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Temporarily adding omalizumab to the standard care for asthma reduces fall asthma exacerbations in inner-city youth. That is the conclusion of a group of paediatricians who published a paper in the Journal of Allergy and Clinical Immunology. The beneficial effect was most notable in children who had recently experienced an exacerbation.

Some children and adolescents suffering from asthma continue to experience exacerbations despite treatment with doses of inhaled corticosteroids (ICSs) and long-acting β-agonists. These exacerbations can happen at any time, but in inner-city school children they happen particularly frequently during the fall after school resumes. Previous research has shown that adding omalizumab to the standard care can reduce these exacerbations, but continuous treatment with both therapeutic modalities can impart certain risks and increased costs. 

This is why Stephen J. Teach, MD, Chair of the Department of Pediatrics at Children's National Health System, and his colleagues studied the effect of a periodic treatment. The randomised, double-blind study included 727 participants, ages six to 17 years, who resided in low-income, inner-city areas. It was conducted over two fall cycles, 2012 and 2013. Participants received placebo, omalizumab or an ICS boost beyond their regular on-going treatment beginning four to six weeks prior to the first school day and ending 90 days following the start of school.

Less exacerbations
The fall exacerbation rate was significantly lower in the omalizumab treated patients than in the placebo group (11.3 versus 21.0 per cent), but there was no significant difference between omalizumab and ICS boost. In a prespecified subgroup analysis, among participants with a recent exacerbation, omalizumab was significantly more efficacious than both placebo and ICS boost. The therapy also appears to restore immune protection against common cold viruses that can trigger severe asthma attacks.

The authors state that their results provide a new way to treat children with allergic asthma. “By identifying those patients who are at high risk for fall asthma exacerbations, we can target directed treatment for them during the times of year that they're at the greatest risk for problems”, according to main investigator Stanley J. Szefler, MD, Director of the Pediatric Asthma Research Program and Research Medical Director of the Breathing Institute at Children's Colorado. 

Sources: Journal of Allergy and Clinical Immunology, Children's Hospital Colorado.