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Table 1 Summary of biological agents used in the treatment of asthma and allergic rhinitis

From: How safe are the biologicals in treating asthma and rhinitis?

Biological agent

Disease studied

Target

Mechanisms

Safety

Efficacy

SCIT

AR & asthma

Specific aeroallergens or venom

Several immune changes including↑IL-10 & TGF-β. isotype switch to IgG

Surveys suggest; fatality rate of 1 in 2.5 million injections34-36 & near fatal reaction rate of 5.4 per 1 million injections37

Appears to depend on dose

SLIT

AR & asthma

Specific aeroallergens

Probably similar to SCIT

Most common AEs oral-mucosal symptoms

AE less common than SCIT but cases of anaphylaxis have been reported

A consistent relationship with dose and efficacy has not been established39

MPL

AR

TRL4

Shift toward Th1 response

SRs reported in 1.6% of the 1736 patients in postmarking surveillence survey50

Clinical efficacy seen in first treat season after 4 injection treatment course

CpG

AR

TRL9

Shift toward Th1 response

No serious treatment-related effects46

Clinical efficacy seen in 1st & 2nd treatment season after one 4 injection course46

Omalizumab

Asthma & AR

IgE

Prevents binding of IgE to mast cells and basophils, downregulatuion of IgE receptor on these cells

Anaphylaxis in 0.09 to 0.2% of patients19,20

Efficacy in medication reduction & exacerbation in asthma, clinical improvement in AR

Mepolizumab

Asthma

IL-5

Blocks binding of IL-5 to α receptor on eosinophils

One episode of hypotension after infusion in EE study57

No significant improvement in asthma55

Pintrakinra58

Asthma

IL-4Rα receptor

Competes with IL-4 and IL-13 for binding to the receptor

Non-neutralizing IgG anti- pintrakinra antibodies in ~30% of pts

Increased PD20 inmethacholine challenge & asthma AE & beta-agonist use

Etanercept

Asthma

TNF-alpha

soluble TNF-alpha receptor

No significant treatment-related AE is asthma 59 but increased risk of serious & opportunistic infection in rheumatologic disease

Increased markers of TNF-alpha activity & improved clinical outcomes in refractory asthma 59

  1. SCIT = subcutaneous immunotherapu, SLIT = sublingual immunotherapy, AR = allergic rhinitis, MPL = -deacylated monophospholipid A, CpG = immunostimulatory oligonucleotide sequence of DNA containing a CpG motif, TNF-alpha = tumor necrosis factor alpha, AE = adverse event, SAE = serious adverse event, EE = eosinophilic esophagitis, PD20 = Provocative Dose, which produces a decrease in FEV1 by 20% from the initial value or baseline value