Focus on Biologics in Allergic Diseases


Your Allergy Partners

Maria Patricia S. Abes, MD; Maria Remedios D. Ignacio MD; Nanneth T. Tiu, MD – a group of expert Filipino Allergists bond together as the H & L Allergy Team, whose aim is to give advice, help readers understand and find relief in dealing with common allergic disorders.

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Do you have symptoms of poorly controlled asthma like frequent coughing, wheezing, or shortness of breath; waking up at night with difficulty breathing; requiring a fast-acting reliever medication several times a day or week; and recurrent hospital admissions, emergency room visits, or need for oral steroids for exacerbations?

Do you have allergic rhinitis with dependency on the medications with concomitant uncontrolled chronic rhinosinusitis (CRS) that require multiple doses of systemic corticosteroids for control or you are dependent on systemic corticosteroids?

Do you have atopic dermatitis that may be chronic, intensely pruritic, and associated with multiple infections or chronic urticaria with recurrent episodes of extremely pruritic hives, sometimes associated with angioedema, for greater than 6 weeks that significantly decrease quality of life?

If you have the severe and uncontrollable symptoms mentioned, then you may be a candidate for a new era of disease management termed as Biologic therapy, “precision” or “personalized” therapy.

What are Biologics?

Biologics are medications made from substances found in living organisms, such as bacteria or mice, that is then modified to target specific molecules in humans which can be IgE antibodies, naturally-occurring proteins called cytokines such as interleukin-4 (IL-4), IL-13, and IL-5), or cell receptors which when injected into your skin or bloodstream will block the pathways for the development of allergic diseases. They could be used as a monotherapy or combined with pre-existing medications, thereby decreasing the severity and frequency of the disease. The most commonly used biological therapies used in allergic diseases such as atopic dermatitis and asthma are monoclonal antibodies directed against important pathologic targets such as IgE and pro-inflammatory cytokines.

Current approved therapeutic monoclonal antibodies targeted by Biologics include:

• Omalizumab to treat allergic asthma and chronic urticaria, target allergy antibodies known as IgE and approved for patients as young as 6 years old
• Mepolizumab, Benralizumab and Reslizumab to treat certain kinds of asthma targets pathways that affect eosinophils, a cell involved in allergic inflammation and approved for patients as young as 12 years old except for Reslizumab which is approved for adults 18 years and older.
• Dupilumab targets a receptor for two molecules that drive allergic inflammation to treat atopic dermatitis.

Preparations for the administration of Biologics: Screening tests, such as bloodwork or environmental allergen skin prick testing should be done to help decide which biologic would be best to treat your allergic disease.

How are Biologics administered?

Most biologics are currently administered in a doctor’s office either as a subcutaneous injection or as an intravenous infusion and observed for between 30 minutes and two hours after administration.

The frequency of administration of each of these biologics are different, ranging from every two weeks to every eight weeks.

Guidelines recommend trialing the medication for at least four months to show if there is any improvement in symptoms.

What are the benefits of Biologics?

It has been demonstrated that they can reduce symptoms, reduce rescue medication use, and improve quality of life in patients with severe, recalcitrant allergic conditions.

What are the side effects of Biologics?

• Common adverse effects:
• Localized injection site reactions (8%–45%)
• headaches (6%–19%)
• Sore throat and fatigue
• Anaphylaxis in patients receiving Omalizumab so an epinephrine autoinjector should be prescribed in case of a severe reaction
• Cardiovascular complications and malignancy reported in Omalizumab
• Association with herpes simplex reactivation in Mepolizumab

Not everyone is a candidate for Biologics, if you are, see your allergist for advice and a complete work-up. It may be just what you need to make your allergy better.

REFERENCES:

1. Biologics for the Management of severe Asthma. AAAAI
2. Choosing Among Biologics. ACAAI
3. Uses of Biologics in Allergic Diseases. Annals of Allergy, Asthma & Immunology

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