Give attention to Biologics in Allergic Ailments – Well being and Way of life
Your allergy partner
Maria Patricia S. Abes, MD; Maria Remedios D. Ignacio MD; Nanneth T. Tiu, MD – A group of experienced Filipino allergists work together as the H&L Allergy Team, the aim of which is to provide advice, help readers understand how to deal with common allergic conditions, and find relief.
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Do you have symptoms of poorly controlled asthma such as frequent coughing, wheezing, or shortness of breath? Waking up at night with difficulty breathing; need a fast-acting aid several times a day or a week; and recurring hospital admissions, emergency rooms, or need for oral steroids for exacerbations?
Do you have drug-dependent allergic rhinitis with concomitant uncontrolled chronic rhinosinusitis (CRS) that requires multiple doses of systemic corticosteroids to control, or are you dependent on systemic corticosteroids?
Do you have atopic dermatitis, which can be chronic, extremely itchy and associated with multiple infections or chronic urticaria, with recurring episodes of extremely itchy hives, sometimes associated with angioedema, over a period of more than 6 weeks, which significantly affect the quality of life?
If you have the severe and uncontrollable symptoms mentioned above, you may be a candidate for a new era in disease management called biological therapy, “precision”, or “personalized” therapy.
What are biologics?
Biologics are drugs made from substances found in living organisms such as bacteria or mice. These are then modified to target specific molecules in humans. These can be IgE antibodies, naturally occurring proteins called cytokines such as interleukin-4 (IL-4). IL-13 and IL-5) or cell receptors that, when injected into your skin or bloodstream, block the pathways for allergic diseases to develop. They can be used as monotherapy or in combination with existing drugs, which will reduce the severity and frequency of the disease. The most commonly used biological therapies for allergic diseases such as neurodermatitis and asthma are monoclonal antibodies against important pathological targets such as IgE and proinflammatory cytokines.
Currently approved therapeutic monoclonal antibodies targeted by Biologics include:
• Omalizumab, used to treat allergic asthma and chronic urticaria, target allergy antibodies known as IgE and approved for use in patients 6 years and older
• Mepolizumab, benralizumab and reslizumab, used to treat certain types of asthma, target pathways that affect eosinophils, a cell that is involved in allergic inflammation and is approved for use in patients aged 12 years and over, with the exception of reslizumab, which is used in adults aged 18 years and over is allowed.
• Dupilumab targets a receptor for two molecules that cause allergic inflammation to treat atopic dermatitis.
Preparing for Biological Administration: Screening tests such as blood tests or skin samples with allergens in the environment should be done to help determine which biological is best for treating your allergic condition.
How are biologics administered?
Most biologics are currently administered in a doctor’s office as either subcutaneous injection or intravenous infusion and observed between 30 minutes and two hours after administration.
The frequency of administration of each of these biologics varies, ranging from every two weeks to every eight weeks.
The guidelines recommend testing the drug for at least four months to see if symptoms improve.
What are the benefits of biologics?
It has been shown to reduce symptoms, reduce the use of emergency medication, and improve the quality of life in patients with severe, recalcitrant allergic diseases.
What are the side effects of biologics?
• Frequent side effects:
• Localized reactions at the injection site (8% -45%)
• headache (6% -19%)
• Sore throat and tiredness
• Anaphylaxis in patients receiving omalizumab, so an adrenaline auto-injector should be prescribed in the event of a severe reaction
• Cardiovascular complications and malignancies reported with omalizumab
• Association with herpes simplex reactivation in mepolizumab
Not everyone is a candidate for biologics. If you are, contact your allergist for advice and a full work-up. It may be just what you need to improve your allergy.
1. Biologics for the treatment of severe asthma. AAAAI
2. Selection among biologics. ACAAI
3. Use of biologicals in allergic diseases. Annals of Allergy, Asthma & Immunology