ArticleFrontiers in immunology2026
IL-5/IL-5R blockade enables safe non-steroidal anti-inflammatory agent reintroduction in non-steroidal anti-inflammatory exacerbated respiratory disease.
Article in Frontiers in immunology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Biologic therapies targeting the interleukin-5 (IL-5) pathway improve asthma control and chronic rhinosinusitis with nasal polyposis (CRSwNP) in patients with non-steroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (NERD). However, their effect on NSAID tolerance remains insufficiently characterized. Objective: This study aimed to investigate whether anti-IL-5/IL-5 receptor (IL-5R) treatments could improve NSAID tolerance in patients with NERD and Blended Reactions (BRs). Method: Clinical parameters, including the Asthma Control Test (ACT), 22-item Sino-Nasal Outcome Test (SNOT-22), visual analog scale (VAS) scores for quality of life, nasal polyp grade, and inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) dose, were compared before and after biologic therapy. ASA provocation tests were repeated during biologic treatment and compared with prior challenge results; outcomes were also compared between the biologic-treated group and the biologic-naive comparison group. Results: Patients who received biological treatments showed significant improvements compared to baseline, with eosinophil counts decreasing from 695 (590-892.5) to 50 (30-60), ACT scores increasing from 12 (8.7-18) to 24 (20.7-24.2), SNOT-22 scores declining from 56 (51-73) to 16 (5.7-28.7), and VAS scores improving from 1 (0-2.2) to 9 (7-10), all with p=0.001. ASA provocation positivity decreased to 28.5% (p=0.002), and all patients stepped down from high-dose to medium/low-dose ICS/LABA. Among the four patients who remained intolerant, reactions occurred at higher cumulative doses, with delayed onset and milder symptoms. Conclusion: Our study indicated that blockade of IL-5 pathway significantly improved clinical outcomes and reduced ASA hypersensitivity in patients with NERD/BRs, highlighting their potential role in modifying disease phenotype beyond asthma control.
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