Effects of Omalizumab on Rhinovirus Infections, Illnesses, and exacerbations of asthma

Ann Esquivel, William W. Busse, Agustin Calatroni, Alkis G. Togias, Kristine G. Grindle, Yury A. Bochkov, Rebecca S. Gruchalla, Meyer Kattan, Carolyn M. Kercsmar, G. Khurana Hershey, Haejin Kim, Petra Lebeau, Andrew H. Liu, Stanley J. Szefler, Stephen J. Teach, Joseph B. West, Jeremy Wildfire, Jaqueline A. Pongracic, James E. Gern

Research output: Contribution to journalArticlepeer-review

186 Scopus citations


Rationale: Allergic inflammation has been linked to increased susceptibility to viral illnesses, but it is unclear whether this association is causal. Objectives: To test whether omalizumab treatment to reduce IgE would shorten the frequency and duration of rhinovirus (RV) illnesses in children with allergic asthma. Methods: In the PROSE (Preventative Omalizumab or Step-up Therapy for Severe Fall Exacerbations) study, we examined children with allergic asthma (aged 6-17 yr; n = 478) from low-income census tracts in eight U.S. cities, and we analyzed virology for the groups randomized to treatment with guidelines-based asthma care (n = 89) or add-on omalizumab (n = 259). Weekly nasal mucus samples were analyzed for RVs, and respiratory symptoms and asthma exacerbations were recorded over a 90-day period during the fall seasons of 2012 or 2013. Adjusted illness rates (illnesses per sample) by treatment arm were calculated using Poisson regression. Measurements and Main Results: RVs were detected in 97 (57%) of 171 exacerbation samples and 2,150 (36%) of 5,959 nonexacerbation samples (OR, 2.32; P < 0.001). Exacerbations were significantly associated with detection of rhinovirus C (OR, 2.85; P < 0.001) and rhinovirus A (OR, 2.92; P < 0.001), as well as, to a lesser extent, rhinovirus B (OR, 1.98; P = 0.019). Omalizumab decreased the duration of RV infection (11.2 d vs. 12.4 d; P = 0.03) and reduced peak RV shedding by 0.4 log units (95% confidence interval, 20.77 to 20.02; P = 0.04). Finally, omalizumab decreased the frequency of RV illnesses (risk ratio, 0.64; 95% confidence interval, 0.49-0.84). Conclusions: In children with allergic asthma, treatment with omalizumab decreased the duration of RV infections, viral shedding, and the risk of RV illnesses. These findings provide direct evidence that blocking IgE decreases susceptibility toRVinfections and illness.

Original languageEnglish (US)
Pages (from-to)985-992
Number of pages8
JournalAmerican journal of respiratory and critical care medicine
Issue number8
StatePublished - Oct 15 2017


  • Asthma
  • IgE
  • Omalizumab
  • Rhinovirus

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine


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