Biologics and Allergy
Biologics and Allergy
Knowledgeabout critical pathophysiologic mechanisms involved in allergic and respiratory disorders has led to the possibility of more targeted therapy or ‘‘precision medicine”. The successful use of biologic agents that target specific and critical pathways important in the pathogenesis of allergic and respiratory disorders in an individual is a challenge in treating allergic and respiratory diseases. Biologic therapies, as the name implies, are products derived in some way from living organisms. These treatments include a variety of vaccines, blood components and proteins that are either derived from natural sources or are synthesized in the laboratory.
There are a number of vaccine types which help protect against a large number of infectious organisms. Live attenuated vaccines use a live but weakened form of the microorganism (example: measles, mumps, rubella), while killed vaccines use organisms which have been inactivated in the laboratory (example: influenza). Toxoid vaccines contain a toxin which is normally made by a microorganism; these vaccines block the harmful, or toxic, effects of the infection (examples: diphtheria and tetanus). Bio-synthetic vaccines contain man-made substances that are similar to parts of the actual microorganism (example: Haemophilus influenza type B conjugate vaccine).
The most commonly used blood product is an infusion of packed red blood cells, which are administered to patients who have experienced acute blood loss. While plasma contains no cells, it is rich with blood proteins, and the three most important are albumin, globulins and fibrinogen. Globulins include immunoglobulins, which are antibody proteins produced by special immune cells (B-lymphocytes) and are key components in preventing infection. These immunoglobulins can be separated into immunoglobulins (Ig) A, M, G, D and E and are referred to as IgA, IgM, IgG, IgD, and IgE.
Ayurvedic View on Biologics and Allergy
Proteins useful for the treatment of diseases include a small number of naturally-occurring proteins called cytokines. Cytokines are proteins which the body uses to both activate and suppress immune cells which are involved in immune regulation and protection against infections. Interleukin-2 (Aldesleukin) is an approved therapy for certain cancers, while interferon gamma and interferon alpha are used as treatments for specific types of infectious illnessesand immunodeficiency states. Monoclonal antibodies, or MAbs, are laboratory-produced antibodies that target specific proteins that are involved in disease processes.
There are 2 major inflammatory pathways that drive allergic diseases: Type-2 (Th-2) inflammation and non-type 2 inflammation. All of the biologic medications currently approved for use, and most of the biologic medications under development for allergic diseases have focused on the Th-2 inflammatory pathway. Biologic targets along this pathway include Anti-Immunoglobulin E (IgE), Anti-Interleukin -5 (IL-5), Anti-IL 4, and Anti-IL-13. Although the most study has been done in the realm of severe asthma, biologic targets for other allergic diseases including atopic dermatitis, chronic rhino sinusitis with nasal polyposis, chronic idiopathic urticarial, eosinophilic esophagitis, and eosinophilic granulomatosis with polyangiitis are also there.
Some of the biologic therapies used in various diseases include,
Biologic agents developed for asthma therapy have focused on the type 2–high pattern of inflammation, probably because there are more readily available biomarkers that one can measure to identify these patients (e.g., blood eosinophils). Patients with type 2–low asthma are more difficult to characterize and identify, and type 2–low asthma is often described as asthma with the absence of type 2–high characteristics.
Patients with eosinophilic or neutrophilic nasal mucosal inflammation have predominant T2 cytokine or T1 cytokine profiles, respectively. Therefore, as with asthma, attempts at treating nasal polyposis have focused primarily on biologics with capabilities of blocking critical T2-high pathways.
Atopic dermatitis is an immunologically complex disease that may be disfiguring, intensely pruritic, and associated with increased infection risk, thereby significantly reducing quality of life. Patients with atopic dermatitis often have elevated levels of IgE. IL-4 and IL-13 are putatively important in the pathogenesis of atopic dermatitis. As a result, dupilumab has been investigated for the therapy of this disorder.
Patients with chronic urticaria experience recurrent episodes of pruritic hives, often associated with angioedema, for greater than 6 weeks. The intense itching and potentially adverse effects on appearance can significantly decrease quality of life.
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Bachelor of Ayurveda Medicine & Surgery
Master’s in Health Administration
Some single drugs used as Rasayana include,
- Kantakari (Solanum surattense)
- Vasa (Adhatoda vasica)
- Madhuyasti (Glycirrhiza glabra)
- Bharangi (Clerodendrum serratum)
- Pushkarmoola (Inula racemosa)
- Vibhitaka (Terminalia bellerica)
- Shati (Hedychium spicatium)
- Tulsi (Ocimum sanctum)
- Shirisha (Albizia lebbek)
- Haridra (Curcuma longa)
Commonly used Rasayana yoga’s in allergies include,
- Chayavanprash Rasayana
- Chitraka Haritaki Rasayana
- Agastya Haritaki Rasayana
- Vyaghri Haritaki Rasayana
- Vasa Avaleha
- Pippali Rasayana
- Tuvaraka Rasayana
- Bakuchi Rasayana
Article Written By: Dr. Sahil Gupta, Ayurvedic Allergist