DUPILAMAB FOR POST-VIRAL SMELL LOSS IN ALLERGIC RHINITIS AND CHRONIC RHINOSINUSITIS WITHOUT NASAL POLYPOSIS

Abstract

<h3>Introduction</h3> Evaluate effectiveness of dupilamab for post-viral smell loss with allergic rhinitis (AR), and chronic rhinosinusitis without nasal polyposis (CRSsNP). <h3>Case Description</h3> 76-year-old male presented with AR, rhinosinusitis, wheezing, treated with oral/inhaled steroids, nebulized albuterol, and antibiotics. Two weeks later he developed anosmia that did not respond to 2 weeks of prednisone or 6 months of intranasal theophylline. No history of nasal polyps, aspirin sensitivity, whiplash injury/head trauma, neurodegenerative disease. Exam remarkable for normal nares, no polyps, expiratory wheezing. Nasopharyngolaryngoscopy: septal deviation, edematous turbinates. LABS: University of Pennsylvania Smell Identification Test (UPSIT) score of 17 of 40, normal >34; negative CXR; sinus CT: chronic ethmoiditis; reactive allergy testing to pollens/dust mites/molds. PFT: reversible small airways obstruction, positive methacholine challenge. Thyroid functions/antibodies, IgE, CRP/ESR, CBC with differential, chemistries, serum/urine immunofixation/immunoelectrophoresis, ANA/ANCA, immunoglobulins, B6/B2, zinc were normal. Dual maintenance controller treatment failed to completely improve wheezing or PFT and he was started on dupilamab. After 8 months of dupilamab self-administered 300 mg bimonthly, improvement in smell and UPSIT score rose to 21. Wheezing and PFT improved. After 22 months of dupilamab, smell subjectively improved. UPSIT rose to 33 (Figure 1). <h3>Discussion</h3> First case report of post-viral smell loss with AR and CRSsNP with significant subjective and objective improvement in smell with dupilamab. Improvement noted objectively within 8 months of treatment and showed progressive improvement through 22 months of therapy. Based on this case report, further research using dupilamab in individuals with post-viral smell loss with AR and CRSsNP should be considered.