282 Successful Treatment of Severe Nonallergic Asthma by Omalizumab. An Observation

BACKGROUND: Omalizumab (Oma) is used in Europe for treatment of severe allergic asthma we describe the use of anti-IgE for severe nonallergic aspirin-induced asthma. METHODS: A non-smoking woman with negative family anamnesis, negative skin prick test (28 allergens), no specific IgE antibody and IgE of 107 kU/l developed a chronic rhinitis with anosmia, sinusitis and severe asthma at the age of 31 years. She suffers from nasal polyps (7 operations) and intolerance to aspirin and ibuprofen as well as alcohol; both leading to severe breathlessness. She was treated over years without success with oral steroids, ICS, LABA's and montelukast. The asthma was not under control and unstable. Therefore, we decided to try Oma as an additional medication. Since 25.08.2010 she is receiving 150 mg Oma/month without any change in other medication. After only 2 months she reported a remarkable reduction in their bronchial and nasal symptoms including improved smell and that she can drink small amounts of alcohol and also stands aspirin. We performed appropriate provocation tests to prove this observation. RESULTS: The FEV1 increased from 1.4 L on the 25.08.2010 to 2.4 L after only 2 months of treatment with Oma and was stable at this normal level for the next 12 months (till October 2011). The severity of symptoms (night and day) were dramatic reduced and the quality of life increased significantly (asthma-control-test normalized from 11 to 21 points). A double-blind placebo-controlled (DBPC) test with 125, 250, and 500 mg aspirin (cumulative dose 875 mg) was negative (all-day well-being, no changes in lung function). The DBPC-test with 3 doses of alcohol (sum of 10 g) was also negative. CONCLUSIONS: A severe, difficult-to treat nonallergic asthma with nasal polyposis, ASS, and alcohol-intolerance (Samter's syndrom) was successfully treated with additionally given Oma. The injection of 150 mg Oma per month induced a clearly improved quality of life, “an asthma under control”, improved the lung function with respect to FEV1 and leads to an unexpected tolerance against ASS and alcohol. To our knowledge this is the first reported observation on successful treatment of a Samter's syndrome using Oma.