Type 2 Inflammatory Medical Conditions
Type 2 inflammation is an overactive immune response. It plays a major role in chronic diseases such as asthma, allergies, eczema, and more. It can lead to significant inflammation in the airways and skin.
Everyone has an immune response to allergens, irritants, viruses, and more. But some people have an immune system that over-reacts to allergens. This produces immunoglobulin E (IgE) antibodies. The IgE binds to specific immune cells like mast cells and basophils, triggering them to release histamine. This can lead to allergic inflammation.
Other people may develop inflammation because they have too many eosinophils (a type of white blood cell) in their blood. When these eosinophils are activated, it can cause inflamed airways or skin.
In people diagnosed with Type 2 inflammation, there is usually a higher amount of inflammation. This results in severe – and sometimes chronic – symptoms in various medical conditions.
Biologic medications are often recommended for people with Type 2 inflammation. These medications work by blocking the activity of IgE or other molecules that activate eosinophils. By targeting the immune response at the cellular level, biologics help prevent inflammation. This can lead to better symptom control. Biologics are available for adult patients and pediatric patients.
The following respiratory, allergic and skin diseases are affected by Type 2 inflammation:
- Moderate to severe asthma
- Eosinophilic asthma
- Aspirin-Exacerbated Respiratory Disease (AERD)
- COPD
- Allergic rhinitis
- Severe chronic rhinosinusitis with nasal polyps (CRSwNP)
- Chronic urticaria (chronic hives)
- Moderate to severe atopic dermatitis (eczema)
- Food allergies
- Eosinophilic esophagitis (EoE)
If you have one or more of these conditions, it’s a sign that your body may have an excess amount of Type 2 inflammation. Talk with your doctor about whether biologics could help treat your condition.
Type 2 inflammatory conditions
How does Type 2 inflammation affect chronic respiratory, allergic and skin diseases? And how can biologics improve your symptoms, disease control and overall well-being?
Below is a list of some chronic diseases impacted by Type 2 inflammation. This list does not address all inflammatory diseases.
Asthma
People with allergic asthma typically have high levels of the protein immunoglobulin E (IgE). The IgE binds to immune cells, such as mast cells and basophils. It then releases histamine. This action contributes to allergic reactions and Type 2 inflammation. It can cause coughing, wheezing and shortness of breath.
Omalizumab (Xolair®) is recommended for people with moderate to severe asthma who have high levels of IgE when they come into contact with an allergen. Omalizumab works by preventing IgE from triggering the release of histamine. This help stop inflammation before it can start. It can also reduce IgE levels in tissue throughout the body.
Tezelepumab-ekko (Tezspire®) is a biologic that can be given to people with all types of asthma, including allergic and nonallergic asthma. The medication blocks thymic stromal lymphopoietin (TSLP). This is a signaling protein involved in the early stages of allergic and inflammatory responses. It prevents the start of Type 2 inflammation.
Eosinophilic asthma
Eosinophilic asthma (sometimes called eos asthma) occurs in people who have too many eosinophils in their blood. This can lead to Type 2 inflammation in the airways. Symptoms may be triggered by having a respiratory illness such as a virus or the flu. People with eosinophilic asthma may develop severe symptoms that include coughing, wheezing or shortness of breath.
The biologics dupilumab (Dupixent®), mepolizumab (Nucala®), benralizumab (Fasenra®) and reslizumab (Cinqair®) are approved to treat this subtype of asthma. The medications work by blocking proteins called interleukins (specifically IL-4, IL-5 and/or IL-13) that activate eosinophils. They can also reduce the number of eosinophils already in the blood. This can help control inflammation and asthma symptoms.
COPD
Chronic Obstructive Pulmonary Disease (COPD) is a long-term disease caused by damaged lungs. Some people with poorly controlled COPD have high levels of eosinophils. This is a marker of Type 2 inflammation. When activated, eosinophils can trigger severe lung and airway inflammation.
Dupilumab (Dupixent) is approved to treat adults with poorly controlled COPD with an eosinophilic phenotype. It works by blocking or reducing IL-4 and IL-13 proteins. This action helps stop or reduce the activation of eosinophils. It can also reduce eosinophils already in the blood. The medication helps COPD patients gain better control of their symptoms.
Allergic Rhinitis
Allergic rhinitis means “inflammation of the nose.” When your immune system over-reacts to allergens such as pollen or mold, it can cause Type 2 inflammation. This leads to a histamine response and an increase in thin, watery mucus in the nasal passages.
Biologics are not indicated to treat allergic rhinitis. They are approved for allergic asthma and CRSwNP. Omalizumab (Xolair) may be effective in treating allergic rhinitis because it reduces high levels of IgE. This helps prevent the release of histamine that can cause allergic rhinitis.
Chronic rhinosinusitis with nasal polyps (CRSwNP)
CRSwNP is a chronic inflammatory sinus disease that also involves nasal polyps. Type 2 inflammation is a key driver of severe CRSwNP. The symptoms are often the result of high levels of IgE antibodies or eosinophils in the blood. This can cause inflamed nasal passages and sinuses.
Biologics are prescribed for CRSwNP to prevent inflammation in the nasal passages and sinuses. They also can reduce polyp size. The following biologics are indicated to treat CRSwNP:
- Omalizumab (Xolair) It blocks IgE from releasing histamine.
- Dupilumab (Dupixent) blocks the action of IL-4 and IL-13. It reduces the activation of eosinophils.
- Mepolizumab (Nucala) blocks IL-5, reducing the activation of eosinophils.
Aspirin-exacerbated respiratory disease (AERD)
AERD is a rare, chronic disease that combines three medical conditions. These conditions are asthma; nasal polyps; and a sensitivity to aspirin and other non-steroidal anti-inflammatory drugs (NSAID). Type 2 inflammation plays a big part in AERD. Inflammation in the airways worsens asthma. And it causes mucus that affects the nasal passages.
Biologics are not specifically indicated for AERD. But they are approved for allergic asthma, eosinophilic asthma and CRSwNP. These medications can help reduce airway inflammation and improve asthma management. They can help people with AERD keep their symptoms under control.
Chronic urticaria (chronic hives)
Chronic urticaria involves itchy and painful hives that last for 6 weeks of longer. Type 2 inflammation can play a role in some cases of chronic urticaria, but it is not the sole driver for symptoms. Chronic idiopathic urticaria (also called chronic spontaneous urticaria) has no clear trigger.
For some people, chronic hives may be associated with high levels of IgE. This can trigger histamine release and lead to inflamed skin. In cases of chronic idiopathic urticaria, the cause of hives can be more complex. It may involve other immune pathways.
Omalizumab (Xolair) is approved to treat chronic idiopathic urticaria (CIU). It is prescribed when antihistamines are not effective. The medication works by binding to IgE, preventing it from activating mast cells and basophils. This prevents the release of histamine. It can help stop skin inflammation and symptoms before they can start. It can also reduce existing hives.
Eczema (atopic dermatitis)
Moderate to severe eczema can result from an overactive immune system. Type 2 inflammation of the skin plays a significant role, especially when exposed to allergens and irritants. It leads to high levels of IgE and the release of histamine. This can trigger inflamed skin. High levels of eosinophils, when activated, can also cause skin inflammation. Eczema symptoms may include itchy, painful rashes with bumps and dry, swollen, thick, flaky, or crusty skin.
Dupilumab (Dupixent), tralokinumab (Adbry®) and lebrikizumab (Ebglyss®) are approved to treat moderate to severe eczema. Dupilumab blocks both IL-4 and IL-13, the proteins that trigger eosinophils. Adbry and Ebglyss target IL-13. These biologics are aimed to help control eczema symptoms and reduce inflammation.
Food allergies
How does Type 2 inflammation impact people with food allergies? When exposed to a food allergen, the immune system over-reacts by producing high levels of IgE. This triggers the release of histamine, causing a host of symptoms affecting multiple body systems. These may include hives on the skin, inflammation and swelling in the mouth, throat and/or airways, breathing difficulty, and stomach or heart problems. In severe cases, it can lead to anaphylaxis.
Omalizumab (Xolair) is approved for food allergies. It blocks the IgE antibodies that release histamine and drive food-allergic reactions. This can keep the body from over-reacting to an allergen.
Omalizumab can allow people with food allergies to tolerate a food allergen in case of an accidental exposure. While the therapy can help reduce the severity and frequency of allergic reactions, it is not a cure. It does not guarantee a tolerance to allergens.
Eosinophilic esophagitis (EoE)
Type 2 inflammation plays a key role in eosinophilic esophagitis (EoE). EoE is a condition that is caused by high levels of eosinophils that build up in the lining of the esophagus. This causes inflammation and swelling, making it difficult to swallow food. EoE can also cause reflux (heartburn). Symptoms are often triggered by allergic reactions to food or environmental allergens.
Dupilumab (Dupixent) is approved to treat EoE. It works by blocking the proteins IL-4 and IL-13 that are involved in the activation of eosinophils. This can help reduce inflammation in the esophagus before it can start. The medication can also improve the ability to swallow food and open up an inflamed esophagus.