• Peter W Heymann, Platts-Mills Thomas A E TAE Asthma and Allergic Diseases Center, University of Virginia, Charlottsville, Va., Judith A Woodfolk, Larry Borish, Deborah D Murphy, Holliday T Carper, Mark R Conaway, John W Steinke, Lyndsey Muehling, Gerald Teague W W Division of Pediatric Respiratory Medicine, University of Virginia, Charlottsville, Va., Joshua L Kennedy, Anne-Marie Irani, Matthew D McGraw, Stephen V Early, Lisa M Wheatley, Amy P Adams, and Ronald B Turner.
• Asthma and Allergic Diseases Center, University of Virginia, Charlottsville, Va; Division of Pediatric Respiratory Medicine, University of Virginia, Charlottsville, Va. Electronic address: pwh5a@virginia.edu.
• J. Allergy Clin. Immunol. 2020 Sep 1; 146 (3): 545-554.

BackgroundRhinovirus frequently causes asthma exacerbations among children and young adults who are allergic. The interaction between allergen and rhinovirus-induced symptoms and inflammation over time is unclear.ObjectiveOur aim was to compare the response to an experimental inoculation with rhinovirus-16 in allergic asthmatics with the response in healthy controls and to evaluate the effects of administrating omalizumab before and during the infection.MethodsTwo clinical trials were run in parallel. In one of these trials, the response to an experimental inoculation with rhinovirus-16 among asthmatics with high levels of total IgE was compared to the response in healthy controls. The other trial compared the effects of administering omalizumab versus placebo to asthmatics in a randomized, double-blind placebo-controlled investigation. The primary outcome for both trials compared lower respiratory tract symptoms (LRTSs) between study groups over the first 4 days of infection.ResultsFrequent comparisons of symptoms, lung function, and blood eosinophil counts revealed differences that were more pronounced among allergic asthmatics than among controls by days 2 and 3 after virus inoculation. Additionally, an augmentation of upper respiratory tract symptom scores and LRTS scores occurred among the atopic asthmatics versus the controls during the resolution of symptoms (P < .01 for upper respiratory symptom tract scores and P < .001 for LRTS scores). The beneficial effects of administering omalizumab on reducing LRTSs and improving lung function were strongest over the first 4 days.ConclusionsLRTSs and blood eosinophil counts were augmented and lung function was reduced among allergic asthmatics early after rhinovirus inoculation but increased late in the infection during symptom resolution. The effect of administering omalizumab on the response to rhinovirus was most pronounced during the early/innate phase of the infection.Copyright © 2020. Published by Elsevier Inc.

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