Introduction: Recently biologics have been established for treating severve, uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP). Due to the interaction in type 2 inflammatory signal pathway comorbidities can be simultanously addressed.

Case reports:

A 59 year old male with CRSwNP (nasal polyp score (NPS) of 7) after one functional endoscopic sinus surgery (FESS) and insufficient therapy with corticosteroids also suffered from chronic spontaneous urticaria (CSU). Main symptoms were nasal congestion, hyposmia, sleep disorder and relapsing urticae with significant impaired quality of life (QoL). Omalizumab 150 mg every four weeks was applied leading to excellent response of CRSwNP after 6 months (SNOT-22: 85 to 9, NPS: 7 to 3, improved smell function). The patient also showed a controlled CSU (urticaria activity score 7 (UAS 7): 12 to 0; urticaria control test (UCT): 3 to 16).

A 47 year old female with CRSwNP also suffered from CSU with significant impaired QoL (SNOT-22: 64), five FESS were performed. As the NPS (2) did not reach the level for an in-lable biologic therapy according to international guidelines the therapy with 300 mg omalizumab was initiated due to refractory CSU. After three months the CSU was well controlled (UAS 7: 23 to 7, UCT: 5 to 12; dermatology life quality index (DLQI): 15 to 1). Comorbid CRSwNP showed disease control with an improvement of smell and nasal congestion and reduction of nasal polyps (NPS: 2 to 0).

Conclusion: The two cases show that the primary therapy of a leading disease can successfully cover comorbidities with severe disease burden despite differing dosages of biologic due to different indications. An interdisciplinary approach to the initiation of biologics for diseases of different organ systems is recommended.

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