There are treatments for having been exposed to an allergen, but there aren’t a lot of treatments that reduce the rock that you will react to a food you are allergic to. It’s not clear to me what the long term safety of this drug is, but it was previously approved for regular use for people with severe asthma.
Not surprising, as omalizumab is a potent anti-inflammatory specifically meant for allergic asthma, chronic idiopathic urticaria, chronic rhinosinusitis, and IgE mediated food allergies. A big drawback of the drug is that it can cause anaphylaxis, so one must be closely monitored when doses are given.
It is an immune modulator, as are other meds in this classification. As such, these meds are a true godsend for a lot of autoimmune diseases including rheumatoid, inflammatory bowel disease, psoriasis/psoriatic arthritis, allergic asthma and many other conditions. But significant side effects can occur.
Isn’t that the kind of drug they call a “biologic” or something, that messes with your immune system? It’s an interesting advance, but I would think it would only be desirable to give it to children if their allergies are life-threatening (like all those kids with peanut allergies who could die if they were in the same room with them; whatever happened to all that?). I mean, I was allergic to all those things as a young child, and it caused my mother some annoyance to avoid them in food for me, but I’m glad no-one tried to fix it by shutting down part of my immune system (this being MPSIMS, I am shooting from the hip somewhat here; I’ll be happy to learn that using these drugs is harmless and can be stopped at any time without damage.)
I bet it’s pretty dangerous to be on. Anything that tamps down your immune response seems intrinsically risky.
In drug discovery, a “biologic” is not something that messes with your immune system. It’s something where the active ingredient was found in a natural plant or animal or bacteria or something, rather than having been invented by humans.
Now once somebody isolates the actual active ingredient from whatever plant or venom or fungus or whatever, they can proceed to try to figure out how to make it in quantity using modern chemistry, not by harvesting rare plants or whatever. In some cases harvesting [whatevers] is easier and cheaper. In most cases the drug can’t scale to significant volume until the chemists can make it from scratch in a vat.
It’s not as dangerous as having your own immune system turn on you, for the most part. The drug’s not right for some people, but for others it helps them greatly to live a more normal life. I’ve seen the magic that these biologics have done for certain folks with certain conditions.
Definition from the National Cancer Institute at the NIH:
A biologic agent is substance that is made from a living organism or its products and is used in the prevention, diagnosis, or treatment of cancer and other diseases. Biologic agents include antibodies, interleukins, and vaccines. Also called biological agent and biological drug.
A better general discussion can be found here: Biologics. Below is the first paragraph of their discussion.
Biological products include a wide range of products such as vaccines, blood and blood components, allergenics, somatic cells, gene therapy, tissues, and recombinant therapeutic proteins. Biologics can be composed of sugars, proteins, or nucleic acids or complex combinations of these substances, or may be living entities such as cells and tissues. Biologics are isolated from a variety of natural sources - human, animal, or microorganism - and may be produced by biotechnology methods and other cutting-edge technologies. Gene-based and cellular biologics, for example, often are at the forefront of biomedical research, and may be used to treat a variety of medical conditions for which no other treatments are available.
Oh, sure. My mom had myasthenia and was on serious immune suppressants for much of her life. They were a lot better than dying of myasthenia. But they had certain costs.
I used the wrong word to refer to these kinds of medicines? And/or, I am mistaken about what these kinds of medicines (however they are referred to) do to fight the symptoms they target?
I only know what I see in commercials, and here is what I, an uneducated but reasonably intelligent John Doe, have gleaned from that: Medicines that have official names that end in “-mab” seem to be used to fight disorders that I have always thought of as auto-immune disorders, like asthma, eczema, psoriasis and psoriatic arthritis, among others. Reading between the lines of the warnings that are in the commercials, these medicines seem to function by disabling some part of the (mis-firing?) immune system that is responsible for the targeted condition. This may result in some other parts of the immune system not functioning as they currently do, and the results might be other conditions become more difficult to control or cure.
My goal in writing the above is not to burden knowledgeable people with curing my ignorance, but to illustrate what a person like me is likely to think about these medicines. Fortunately for me, my asthma and eczema/dermatitis are pretty well controlled all of the time with other medicines and treatments, and my food allergies are manageable through abstinence, so I have never asked for nor been offered any of these medicines. But it was a different story when I was a child. I would have loved some relief from the extensive eczema I suffered from until puberty, which made me socially and physically isolated, and probably helped make my personality permanently weird. I would not have given a second thought to possible side effects, but I hope my parents and doctor would have. All of that is the reason for my concern about these kinds of medicines being given to children unless it is to save their lives, not just to save them from discomfort or isolation, however bad those things might be.
I am on Zolair. I get two injections every two weeks for an auto-immune mast cell disorder. It’s saved my sanity. Unbearable, unrelenting itching is hell on earth.
I carry an Epi pen with me. For the first several months, I had to wait a couple hours after the injections in case I went into anaphylactic shock. I no longer have to wait, but they do check to make sure I have the Epi-Pen along.
I have not had any adverse side effects.
Allergies are an over-reaction of the immune system. Calming that down (“tamping”, if you will) is how you treat them whether that’s old-line anti-histamine, old-school allergy shots, or newer pharmaceuticals.
All of those therapies have benefit/risk ratios.
Another downside of Xolair is that it’s very expensive, which is another reason it tends to be reserved for severe/life-threatening allergies that can’t be managed other ways (outside of epi-pens).
This is not going to become a standard, first line treatment.
Well, consider that some of the older treatments for things like severe asthma have side effects like cataracts, osteoporosis, and so on. There is a tendency to poo-poo the severity of some allergies because most allergies are relatively mild, like seasonal hayfever and that’s what most people tend to think of. They don’t think about your own immune system killing you in a matter of minutes, which is the other end of the spectrum.
Xolair is for severe, potentially life-threatening types of allergies and disorders, not for the average allergic person. Or even some of us not-so-average allergic people. I mean, I’ve experienced anaphylaxis twice and I carry an epi-pen, but I’ve never been offered Xolair and don’t expect to be. I’ve got severe allergies but they can be managed without Xolair (I haven’t had a trip to the ER since the 20th Century) so I’m not an appropriate candidate for the treatment.
Yes, exactly.
I’m sure it’s worth it for many people. My mom would literally have died without immune suppressing drugs. She had myasthenia gravis, which was diagnosed after she stopped breathing. (It took a while to diagnose. She was in intensive care on a respirator for months. It was a nightmare for all concerned.) But she developed osteoporosis and covid killed her despite several vaccinations, both of which were probably the result of those otherwise life-saving drugs.
That’s really interesting to me as someone who is very little about drugs and interactions. Are there many drugs out there with potentially significant side effects that are the exact same thing the drugs are are intended to reduce?
Here’s an overview of where we stand on therapies to overcome food allergies. It’s unlikely that any one new drug will be the magic bullet, but progress is being made on multiple fronts. I wouldn’t have a problem with the concept of “messing with the immune system” if done with reasonable care and precision, since our immune systems have no qualms about messing with us on occasion.
Immunomodulation is an intriguing field. I will never know how/whether this worked, but my former severe reactions to wasp stings dissipated and ultimately disappeared after I moved to Texas and began experiencing fire ant stings on a regular basis (those reactions, initially marked, faded into tolerance as well).
The suffix of a med name indicates what kind of bio-chemical process it uses, not what disease categories it addresses.
“-mab” means it’s manufactured and delivered into the body as a monoclonal antibody.
See Drug nomenclature - Wikipedia for lots more.
You are correct, regarding the drug’s suffix. (Generic name: omalizumab.) This drug has been on the market for many years, like they said, usually for asthma. Of course, it’s not suitable for many asthmatics either, so patients need to be carefully screened. The -mab or -ab suffix indicates that it’s antibody therapy, or antibody-derived.
My “favorite” Xolair memory was at the old hospital, where patients would come in IIRC every 2 months to get a sub-Q injection, and I do remember that this med was extremely viscous and took a long time to dissolve. Anyway, the order entry people forgot to tell the pharmacist, who forgot to tell the IV room technicians that we had a Xolair order, and it got lost in the shuffle and we started getting irate call after irate call from the nurse, because the patient was basically threatening to rip a few heads off for being kept waiting.
I for one got the word out in the department that if a Xolair order came in, prioritize it and tell us it’s there.
You bet. The best example: There are some cancer chemotherapy drugs that have as a potential side effect…secondary cancers.
Melphalan and nitrogen mustard, two of the first such drugs, are especially notorious for this.