Medical Conditions
Biologic medications are special types of drugs made from living cells of organisms. They are different from traditional medicines such as pills or tablets, which are developed from small molecules. Biologics are delivered as injections or infusions. They are designed to target certain parts of the immune system. These medications help treat respiratory, allergic and skin diseases by controlling immune responses. They can calm overactive immune reactions or, in some cases, improve immune function.
Let’s take a look at how biologics can treat respiratory, allergic and skin diseases.
Biologics for asthma
Asthma is a chronic lung disease. It causes inflammation in the airways. This produces extra mucus which can clog the airways and cause difficulty breathing. Then muscles surrounding the airways tighten and constrict, further narrowing the airways. This results in coughing, wheezing and shortness of breath.
Some people experience asthma symptoms after exposure to allergens or irritants. This is called allergic asthma. It occurs after inhaling an allergen or irritant. This triggers the protein antibody immunoglobulin E (IgE) to bind with mast cells and basophils. This leads to histamine release. It causes inflammation in the airways and other asthma symptoms.
Which biologics treat asthma? Omalizumab (Xolair®) is approved to treat moderate to severe allergic asthma. The medication prevents IgE from binding with cells. Omalizumab can help stop inflammation and other asthma symptoms before they can start. This can lead to improved symptom control and quality of life.
Tezelepumab-ekko (Tezspire®) is a biologic that can be given to people with all types of asthma. (This includes allergic and nonallergic asthma.) The medication blocks thymic stromal lymphopoietin (TSLP). TSLP is a signaling protein involved in the early stages of allergic and inflammatory responses.
Biologics for eosinophilic asthma
Eosinophilic asthma is a subtype of asthma that is often severe. (It is sometimes called eos asthma or E-asthma.) People with this condition develop too many eosinophils, a type of white blood cell. This can occur due to a respiratory virus or another trigger. The high eosinophil count can cause inflammation in the airways. This leads to moderate to severe asthma symptoms.
Eosinophilic asthma is less common than allergic asthma. It is more common in people who develop asthma in adulthood, but it may occur in children and young adults.
The biologics dupilumab (Dupixent®), mepolizumab (Nucala®), benralizumab (Fasenra®) and reslizumab (Cinqair®) are approved to treat eosinophilic asthma. The medications work by blocking proteins called interleukins (IL-4, IL-5, and/or IL-13). These activate eosinophils and cause inflammation. They can also reduce eosinophils already in the blood.
Clinical studies show biologics can significantly improve asthma control. They can also reduce the risk of asthma attacks in people with high eosinophil counts.
Biologics for COPD
Chronic Obstructive Pulmonary Disease (COPD) is a long-term lung disease. People with the disease have damaged lungs that cause breathing problems. COPD primarily affects adults ages 40 and older. The two most common types of COPD are emphysema and chronic bronchitis.
COPD is typically caused by smoking or a long-term exposure to harmful substances in the air. Symptoms include shortness of breath, coughing, chest tightness and mucus production.
Dupilumab (Dupixent) is approved to treat COPD. It is indicated for adults with inadequately controlled COPD with an eosinophilic phenotype. This means dupilumab is prescribed to COPD patients who have high levels of eosinophils, a type of white blood cell. A high eosinophil count can trigger lung and airway inflammation.
Dupilumab focuses on blocking the proteins IL-4 and IL-13. These activate eosinophils and trigger COPD inflammation and other symptoms. Dupilumab can help patients gain better control of their COPD symptoms.
Biologic treatment for CRSwNP
Chronic rhinosinusitis is a chronic inflammatory sinus disease. It is diagnosed when you have a sinus infection (sinusitis) for 12 weeks or more. When nasal polyps develop, you have chronic rhinosinusitis with nasal polyps (CRSwNP). Nasal polyps are small noncancerous growths. They develop as a result of inflammation in the nasal passages and sinuses.
Biologics are increasingly used to treat severe CRSwNP. They can prevent inflammation in the nasal passages and sinuses, clearing the airways. Biologics can also help reduce polyp size.
Severe CRSwNP is often linked to high IgE levels and/or high eosinophil counts in the blood. Omalizumab (Xolair) addresses IgE by keeping it from binding with cells that trigger symptoms. Dupilumab (Dupixent) and mepolizumab (Nucala) block the activation of eosinophils that can also cause symptoms.
Biologics for eczema (atopic dermatitis)
Eczema is a chronic skin condition that causes itchy, inflamed patches, bumps and/or blisters on the skin. The skin may become dry, swollen, thick, flaky or crusty, sometimes with open sores. Eczema can appear on the face, neck, hands, wrists, elbows, knees, ankles and feet. When people with eczema have a flare-up, it can make the skin feel very uncomfortable.
People with moderate to severe eczema may experience daily symptoms that impact their quality of life. They may experience periods of intense skin itching or a burning sensation. For these patients, moisturizers and topical medications may not be enough.
Moderate to severe eczema is affected by immune system responses to allergens and irritants. This can lead to high levels of IgE and the release of histamine, triggering symptoms. High levels of eosinophils in the blood, when activated, can also cause inflamed skin.
The biologics Dupilumab (Dupixent), tralokinumab (Adbry®), and lebrikizumab (Ebglyss®) are approved to treat moderate to severe eczema. They block specific proteins and reduce the eosinophil levels. Dupilumab blocks the proteins IL-4 and IL-13, while tralokinumab and lebrikizumab target IL-13. These biologics aim to reduce skin inflammation and improve quality of life.
Biologics for chronic urticaria (chronic hives)
Chronic urticaria consists of hives that occur for 6 weeks of longer. The condition is caused by an overactive immune response. This response may be triggered by allergens, irritants, or changes in body temperature. Other times the cause is unknown. This is called chronic idiopathic urticaria or chronic spontaneous urticaria.
Chronic urticaria involves the release of histamine into the outer layers of the skin. This results in hives. The hives are round, raised and itchy welts on inflamed skin. They can be itchy and painful at times.
Antihistamines are the first line of treatment for chronic urticaria. If symptoms are severe, omalizumab (Xolair) is an option. Omalizumab keeps IgE from binding with cells, preventing histamine release. It can help stop symptoms before they can start and reduce the number of hives and their severity.
In some cases, high levels of eosinophils may also contribute to chronic urticaria. Biologics that target eosinophils for chronic hives are in clinical trials. They show promise as a chronic urticaria treatment. But they are not FDA-approved at this time.
Biologics for food allergies
A food allergy is an immune system response to a certain food. The top 9 food allergens are peanut, tree nuts, egg, cow’s milk, soy, wheat, fish, shellfish and sesame. Some food-allergic reactions are potentially life-threatening and may require emergency treatment with epinephrine.
When ingesting a food allergen, the body may react by producing high levels of the protein antibody immunglobulin E (IgE). This antibody triggers the release of histamine, causing a host of symptoms. These symptoms may include hives on the skin, swelling and inflammation in the mouth, throat and airways, difficulty breathing, and stomach problems.
Omalizumab (Xolair) is FDA-approved to help people with severe food allergies.The goal of the treatment is to help them better tolerate an accidental food allergy exposure. The biologic blocks the IgE antibody that drives food-allergic reactions. This can help prevent the body from reacting to an allergen. Omalizumab can also reduce the risk and severity of allergic reactions.
Biologics for eosinophilic esophagitis
Eosinophilic esophagitis (EoE)is a rare disease in which eosinophils build up in the esophagus. This buildup can cause inflammation and swelling. It makes it difficult to swallow. People with EoE may get food stuck in their throat. They may have frequent heartburn (reflux) and chest tightness.
Dupilumab (Dupixent) is approved to treat EoE. It blocks the proteins IL-4 and IL-13 from activating the eosinophils that cause inflammation. The medicine can improve the ability to swallow food. It can also help open up an inflamed, narrow esophagus.