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Published on 5 Jan 2026

Guide to Biologic Treatments for Nasal Polyps

I still remember the exact moment nasal polyps took over my life.

Guide to Biologic Treatments for Nasal Polyps

I was standing in my kitchen, trying to smell freshly brewed coffee… and there was just nothing. No aroma, no hint of bitterness, just hot brown water. That was the day I realized, okay, this isn’t just allergies anymore.

A few ENT visits, a scope up my nose (not glamorous), a CT scan, and there it was: chronic rhinosinusitis with nasal polyps (CRSwNP). If you’re reading this, you probably know that diagnosis way too well.

Fast forward: I’ve tried steroid sprays, saline rinses, short bursts of oral steroids, antibiotics, and one sinus surgery. The thing about nasal polyps? They can be annoyingly persistent.

That’s when I started digging seriously into biologic treatments – those fancy injectable drugs you see in commercials promising people can “breathe better again.” I didn’t want marketing; I wanted real data, real experience, and real expectations.

Here’s the guide I wish I had when I first heard the words: “We could consider a biologic.”

What Are Biologic Treatments for Nasal Polyps, Really?

When I first heard the term biologic, I pictured something like a probiotic yogurt. Yeah… no.

Guide to Biologic Treatments for Nasal Polyps

Biologics are lab-made antibodies that target very specific parts of your immune system. Instead of just blasting your body with general steroids, they’re more like snipers than grenades.

For nasal polyps linked to chronic inflammation (especially type 2 inflammation, driven by cells like eosinophils and cytokines like IL‑4, IL‑5, and IL‑13), certain biologics can:

  • Reduce inflammation in the nasal passages
  • Shrink existing polyps
  • Decrease the need for oral steroids and sometimes surgery
  • Improve smell and breathing quality

Unlike a one-time surgery, biologics are ongoing treatments, usually injections every 2, 4, or 8 weeks.

The Main Biologics Approved for Nasal Polyps

When I sat with my ENT and allergist, these were the names that kept coming up.

1. Dupilumab (Dupixent)

This was the first one I really dove into.

  • How it works: Blocks the IL‑4 receptor alpha, which affects both IL‑4 and IL‑13, key drivers of type 2 inflammation.
  • Indication: FDA-approved for adults with inadequately controlled CRSwNP.
  • Dosing: Typically every 2 weeks via injection.

In phase 3 trials (SINUS-24 and SINUS-52, published in JAMA 2019), dupilumab significantly reduced polyp size and improved nasal congestion and sense of smell. I remember reading that about 60–70% of patients had major symptom improvement, not 100% — which helped ground my expectations.

When I tested this myself, the first thing I noticed wasn’t breathing – it was smell. About 4–6 weeks in, I walked past a bakery and actually smelled bread. I almost cried on a sidewalk. But I also had some mild eye irritation and injection site redness for the first few doses.

2. Omalizumab (Xolair)

This one’s more famous for asthma and allergies.

  • How it works: Anti-IgE antibody. It ties up IgE, a key player in allergic responses.
  • Best suited for: People whose nasal polyps come with strong allergic triggers and/or asthma.
  • Dosing: Every 2–4 weeks; dose depends on weight and IgE levels.

Studies like the POLYP 1 and POLYP 2 trials (published in 2020 in Journal of Allergy and Clinical Immunology) showed omalizumab improved nasal congestion and reduced polyp size versus placebo.

In my experience talking to other patients in online support groups, omalizumab tends to be offered when allergy is front and center or when a patient is already on it for asthma and then develops polyps.

3. Mepolizumab (Nucala)

This one targets eosinophils, those overachieving inflammatory cells.

  • How it works: Anti-IL‑5 antibody, reducing eosinophil survival.
  • Best suited for: Patients with eosinophilic asthma and high eosinophil counts.
  • Dosing: Once every 4 weeks.

The SYNAPSE trial (published in The Lancet, 2021) showed mepolizumab reduced need for surgery and improved nasal polyp scores. The effect seemed strongest in patients with high blood eosinophils.

Personally, my eosinophil levels were only mildly elevated, so my allergist felt dupilumab was a better fit. But I’ve interviewed patients who swear mepolizumab was their “finally I can sleep and breathe” moment.

How Do You Know If You’re a Candidate?

Here’s roughly how my ENT walked me through it.

You might be a candidate for biologics if you:

  • Have chronic rhinosinusitis with nasal polyps confirmed by endoscopy or CT
  • Still have significant symptoms (blocked nose, no smell, facial pressure) despite:
  • Regular intranasal steroid sprays
  • Saline rinses
  • At least one course of oral steroids
  • And often, even after sinus surgery
  • Often also have asthma, aspirin-exacerbated respiratory disease (AERD), or eosinophilic inflammation

My doctor literally said: “We try surgery or optimize meds first. Biologics come in when we’re running into repeat flares or losing control again and again.”

They also looked at:

  • My quality of life (SNOT-22 questionnaire – yes, that’s the real name)
  • Number of steroid courses in the last 12–24 months
  • Any prior sinus surgeries

What It’s Like to Actually Start a Biologic

When I finally decided to try one, I was weirdly more nervous about the needle than the science.

Here’s how it went for me and what’s typical:

  • Baseline tests: Blood work (eosinophils, IgE), sometimes lung function if you have asthma.
  • Insurance marathon: Prior authorization, letters, documentation of failed therapies. This part can be exhausting; it took me about 5 weeks of back-and-forth.
  • First dose in clinic: They watched me for 1–2 hours after in case of rare allergic reactions.
  • Then at-home injections: Pre-filled pens or syringes into the thigh or abdomen.

I’d describe the injection as a sharp sting for ~10 seconds and then done. For me, mild fatigue the day after the first two doses, then nothing major.

Some people in patient forums report:

  • Injection site redness or swelling
  • Headache
  • Mild joint pain
  • Transient worsening of sinus pressure

My ENT warned me: “Biologics are not instant.” In my case, small changes by week 3–4, clear improvements by week 8–12.

Pros and Cons: The Honest Version

I get wary when anything is presented as a miracle cure. Biologics are powerful, but they’re not magic.

The Upsides I’ve Seen (Personally and in Data)

  • Better smell and taste: This was the #1 win for me.
  • Less congestion and postnasal drip: Nighttime breathing improved a lot.
  • Fewer steroid bursts: I went from 3–4 courses a year to zero in the first year on treatment.
  • May delay or reduce need for repeat surgery: Studies show lower surgery rates in patients on biologics.
  • Improved asthma control (if you have it): Many biologics are dual-approved for asthma.

The Downsides and Trade-Offs

  • Cost: Let’s be blunt – these drugs can list at $30,000–$40,000 per year before insurance. Copay programs help some people, others still struggle.
  • Injections every few weeks: If you hate needles, this is a commitment.
  • Not everyone responds: Some people get minimal benefit, even after months.
  • Side effects: Usually mild, but rare serious reactions are possible.
  • Long-term unknowns: We have several years of data, but not decades.

My allergist framed it like this: “This is like a subscription. It helps control the disease as long as you’re on it. If we stop, the inflammation may creep back.” That really shaped how I thought about long-term planning.

Biologics vs Surgery vs Steroids: How Do They Fit Together?

I used to imagine there was a perfect order: meds → surgery → biologics. Reality is messier and more personalized.

Surgery (functional endoscopic sinus surgery) can:
  • Remove existing polyps
  • Open sinus pathways so sprays and rinses work better
But polyps often regrow if the underlying inflammation isn’t controlled.

Here’s how many ENTs and allergists seem to approach it now (general pattern, not a rule):

  • If you’ve never had surgery and your disease is moderate, they may try optimizing sprays and short oral steroids first.
  • If your polyps are massive or causing complications, surgery may come early.
  • If you’ve already had surgery and polyps keep coming back, biologics jump much higher on the list.

When I asked my ENT, “If biologics shrink polyps, do I still need surgery?” he said: “Sometimes yes, sometimes no. We’ve had patients avoid repeat surgery, and others who still benefit from a combined approach.”

That nuance – that it’s not either/or – made me trust him more.

Questions to Ask Your Doctor Before Starting a Biologic

These are adapted from my own messy notebook from my first biologic consult:

  • Which biologic do you recommend for my profile, and why?
  • What realistic improvement should I expect at 3 months? 6 months?
  • How will we measure success – symptom scores, CT, endoscopy, fewer steroids?
  • How long do patients typically stay on this?
  • What happens if we stop – do symptoms usually return?
  • What support is there for cost – copay cards, patient assistance?
  • How will this interact with my asthma meds or other conditions?

One thing I appreciated was when my doctor said, “If we don’t see significant benefit by about 6 months, we’ll reconsider whether it’s worth it for you.” Clear exit strategy.

My Takeaway After Living With Biologic Treatment

If you’ve read this far, you’re probably in that tired, frustrated place I was: done with guessing, done with three different nasal sprays on the bathroom counter, done with being the person who can’t smell their own shampoo.

In my experience:

  • Biologics didn’t make my nose perfect.
  • I still use saline rinses and a steroid spray.
  • I still have mild congestion when I get a cold.

But my day-to-day life? Completely different. I can smell coffee again. My voice sounds less “nasal.” I sleep without feeling like I’m breathing through two drinking straws.

They’re not the right answer for everyone. They’re expensive, they’re ongoing, and they require patience. But for people with severe, stubborn nasal polyps who’ve already done the standard treatments, biologics can be a genuine game-changer – not because they cure you, but because they finally put you back in control.

If you’re on the fence, my best practical suggestion is this: keep a brief symptom journal for a few weeks, then take it to a dual ENT–allergy consultation. Data + your lived experience is a powerful combo when you’re deciding whether to take this step.

Your nose may never be Instagram-perfect, but if you can smell rain again after a storm? That’s pretty close.

Sources

Alex Morgan · 5 min read

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