Abstract

With the advent of biologicals, more and more therapeutics are available that specifically address specific switch points in the pathomechanism of immunologically dominated diseases. Thus, the focus of diagnostics and therapy (precision medicine) is more on the individual disease characteristics of the individual patient. Regarding the different phenotypes of atopic diseases, severe asthma was the first entity for which biologicals were approved, followed by urticaria, and finally atopic dermatitis and chronic rhinosinusitis with nasal polyps. Experience in the treatment of severe bronchial asthma has shown that the intensity of the response to biological therapy depends on the quality of clinical and immunological phenotyping of the patients. This also applies to different diseases of the atopic form, as patients can suffer from several atopic diseases at the same time, each with different characteristics. Biologics are already emerging that may represent a suitable therapy for allergic bronchial asthma, which often occurs together with severe neurodermatitis, and chronic rhinosinusitis with nasal polyps. In practice, however, the question of possible combinations of biologicals for the therapy of complex clinical pictures of individual patients is increasingly arising. In doing so, the side effect profile must be taken into account, including hypersensitivity reactions, whose diagnostic and logistical management must aim at a safe and efficient therapy of the underlying disease. Increased attention must also be paid to biological therapy in pregnancy and planned (predictable) vaccinations as well as existing infections, such as SARS-CoV-2 infection. Before starting a biological therapy, the immune status should be checked with regard to chronic viral and bacterial infections and, if necessary, the vaccination status should be refreshed or missing vaccinations should be made up for before starting therapy. Currently, reliable data on the effect of biologicals on the immunological situation of SARS-CoV-2 infection and COVID-19 are not available. Therefore, research and development of suitable diagnostic methods for detection of immunologically caused side effects as well as detection of potential therapy responders and non-responders is of great importance.

Author Details

Authors

• Uta Jappe¹,²
• Hendrik Beckert³
• Karl-Christian Bergmann⁴
• Askin Gülsen²
• Ludger Klimek⁵
• Sandra Philipp⁶
• Julia Pickert⁷
• Michèle M. Rauber-Ellinghaus⁸
• Harald Renz⁹
• Christian Taube³
• Regina Treudler¹⁰
• Martin Wagenmann¹¹
• Thomas Werfel¹²
• Margita Worm¹³
• Torsten Zuberbier¹⁴

Departments

• ¹ Research Group Clinical and Molecular Allergology of the Research Center Borstel, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL),
• ² Interdisciplinary Allergy Outpatient Clinic, Medical Clinic III, University of Lübeck,
• ³ Department of Pulmonary Medicine, University Hospital Essen – Ruhrlandklinik, Essen,
• ⁴ Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health,
• ⁵ Center for Rhinology and Allergology, Wiesbaden,
• ⁶ Dermatology practice Dr. Markus Friedrich/Dr. Sandra Philipp, Oranienburg,
• ⁷ Department of Dermatology and Allergology, University Hospital Gießen and Marburg, Marburg site,
• ⁸ Experimental Dermatology and Allergology, Justus Liebig University Giessen,
• ⁹ Department of Medicine, Institute of Laboratory Medicine and Pathobiochemistry – Molecular Diagnostics, Member of the German Centre for Lung Research (DZL), Philipps-University, Marburg,
• ¹ 
• ⁰ Leipzig Comprehensive Allergy Center LICA-CAC, Department of Dermatology, Venereology and Allergology, University of Leipzig,
• ¹ 
• ¹ Department of Otorhinolaryngology, HNO-Klinik, Universitätsklinikum Düsseldorf, Düsseldorf,
• ¹ 
• ² Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover,
• ¹ 
• ³ Dermatology, Venerology and Allergology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin,
• ¹ 
• ⁴ Department of Dermatology and Allergy, Charité Universitätsmedizin, Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Comprehensive Allergy Center, Berlin, Germany

Address

Prof. Dr. med. Uta Jappe, Research Center Borstel, Leibniz Lung Center, Parkallee 35, 23845 Borstel
Email: [email protected]

Citation