Hay fever is a disease with IgE mediated allergic rhinitis, allergic conjunctivitis, asthma, urticaria, allergic dermatitis and other symptoms in patients with specific constitution after inhalation or exposure to pollen allergens (1). The occurrence of symptoms is related to the region and dissemination season of pollen. When inhaled allergens contact the eyelids, ocular conjunctiva and nasal mucosa, they will cause eyelid swelling, conjunctival congestion, aqueous secretions, nasal itching, runny nose, sneezing, nasal congestion and other symptoms (1, 2). These symptoms seriously affect the quality of life of patients, as well as the learning efficiency of adolescent patients (3). In the four seasons of the year, pollinosis is mainly caused by outdoor pollen transmitted by wind, including tree pollen, grass pollen and weed pollen (4). The spring pollen that causes hay fever in Beijing is mainly juniper, and the fall pollen is mainly Artemisia absinthium and Humulus lupulus (5–7).

The current treatment of hay fever patients mainly aims at controlling symptoms and depends on many factors, such as the severity of symptoms and the self-management of patients. The treatment of hay fever mainly lies in the control of symptoms, rather than the quality of life (8). The symptoms of allergic rhinoconjunctivitis seriously affect the quality of life of patients. Anti-histamine medications, local steroid medications, and mast cell stabilizers are currently the main medicine treatments utilized to reduce the symptoms. More research has been devoted to the use of allergen specific immunotherapy for the treatment and prevention of hay fever. Allergens can be used subcutaneously or sublingually (9). In recent years, the widespread use of biological agents has played an important role in the treatment of allergic diseases. Omalizumab, as a typical representative, has been approved by the FDA for the treatment of allergic asthma and chronic urticaria (10, 11). Omalizumab is a monoclonal antibody against IgE. Omalizumab has been proved to have the advantages of high safety and low side effects in the treatment of allergic diseases (12), and may be effective for patients who are ineffective in traditional medicine treatment. Omalizumab has been approved in Japan for the treatment of severe hay fever (11).

In this study, we retrospectively compared the efficacy of different treatments for hay fever, including standard medicine therapy, omalizumab, and subcutaneous allergen specific immunotherapy (SCIT).

In this retrospective cohort study, we systematically evaluated and compared the efficacy of three hay fever treatments: medication, omalizumab, and SCIT. Utilizing patient-controlled data, our findings demonstrate that all three treatments—medication, omalizumab, and SCIT—effectively reduced VAS scores,symptom scores and medication scores among hay fever patients. Notably, the omalizumab-treated and SCIT-treated group exhibited a reduced reliance on medications. Upon intergroup analysis, our study revealed a predilection for omalizumab treatment in patients with higher pre-treatment VAS and symptom scores. However, post-treatment VAS scores and symptom scores did not exhibit significant differences among the three treatment groups. This suggests that the superior efficacy of omalizumab, particularly in addressing hay fever symptoms, might render it a more favorable option compared to medication and SCIT.

Furthermore, our investigation identified that both omalizumab and SCIT resulted in lower post-treatment symptom and medication scores when contrasted with the medication-only group ( Figure 3D ). This underscores the potential advantages of omalizumab and SCIT over conventional medication in achieving improved therapeutic outcomes for hay fever patients. In summary, our study contributes valuable insights into the comparative effectiveness of hay fever treatments, highlighting the potential superiority of omalizumab and SCIT over traditional medication. These findings have significant implications for clinical decision-making and the pursuit of more tailored and efficacious therapeutic approaches for hay fever management.

Corticosteroids, antihistamines, and leukotriene receptor antagonists are established as first-line treatments for hay fever due to their efficacy in alleviating nasal and conjunctival symptoms (15). Omalizumab, an IgE-specific antibody, has gained approval for managing moderate to severe asthma and chronic urticaria (10). Extensive clinical trials in the United States and Europe over several years have demonstrated promising outcomes in treating allergic rhinitis, showing efficacy even in cases of single resistance (16, 17). A systematic review and meta-analysis confirm the favorable efficacy and safety profile of omalizumab for patients with allergic rhinitis inadequately controlled by conventional therapies (17). Building upon our previous research, we found that prophylactic omalizumab injections before the pollen season surpass conventional drug therapy in alleviating symptoms and enhancing overall quality of life (12).

Allergen immunotherapy, with a history spanning over a century, has established both short-term and long-term efficacy. Existing research demonstrates its ability to alleviate allergic symptoms, decrease drug usage, enhance quality of life even post-treatment cessation, and hinder the progression of allergic conditions such as hay fever, allergic rhinitis, and asthma, while preventing new sensitizations (18). Christian Woehlk et al.’s study indicates that allergen immunotherapy effectively mitigates exacerbations in seasonal and perennial allergic asthma, as well as the risk of lower respiratory tract infections (9). Recent research, focusing on improving subcutaneous immunotherapy products for grass pollen allergic rhinitis, has yielded positive short-term outcomes, notably reducing patient symptoms and comprehensive drug scores (16). Our findings further affirm that subcutaneous immunotherapy effectively manages hay fever symptoms, diminishes medication dependency, and enhances overall quality of life.

In this study, the rise in total IgE immediately after the initiation of treatment might be attributed to the short human serum half-life of IgE, which is 2.4 days, in contrast to the extended half-life of IgE bound to omalizumab complexes, which is 20 days. Furthermore, as omalizumab is an IgG class antibody with a prolonged serum half-life of 26 days, the half-life of the IgE-omalizumab complex is extended upon binding with omalizumab. Since conventional total serum IgE measurement methods, such as ImmunoCAP, cannot differentiate between IgE simplexes and complexes, total serum IgE levels may appear elevated. The serum IgE level experiences an increase for approximately 1-2 months before reaching a plateau (19). In our study, regular treatment significantly reduced patients’ symptoms, even in cases where levels of total IgE and specific IgE increased. This suggests that the severity of symptoms may not directly correlate with IgE levels. The measurement of serum total IgE and specific IgE is a widely employed in vitro method for allergen detection and a crucial aspect of allergic disease diagnosis (20). Elevated total IgE alone does not serve as a definitive diagnostic marker for allergic diseases; for instance, a threshold of 1000 kU/L is a key criterion in diagnosing variant pulmonary aspergillosis, underscoring its diagnostic significance (21). Specific IgE provides information on sensitization to inhaled allergens and can signal the risk of hay fever or asthma, but research indicates that asthma severity lacks a significant correlation with sIgE levels, consistent with our study results (22, 23).

In conclusion, our study firstly compared the efficacy of three interventions for hay fever patients, revealing that both omalizumab treatment and subcutaneous immunotherapy outperformed conventional drug treatment. This provides a novel reference for patient management. Omalizumab can be considered for individuals with severe symptoms who face challenges in adhering to desensitization treatment or maintaining regular long-term drug use.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The studies involving humans were approved by the ethics committee of Peking Union Medical College Hospital (No. K4858). The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation in this study was provided by the participants’ legal guardians/next of kin.

RT: Conceptualization, Supervision, Writing – review & editing. XL: Formal Analysis, Writing – original draft. YH: Formal Analysis, Writing – original draft. YY: Data curation, Investigation, Writing – review & editing. GF: Data curation, Writing – review & editing. LZ: Data curation, Methodology, Writing – review & editing. LX: Data curation, Methodology, Writing – review & editing. HL: Conceptualization, Funding acquisition, Supervision, Writing – review & editing. RW: Conceptualization, Writing – review & editing.