Asthma is a common condition seen in our practice. Many people with asthma respond well to established therapies, especially if they are compliant and follow through with the treatment plan. However, there is a significant subset of people who have severe and/or unresponsive disease. These people may suffer tremendously with a decreased quality of life, corticosteroid side effects, and an increased risk of hospitalization, or even death from an asthma attack. Recently, a number of helpful biological medicines have emerged to address this need for asthma, as well as chronic hives, and eczema (atopic dermatitis). Biological medications are medications that use advanced biotechnology to target specific disease pathways. They have revolutionized the treatment of the above mentioned allergic conditions and have given long-suffering patients a new lease on life. In part 1, I will discuss the use of biologics in asthma. In part 2, I will addresst he use of biological medications in chronic hives, and eczema.
The disease of asthma is divided into multiple subtypes. One of the common subtypes is known as type 2 (T2) asthma. (T2 asthma is associated with T2 inflammation with expression of cytokine proteins such as interleukin-4 (IL-4), interleukin-5 (IL-5), and interleukin-13 (IL-13), that drive the allergic inflammatory response.) People with T2 asthma are frequently allergic, have a type of white blood cell in their airways called eosinophils, and may have an elevated level of nitric oxide in their exhaled breath. The FDA has approved four biological medicines that target severe T2 asthma. Xolair (omalizumab) binds to the allergy antibody IgE to make it unavailable to participate in allergic reactions. Nucala (mepolizumab), Cinqair (reslizumab), and Fasenra (benralizumab) bind to either IL-5 (Nucala, Cinqair), or the IL-5 receptor (Fasenra), all of which lower the number of eosinophils in the lungs. These new medications have been shown to dramatically decrease asthma exacerbations, improve the quality of life, reduce or remove the need for oral corticosteroids, and lessen asthma symptoms. These medicines are given by injection in an allergy office. They have been found to be very safe and have few side effects.
Targeted biological therapies are extremely effective and safe in many people with severe asthma. They represent a dramatic step forward toward addressing an unmet need in patients who would otherwise suffer, have a decreased quality of life, and have side effects from more dangerous medications. We can look forward to ongoing research ultimately providing more biological medicines in the future.
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2. Saco, T. Uses of biologics in allergic disease: What to choose and when. Ann Allergy Asthma Immunol 2018:120:357-366.
3. Berry, A. Biomarkers and asthmatic patients: Has their time come to direct treatment? J Allergy Clin Immun 2016:137:1317-24