Dupilumab (Dupixent) and omalizumab (Xolair) are biologics/monoclonal antibodies used to treat nasal polyps and asthma. So, can you take the COVID-19 vaccine while on these medications?

THE TWO FDA-APPROVED VACCINES ARE NOT LIVE VACCINES

The two COVID-19 vaccinations currently available (Pfizer-BioNTech and Moderna) are both non-live, mRNA vaccines. The package insert for dupilumab states that live vaccines should be avoided because it has not been studied with live vaccines. Thus, from this standpoint, both of the medicines can be given.

ANTIBODY RESPONSES PRODUCED WITH OTHER VACCINES IN PATIENTS ON BIOLOGICS

Dupilumab has been studied with other non-live vaccines and the vaccines worked. In a study of atopic dermatitis adults on dupilumab, both the meningococcal polysaccharide and tetanus vaccines showed similar antibody responses in both placebo-treated and dupilumab-treated subjects.

NEITHER MEDICINE HAS IMMUNOSUPPRESSIVE EFFECTS

Dupilumab and omalizumab "modulate" or change the behavior of the immune system, but neither medicine has been shown to reduce the immune system in studies.

JOINT STATEMENT FROM EXPERTS 

According to a Joint Statement by the American Academy of Otolaryngology–Head and Neck Surgery (AAO–HNS) and the American Academy of Otolaryngic Allergy (AAOA), dupilumab (Dupixent) and omalizumab (Xolair) should not be given on the same day but otherwise can be administered on the normal schedule.

CONCLUSION
​
Experts are currently recommending that patients continue dupilumab (Dupixent) and omalizumab (Xolair) when getting the COVID-19 vaccine as long as both the biologic and vaccine are not administered on the same day. Neither medication has been found to lower the immune system and the current vaccines are non-live. Always consult your treating physician for individual medical advice.   

Cheers,
Thomas S. Higgins, MD, MSPH

Father. Husband. Sinus Nerd.

Source: https://www.entnet.org/content/allergic-reactions-related-covid-19-vaccinations-allergic-patients

Medscape.com asked me to give them a Case Challenge. I had a good one for them.

​"A 35-year-old man with a history of adult-onset asthma has had nasal obstruction and smelling loss for 4 months. He also reports postnasal drainage, cough, runny nose, and facial pressure. He has no history of asthma or allergies as a child. He also has no history of previous nasal or paranasal sinus surgery. His symptoms worsen after drinking certain beers and also after using ibuprofen or aspirin."

This is a CT scan of his sinuses. White is bone. Black is air. Soft tissue is gray. The sinuses are supposed to contain air (black)!

There is not much black, meaning they certainly are filled up. No wonder he couldn't breathe!
Anyway, I was able get him better and he can even drink some beer now.

Read more here.

We have found that some ear conditions are ultimately related to the nose.  Once you think about the intertwined anatomy and physiology of these two body parts, it makes complete sense. The nose is connected to the ear via a functional tube called the Eustachian tube. This tube helps ventilate, drain, and maintain an equilibrium of air pressure in the middle ear. It opens in the back of the nose called the nasopharynx. If something were to block that opening, the system gets backed up, causing increased ear pressure and ear fluid.

We have known that one of the causes of ear infections or persistent middle ear fluid in kids is obstruction of the Eustachian tube from the adenoids, which are in the nasopharynx. Thus, performing an adenoidectomy is one of the treatments for chronic ear fluid in kids.

Our research group set out to see if chronic rhinosinusitis affected ear symptoms in adults and our findings were significant. We found that, in patients with chronic rhinosinusitis, ear symptoms and nose/sinus symptoms were strongly correlated.  So, those with worse sinus symptoms seemed to have worse ear symptoms.

We also looked at how sinus surgery affected ear symptoms. In this study, 80% of the patients had improvement in ear symptoms with sinus surgery alone and 60% had complete resolution (or normalization) of their ear symptoms!

So, we have found it important to ask questions about both nose and ear symptoms because treating the nose is often the answer to solving certain ear problems.    

Watch this video about how we're returning to clinics and surgery.

Getting rid of a sinus infection depends on the cause. Viruses, bacteria, and fungi are potential culprits. Some non-infectious sources may also mimic the symptoms of sinus infections. Here is a list of remedies to consider based on the cause.

1. For a snotty nose that just started, the cause is likely a viral "cold" and humidification, decongestants,  and saline nasal rinses, are helpful to get you through it. 

2. For drainage lasting a week, especially if worsening, the cause is likely bacterial and antibiotics are helpful.  

3. For headache and facial pain without drainage, consider something not related to the sinuses, such as tension headache, migraine, and facial muscle tension. The right treatment starts by knowing the right diagnosis.

4. For symptoms lasting over 3 months, you may have "chronic sinusitis" and you should consult a specialist. Things get complicated here and getting help is the way to go. You shouldn't have to go at it alone!

The treatment of nose and sinus conditions has advanced markedly over the past few decades. Our understanding of the mechanisms involved in the body's inflammatory cascade has allowed development of new therapies. Advancements in functional endoscopic sinus surgery, image guidance, and balloon sinus ostial dilation have made surgical intervention much safer with far easier recovery than in the past when open procedures were standard and complications were more common. Here, I will summarize what I see as the innovations in nose and sinus treatment for 2019.        

In the past, the treatment of nasal polyps was straightforward. The doctor would just look in the nose with a headlight and grab as many polyps as could be seen or until the patient could breathe again, then tamponade the bleeding. Researchers now recognize that different kinds of nasal polyps exist, and they are often associated with severe inflammation. A combination of surgery and medical therapies are often necessary. From topical therapies to medications specifically targeting the receptors of inflammation, many therapeutic options are now being studied and broadening the treatment algorithm.   

The nasal valve is a narrow part at the entrance of the nasal passageways. It can contribute to nasal obstruction when the nostril is either narrow (often a slit-like opening) or collapsing when sniffing. Nasal valve stenosis, as it is called, is the reason some athletes wear nasal strips as they temporarily stent open the nose. Surgical management using closed or open nasal valve repair or rhinoplasty techniques can be effective, but they often are associated with delicate soft tissue dissection, general anesthesia, and prolonged recovery with bruising. New techniques have been developed to address nasal valve stenosis in the office and quicker recovery.    

Image guidance is like a GPS system surgeons can use to determine exact location (to a millimeter or so) in which their instruments are in the sinus cavities. This system helps surgeons thoroughly investigate the surgical site and avoid severe complications from injury of surrounding structures.  Because the advances in computer science, image guidance systems are now getting important updates, including higher accuracy, mapping of the sinus pathways, warnings for encroachment on vital structures, and virtual endoscopy.   

Have you ever noticed all the grandpas and grandmas who have tissue paper with them to wipe the constant drip from their noses? This drip is a form of vasomotor rhinitis (a nerve-generated runny nose). A nasal spray may help, but it is not always effective and some may not like its drying effects. There is a surgical approach to cut the nerve responsible for this condition; however, the surgery can be challenging and cause severe dry eye. New technology permits freezing the nerve to deactivate it in the office. Research has shown effectiveness, although it is still too early to know exactly how long the symptom resolution lasts.      

This one shows how far healthcare lags behind the general market in digital technology. Homes all across the world have 4K Ultra HD televisions now. And we are excited about 4K Ultra HD monitors? Doctors are going to be bragging about having 4K monitors and going home to their 8K HD television sets! Anyway, these monitors do greatly enhance our visualization, so they are still a medical innovation worth mentioning.

These innovations are helping doctors treat nose and sinus conditions better than ever before. As our understanding of the complexity of these conditions expands, researchers continue to discover more effective and safer treatment options. It is an exciting time to be involved in the care and research of rhinologic problems.