Biomarkers in therapy of allergic rhinitis
Currently, optional therapeutic measures for AR involve patient
education, environmental control, pharmacotherapy, allergen
immunotherapy (AIT), and surgery.90,91 Traditional
medications include nasal corticosteroids, antihistamines, mast cell
stabilizers, decongestants, etc. MP29-02, a combination of nasal
corticosteroid and antihistamine, is a novel topical medication which
has proved to be effective in reducing nasal hyperreactivity and nasal
mediators such as substance P, in patients with AR.92As ILC2s have been shown to produce significant amounts of
proinflammatory mediators in response to epithelium-derived
cytokines80,81 and PGD2 and cysLTs82in AR patients, agents targeting the ILC2s and the mediators activating
these cells have become targets for therapy. Rittchen and Heinemann have
recently reviewed the central role of hematopoietic PGD2 synthase in
allergic inflammation and indicated that PGD2 signaling might be a
promising therapeutic target for AR, as PGD2 can activate Th2 cells,
eosinophils and basophils.93 Indeed, a randomized
controlled phase II clinical trial has recently demonstrated that
ONO-4053, a novel prostaglandin D receptor 1 antagonist, was more
effective than pranlukast, a leukotriene receptor antagonist, in
treating patients with seasonal AR.94 Most recently,
emerging studies have focused on biologics for treating allergic
diseases; especially severe, uncontrolled asthma and AD, as well as
AR.95,96 To date a high number of specific biologics
targeting markers of Th1/2/17 inflammation have been introduced; with
more under development.95,97 In particular, targeting
IgE by omalizumab, a recombinant humanized anti-IgE antibody, has been
shown to significantly improve symptoms in patients with inadequately
controlled AR.98 Furthermore, combining omalizumab
with sub-cutaneous immune therapy (SCIT) in patients with SAR and
comorbid seasonal allergic asthma has been shown to lead to greater
clinical improvements in AR and lung function than SCIT
alone.99 Similarly, dupilumab, a biologic which
targets IL-4Rα to block the activity of both IL-4 and IL-13, has been
shown to provide nasal symptom relief in patients with uncontrolled
asthma and comorbid AR.100