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Parasitic (Helminthic) Infection While on Asthma Biologic Treatment: Not Everything Is What It Seems

Authors Tan LD, Schaeffer B, Alismail A

Received 16 July 2019

Accepted for publication 21 November 2019

Published 11 December 2019 Volume 2019:12 Pages 415—420


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Amrita Dosanjh

Laren D Tan,1,2,* Brett Schaeffer,3,* Abdullah Alismail2

1Division of Pulmonary, Critical Care, Hyperbaric, Allergy and Sleep Medicine, Loma Linda University Health, Loma Linda, California, USA; 2Department of Cardiopulmonary Sciences, School of Allied Health Professions, Loma Linda University, Loma Linda, California, USA; 3Department of Internal Medicine, School of Medicine, Loma Linda University, Loma Linda, California, USA

*These authors contributed equally to this work

Correspondence: Laren D Tan
Department of Medicine, Division of Pulmonary, Critical Care, Hyperbaric, Allergy and Sleep Medicine, Loma Linda University School of Medicine, 11234 Anderson Street, Suite 6439, Loma Linda, California 92354, USA
Tel +1 909 558 8081
Fax +1 909 558 0581

Abstract: Asthma is a chronic inflammatory disorder of the airway that is characterized by bronchial hyperresponsiveness and variable airflow limitation. Approximately 235 million people are affected by asthma worldwide and 5–10% are considered to be refractory to standard asthma treatment. These patients are known to have repeated exacerbations requiring multiple courses of systemic corticosteroids and as a result, are at risk for increased adverse effects (i.e., osteoporosis, infections). Several new medications known as biologic agents have been approved for the treatment of moderate-to-severe asthmatics. These biologic agents target essential parts of the cell-mediated allergic and to a lesser degree non-allergic immune response (IgE, IL-5, and IL-4/IL-13). They are gaining more favor in the treatment of moderate-to-severe asthma due to their efficacy and excellent safety profile. Despite the most common adverse events being minor, such as injection site reactions, upper respiratory infections, or headaches, these agents carry a small risk of more severe complications such as anaphylaxis and decreased defense against parasitic infections (PI). The incidence of PI compared with other rare adverse events is not well reported, and there are no consensus guidelines for risk prevention of PI in asthmatics undergoing evaluation for, or currently using, biologic therapy. Thus, this article sets out to review the incidence of reported PI and other rare adverse events among asthmatics using current FDA-approved biologic therapies. Secondly, we discuss the clinical implications for the importance of risk prevention of PI with the use of biologic therapies in asthmatics. Lastly, we share an educational handout to assist providers in informing their patients of behaviors that could potentially increase their risk of PI while being on a biologic agent.

Keywords: asthma, biologics, parasitic infection, IgE

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