Treatment options for asthma and other atopic conditions continue to evolve. In regard to asthma treatment, we primarily use inhaled corticosteroids and bronchodilators, we treat flares with steroids, and we offer allergy shots to patients with allergy triggers. Yet a significant proportion of patients remain poorly controlled and susceptible to morbidity from their asthma and the toll steroids take upon them.
Beginning 14 years ago, the first biologic medication, Xolair (omalizumab), became available to treat moderate to severe asthma with allergy triggers. As the name implies, biologic medications are products derived in some way from living organisms. Such a medication can enhance or inhibit a specific physiologic function, often with laboratory-produced antibodies that target specific proteins involved in disease processes, and are delivered as an injection, or IV infusion.
Xolair (omalizumab), is a monoclonal antibody engineered to block circulating IgE, a class of antibodies implicated in allergic disease. For roughly 10 years it remained the only monoclonal antibody for the treatment of asthma. However, in the past four years we have seen a rapid change in the landscape of treatment for allergic/atopic disease with the use of monoclonal antibodies. In 2014, Xolair gained a second approval to treat chronic idiopathic urticaria. In 2015 and 2016, two new monoclonal antibodies were developed to treat severe eosinophilic asthma - Nucala (mepolizumab) and Cinqair (reslizumab) each block interleukin 5 resulting in a large reduction of peripheral eosinophils. This year, a new monoclonal antibody Dupixent (dupilumab), anti-IL4R, was approved for the treatment of severe atopic dermatitis.
Looking over these new introductions to the care of asthma and atopic disease, we see a remarkable shift toward application of molecular signaling for the targeted treatment of severe disease. This has changed how asthma and atopic disease are managed. These new medications offer the potential for greater control and the reduction of exacerbations, as well as fewer side effects from the chronic use of steroids. For those suffering, the benefit can be life changing. For the provider, the ability to offer effective care is profound.
These newly tailored medications also reflect a more complex understanding of atopic disease, and present a more complex care plan. More than ever before there is a need for a complete understanding of a patient’s allergic profile using allergy testing and other biologic markers, including total IgE, absolute eosinophils, and exhaled nitric oxide. Other biomarkers are likely to come. These markers provide important clues as to which patient is likely to benefit from the addition of these newer medications.
Beyond even these latest therapeutics, another generation of hopeful medications begin a journey toward development. Currently in development, and likely to gain FDA approval, is yet another monoclonal antibody which blocks the eosinophilic pathway - benralizumab, Dupixent (dupilumab) is also seeking another indication; this time for asthma.
The landscape will continue to change. This surge in therapeutic development will hopefully meet the need of those patients who, despite all we have to offer, are still poorly controlled.
Alabama Allergy & Asthma Center is proud to offer patients the following biologic treatments:
To refer a patient, please visit alabamaallergy.com or call 205-871-9661.
Clinical trials currently being conducted at the Clinical Research Center of Alabama include:
To refer a patient for a clinical study, please visit alclinicalresearch.com or call 205-209-4100.
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