Skip to main content

Practical Considerations in Management of Allergic Asthma

  • Chapter
  • First Online:
Difficult To Treat Asthma

Part of the book series: Respiratory Medicine ((RM))

  • 1160 Accesses

Abstract

Allergic asthma is the dominant form of asthma in school-aged children and young adults. Diagnosis of allergic asthma is based on patient’s symptoms, demonstration of specific IgE to aeroallergens, and significant exposure to the appropriate aeroallergens. Environmental control and avoidance of exposure is critical in the management of allergic asthma and their use is well supported by the current literature. Allergen-specific immunotherapy can play a role in the treatment of allergic asthma but only in patients whose asthma is well controlled. Overall, allergic asthma responds well to conventional medications for asthma, but about 5% of cases have severe disease that may benefit from biologic therapies. The use of biologic therapies including those that target IgE, IL-5, and IL-4/IL-13 have demonstrated efficacy in patients with severe allergic disease.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Eisenbarth SC, Piggott DA, Huleatt JW, Visintin I, Herrick CA, Bottomly K. Lipopolysaccharide-enhanced, toll-like receptor 4-dependent T helper cell type 2 responses to inhaled antigen. J Exp Med [Internet]. 2002/12/18. 2002;196(12):1645–51. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12486107.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Pochard P, Vickery B, Berin MC, Grishin A, Sampson HA, Caplan M, et al. Targeting Toll-like receptors on dendritic cells modifies the T(H)2 response to peanut allergens in vitro. J Allergy Clin Immunol [Internet]. 2010/06/12. 2010;126(1):92–7.e5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20538332.

    Article  Google Scholar 

  3. Wambre E, Bajzik V, DeLong JH, O’Brien K, Nguyen QA, Speake C, et al. A phenotypically and functionally distinct human TH2 cell subpopulation is associated with allergic disorders. Sci Transl Med [Internet]. 2017/08/05. 2017;9(401). Available from: http://www.ncbi.nlm.nih.gov/pubmed/28768806.

  4. Renand A, Shamji MH, Harris KM, Qin T, Wambre E, Scadding GW, et al. Synchronous immune alterations mirror clinical response during allergen immunotherapy. J Allergy Clin Immunol [Internet]. 2017/11/13. 2018;141(5):1750–60.e1. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29128670.

    Article  PubMed  Google Scholar 

  5. Shamji MH, Durham SR. Mechanisms of allergen immunotherapy for inhaled allergens and predictive biomarkers. J Allergy Clin Immunol [Internet]. 2017/12/10. 2017;140(6):1485–98. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29221580.

    Article  CAS  PubMed  Google Scholar 

  6. Mindt BC, Fritz JH, Duerr CU. Group 2 Innate Lymphoid Cells in Pulmonary Immunity and Tissue Homeostasis. Front Immunol [Internet]. 2018/05/16. 2018;9:840. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29760695.

  7. Licona-Limon P, Kim LK, Palm NW, Flavell RA. TH2, allergy and group 2 innate lymphoid cells. Nat Immunol [Internet]. 2013/05/21. 2013;14(6):536–42. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23685824.

    Article  PubMed  Google Scholar 

  8. Lao-Araya M, Steveling E, Scadding GW, Durham SR, Shamji MH. Seasonal increases in peripheral innate lymphoid type 2 cells are inhibited by subcutaneous grass pollen immunotherapy. J Allergy Clin Immunol [Internet]. 2014/09/13. 2014;134(5):1193–5.e4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25212194.

    Article  Google Scholar 

  9. Reddel HK, Bateman ED, Becker A, Boulet L-P, Cruz AA, Drazen JM, et al. A summary of the new GINA strategy: a roadmap to asthma control. Eur Respir J. 2015 Sep;46(3):622–39.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Barnig C, Purohit A, Casset A, Sohy C, Lieutier-Colas F, Sauleau E, et al. Nonallergic airway hyperresponsiveness and allergen-specific IgE levels are the main determinants of the early and late asthmatic response to allergen. J Investig Allergol Clin Immunol [Internet]. 2013/08/24. 2013;23(4):267–74. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23964557.

  11. Cockcroft DW, Davis BE, Boulet LP, Deschesnes F, Gauvreau GM, O’Byrne PM, et al. The links between allergen skin test sensitivity, airway responsiveness and airway response to allergen. Allergy [Internet]. 2004/12/04. 2005;60(1):56–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15575931.

    Article  CAS  PubMed  Google Scholar 

  12. Kanchongkittiphon W, Mendell MJ, Gaffin JM, Wang G, Phipatanakul W. Indoor environmental exposures and exacerbation of asthma: an update to the 2000 review by the Institute of Medicine. Env Heal Perspect [Internet]. 2014/10/11. 2015;123(1):6–20. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25303775.

    Article  CAS  PubMed  Google Scholar 

  13. Gergen PJ, Mitchell HE, Calatroni A, Sever ML, Cohn RD, Salo PM, et al. Sensitization and exposure to pets: the effect on asthma morbidity in the US population. J Allergy Clin Immunol Pr [Internet]. 2017/07/12. 2018;6(1):101–7.e2. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28694047.

    PubMed  Google Scholar 

  14. Salo PM, Wilkerson J, Rose KM, Cohn RD, Calatroni A, Mitchell HE, et al. Bedroom allergen exposures in US households. J Allergy Clin Immunol [Internet]. 2017/12/05. 2018;141(5):1870–9.e14. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29198587.

    Article  PubMed  Google Scholar 

  15. Wood RA, Chapman MD, Adkinson Jr. NF, Eggleston PA. The effect of cat removal on allergen content in household-dust samples. J Allergy Clin Immunol [Internet]. 1989/04/01. 1989;83(4):730–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2708734.

    Article  CAS  PubMed  Google Scholar 

  16. Shirai T, Matsui T, Suzuki K, Chida K. Effect of pet removal on pet allergic asthma. Chest [Internet]. 2005/05/13. 2005;127(5):1565–71. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15888829.

    Article  PubMed  Google Scholar 

  17. Peat JK, Tovey E, Toelle BG, Haby MM, Gray EJ, Mahmic A, et al. House dust mite allergens. A major risk factor for childhood asthma in Australia. Am J Respir Crit Care Med [Internet]. 1996/01/01. 1996;153(1):141–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8542107.

    Article  CAS  PubMed  Google Scholar 

  18. Turner KJ, Dowse GK, Stewart GA, Alpers MP, Woolcock AJ. Prevalence of asthma in the South Fore people of the Okapa District of Papua New Guinea. Features associated with a recent dramatic increase. Int Arch Allergy Appl Immunol [Internet]. 1985/01/01. 1985;77(1–2):158–62. Available from: http://www.ncbi.nlm.nih.gov/pubmed/4008068.

    Article  CAS  Google Scholar 

  19. Dowse GK, Turner KJ, Stewart GA, Alpers MP, Woolcock AJ. The association between Dermatophagoides mites and the increasing prevalence of asthma in village communities within the Papua New Guinea highlands. J Allergy Clin Immunol [Internet]. 1985/01/01. 1985;75(1 Pt 1):75–83. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2578494.

  20. Andiappan AK, Puan KJ, Lee B, Nardin A, Poidinger M, Connolly J, et al. Allergic airway diseases in a tropical urban environment are driven by dominant mono-specific sensitization against house dust mites. Allergy [Internet]. 2014/01/25. 2014;69(4):501–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24456108.

    Article  CAS  PubMed  Google Scholar 

  21. Murray CS, Foden P, Sumner H, Shepley E, Custovic A, Simpson A. Preventing Severe Asthma Exacerbations in Children. A Randomized Trial of Mite-Impermeable Bedcovers. Am J Respir Crit Care Med [Internet]. 2017/03/11. 2017;196(2):150–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28282501.

    Article  CAS  PubMed  Google Scholar 

  22. Rosenstreich DL, Eggleston P, Kattan M, Baker D, Slavin RG, Gergen P, et al. The role of cockroach allergy and exposure to cockroach allergen in causing morbidity among inner-city children with asthma. N Engl J Med [Internet]. 1997/05/08. 1997;336(19):1356–63. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9134876.

    Article  CAS  PubMed  Google Scholar 

  23. Rabito FA, Carlson JC, He H, Werthmann D, Schal C. A single intervention for cockroach control reduces cockroach exposure and asthma morbidity in children. J Allergy Clin Immunol [Internet]. 2017/01/22. 2017;140(2):565–70. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28108117.

    Article  PubMed  Google Scholar 

  24. Kale SL, Agrawal K, Gaur SN, Arora N. Cockroach protease allergen induces allergic airway inflammation via epithelial cell activation. Sci Rep [Internet]. 2017/02/16. 2017;7:42341. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28198394.

  25. Grant T, Aloe C, Perzanowski M, Phipatanakul W, Bollinger ME, Miller R, et al. Mouse sensitization and exposure are associated with asthma severity in urban children. J Allergy Clin Immunol Pr [Internet]. 2016/12/08. 2017;5(4):1008–14.e1. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27923647.

    PubMed  Google Scholar 

  26. Matsui EC, Perzanowski M, Peng RD, Wise RA, Balcer-Whaley S, Newman M, et al. Effect of an integrated pest management intervention on asthma symptoms among mouse-sensitized children and adolescents with asthma: a randomized clinical trial. JAMA [Internet]. 2017/03/07. 2017;317(10):1027–36. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28264080.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Mendell MJ, Mirer AG, Cheung K, Tong M, Douwes J. Respiratory and allergic health effects of dampness, mold, and dampness-related agents: a review of the epidemiologic evidence. Env Heal Perspect [Internet]. 2011/01/29. 2011;119(6):748–56. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21269928.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Barnes CS, Dowling P, Van Osdol T, Portnoy J. Comparison of indoor fungal spore levels before and after professional home remediation. Ann Allergy Asthma Immunol [Internet]. 2007/03/24. 2007;98(3):262–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17378258.

    Article  Google Scholar 

  29. Sauni R, Verbeek JH, Uitti J, Jauhiainen M, Kreiss K, Sigsgaard T. Remediating buildings damaged by dampness and mould for preventing or reducing respiratory tract symptoms, infections and asthma. Cochrane Database Syst Rev [Internet]. 2015/02/26. 2015;(2):CD007897. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25715323.

  30. Morgan WJ, Crain EF, Gruchalla RS, O’Connor GT, Kattan M, Evans 3rd R, et al. Results of a home-based environmental intervention among urban children with asthma. N Engl J Med [Internet]. 2004/09/10. 2004;351(11):1068–80. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15356304.

    Article  CAS  PubMed  Google Scholar 

  31. Platts-Mills TA, Mitchell EB. House dust mite avoidance. Lancet [Internet]. 1982/12/11. 1982;2(8311):1334. Available from: http://www.ncbi.nlm.nih.gov/pubmed/6128614.

    Article  Google Scholar 

  32. Takaro TK, Krieger J, Song L, Sharify D, Beaudet N. The Breathe-Easy Home: the impact of asthma-friendly home construction on clinical outcomes and trigger exposure. Am J Public Heal [Internet]. 2010/12/15. 2011;101(1):55–62. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21148715.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Esty B, Phipatanakul W. School exposure and asthma. Ann Allergy Asthma Immunol [Internet]. 2018/02/07. 2018;120(5):482–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29407419

  34. Almqvist C, Wickman M, Perfetti L, Berglind N, Renstrom A, Hedren M, et al. Worsening of asthma in children allergic to cats, after indirect exposure to cat at school. Am J Respir Crit Care Med [Internet]. 2001/03/20. 2001;163(3 Pt 1):694–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11254526.

    Article  CAS  PubMed  Google Scholar 

  35. Calderon MA, Alves B, Jacobson M, Hurwitz B, Sheikh A, Durham S. Allergen injection immunotherapy for seasonal allergic rhinitis. Cochrane Database Syst Rev [Internet]. 2007/01/27. 2007;1:CD001936. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17253469.

  36. Meadows A, Kaambwa B, Novielli N, Huissoon A, Fry-Smith A, Meads C, et al. A systematic review and economic evaluation of subcutaneous and sublingual allergen immunotherapy in adults and children with seasonal allergic rhinitis. Heal Technol Assess [Internet]. 2013/07/06. 2013;17(27):vi, xi–xiv, 1–322. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23827204.

  37. Radulovic S, Jacobson MR, Durham SR, Nouri-Aria KT. Grass pollen immunotherapy induces Foxp3-expressing CD4+ CD25+ cells in the nasal mucosa. J Allergy Clin Immunol [Internet]. 2008/04/22. 2008;121(6):1467–72, 1472.e1. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18423565.

    Article  Google Scholar 

  38. Francis JN, James LK, Paraskevopoulos G, Wong C, Calderon MA, Durham SR, et al. Grass pollen immunotherapy: IL-10 induction and suppression of late responses precedes IgG4 inhibitory antibody activity. J Allergy Clin Immunol [Internet]. 2008/04/01. 2008;121(5):1120–5.e2. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18374405.

    Article  PubMed  Google Scholar 

  39. Durham SR, Walker SM, Varga EM, Jacobson MR, O’Brien F, Noble W, et al. Long-term clinical efficacy of grass-pollen immunotherapy. N Engl J Med [Internet]. 1999/08/12. 1999;341(7):468–75. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10441602.

    Article  CAS  PubMed  Google Scholar 

  40. Noon L. Prophylactic inoculation against hay fever (historical document). Ann Allergy [Internet]. 1955/11/01. 1955;13(6):713–6; passim. Available from: http://www.ncbi.nlm.nih.gov/pubmed/13268980.

  41. Cox L, Nelson H, Lockey R, Calabria C, Chacko T, Finegold I, et al. Allergen immunotherapy: a practice parameter third update. J Allergy Clin Immunol [Internet]. 2010/12/03. 2011;127(1 Suppl):S1–55. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21122901.

    Article  PubMed  Google Scholar 

  42. Greenhawt M, Oppenheimer J, Nelson M, Nelson H, Lockey R, Lieberman P, et al. Sublingual immunotherapy: A focused allergen immunotherapy practice parameter update. Ann Allergy Asthma Immunol [Internet]. 2017/03/13. 2017;118(3):276–82.e2. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28284533.

    Article  Google Scholar 

  43. Virchow JC, Backer V, Kuna P, Prieto L, Nolte H, Villesen HH, et al. Efficacy of a house dust mite sublingual allergen immunotherapy tablet in adults with allergic asthma: a randomized clinical trial. JAMA. 2016;315(16):1715–25.

    Article  CAS  PubMed  Google Scholar 

  44. Canonica GW, Virchow JC, Zieglmayer P, Ljorring C, Smith IM, Mosbech H. Efficacy and safety of SQ house dust mite (HDM) SLIT-tablet treatment of HDM allergic asthma. Expert Rev Clin Immunol. 2016;12(8):805–15.

    Article  CAS  PubMed  Google Scholar 

  45. Lin SY, Azar A, Suarez-Cuervo C, Diette GB, Brigham E, Rice J, et al. No Title. In: The role of immunotherapy in the treatment of asthma. AHRQ Comparative Effectiveness Reviews, No. 196. Available from: https://www.ncbi.nlm.nih.gove/books/NBK42934/.

  46. Larenas-Linnemann D, Wahn U, Kopp M. Use of omalizumab to improve desensitization safety in allergen immunotherapy. J Allergy Clin Immunol. 2014;133(3):937–937.e2.

    Article  CAS  PubMed  Google Scholar 

  47. Massanari M, Nelson H, Casale T, Busse W, Kianifard F, Geba GP, et al. Effect of pretreatment with omalizumab on the tolerability of specific immunotherapy in allergic asthma. J Allergy Clin Immunol. 2010;125(2):383–9.

    Article  CAS  PubMed  Google Scholar 

  48. Jacobsen L, Niggemann B, Dreborg S, Ferdousi HA, Halken S, Host A, et al. Specific immunotherapy has long-term preventive effect of seasonal and perennial asthma: 10-year follow-up on the PAT study. Allergy [Internet]. 2007/07/11. 2007;62(8):943–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17620073.

    Article  CAS  PubMed  Google Scholar 

  49. Zielen S, Devillier P, Heinrich J, Richter H, Wahn U. Sublingual immunotherapy provides long-term relief in allergic rhinitis and reduces the risk of asthma: a retrospective, real-world database analysis. Allergy [Internet]. 2017/06/01. 2018;73(1):165–77. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28561266.

    Article  PubMed  Google Scholar 

  50. Schmitt J, Schwarz K, Stadler E, Wustenberg EG. Allergy immunotherapy for allergic rhinitis effectively prevents asthma: results from a large retrospective cohort study. J Allergy Clin Immunol [Internet]. 2015/09/16. 2015;136(6):1511–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26371838.

    Article  PubMed  Google Scholar 

  51. Moustaki M, Loukou I, Tsabouri S, Douros K. The role of sensitization to allergen in asthma prediction and prevention. Front Pediatr [Internet]. 2017/08/22. 2017;5:166. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28824890.

  52. Rothe T, Spagnolo P, Bridevaux PO, Clarenbach C, Eich-Wanger C, Meyer F, et al. Diagnosis and management of asthma – the Swiss guidelines. Respiration [Internet]. 2018;95(5):364–80. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29614508.

    Article  PubMed  Google Scholar 

  53. Bateman ED, Reddel HK, van Zyl-Smit RN, Agusti A. The asthma-COPD overlap syndrome: towards a revised taxonomy of chronic airways diseases? Lancet Respir Med. 2015;3(9):719–28.

    Article  PubMed  Google Scholar 

  54. National Asthma Education and Prevention Program. Expert Panel Report 3 (EPR-3): guidelines for the diagnosis and management of asthma-summary report 2007. J Allergy Clin Immunol [Internet]. 2007;120(5 Suppl):S94–138. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17983880.

  55. Parulekar AD, Diamant Z, Hanania NA. Role of T2 inflammation biomarkers in severe asthma. Curr Opin Pulm Med. 2016;22(1):59–68.

    Article  CAS  PubMed  Google Scholar 

  56. Medrek SK, Parulekar AD, Hanania NA. Predictive biomarkers for asthma therapy. Curr Allergy Asthma Rep. 2017;17(10):69.

    Article  PubMed  Google Scholar 

  57. Parulekar AD, Diamant Z, Hanania NA. Role of biologics targeting type 2 airway inflammation in asthma: what have we learned so far? Curr Opin Pulm Med. 2017;23(1):3–11.

    Article  CAS  PubMed  Google Scholar 

  58. Maltby S, Gibson PG, Powell H, McDonald VM. Omalizumab treatment response in a population with severe allergic asthma and overlapping COPD. Chest [Internet]. 2017;151(1):78–89. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27742181.

    Article  PubMed  Google Scholar 

  59. Ledford D, Busse W, Trzaskoma B, Omachi TA, Rosen K, Chipps BE, et al. A randomized multicenter study evaluating Xolair persistence of response after long-term therapy. J Allergy Clin Immunol. 2017;140(1):162–169.e2.

    Article  CAS  PubMed  Google Scholar 

  60. Humbert M, Busse W, Hanania NA, Lowe PJ, Canvin J, Erpenbeck VJ, et al. Omalizumab in asthma: an update on recent developments. J Allergy Clin Immunol Pract. 2014;2(5):525–36.e1.

    Article  PubMed  Google Scholar 

  61. Chipps BE, Lanier B, Milgrom H, Deschildre A, Hedlin G, Szefler SJ, et al. Omalizumab in children with uncontrolled allergic asthma: review of clinical trial and real-world experience. J Allergy Clin Immunol. 2017;139(5):1431–44.

    Article  CAS  PubMed  Google Scholar 

  62. Busse WW, Morgan WJ, Gergen PJ, Mitchell HE, Gern JE, Liu AH, et al. Randomized trial of omalizumab (anti-IgE) for asthma in inner-city children. N Engl J Med. 2011;364(11):1005–15.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Busse WW, Massanari M, Kianifard F, Geba GP. Effect of omalizumab on the need for rescue systemic corticosteroid treatment in patients with moderate-to-severe persistent IgE-mediated allergic asthma: a pooled analysis. Curr Med Res Opin. 2007;23(10):2379–86.

    Article  CAS  PubMed  Google Scholar 

  64. Busse W, Buhl R, Fernandez Vidaurre C, Blogg M, Zhu J, Eisner MD, et al. Omalizumab and the risk of malignancy: results from a pooled analysis. J Allergy Clin Immunol. 2012;129(4):983–9.e6.

    Article  CAS  PubMed  Google Scholar 

  65. Hanania NA, Alpan O, Hamilos DL, Condemi JJ, Reyes-Rivera I, Zhu J, et al. Omalizumab in severe allergic asthma inadequately controlled with standard therapy: a randomized trial. Ann Intern Med. 2011;154(9):573–82.

    Article  PubMed  Google Scholar 

  66. Blaiss MS, Castro M, Chipps BE, Zitt M, Panettieri RAJ, Foggs MB. Guiding principles for use of newer biologics and bronchial thermoplasty for patients with severe asthma. Ann Allergy Asthma Immunol. 2017;119(6):533–40.

    Article  PubMed  Google Scholar 

  67. Busse W, Spector S, Rosen K, Wang Y, Alpan O. High eosinophil count: a potential biomarker for assessing successful omalizumab treatment effects. J Allergy Clin Immunol United States. 2013;132:485–6.e11.

    Article  Google Scholar 

  68. Casale TB, Chipps BE, Rosen K, Trzaskoma B, Haselkorn T, Omachi TA, et al. Response to omalizumab using patient enrichment criteria from trials of novel biologics in asthma. Allergy. 2018;73(2):490–7.

    Article  CAS  PubMed  Google Scholar 

  69. Hanania NA, Wenzel S, Rosen K, Hsieh H-J, Mosesova S, Choy DF, et al. Exploring the effects of omalizumab in allergic asthma: an analysis of biomarkers in the EXTRA study. Am J Respir Crit Care Med. 2013;187(8):804–11.

    Article  CAS  PubMed  Google Scholar 

  70. Humbert M, Taillé C, Mala L, Le Gros V, Just J, Molimard M. Omalizumab effectiveness in patients with severe allergic asthma according to blood eosinophil count: the STELLAIR study. Eur Respir J [Internet]. 2018 Jan 1;1702523. Available from: http://erj.ersjournals.com/content/early/2018/03/09/13993003.02523-2017.abstract.

  71. Casale TB, Luskin AT, Busse W, Zeiger RS, Trzaskoma B, Yang M, et al. Omalizumab effectiveness by biomarker status in patients with asthma: evidence from PROSPERO, a prospective real-world study. J Allergy Clin Immunol Pract. 2018;7(1):156–164.e1.

    Article  PubMed  Google Scholar 

  72. Djukanovic R, Hanania N, Busse W, Price D. IgE-mediated asthma: new revelations and future insights. Respir Med. 2016;112:128–9.

    Article  PubMed  Google Scholar 

  73. Teach SJ, Gill MA, Togias A, Sorkness CA, Arbes SJJ, Calatroni A, et al. Preseasonal treatment with either omalizumab or an inhaled corticosteroid boost to prevent fall asthma exacerbations. J Allergy Clin Immunol. 2015;136(6):1476–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  74. Esquivel A, Busse WW, Calatroni A, Togias AG, Grindle KG, Bochkov YA, et al. Effects of Omalizumab on rhinovirus infections, illnesses, and exacerbations of asthma. Am J Respir Crit Care Med. 2017;196(8):985–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  75. Gill MA, Liu AH, Calatroni A, Krouse RZ, Shao B, Schiltz A, et al. Enhanced plasmacytoid dendritic cell antiviral responses after omalizumab. J Allergy Clin Immunol. 2018;141(5):1735–1743.e9.

    Article  CAS  PubMed  Google Scholar 

  76. Ortega HG, Liu MC, Pavord ID, Brusselle GG, FitzGerald JM, Chetta A, et al. Mepolizumab treatment in patients with severe eosinophilic asthma. N Engl J Med. 2014;371(13):1198–207.

    Article  PubMed  Google Scholar 

  77. FitzGerald JM, Bleecker ER, Nair P, Korn S, Ohta K, Lommatzsch M, et al. Benralizumab, an anti-interleukin-5 receptor alpha monoclonal antibody, as add-on treatment for patients with severe, uncontrolled, eosinophilic asthma (CALIMA): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet (London, England). 2016;388(10056):2128–41.

    Article  CAS  Google Scholar 

  78. Bleecker ER, FitzGerald JM, Chanez P, Papi A, Weinstein SF, Barker P, et al. Efficacy and safety of benralizumab for patients with severe asthma uncontrolled with high-dosage inhaled corticosteroids and long-acting beta2-agonists (SIROCCO): a randomised, multicentre, placebo-controlled phase 3 trial. Lancet (London, England). 2016;388(10056):2115–27.

    Article  CAS  Google Scholar 

  79. Castro M, Mathur S, Hargreave F, Boulet L-P, Xie F, Young J, et al. Reslizumab for poorly controlled, eosinophilic asthma: a randomized, placebo-controlled study. Am J Respir Crit Care Med. 2011;184(10):1125–32.

    Article  CAS  PubMed  Google Scholar 

  80. Castro M, Zangrilli J, Wechsler ME, Bateman ED, Brusselle GG, Bardin P, et al. Reslizumab for inadequately controlled asthma with elevated blood eosinophil counts: results from two multicentre, parallel, double-blind, randomised, placebo-controlled, phase 3 trials. Lancet Respir Med. 2015;3(5):355–66.

    Article  CAS  PubMed  Google Scholar 

  81. Bel EH, Wenzel SE, Thompson PJ, Prazma CM, Keene ON, Yancey SW, et al. Oral glucocorticoid-sparing effect of mepolizumab in eosinophilic asthma. N Engl J Med. 2014;371(13):1189–97.

    Article  PubMed  Google Scholar 

  82. Nair P, Wenzel S, Rabe KF, Bourdin A, Lugogo NL, Kuna P, et al. Oral glucocorticoid-sparing effect of Benralizumab in severe asthma. N Engl J Med. 2017;376(25):2448–58.

    Article  CAS  PubMed  Google Scholar 

  83. Chipps BE, Newbold P, Hirsch I, Trudo F, Goldman M. Benralizumab efficacy by atopy status and serum immunoglobulin E for patients with severe, uncontrolled asthma. Ann Allergy Asthma Immunol. 2018;120(5):504–511.e4.

    Article  CAS  PubMed  Google Scholar 

  84. Parulekar AD, Kao CC, Diamant Z, Hanania NA. Targeting the interleukin-4 and interleukin-13 pathways in severe asthma: current knowledge and future needs. Curr Opin Pulm Med. 2018;24(1):50–5.

    Article  CAS  PubMed  Google Scholar 

  85. Blauvelt A, de Bruin-Weller M, Gooderham M, Cather JC, Weisman J, Pariser D, et al. Long-term management of moderate-to-severe atopic dermatitis with dupilumab and concomitant topical corticosteroids (LIBERTY AD CHRONOS): a 1-year, randomised, double-blinded, placebo-controlled, phase 3 trial. Lancet (London, England). 2017;389(10086):2287–303.

    Article  CAS  Google Scholar 

  86. Simpson EL, Bieber T, Guttman-Yassky E, Beck LA, Blauvelt A, Cork MJ, et al. Two phase 3 trials of Dupilumab versus placebo in atopic dermatitis. N Engl J Med. 2016;375(24):2335–48.

    Article  CAS  PubMed  Google Scholar 

  87. Castro M, Corren J, Pavord ID, Maspero J, Wenzel S, Rabe KF, et al. Dupilumab efficacy and safety in moderate-to-severe uncontrolled asthma. N Engl J Med. 2018;378(26):2486–96.

    Article  CAS  PubMed  Google Scholar 

  88. Rabe KF, Nair P, Brusselle G, Maspero JF, Castro M, Sher L, et al. Efficacy and safety of Dupilumab in glucocorticoid-dependent severe asthma. N Engl J Med. 2018;378(26):2475–85.

    Article  CAS  PubMed  Google Scholar 

  89. Weinstein SF, Katial R, Jayawardena S, Pirozzi G, Staudinger H, Eckert L, et al. Efficacy and safety of dupilumab in perennial allergic rhinitis and comorbid asthma. J Allergy Clin Immunol. 2018;142(1):171–177.e1.

    Article  CAS  PubMed  Google Scholar 

  90. Castro M, Corren J, Hanania N, Pavord I, Quirce S, Thangavelu K, et al. Dupilumab efficacy in uncontrolled, moderate-to-severe allergic asthma in the phase 3 Liberty asthma quest study. Ann Allergy, Asthma Immunol [Internet] 2018 Nov 1 [cited 2018 Nov 26];121(5):S8. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1081120618307671.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to R. John Looney .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Hanania, N.A., Stern, J., Looney, R.J. (2020). Practical Considerations in Management of Allergic Asthma. In: Khurana, S., Holguin, F. (eds) Difficult To Treat Asthma. Respiratory Medicine. Humana, Cham. https://doi.org/10.1007/978-3-030-20812-7_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-20812-7_9

  • Published:

  • Publisher Name: Humana, Cham

  • Print ISBN: 978-3-030-20811-0

  • Online ISBN: 978-3-030-20812-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics