May 21, 2024
Allergic Asthma Therapeutics

Advancements in Allergic Asthma Treatment Medications, Biologics, and Emerging Therapies

Asthma is a chronic lung disease characterized by inflammation and narrowing of the airways. Allergic asthma is triggered by allergens such as pollen, dust mites, and pet dander. While there is no cure for asthma, effective treatment options are available to help control symptoms and prevent asthma attacks. This article provides a comprehensive overview of current and emerging therapeutics used for the treatment of allergic asthma.

Controlling Symptoms with Medication

The primary treatment approach for allergic asthma involves using medications to control symptoms and prevent flare-ups. The two main types of medications used are controllers and relievers. Controller medications are taken daily on a long-term basis to keep asthma under control. Common controller medications include inhaled corticosteroids, leukotriene modifiers, and long-acting beta2-agonists. Reliever or rescue medications are used intermittently to provide quick relief from acute asthma symptoms. Short-acting beta2-agonists are the most common reliever medication. Using controller medications as prescribed along with reliever medications for breakthrough symptoms is essential for managing asthma effectively.

Inhaled Corticosteroids

Inhaled corticosteroids (ICS) are currently the most effective anti-inflammatory treatment for allergic asthma. They work by reducing airway inflammation triggered by allergens. Common ICS medications include beclometasone, budesonide, ciclesonide, fluticasone, and mometasone. ICS can effectively control symptoms for both children and adults when taken consistently as directed. They have also been shown to prevent exacerbations when used regularly over the long term as maintenance therapy. While very safe, high doses or long-term use of ICS may cause adverse effects like oral thrush or reduction in bone mineral density, so it is important to use the lowest effective dose.

Combination Therapies

Combining medications from different classes can provide enhanced asthma control compared to single therapies. A commonly used combination is an ICS combined with a long-acting beta2-agonist (LABA) in a single inhaler. Popular ICS/LABA combinations include Advair, Symbicort, and Dulera. These combinations provide both anti-inflammatory effects and bronchodilation for improved symptom relief. ICS/LABA combinations have also demonstrated effectiveness in reducing exacerbations in patients with moderate to severe asthma. Combining an ICS with an oral leukotriene modifier or theophylline is another therapeutic option for achieving better asthma management.

Targeted Biologic Therapies

For patients with severe allergic asthma that remains uncontrolled despite guideline-based pharmacotherapy, biologic agents targeting specific inflammatory pathways are available. These treatments provide more precisely targeted anti-inflammatory effects than traditional corticosteroids alone.

Anti-IgE Therapy

Omalizumab (Xolair) is a monoclonal antibody Allergic Asthma Therapeutics targeting immunoglobulin E (IgE). It binds to free IgE in the bloodstream, preventing it from triggering an allergic reaction in the lungs. Multiple clinical trials have demonstrated omalizumab’s effectiveness in reducing exacerbation frequency and improving asthma control in patients with uncontrolled allergic asthma. It is generally well-tolerated with minimal side effects. Omalizumab has been shown to allow lowered doses of corticosteroids in some patients.

Anti-IL-5 Therapy

Mepolizumab (Nucala) and reslizumab (Cinqair) are monoclonal antibodies that specifically bind to and neutralize interleukin-5 (IL-5). IL-5 is a cytokine that plays a key role in eosinophil activation and survival. By blocking IL-5, these therapies reduce numbers of active eosinophils, which are major contributors to airway inflammation in allergic asthma. Studies have found mepolizumab and reslizumab reduce exacerbations when added to standard therapy in patients with eosinophilic asthma. Benralizumab (Fasenra) is another anti-IL-5 drug but it causes depletion of eosinophils through targeted apoptosis.

Emerging Treatments

The field of targeted biologics continues to develop new treatments for severe asthma. Fevipiprant belongs to a new class of drugs called prostaglandin D2 (PGD2) receptor antagonists. By blocking PGD2 receptors, it aims to reduce airway inflammation and constriction. Its effectiveness is currently being evaluated in Phase 3 clinical trials. Other therapies in development aim to block interleukin-13 (IL-13) which plays a key role in airway remodeling and mucus production. Dupilumab, an FDA-approved biologic for atopic dermatitis, shows promise in asthma as a dual IL-4/IL-13 inhibitor. With improved understanding of asthma mechanisms and pathophysiology, more customized and precisely acting therapeutics will be discovered to better manage this chronic disease.

Non-Pharmacological Approaches

Certain lifestyle modifications and environmental control strategies can help reduce asthma triggers for those with allergies. Allergen avoidance involves steps like using allergen-proof bedding and mattress covers, vacuuming frequently with a HEPA filter vacuum, and controlling humidity levels. Smoking cessation should be strongly encouraged for patients who smoke. Obesity management may also benefit asthma control. Asthma self-management education improves medication adherence and self-monitoring skills. Managing stress through relaxation techniques can decrease asthma symptoms exacerbated by stress and anxiety in some patients. A comprehensive therapeutic approach combining medications, avoidance strategies and self-management support provides the best outcomes for people living long-term with allergic asthma.

*Note:
1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it