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Using Biologics to Treat Severe and Eosinophilic Asthma

Most people who have mild to moderate asthma are able to achieve asthma control and prevent symptoms through the use of a daily inhaled steroid. When asthma attacks do occur, quick-relief medicines are used to treat asthma symptoms and re-establish control. Unfortunately, for about 5 to 10% of the asthma population, asthma is more severe and often resistant to steroid treatment.

Some people with this severe form of the disease have a unique type of asthma called eosinophilic asthma (EA for short). The good news is that in the past decade or two, a new form of asthma medication called biologics has been developed. Biologics have shown promising results for people with severe asthma, including those who have EA.

Quick summary about eosinophilic asthma

You can read more about this type of asthma in other places on this site, but here’s a quick review.1

  • Severe asthma, marked by high levels of white blood cells called eosinophils, which are part of your body’s natural immune system.
  • Eosinophils cause inflammation and swelling
  • EA tends to occur more in adults, rather than children and is not strongly associated with allergies, as with most asthma
  • Generally treated initially with high doses of inhaled and oral steroids, but often unsuccessfully

The symptoms of EA are the same as allergic asthma, namely:

However, there can be additional symptoms, such as nasal polyps, airway blockage, and excess nasal congestion. In some cases, symptoms even resemble those of COPD.1

New hope for severe and eosinophilic asthma through biologics

Fortunately, for people with severe asthma who have not responded well to inhaled steroids, short-acting beta-agonists, and other standard asthma treatments, there is an alternative. Over the past 10 to 20 years, scientists have developed a newer class of drugs that attack asthma at the cellular level, rather than just treating symptoms.

Biologics are man-made proteins designed to prevent inflammation by acting on specific substances in your body’s immune system.1 These so-called biologics for asthma can work in different ways:

  • They can target an immune system protein called immunoglobulin E (IgE), which is the cause of some cases of severe steroid-resistant asthma
  • Others can target eosinophils.
  • One biologic targets key proteins that contribute to the inflammation in the airways.

Omalizumab (brand name Xolair)

Omalizumab is the biologic that targets IgE. It’s an antibody that blocks IgE receptors on your immune cells. In turn, this prevents them from releasing chemicals that cause inflammation.2,3

You’ll get this drug in your doctor’s office. It’s given as an injection once or twice a month, depending on your treatment plan. It can be used for anyone over the age of 6, but generally only in those who have proven abnormally high IgE levels.2,3

It’s considered safe and effective for use and has very few side effects.

Mepolizumab (Nucala), reslizumab (Cinqair), and benralizumab (Fasenra)

Mepolizumab (Nucala), reslizumab (Cinqair), and benralizumab (Fasenra) are anti-eosinophilic antibodies. They are specifically designed for people with EA. Eosinophils can be helpful in fighting disease. But sometimes for unknown reasons, their numbers are too high, and when that happens in the airways, it can result in inflammation and swelling.2,3

These 3 drugs act to reduce the number of eosinophils in the blood and sputum. Each drug works in slightly different ways, but can greatly improve inflammation and the resulting asthma symptoms. They can be given intravenously or as an injection every one to two months.

  • Mepolizumab and benralizumab can both be given to anyone age 12 and older
  • Reslizumab is only approved for adults age 18 and older

As with omalizumab, these medications are considered safe and effective for most people in the approved age groups, with very few side effects.

In summary: Biologics for asthma

Biologics are not necessarily the answer for every person with severe asthma, whether the allergic type or EA. However, they can offer hope for better asthma control. In some cases, they may be combined with more traditional asthma treatments. In others, they may be used more as primary treatment.4

Talk to your doctor if you’re having ongoing problems with asthma control and asthma attacks are interfering with your health and quality of life. Together you can decide if biologics might be right for you.

Share your story with using biologics for asthma

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Asthma.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. Healthline.com (2018). Holland K. Eosinophilic Asthma [online] Available at: https://www.healthline.com/health/eosinophilic-asthma [Accessed 29 December 2019].
  2. Healthline.com (2018). Watson S. How Do Biologics Treat Severe Asthma? [online] Available at: https://www.healthline.com/health/get-serious-about-severe-asthma/biologics#1 [Accessed 29 December 2019].
  3. McCracken JL, Tripple JW, Calhoun WJ. Biologic therapy in the management of asthma. Curr Opin Allergy Clin Immunol. 2016;16(4):375–382. doi:10.1097/ACI.0000000000000284
  4. deGroot JC, Brinke A, Bell E. Management of the patient with eosinophilic asthma: a new era begins. ERJ Open Research 2015 1: 00024-2015.

Comments

  • Vanquish
    2 weeks ago

    Hi,
    Now 15 months of Benralizumab, it works for me. At least 6 exacerbations a year and the last year only three. Xolair didn’t do anything. Since end 2018 diagnosed with EA. My question which comes up reading the article: Can I assume EA a non-allergic type?
    I do have some allergies diagnosed, but I can tell you, I do not get the symptoms you mention from my allergies. I’m also diagnosed with Occupational Asthma since 1991 , to be specific , Irritant Induced.
    Late onset asthma is also diagnosed. My age is 53.
    Can Eosinophilic Asthma be the outcome of working with these hazardous and irritating substances I worked with (these are not the known allergens but the so called, low molecular weight irritants, for example, Chromium VI in paint) and poor working conditions. (reports of these poor working conditions are in my possession)
    As a child I did not have the slightest symptoms of asthma. Nor does it run in the family.
    The fact that Benralizumab works for me and many people label EA as non-allergic may not be enough evidence, but???
    Can I assume EA is a non-allergic type? Or do you know for sure??
    With regards Donald
    the Netherlands

  • Jacquemac1
    3 weeks ago

    I just start Xolair two times a month. I pray it works. The allergy shots stop working in September.

  • Leon Lebowitz, RRT moderator
    3 weeks ago

    Hi Jacquemac1, and thanks for joining in this conversation. We appreciate you sharing your situation having just started Xolair. I’m hopeful you will be successful using it too. If you don’t mind, please do check back and let us know how you are doing on this new medication. Wishing you well, Leon (site moderator asthma.net)

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