Dec
19
2020

The Use of Biologics for Treatment of Autoimmune Diseases

Notably, the use of biologics for treatment of autoimmune diseases is one of the newer achievements of medicine. In particular, a recent review summarized the use of biologics. For instance, chronic inflammatory conditions like skin eczema and asthma are some of the diseases where physicians use biologics.

Dupilumab (Dupixent)

It is important to realize that biologics are newer medications. They are mostly monoclonal antibodies developed in the lab and directed against various receptors. In particular, one of these is an interleukin-4 receptor. Specifically, this blocks inflammatory mediators such as interleukin-4 and interleukin-13. Dupilumab (Dupixent) is a monoclonal antibody. It must be remembered that it is a useful tool to treat atopic dermatitis (eczema), asthma and nasal polyps from chronic allergic rhinitis. For one thing, the common denominator for all these conditions is chronic inflammation. Here is more background information about Dupilumab. Specifically, this drug blocks certain proteins from attacking your own body. Besides, side effects of the drug are pink eye like inflammation of the eyes. Another side effect were mild skin rashes at the injection site.

Omalizumab (Xolair)

This drug is a monoclonal antibody also. It is given by injection into the skin every 2 to 4 weeks by a doctor or nurse. Originally it was developed for control of moderate to severe asthma. However, subsequently physicians treated moderate to severe atopic dermatitis cases also. Biologics are very expensive. It depends on your insurance carrier whether or not it is affordable for you.

Rheumatoid arthritis

Another disease that is autoimmune is rheumatoid arthritis. This can lead to crippling deformities in the hands and feet. Two of the earlier biologics for RA were etanercept (Enbrel) and adalimumab (Humira). But there are a host of other biologics that are effective as well.  Generally speaking, the physician will start with conventional medicine, like Methotrexate. If Methotrexate does not sufficiently control the symptoms of rheumatoid arthritis, the physician usually adds biologics. Often patients need a combination of Methotrexate and biologics.

Different biologics affect different aspects of the autoimmune response. The first biologic for RA was a tumor necrosis factor (TNF)-antagonist, etanercept (Enbrel). Other TNF antagonists are infliximab (Remicade) and adalimumab (Humira). A different approach is an interleukin (IL)-1 inhibitor, called anakinra (Kineret). This biologic interrupts the inflammatory pathway of RA. Another biologic interrupts the T-cells or killer cells; it is called a T cell co-stimulation blocker, abatacept (Orencia). A different mechanism of action is the B-cell depleting agent, rituximab (Rituxan and Mabthera). This suppresses the formation of RA-autoantibodies from B cells.

The rheumatologist has a wide range of biologics from which to choose. The key is that the specialist individualizes the treatment protocol according to the response of each patient.

Crohn’s disease

Crohn’s disease and ulcerative colitis belong to the inflammatory bowel diseases (IBD). They are also autoimmune diseases where biologics can be useful.

There are three categories of treatment that are worth mentioning.

  • Anti-Tumor Necrosis Factor Agents

Adalimumab (Humira) was one of the first anti-tumor necrosis factor agents. The physician uses Humira in moderate to severe cases of Crohn’s disease and ulcerative colitis. It will calm down the symptoms of Crohn’s/ulcerative colitis and will maintain the disease in this symptom-free state. There are 8 other anti-tumor necrosis factor agents on the market.

  • Integrin Receptor Antagonists

These medications block a protein that coats the inflammatory cells. This arrests the cells, so they don’t move out into blood vessels and to tissues where they could cause tissue destruction. Examples are vedolizumab (Entyvio) and natalizumab (Tysabri). Unfortunately, natalizumab can have a serious side effect, a brain condition called progressive multifocal leukoencephalopathy (PML), This is caused by John Cunningham (JC) virus, which is a virus that 60% of the population carry. Natalizumab suppresses the immune system, which allows the JC virus to flare up and cause PML in the brain. Vedolizumab (Entyvio) is an alternative drug among the integrin receptor antagonists. Contrary to natalizumab it does not enter the brain. In a large clinical trial, it did not cause PML. This drug is infused over 30 minutes initially, then after 2 weeks, 6 weeks and every 8 weeks for maintenance.

  • Interleukin-12 and -23 Antagonist

Two inflammatory kinins, interleukin-12 and interleukin-23 are involved in causing inflammation in Crohn’s disease. They are proteins and the interleukin-12 and -23 antagonist helps to suppress the inflammation. The FDA approved ustekinumab (Stelara) for moderately or severe Crohn’s disease cases where conventional treatment did not show adequate responses. The physician administers the first treatment intravenously. The follow-up treatment occurs subcutaneously every 8 weeks by a nurse. Alternatively, the patient trains to self-inject the drug subcutaneously and administers the drug every 8 weeks.

The Use of Biologics for Treatment of Autoimmune Diseases

The Use of Biologics for Treatment of Autoimmune Diseases

Conclusion

Biologics have entered the treatment world of autoimmune diseases. Biologics can be monoclonal antibodies that inactivate part of an inflammatory cause, such as interleukins. Others may counter certain hyperactive immune cells. One of the side effects can be that the immune system is weakened. This allows latent viruses such as the John Cunningham (JC) virus to suddenly flare up. This is the case with progressive multifocal leukoencephalopathy (PML) following natalizumab (Tysabri) treatment for Crohn’s disease. Due to the development of new medications, this treatment is no longer the best option. Vedolizumab (Entyvio) is an alternative drug among the integrin receptor antagonists where PML does not develop.

Such varied conditions like rheumatoid arthritis, atopic dermatitis (eczema), Crohn’s disease and ulcerative colitis respond to biologics. In addition, nasal polyps from chronic allergic rhinitis and asthma also respond to these drugs. The physician has to carefully match the treatment option to the condition of the patient. The more specific the targets of biologics are the less immunosuppressive side effects they have.

Jan
18
2020

Antibiotics In Children Can Trigger Allergies And Asthma Later In Life

Whoever treats a child’s cold must know that antibiotics in children can trigger allergies and asthma later in life. This is what a study released on Dec. 20, 2019 has shown. The researchers examined records of 798,426 children seen at the Department of Defense TRICARE health care program. They were born between 2001 and 2013. The physicians examined the children later again for allergies. The more antibiotics the children received in childhood, the more severe the youngster’s allergies were later in life.

More details about the study

The researchers found that different antibiotic types had different risks to cause allergic reactions later in life.

  • Penicillin: 1.3-fold risk
  • Penicillin with a β-lactamase inhibitor: 1.21-fold risk
  • Macrolides: 1.28-fold risk)
  • Cephalosporins: 1.19-fold risk
  • Sulfonamides: 1.06-fold risk

The type of allergies that the children developed later in life were food allergies, anaphylaxis, asthma, atopic dermatitis, allergic rhinitis, allergic conjunctivitis or contact dermatitis. The researchers stressed that their finding indicated an association between taking antibiotics and developing allergies later. It was not a causal relationship.

Food allergies in more detail

Anaphylaxis

This allergic condition is an emergency and requires immediate medical attention. It can occur when the body overreacts to peanuts or penicillin. It can occur with foods, and the reaction is sudden and severe. The symptoms may include wheezing, shortness of breath, a cough or tightness in the throat. The blood pressure may drop leading to light-headedness and passing out. The skin may show hives, swelling and a rash. The digestive symptoms may be nausea, vomiting and diarrhea. Other symptoms may involve itching eyes, headaches, anxiety and a feeling of impending doom.

Asthma

Airborne grass and tree pollens, mold spores and dust, but also peanuts and other strong allergens can trigger an asthma attack. The symptoms can be shortness of breath, wheezing, tightness in the chest, trouble falling asleep because of coughing and being short of breath.

Atopic dermatitis (eczema)

Often atopic dermatitis starts below the age of 5 and can last until late adolescence or adulthood. The symptoms can be dry skin, itching red patches of skin and thickened scaly skin. Allergic contact dermatitis is common in patients with atopic dermatitis.

Allergic rhinitis

People who suffer from allergic rhinitis are sensitized to particles in the air like grass and tree pollen, molds or cigarette fumes. They develop a stuffy nose, itching and watery eyes, sneezing and swelling around the eye lids. An allergist can do skin scratch tests to find out what the patient is allergic to. Subsequently, if the allergies are strong, the allergist may decide to start desensitization with allergy shots.

Allergic conjunctivitis

A person who is allergic to pollen and mold spores will react to this when in contact with it and often develop allergic conjunctivitis. An eye inflammation will develop within a few minutes leading to swelling of the conjunctiva around the eye ball. The eyes end up looking red, itching, burning and being watery.

Contact dermatitis

Contact dermatitis develops when your body brushes against a substance that your body has been previously sensitized to. One example is poison ivy contact dermatitis. But many other substances can cause similar reactions: solvents, shampoos, permanent wave solutions and rubbing alcohol. In addition, plants, bleach and detergents, fertilizers, pesticides and airborne substances (sawdust, dust from woollen materials) can also do the same.

The gut biome

Dr. Purvi Parikh is an allergist and immunologist at NYU Langone Health in New York. She was not involved in the study, but commented to it as follows: “One reason why there might be an association is because our microbiome, specifically in our gut, plays a large role in our immune systems. Antibiotics are known to not only kill the bacteria that are causing an infection, but also ‘good’ bacteria our immune system needs to protect us from developing allergic or autoimmune diseases.”

Treat bacterial infections with antibiotics when needed

She went on to say: “Overall, parents should know that this study shows an association but not necessarily cause and effect. So, if a child truly needs an antibiotic for a bacterial infection, they should not withhold it due to fear of allergic disease. However, on that same note, one should not over use antibiotics if not needed – for a virus or a cold – as there may be long-term consequences from over use.”

Antibiotics In Children Can Trigger Allergies And Asthma Later In Life

Antibiotics In Children Can Trigger Allergies And Asthma Later In Life

Conclusion

A new study showed that antibiotics can cause allergies and asthma later in life. The reason seems to be that our gut bacteria react to the antibiotics and the gut dysbiosis (disbalance of the gut bacteria) persists, when the antibiotics have been discontinued. The immune system can then react in ways that are detrimental to the child and adolescent. Anaphylaxis, asthma, atopic dermatitis, allergic rhinitis, allergic conjunctivitis or contact dermatitis are all different manifestations of allergies that can develop later in life. At this point we only know that there is an association between these allergic manifestations and the antibiotic use in childhood. More clinical trials will need to shed a light on what causes allergies in some children, but not in others.