Severe allergic asthma: Does alexithymia interfere with omalizumab treatment outcome?

Background: Alexithymia is among psychological factors reported to interfere with asthma management. Severe allergic asthma (SAA) is characterized by uncontrolled asthma despite maximal standard pharmacological treatment which can benefit from an add-on treatment with Omalizumab, an anti-IgE monoclonal antibody. Objectives: To evaluate if alexithymia influences the efficacy of omalizumab in SAA. Methods: The TAS 20 questionnaire allowed to detect alexithymia. SAA was monitored recording number of exacerbations, ACT, AQLQ and FEV1 before starting omalizumab, 1 and 2 years after. Results: The study was conducted on 18 patients; Group 1, TAS 20 ≥ 61, was of 2 m and 4 f with SAA and alexithymia, while Group 2 , TAS 20 ≤51, was of 8 m and 4 f, without alexithymia. Group 1 had a statistically significant decrease in asthma exacerbations (p=0.004), while ACT (p=0.008) and AQLQ scores statistically increased. FEV1 values increased but not statistically significantly (p> 0.05). Group 2 had a highly statistically significant decrease in the number of exacerbations (p<0.0001) and a highly statistically significant increase of ACT (p<0.0001;fig.2), FEV1 (p=0.008; fig.3) and AQLQ scores. Conclusion: Regardless the presence or not of alexithymia, all patients with SAA obtained a marked improvement after starting treatment with omalizumab. Nevertheless, patients with alexithymia even if they had a clinical improvement of SAA signs and symptoms had a less significant improvement most likely correlated to alexithymia.