The role of omalizumab or rhuMAB-E25 in the treatment of allergic rhinitis.

I read with interest the recent article by HANF et al. [1], demonstrating the significant inhibition of both allergen challenge-induced nasal symptoms and the increase of human serum albumin in nasal lavage fluid after allergen challenge, in addition to the significant reduction in tumour necrosis factor-a levels in basal nasal lavage fluid, following administration of omalizumab. However, it is difficult to gauge from the study, the exact degree of disease severity in the study population, as no data were given with regards to the patients9 usual therapy for allergic rhinitis, be it topical or oral, and hence no assessment of correlation between treatment and symptoms can be made. In addition, the characterisation of the study population was inadequate, as to whether patients suffered from seasonal or perennial allergic rhinitis, as no detailed data with regards to each individual9s aeroallergen sensitisation were presented. Moreover, one has to be wary of the potential confounding effects of conducting the study during the pollen season, especially in patients who were sensitised to birch and grass pollen. Although the study did shed some light on the potential for the use of omalizumab in allergic rhinitis, the exact indications for its use remain unclear. It is a pity that patients were not better categorised or characterised, as one could have perhaps argued a case for the role of omalizumab as a secondor third-line agent following failure with conventional therapy, such as corticosteroids, histamine H1-receptor antagonists and leukotriene CysLT1-receptor antagonists. Furthermore, the fact that the mode of delivery of omalizumab is through subcutaneous administration must not be ignored, as this will disadvantage it against other established first-line topical or oral therapy for allergic rhinitis.