Biologics

Allergy and immunology treatment options continue to expand, thanks in large part to a drug class called biologics. Derived from living organisms, these medications can target specific components of the immune system and prevent inflammation that causes a variety of conditions. Greater Austin Allergy’s specialists stay up-to-date on the latest advancements in the field. We offer several biologics that provide a beacon of hope for some patients whose conditions, including severe asthma and eczema, have not responded well to traditional treatments.

Diagnosis & Treatment Options

Xolair (omalizumab)

Xolair was FDA-approved in 2003 as the first (and remains the only) biologic medication specifically created to treat moderate-to-severe persistent allergic asthma. Patients who benefit from this innovative drug must have allergic asthma that remains uncontrolled even with the use of inhaled corticosteroids; be six years old or older; and have an allergy to a year-round indoor allergen such as dust, pet dander, mold, or cockroach debris.

Xolair binds to the allergy antibodies in the blood and to the surface of immune cells. It prevents the immune cells from releasing the chemicals that set off symptoms including wheezing, coughing, and shortness of breath. Xolair can significantly improve quality of life due to fewer asthma flare-ups and hospitalizations, as well as less daily medication needed to treat asthma symptoms (but do not stop taking your prescribed medications without your doctor’s approval).

In addition to allergic asthma, Xolair is approved for the treatment of chronic urticaria (hives) with no identifiable cause. Patients must be 12 years old or older and must not respond to antihistamine treatment.

Patients who qualify for this innovative medication will receive an injection in our office every two to four weeks. You will be monitored after each injection to ensure you do not have an allergic reaction, as side effects including anaphylaxis can occur. You will also be counseled about recognizing side effects should they emerge after you leave the office.

To learn more about Xolair, visit Xolair.com.

Dupixent (dupilumab)

Eczema (atopic dermatitis) flare-ups can severely impact patients’ day-to-day lives. These itchy skin rashes result from the immune system becoming more inflamed than normal. A biologic medication called Dupixent was FDA-approved in 2017 to treat moderate-to-severe eczema that does not respond well to other prescription topical therapies. At this time, Dupixent can only be used in patients who are at least 18 years old.

Dupixent blocks a protein called an interleukin from binding to cell receptors. In a properly functioning immune system, Interleukins help fight off bacteria and viruses. However, patients with eczema experience an immune system dysfunction that results in an inflammatory overreaction that can be calmed by Dupixent. Even when the skin is clear, this medication will work to prevent the immune system’s inflammatory response and keep symptoms at bay.

Patients who qualify for Dupixent will receive one injection every other week. Some are able to take these injections at home after training by one of our allergy specialists, while others continue coming to the office for their treatment. Research studies conclude that this medication is safe and effective, but potential side effects include throat pain, cold sores, injection site infections, and eye inflammation.

Nucala (mepolizumab)

A biologic therapy approved by the FDA in 2015, Nucala provides relief for patients 12 and older battling eosinophilic asthma that is not controlled by other asthma medications. This type of asthma results from an overabundance of eosinophils (a type of white blood cell). When too many eosinophils are present, resulting airway inflammation can lead to severe asthma attacks. Nucala reduces the inflammation by blocking a molecule that triggers the release of eosinophils.

A blood test can determine the eosinophil count in your blood, and this will help your physician determine whether or not Nucala is the best next step to treat your asthma. If it is, you will receive an injection in the office every four weeks, regardless of if you have asthma symptoms at the time. After each injection, you will receive monitoring in the office to watch for side effects ranging from headache, injection site reactions, back pain, and fatigue to (rarely) anaphylaxis. Serious reactions can occur hours to days later, so your allergy specialist will speak with you about this. Patients should keep taking their current asthma medications unless advised to stop by their doctor. Nucala takes time to work, so patients should not anticipate immediate asthma relief.

Fasenra (benralizumab)

Severe eosinophilic asthma patients who have not seen improvement with other prescription medications may finally breathe easier thanks to Fasenra, a biologic approved by the FDA in 2017. Eosinophils aid healthy immune systems in the fight against infections and parasites. However, the existence of too many eosinophils can result in inflammation that causes impaired lung function, as well as more frequent and more severe asthma attacks. Fasenra targets and rapidly destroys eosinophils, resulting in improved lung function, fewer asthma attacks, and a reduction of oral steroid use.

Fasenra is administered to eosinophilic asthma patients 12 years and over via injection every four weeks for the first three doses. Thereafter, injections are needed once every eight weeks. This medication does not work immediately and should be continued even when symptoms improve. The most common side effects include headache, sore throat, and injection site reactions. Serious side effects like anaphylaxis can occur; your physician will discuss any possible adverse reactions with you.