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Biologics – Xolair, Nucala, Fasenra and Dupixent

For many years, treatment for allergic conditions and asthma included avoidance, implementation of environmental controls, use of antihistamines and anti-inflammatory medications and subcutaneous or sublingual immunotherapy. However, in recent years, several biologic therapies (Xolair, Nucala, Fasenra and Dupixent) have been developed, targeting specific receptors within the immune system that contribute to chronic inflammatory diseases such as asthma and atopic dermatitis, and thus preventing the cycle of inflammation in the first place. In addition, biologics take an “inside out” approach to treating inflammatory conditions by addressing the issue at the immune system level, the root cause of many diseases. Studies have shown that these medications can help to prevent severe asthma attacks often leading to emergency room visits, reduce the use of oral steroids, increase one’s level of activity and most importantly, increase one’s quality of life.

XOLAIR (omalizumab)

Xolair is a prescription medication designed to treat moderate to severe asthma. IgE is a substance that occurs naturally in the body. When people with allergic asthma breathe in allergens, such as cat, dust-mite or pollen, their bodies make more IgE. This increase in IgE can then lead to increased symptoms, including an asthma attack. Xolair works by helping to block IgE from triggering an allergic reaction.

Our office has been administering Xolair since it was initially approved for allergic asthma in 2003. The Xolair moderate to severe asthma patient should have a positive skin test to a significant allergen such as pollen, cat or dust.
Xolair was approved to treat Chronic Urticaria (hives) in 2014, making it the first and only drug targeting this condition.

At this time, treatment with Xolair should be continuous. Initial dosage for moderate to severe asthma is determined by serum IgE levels (via a blood test) and your weight. The dose may be changed if there are significant fluctuations in weight. The dose for the treatment of Chronic Urticaria is 300 mg once a month.

NUCALA (mepolizumab) and Fasenra (benralizumab)

Eosinophils are white blood cells that are a normal part of the body’s immune system. However, too many eosinophils may lead to inflammation in the lungs, causing asthma symptoms to flare. A simple blood test can measure the number of eosinophils in the blood and in clinical studies, treatment with Nucala and Fasenra reduced the number of eosinophils, leading to better control of their asthma.


Dupixent is approved for both the treatment of Atopic Dermatitis and asthma.
Skin conditions are not only physically uncomfortable, but can cause patients to be self-conscious about their appearance. There have been numerous biologic medications that have been effective at treating conditions like psoriasis, but it was only recently that Dupixent was approved to treat eczema, or Atopic dermatitis. Dupixent works by blocking a type of protein called an interleukin (IL) from binding to their cell receptors. Interleukins contribute to a functioning immune system by helping to fight off viruses or bacteria in our bodies. When the immune system goes haywire, it can trigger certain ILs to mistakenly attack the body, resulting in chronic inflammatory conditions such as atopic dermatitis. Dupixent curbs the immune system over-reaction that results in atopic dermatitis. In clinical trials, nearly half of the patients in the study experienced significant improvement in their skin after only 16 weeks of treatment with Dupixent. Patients who may be candidates for treatment with Dupixent include those that have tried a variety of topical prescription therapies and is still uncontrolled, those that suffers from inadequate control of itching and those with ≥10% of their body covered with lesions and/or may involve problem areas such as the face, hands, and feet.

In moderate to severe asthma, Dupixent’s mechanism of action is to inhibit the overactive signaling of interleukin-4 (IL-4) and interleukin-13 (IL-13). These are two key proteins that contribute to Type 2 inflammation, which is linked to moderate-to-severe asthma. Inhibiting the signaling was associated with decreases of inflammatory biomarkers, leading to a reduction in asthma symptoms.

What are possible side effects of Biologicals?

The most common side effect associated with these medications is an injection-site reaction. Severe allergic or hypersensitivity reactions are rare, but can occur. Patients receiving Xolair and other biologicals (with the exception of Dupixent, which can be self- administered at home) are kept in the office for at least thirty minutes and are observed closely for any adverse reactions. To monitor lung function and look for evidence of acute bronchospasm, a breathing test is typically done before and after each administration of Xolair, Nucala or Fasenra.

Treatment with Biologics can be very effective, but as with all treatments, there are multiple factors to consider, including cost, potential side effects and time commitment. We are here to help guide you so you can make the most informed decision about the best treatment for your asthma, chronic hives or atopic dermatitis.