asthma, small airways dysfunction, dyspnea