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Alska E, Łaszczych D, Napiórkowska-Baran K, Szymczak B, Rajewska A, Rubisz AE, Romaniuk P, Wrzesień K, Mućka N, Bartuzi Z. Advances in Biologic Therapies for Allergic Diseases: Current Trends, Emerging Agents, and Future Perspectives. J Clin Med 2025; 14:1079. [PMID: 40004611 PMCID: PMC11856668 DOI: 10.3390/jcm14041079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2024] [Revised: 01/23/2025] [Accepted: 02/04/2025] [Indexed: 02/27/2025] Open
Abstract
Biologic therapies have revolutionized the treatment of severe allergic diseases, including asthma, atopic dermatitis (AD), chronic spontaneous urticaria (CSU), chronic rhinosinusitis with nasal polyps (CRSwNP), eosinophilic gastrointestinal diseases (EGIDs), and allergic rhinitis (AR). These molecularly targeted agents provide significant benefits for patients unresponsive to conventional treatments by addressing underlying immune mechanisms, particularly type 2 inflammation driven by cytokines such as IL-4, IL-5, and IL-13. Recent advancements include biologics targeting alarmins like thymic stromal lymphopoietin (TSLP) and IL-33, which may address both type 2 and non-type 2 inflammation, broadening their therapeutic scope. Despite their effectiveness, biologics remain expensive, posing socioeconomic challenges, and there are concerns regarding long-term safety and inter-individual variability in responses. Promising innovations such as bispecific antibodies and ultra-long-acting agents are under investigation, alongside digital health tools like remote biomarker monitoring and AI-driven decision support systems, which aim to enhance personalized care. However, disparities in access, particularly for underserved populations, underscore the need for policy reforms and affordable biosimilars. This review synthesizes recent findings and emerging trends, highlighting the evolving role of biologics in transforming allergic disease management and offering insights into future research directions.
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Affiliation(s)
- Ewa Alska
- Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Torun, 85-067 Bydgoszcz, Poland; (E.A.); (Z.B.)
| | - Dariusz Łaszczych
- Student Research Club of Clinical Immunology, Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Torun, 85-067 Bydgoszcz, Poland; (D.Ł.); (B.S.); (A.R.); (A.E.R.); (P.R.); (K.W.); (N.M.)
| | - Katarzyna Napiórkowska-Baran
- Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Torun, 85-067 Bydgoszcz, Poland; (E.A.); (Z.B.)
| | - Bartłomiej Szymczak
- Student Research Club of Clinical Immunology, Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Torun, 85-067 Bydgoszcz, Poland; (D.Ł.); (B.S.); (A.R.); (A.E.R.); (P.R.); (K.W.); (N.M.)
| | - Alicja Rajewska
- Student Research Club of Clinical Immunology, Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Torun, 85-067 Bydgoszcz, Poland; (D.Ł.); (B.S.); (A.R.); (A.E.R.); (P.R.); (K.W.); (N.M.)
| | - Aleksandra Ewa Rubisz
- Student Research Club of Clinical Immunology, Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Torun, 85-067 Bydgoszcz, Poland; (D.Ł.); (B.S.); (A.R.); (A.E.R.); (P.R.); (K.W.); (N.M.)
| | - Paulina Romaniuk
- Student Research Club of Clinical Immunology, Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Torun, 85-067 Bydgoszcz, Poland; (D.Ł.); (B.S.); (A.R.); (A.E.R.); (P.R.); (K.W.); (N.M.)
| | - Katarzyna Wrzesień
- Student Research Club of Clinical Immunology, Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Torun, 85-067 Bydgoszcz, Poland; (D.Ł.); (B.S.); (A.R.); (A.E.R.); (P.R.); (K.W.); (N.M.)
| | - Natalia Mućka
- Student Research Club of Clinical Immunology, Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Torun, 85-067 Bydgoszcz, Poland; (D.Ł.); (B.S.); (A.R.); (A.E.R.); (P.R.); (K.W.); (N.M.)
| | - Zbigniew Bartuzi
- Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Torun, 85-067 Bydgoszcz, Poland; (E.A.); (Z.B.)
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Ensina LF, Brandão L, Arruda LK, Sarquis Serpa F, Campos RA, Valle SRO, Criado PR, Saini SS, Criado RFJ. IgE as a predictor to omalizumab response in patients with chronic spontaneous urticaria. FRONTIERS IN ALLERGY 2025; 5:1451296. [PMID: 39917427 PMCID: PMC11798913 DOI: 10.3389/falgy.2024.1451296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 12/16/2024] [Indexed: 02/09/2025] Open
Abstract
This multicenter study aimed to explore whether baseline total immunoglobulin E (IgE) levels could predict omalizumab response in chronic spontaneous urticaria (CSU) patients. Refractory CSU patients, treated with omalizumab after failing second-generation H1-antihistamines, were analyzed retrospectively across seven centers in Brazil. The study assessed total IgE levels at baseline, comparing responders to non-responders and considering complete and partial responses. The results showed a significant reduction in CSU symptoms post-treatment. Non-responders had lower baseline IgE levels. A sensitivity of 67.8% and specificity of 93.3% for predicting a response were found at an IgE level of 59.5 IU/ml. Similar values were observed for complete responders. Notably, a baseline IgE level lower than 59.5 IU/ml may indicate late responders. The study underscores the potential of baseline IgE levels as a predictive biomarker for omalizumab response in CSU patients. Further research, incorporating diverse populations and analyzing response variables, is warranted to validate these findings.
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Affiliation(s)
- Luis Felipe Ensina
- Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
| | - Larissa Brandão
- Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
| | - Luisa Karla Arruda
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Faradiba Sarquis Serpa
- Division of Allergy and Immunology, Escola Superior de Ciências da Santa Casa de Misericordia de Vitória, Vitória, Brazil
| | | | | | - Paulo Ricardo Criado
- Department of Dermatology, Centro Universitário Faculdade de Medicina do ABC, Santo André, Brazil
| | - Sarbjit Singh Saini
- Division of Allergy and Clinical Immunology, The John Hopkins School of Medicine, Baltimore, MD, United States
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Zuberbier T, Ensina LF, Giménez-Arnau A, Grattan C, Kocatürk E, Kulthanan K, Kolkhir P, Maurer M. Chronic urticaria: unmet needs, emerging drugs, and new perspectives on personalised treatment. Lancet 2024; 404:393-404. [PMID: 39004090 DOI: 10.1016/s0140-6736(24)00852-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 04/04/2024] [Accepted: 04/22/2024] [Indexed: 07/16/2024]
Abstract
Chronic urticaria is a common and debilitating mast cell-driven skin disease presenting with itchy wheals, angio-oedema, or both. Chronic urticaria is classified as spontaneous (without definite triggers) and inducible (with definite and subtype-specific triggers; eg, cold or pressure). Current management guidelines recommend step-up administration of second-generation H1-antihistamines to four-fold the approved dose, followed by omalizumab and ciclosporin. However, in many patients, chronic urticaria does not respond to this linear approach due to heterogeneous underlying mechanisms. A personalised endotype-based approach is emerging based on the identification of autoantibodies and other drivers of urticaria pathogenesis. Over the past decade, clinical trials have presented promising options for targeted treatment of chronic urticaria with the potential for disease modification, including Bruton's tyrosine kinase inhibitors, anti-cytokine therapies, and mast cell depletion. This Therapeutics article focuses on the evidence for these novel drugs and their role in addressing an unmet need for personalised management of patients with chronic urticaria.
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Affiliation(s)
- Torsten Zuberbier
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology, Immunology and Allergology, Berlin, Germany.
| | - Luis Felipe Ensina
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
| | - Ana Giménez-Arnau
- Department of Dermatology, Hospital del Mar Research Institute, Universitat Pompeu Fabra, Barcelona, Spain
| | - Clive Grattan
- St John's Institute of Dermatology, Guy's Hospital, London, UK
| | - Emek Kocatürk
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology, Immunology and Allergology, Berlin, Germany; Department of Dermatology, Koç University School of Medicine, Istanbul, Türkiye
| | - Kanokvalai Kulthanan
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pavel Kolkhir
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology, Immunology and Allergology, Berlin, Germany
| | - Marcus Maurer
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology, Immunology and Allergology, Berlin, Germany
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