Treatment of nasal polyposis with insufficient efficacy of intranasal glucocorticosteroid therapy in patients 18 years and older

Introduction. Improvement of conservative therapy of polypous rhinosinusitis is important for scientific and practical otorhi­nolaryngology.

Aim. To study the therapeutic possibilities of a recombinant antibody to immunoglobulin E for polypous rhinosinusitis in patients with bronchial asthma with insufficient efficacy of intranasal glucocorticosteroid therapy.

Materials and methods. The study was performed with the participation of 78 patients out of 204 registered with pulmonol­ogists and otorhinolaryngologists aged 18-45 years, with an average weight of 60-90 kg. Inclusion criteria: the presence of polypous rhinosinusitis (J33) in combination with bronchial asthma with a predominance of the allergic component (J45.0), mild to moderate severity, persistent form, uncontrolled course. The effectiveness of recombinant antibody to immunoglobulin E was evaluated at 3^rd, 4^th and 5^th months compared with groups that received only standard basic complex therapy.

Results and discussion. In patients with polypous rhinosinusitis accompanied by bronchial asthma receiving the recombinant antibody to immunoglobulin IgE: nasal respiration was restored by 63%, 66.2% and 68.9%, olfactory improvement by 52%, 63.5% and 67.9% on the 3^rd, 4^th and 5^th month of therapy, respectively. According to CT data, at the end of the 5^th month of ther­apy, 70% of patients had a polypous process of 0-5 points, 30% of patients had values of 6-10 points of Lund-Mackay staging. According to the SF-36 questionnaire, normalization of quality-of-life indicators was recorded in the form of improved role functioning, vital activity and emotional state by 33.6, 33.3 and 30.2 points, respectively. The subjects receiving conservative therapy did not experience any allergic reactions or side effects during treatment.

Conclusions. The leading clinical manifestations of persistent atopic bronchial asthma, allergic rhinitis, nasal polyposis, and chronic idiopathic urticaria are nasal obstruction, rhinorrhea, hyperemia, and itching of the skin. These symptoms are caused by premature release of inflammatory mediators, the main one being histamine. The use of targeted therapy with humanized monoclonal antibodies is more likely to control the cascade of symptoms in patients with diseases refractory to H1 blockers.

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