<p>Parasitic (Helminthic) Infection While on Asthma Biologic Treatment: Not Everything Is What It Seems</p>

Abstract

Asthma is a chronic inflammatory disorder of the airway that is characterized by bronchial hyperresponsiveness and variable airflow limitation. Approximately 235 million people are affected by asthma worldwide and 5–10% are considered to be refractory to standard asthma treatment. These patients are known to have repeated exacerbations requiring multiple courses of systemic corticosteroids and as a result, are at risk for increased adverse effects (i.e., osteoporosis, infections). Several new medications known as biologic agents have been approved for the treatment of moderate-to-severe asthmatics. These biologic agents target essential parts of the cell-mediated allergic and to a lesser degree non-allergic immune response (IgE, IL-5, and IL-4/IL-13). They are gaining more favor in the treatment of moderate-to-severe asthma due to their efficacy and excellent safety profile. Despite the most common adverse events being minor, such as injection site reactions, upper respiratory infections, or headaches, these agents carry a small risk of more severe complications such as anaphylaxis and decreased defense against parasitic infections (PI). The incidence of PI compared with other rare adverse events is not well reported, and there are no consensus guidelines for risk prevention of PI in asthmatics undergoing evaluation for, or currently using, biologic therapy. Thus, this article sets out to review the incidence of reported PI and other rare adverse events among asthmatics using current FDA-approved biologic therapies. Secondly, we discuss the clinical implications for the importance of risk prevention of PI with the use of biologic therapies in asthmatics. Lastly, we share an educational handout to assist providers in informing their patients of behaviors that could potentially increase their risk of PI while being on a biologic agent.

<p>Helminth Induced Immunoregulation and Novel Therapeutic Avenue of Allergy</p>

“…94 Despite this, in future microbiota or helminthic products or even live helminth infections will be involved in the human body as a novel therapeutic avenue for the treatment of a wide range of allergic and autoimmune diseases. [95][96][97] The immune disorder can be treated through the deliberate infestation of helminth ova or larvae. 3 It is done by choosing species with low pathogenicity and dose (inadequate threshold of pathogenesis), the immune response could be efficiently modulated, and allergic reactions can be altered in patients.…”

Can omalizumab be used effectively to treat severe conjunctivitis in children with asthma? A case example and review of the literature

“…The most common previously reported adverse effects to omalizumab include upper respiratory infections, headaches, arthralgia, pain, fatigue and abdominal discomfort[ 15 ]. The risk of anaphylaxis is 0.14% in patients receiving omalizumab, similar to other biologic drugs[ 16 ]. The British National Formulary reports further, rarer side effects, including eosinophilic granulomatosis with polyangiitis (usually associated with reduction of oral corticosteroids) and hypersensitivity reactions[ 17 ].…”

Efficacy and safety of dupilumab in adult moderate-to-severe atopic dermatitis: An update narrative literature review

“…Patients with helminthic infections should not initiate treatment with dupilumab due to the influence of this drug on the immune response during an infection. Thus, patients are advised to resolve the infection and suspend treatment in any reoccurring or new helminthic infections [20,26]. In regard to vaccination during treatment, post-initiation and pre-initiation are discussed in later sections of this NLR.…”