Biologic Therapy in Severe Asthma Management

Introduction to Biologic Therapy

The American College of Allergy, Asthma, and Immunology recommends biologic therapy for patients aged 12 years and older with severe persistent asthma whose symptoms remain inadequately controlled despite high-dose inhaled corticosteroids plus long-acting beta-agonists 1, 2, 3, 4

Biologics are indicated for patients with treatment failure on optimized therapy, defined as persistent symptoms despite high-dose inhaled corticosteroids plus long-acting beta-agonists for an adequate duration, according to the American Thoracic Society 1, 2, 4
The minimum age requirement for most biologics, including omalizumab, mepolizumab, benralizumab, and dupilumab, is 12 years, as recommended by the European Respiratory Society 1, 2, 4

For allergic asthma, omalizumab is the first-line biologic choice when there is documented atopy with positive skin testing or RAST to perennial aeroallergens and elevated serum IgE levels, according to the American Academy of Allergy, Asthma, and Immunology 1, 3, 4
The American College of Chest Physicians recommends omalizumab for patients with severe persistent asthma and elevated IgE levels 1, 4

The administration of omalizumab requires a healthcare setting with providers trained in anaphylaxis recognition and treatment, and patients must be observed after injection and prescribed an epinephrine autoinjector, as recommended by the National Institute for Health and Care Excellence 3, 4, 5
The anaphylaxis risk associated with omalizumab is approximately 0.09%, and the FDA has issued a black-box warning for anaphylaxis, according to the FDA 4, 5