D2.455 - Does Biological Therapy Modify NSAID Hypersensitivity? Experience with Omalizumab and Mepolizumab in Patients with Asthma and Nasal Polyps with N-ERD

Nonsteroidal anti-inflammatory drug–exacerbated respiratory disease (N-ERD) is associated with significant morbidity in patients with asthma and nasal polyps. While biological therapies are known to improve asthma and nasal polyp control, their effects on NSAID hypersensitivity remain poorly defined. This study aimed to evaluate changes in NSAID tolerance following omalizumab or mepolizumab treatment in patients with N-ERD.

This retrospective observational study was conducted at the Immunology and Allergy Clinic of Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital. Fifteen patients diagnosed with asthma, nasal polyps, and N-ERD were included. Ten patients received omalizumab and five received mepolizumab. Post-treatment aspirin provocation testing was not feasible; therefore, NSAID tolerance was assessed based on patient self-reports. NSAID-induced reaction severity was classified according to the Ring and Messmer grading system. Complete NSAID tolerance or a reduction in reaction severity was defined as a clinical response.

After initiation of biological therapy, four patients attempted re-exposure to a previously reactive NSAID. In the omalizumab group, one patient (10%) achieved complete NSAID tolerance, while one showed no change in reaction severity. The remaining patients avoided NSAID use and could not be evaluated. In the mepolizumab group, two patients (40%) demonstrated a clinical response: one achieved complete NSAID tolerance and one experienced a marked reduction in reaction severity. Patients with a clinical response had predominantly moderate-to-severe NSAID-induced reactions prior to biological therapy. Although no statistically significant difference was observed between groups, the clinical response rate was numerically higher in the mepolizumab group, independent of baseline NSAID exposure frequency and reaction severity.

Both omalizumab and mepolizumab were associated with improved NSAID tolerance in patients with N-ERD. These findings suggest that improvement in NSAID tolerance may be related to the overall effect of biological therapy rather than the superiority of a specific agent. Suppression of eosinophilic inflammation, in addition to IgE-mediated mechanisms, may play a role in restoring NSAID tolerance. Larger prospective studies are needed to confirm these observations.