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Allergologie select, Volume 8 (2024) - 1st issue (365 - 406)

Biologics in allergology and clinical immunology: Update on therapies for atopic diseases, urticaria, and angioedema and on safety aspects focusing on hypersensitivity reactions
Uta Jappe1, 2, Karl-Christian Bergmann3, Folke Brinkmann4, Valentina Faihs5, Askin Gülsen6, Ludger Klimek7, Harald Renz8, Sebastian Seurig9, Christian Taube10, Stephan Traidl11, Regina Treudler12, Martin Wagenmann13, Thomas Werfel11, Margitta Worm14, Torsten Zuberbier3
1 Division Clinical and Molecular Allergology, Research Center Borstel, Leibniz Lung Center, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Borstel, 2 Interdisciplinary Allergy Outpatient Clinic, Department of Pneumology, University Medical Center Schleswig-Holstein, Campus Lübeck, University of Lübeck, 3 Institute of Allergology, Charité Universitätsmedizin Berlin und Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, 4 Division of Pediatric Pulmonology and Allergology, University Children’s Hospital, German Center for Lung Research (ARCN, DZL), Lübeck, 5 Department of Dermatology and Allergy Biederstein, Klinikum rechts der Isar, Technical University of Munich, 6 Division of Cardiology, Pulmonary Diseases, Vascular Medicine, University Hospital Duesseldorf, 7 Center for Rhinology and Allergology, Wiesbaden, 8 Institute of Laboratory Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Philipps Universität Marburg, Member of the German Center for Lung Research (DZL) Marburg, 9 Interdisciplinary Allergy Center Nuremberg (NIZA), Department of Internal Medicine 3 , Pneumology, Nuremberg Hospital, Nuremberg, 1  0 Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Essen, 1  1 Department of Dermatology and Allergy, Hannover Medical School, Hannover, 1  2 Institute of Allergology IFA, Charité Universitätsmedizin corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Berlin, 1  3 Department of Otorhinolaryngology, Düsseldorf University Hospital, Heinrich Heine University, Düsseldorf, 1  4 Division of Allergy and Immunology, Department of Dermatology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany

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DOI 10.5414/ALX02533E

Abstract

The development of targeted therapies for atopic diseases, urticaria, and angioedema with biologics is progressing rapidly: New “targets” of clinical-therapeutic relevance have been identified, the corresponding targeted antibodies developed, tested in clinical trials, and approved for therapy. These include the anti-IgE antibody omalizumab (also effective and approved for the treatment of urticaria), the anti-IL-4/13 receptor-specific antibody dupilumab, the two anti-IL-13 antibodies lebrikizumab and tralokinumab, the anti-TSLP antibody tezepelumab, the two anti-IL-5 antibodies mepolizumab and reslizumab, and the anti-IL5 receptor-specific antibody benralizumab for the treatment of atopic diseases. For the treatment of hereditary angioedema, C1 inhibitor and the antibody lanadelumab (directed against kallikrein) have also long been approved as biologics in addition to low-molecular substances. Other therapeutic antibodies are in various stages of development. Furthermore, the range of indications for some very effective biologics has been successfully expanded to include additional diseases. In this context, the first results on biologic therapy of food allergy and eosinophilic esophagitis are interesting. Biologics that address different target structures are also increasingly being administered in combination, either simultaneously or sequentially, in order to achieve optimal efficacy. A developing area is the use of biologics in children and the observation of immunological and non-immunological side effects. In some cases, new unexpected side effects and hypersensitivity reactions have emerged, which in turn raise pathomechanistic questions, such as conjunctivitis with dupilumab therapy, which only appears to occur in the treatment of atopic dermatitis but not in the treatment of other atopic diseases. In dermatology, paradoxical reactions have been described under therapy with some biologics. And immune reactions of type alpha to epsilon to biologics (hypersensitivity reactions) continue to be a clinically relevant problem, whereby the selection of an alternative therapeutic agent is a challenge and the diagnostics that support this have not yet been sufficiently incorporated into routine work.

Author Details

Authors

Departments

  • 1 Division Clinical and Molecular Allergology, Research Center Borstel, Leibniz Lung Center, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Borstel,
  • 2 Interdisciplinary Allergy Outpatient Clinic, Department of Pneumology, University Medical Center Schleswig-Holstein, Campus Lübeck, University of Lübeck,
  • 3 Institute of Allergology, Charité Universitätsmedizin Berlin und Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin,
  • 4 Division of Pediatric Pulmonology and Allergology, University Children’s Hospital, German Center for Lung Research (ARCN, DZL), Lübeck,
  • 5 Department of Dermatology and Allergy Biederstein, Klinikum rechts der Isar, Technical University of Munich,
  • 6 Division of Cardiology, Pulmonary Diseases, Vascular Medicine, University Hospital Duesseldorf,
  • 7 Center for Rhinology and Allergology, Wiesbaden,
  • 8 Institute of Laboratory Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Philipps Universität Marburg, Member of the German Center for Lung Research (DZL) Marburg,
  • 9 Interdisciplinary Allergy Center Nuremberg (NIZA), Department of Internal Medicine
  • 3 , Pneumology, Nuremberg Hospital, Nuremberg,
  • 1 
  • 0 Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Essen,
  • 1 
  • 1 Department of Dermatology and Allergy, Hannover Medical School, Hannover,
  • 1 
  • 2 Institute of Allergology IFA, Charité Universitätsmedizin corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Berlin,
  • 1 
  • 3 Department of Otorhinolaryngology, Düsseldorf University Hospital, Heinrich Heine University, Düsseldorf,
  • 1 
  • 4 Division of Allergy and Immunology, Department of Dermatology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany

Address

Prof. Dr. med. Uta Jappe, Division Clinical and Molecular Allergology, Research Center Borstel, Leibniz Lung Center, Parkallee 35, 23845 Borstel, Germany
Email: [email protected]

Citation

Uta Jappe, Karl-Christian Bergmann, Folke Brinkmann, Valentina Faihs, Askin Gülsen, Ludger Klimek, Harald Renz, Sebastian Seurig, Christian Taube, Stephan Traidl, Regina Treudler, Martin Wagenmann, Thomas Werfel, Margitta Worm, and Torsten Zuberbier.Biologics in allergology and clinical immunology: Update on therapies for atopic diseases, urticaria, and angioedema and on safety aspects focusing on hypersensitivity reactions. Allergologie Select. 2024; 8: 365-406. doi: 10.5414/ALX02533E.

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