2022 Volume 115 Issue 9 Pages 765-769
The incidence of allergic rhinitis caused by Japanese cedar pollen has been increasing in recent years. Treatment of seasonal allergic rhinitis includes oral treatment centered on second-generation antihistamines, topical steroid sprays, sublingual immunotherapy, etc. In addition, omalizumab, an anti-IgE antibody preparation, was approved in December 2019 for use in patients with severe or very severe symptoms who show inadequate response to existing treatments. During the 2020 cedar pollinosis season, which was the first cedar pollen season in Japan after the approval of omalizumab, we treated some patients with cedar pollen-induced seasonal allergic rhinitis with omalizumab at our hospitals. We report the clinical effects of the drug administered during the pollen season in 2020 and the effects of re-administration of the drug again in 2021 in patients with Japanese cedar pollinosis.
In 2020, omalizumab was administered to 4 patients with severe symptoms and 1 patient with very severe symptoms. One of the patients received the drug for 2 weeks, while the remaining four patients received the drug for 4 weeks. All the patients showed improvement of symptoms after treatment, as compared to the symptom severity before the start of treatment. Of the 5 patients, 4 requested omalizumab treatment again in 2021, so that 80% were re-administered the drug in 2021. These patients received omalizumab statically significant earlier in 2021 as compared to 2020 (p = 0.014: Mann-Whitney U test). Only one of the patients also received sublingual immunotherapy. Even patients receiving sublingual immunotherapy could show severe allergic symptoms during the cedar pollinosis season, and omalizumab was effective even in the patient who showed symptoms while receiving sublingual immunotherapy at our hospital. Even when omalizumab treatment was started from the middle of the Japanese cedar pollen season, the intranasal findings improved after 2 weeks. Assessment of two patients with intranasal findings by the Japanese Rhinoconjunctivitis Quality of Life Questionnaire confirmed improvement of the nasal symptoms in patients who were treated with omalizumab. Omalizumab appears to be a useful drug for seasonal allergic rhinitis, but further studies are needed to confirm the findings.
