Biologic Therapies: Biologic therapies are synthetic proteins called monoclonal antibodies that block inflammatory mediators that are involved in various conditions such as asthma, allergic rhinitis, and eczema (atopic dermatitis). These treatments are meant to reduce systemic steroid use and improve severe conditions. Current biologics include but are not limited to include:
- Xolair (omalizumab): Xolair is indicated for patients as young as 6 with moderate to severe persistent asthma and for patients as young as 12 with chronic idiopathic urticaria. By selectively binding to Immunoglobulin E, Xolair helps decrease the incidence of asthma exacerbations and urticaria outbreaks. Xolair is administered in the clinic by our medical staff in the form of a subcutaneous injection once every 2 or 4 weeks.
- Cinqair (reslizumab): Cinqair is primarily indicated for patients 18 years or older with severe, eosinophilic asthma. Cinqair functions as an Interleukin-5 inhibitor to help relieve symptoms of eosinophilic asthma. It must be administered via intravenous infusion once every four weeks.
- Fasenra (benralizumab): Fasenra is indicated for patients 12 years or older with severe eosinophilic asthma. Fasenra may be administered in a clinical setting by our health professionals and is done so via a subcutaneous injection that is administered once every four weeks for the first three doses, and then once every eight weeks thereafter.
- Dupixent (dupilumab): Dupixent is indicated for children and adults that suffer from moderate to severe atopic dermatitis and have not received relief from topical therapies. More recently, Dupixent has also been indicated as an add-on maintenance for patients 6 years or older with moderate to severe eosinophilic or steroid dependent asthma and as an add-on for adults experiencing uncontrolled chronic rhinosinusitis with nasal polyposis. Dupixent helps decrease symptoms for all three indications by functioning as an interleukin-4 receptor alpha-antagonist decreasing Interleukin 4 and 13 levels which are involved in the inflammatory process. Dupixent is also administered through a subcutaneous injection by our healthcare providers in a clinical environment or may be self-administered at home. The first dose consists of two injections, with one dose given every other week after that.
- Nucala (mepolizumab): Nucala is indicated as an add-on maintenance for patients 12 years or older with severe, eosinophilic asthma or for adults with hypereosinophilic syndrome (HES) or eosinophilic granulomatosis with polyangitis (EGPA). Nucala may be administered by our healthcare providers in a clinical setting via a subcutaneous injection.
- Adbry (AdbryTralokinumab-ldrm): Adbry is the most recent breakthrough in biologic therapeutics to help patients with moderate-to-severe atopic dermatitis that has failed to be resolved by topical corticosteroids or other oral medications. Adbry works by blocking Interleukin-13 (IL-13) from binding to cell surface receptors which stops the immune-system overreaction that typically results in Atopic Dermatitis.
- Cibinqo (abrocitinib): Cibinqo was recently FDA-approved as an oral therapy for Eczema patients experiencing moderate-to-severe atopic dermatitis. Cibinqo works by acting as a JAK inhibitor, which blocks immune signals that cause an overactive inflammatory response. Cibinqo has only been approved for adults so far.
- Opzelura (ruxolitinib): is a unique topical cream for eczema relief. It acts as a Jak inhibitor for mild to moderate atopic dermatitis in non-immunocompromised patients 12 and older. Opzelura has shown significant improvements for patients with mild to moderate eczema by significantly improving itch reduction and clearing skin.
- Tezspire (tezepelumab-ekko): Tezspire is a unique, one-of-a-kind therapy approved for patients with severe asthma. It is a prescription medication that is used with other asthma medications for the maintenance of symptoms in people 12 or older. Tezspire acts by blocking thymic stromal lymphopoietins (TSLP) and reduces the release of downstream mediators that cause the airway inflammation and hyperresponsive characteristic of severe asthma.
Immunoglobulin G (IgG) is a notable protein in our bodies that protects against bacterial and viral infections. They produce antibodies that recognize foreign antigens and bind to them to make them more easily identifiable and aid in their destruction. People with primary immune deficiencies may have an impaired quantity or function of IgG which contributes to an increased frequency and severity of infections. IgG replacement therapy is a suitable option for these patients. Our physicians coordinate with trusted infusion centers to ensure that a regular treatment plan is maintained.
Subcutaneous Allergen Immunotherapy: Allergy shots are a form of allergen desensitization, which serves as a long-term, therapeutic treatment for your allergy symptoms! Starting at low dilutions and working to the top, your immune system becomes tolerant to what it was allergic to. This works 80% of the time in improving allergic rhinitis (e.g. hay fever) and asthma symptoms. Treatment duration is 3-5 years. Patients have the option to choose from standard vs cluster (rapid desensitization) immunotherapy.
Sublingual Immunotherapy (SLIT): Sublingual immunotherapy can be an effective alternative to subcutaneous allergen immunotherapy to environmental allergens. This treatment can be done at the comfort of your own home as there is less risk of anaphylaxis. Furthermore, they are stored at room temperature which makes them convenient for travel. An individual places a droplet of what they are allergic to on a daily basis for a 3-5 year duration. Just as subcutaneous allergen immunotherapy, they work 80% of the time in improving allergic rhinitis (e.g. hayfever) and asthma symptoms.
Similar to allergen immunotherapy, drug desensitization consists of exposing your body to small, increasing doses of the drug that you’re allergic to in order to build up a tolerance to it. In many cases, drug allergies can produce anaphylactic or a severe response, but these drugs may be necessary for your health. Aspirin, for example, maybe a necessary drug for people who need it as a blood thinner. By conducting this in a controlled clinical environment, we slowly reintroduce your body to the drug in small doses over a fixed time interval while monitoring symptoms and ensuring reactions are not occurring. By doing so, the patient can return to taking the medication with no issues!
- Drug Challenges: Drug challenges are offered to patients whereby history and objective testing has shown a low likelihood of being allergic to an offending drug. Once skin testing has confirmed an allergic reaction is less likely a patient is given very small doses of the drug in fixed time intervals to rule out an allergy to the suspected drug. This is done over the course of nearly 4 hours so that a patient’s heart rate, blood pressure, and any signs of allergic symptoms can be consistently monitored.
- Food Challenges: Food challenges are primarily offered to patients whereby the likelihood of having a true food allergy is low based on history and objective testing. Common food allergens we challenge to include but are not limited to: (dairy, nuts, eggs, wheat, fish, shellfish, soy, sesame seed). At times we may proceed with a baked food challenge. We have special recipes for muffins that are given to the child’s parent or guardian that contain small amounts of the allergen with other non-allergen ingredients.