EAACI IG Biologicals task force paper on the use of biologic agents in allergic disorders

Abstract

Biologic agents (also termed biologicals or biologics) are therapeutics that are synthesized by living organisms and directed against a specific determinant, for example, a cytokine or receptor. In inflammatory and autoimmune diseases, biologicals have revolutionized the treatment of several immune-mediated disorders. Biologicals have also been tested in allergic disorders. These include agents targeting IgE; T helper 2 (Th2)-type and Th2-promoting cytokines, including interleukin-4 (IL-4), IL-5, IL-9, IL-13, IL-31, and thymic stromal lymphopoietin (TSLP); pro-inflammatory cytokines, such as IL-1b, IL-12, IL-17A, IL-17F, IL-23, and tumor necrosis factor (TNF); chemokine receptor CCR4; and lymphocyte surface and adhesion molecules, including CD2, CD11a, CD20, CD25, CD52, and OX40 ligand. In this task force paper of the Interest Group on Biologicals of the European Academy of Allergy and Clinical Immunology, we review biologicals that are currently available or tested for the use in various allergic and urticarial pathologies, by providing an overview on their state of development, area of use, adverse events, and future research directions.Abbreviations ABPA, allergic bronchopulmonary aspergillosis; ACQ-5/ACQ-6/ACQ-7, 5-item/6-item/7-item

Oncostatin M and interleukin-31: Cytokines, receptors, signal transduction and physiology

“…injection of IL-31, it reduced ear swelling and the dermatitis score in a chronic pruritus-inducing AD-like model and importantly showed therapeutic effects even after the onset of disease [166]. Monoclonal antibodies to IL-31 (BMS-981164) and IL-31RA (CIM331) are currently in phase 1 and 2, respectively, for the treatment of atopic dermatitis [167].…”

Anti-Interleukin-9 Antibody Increases the Effect of Allergen-Specific Immunotherapy in Murine Allergic Rhinitis

“…IL-9, together with IL-4, IL-5, and IL-13, is a cytokine of the type 2 immune response that induces allergic inflammation 13. IL-9 plays multiple roles, acting as a growth factor for T cells, enhancing immunoglobulin E (IgE) production, inducing mucus production by epithelial cells, and promoting tissue mast cell accumulation 1415. In a mouse model of asthma, administration of anti-IL-9 antibody reduced allergic pathologies 16.…”

dIvergEnt: How IgE Axis Contributes to the Continuum of Allergic Asthma and Anti-IgE Therapies

“…Omalizumab was approved for use in asthma and has been used for more than 10 years now, with extensive reports of evident clinical benefits in the literature [66]. Moreover, omalizumab has helped to identify additional roles of IgE in allergic asthma beyond the suppression and blocking of the immediate allergic reaction [67,68]. …”

“…Biological modification of Th2-type cells has been also reported as an approach for specific patients in whom the appropriate Th2 immune pathway is predominant [67,69,70]. Table 2 summarises some conceptual aspects that distinguish between the approaches of blocking Th2 cytokines and the IgE, which are not mutually exclusive.…”