NEW ENGLAND ALLERGY JULY BLOG
Several new advances have been made which impinge on allergy practices currently and in the future:
I. DUST MITE TABLETS
ALK-Abelló, Inc. has received FDA approval for dust mite sublingual tablets called Odactra which are available for patients 18 to 65 to address the question of dust mite allergy in those patients who do not desire subcutaneous immunotherapy to this antigen, of those not responding to dust mite containment measures.
II. DUPILUMAB AND ATOPIC ECZEMA
Dupilumab has been FDA-approved, a product of Sanofi and Regeneron, Inc. This is an anti-IL 4 and anti-IL 13 monoclonal antibody, highly effective in treating atopic eczema clearing the skin in up to 50% of patients within a period of 8 to 12 weeks of therapy.
Nucala is an anti-IL 5 antibody which has been developed and released by SmithKline, Inc. The monoclonal antibody is termed mepolizumab and is highly effective TH 2 positive eosinophilic conditions such as allergic asthma.
Cinqair or reslizumab has also been approved by the FDA and is also an anti-IL 5 agent which, in contrast to Nucala, is given by intravenous infusion. This medication works in a manner similar to Nucala and is useful in allergic eosinophilic asthma.
V. XOLAIR AND CHRONIC HIVES
Xolair, which is an anti-IgE monoclonal antibody, has been approved by the FDA for chronic idiopathic urticaria. The mechanism of action is felt to be secondary to binding with IgE antibodies, so that they can no longer attach to the mast cell IgE receptors, and as a result the IgE receptors invaginate and are no longer present on the surface of mast cells to be activated by IgG antibody. Xolair has been very effective in the past for treating severe steroid dependent asthma. Currently the response to common idiopathic urticaria has been dramatic in many cases.
Look for the following services in allergy offices:
- Exhaled nitric oxide or ENO. This allows of the titration of asthma to be brought to the point where there is no active residual pulmonary inflammation.
- Pulmonary oscillometry which is useful in children age 5 and above who can concentrate for a minimum of 17 seconds. Measurements before and after bronchodilator allow for the diagnosis of asthma in this age group.
- Nasal smears for eosinophils which can be performed on patients with nasal congestion to look for eosinophil activity indicative of active allergy.