Purpose of Review
Atopic dermatitis (AD), chronic spontaneous urticaria (CSU), and allergic contact dermatitis (ACD) represent three important allergic dermatoses with many unmet therapeutic needs. The development of biologic agents has opened the door to both new treatment options and improved understanding of the underlying pathophysiology, both shared and unique for these entities. With several FDA-approved medications available and many more in development, the biologic revolution has begun for allergic dermatoses.
This is a narrative review on the current state of pathomechanisms and appropriately targeted biologic agents for these three common allergic skin conditions. The importance of Th2 inflammation and the effect of inflammatory cytokines on the skin barrier may help explain the impressive efficacy of biologic agents, while maintaining relative safety. While some of the biologic agents show efficacy across multiple allergic dermatoses, more often it seems these more targeted pathways show accordingly precise efficacy. However, in each disease, multiple agents hold promise, and may be differentiated by safety and adverse effect profile rather than simply by efficacy.
New understanding of the pathogenesis of the allergic dermatoses has ushered in a new era of biologic therapies. Competing mechanisms and molecules will continue to be developed and vetted in trials with hopes of continuously refined precision therapies with optimized safety and efficacy profiles.
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Conflict of Interest
Dr. Bilimoria reports a grant from the National Eczema Association during the conduct of the study. Dr. Lio reports personal fees from UCB, personal fees from Dermavant, grants and personal fees from Regeneron/Sanofi Genzyme, personal fees from Dermira, personal fees from Pfizer, personal fees from LEO Pharmaceuticals, grants and personal fees from AbbVie, personal fees from Kiniksa, personal fees from Eli Lilly, during the conduct of the study; personal fees from La Roche Posay/L’Oreal, personal fees from Pierre-Fabre, personal fees from Johnson & Johnson, personal fees from Unilever, personal fees from Menlo Therapeutics, personal fees from Theraplex, personal fees from IntraDerm, personal fees from Exeltis, grants and personal fees from AOBiome, personal fees from Realm Therapetuics, personal fees and other from Franklin Bioscience/Altus Labs, personal fees from Verrica, personal fees from TopMD, personal fees from Arbonne, personal fees from Burt’s Bees, grants from the National Eczema Association, outside the submitted work. In addition, Dr. Lio has a patent Theraplex Product with royalties paid and Board member and Scientific Advisory Committee Member of the National Eczema Association.
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Bilimoria, S.N., Lio, P.A. Biologics for Allergic Dermatologic Diseases. Curr Allergy Asthma Rep 20, 35 (2020). https://doi.org/10.1007/s11882-020-00923-7
- Atopic dermatitis
- Allergic contact dermatitis