More than 22 million people in the U.S. suffer from asthma. As Centreville allergists, we know there are many options for treating your
allergies. Though several effective medications are available, many asthmatics frequently experience severe flare-ups of their asthma causing shortness of breath, wheezing, and/or cough. About 400, 000 people end up getting hospitalized every year in the U.S. for management of their acute exacerbations.
As asthma is a chronic inflammatory condition involving the lungs, most currently available preventive maintenance medications are in the form of anti-inflammatory drugs inhaled directly into the lungs. A few oral medications are also frequently employed, though they are usually less effective.
A third class of medications consists of injectable agents given every few weeks on a regular basis. These are called monoclonal antibodies which target and reduce the numbers of certain specific mediators which contribute to the severity of asthma.
One of them, Xolair (omalizumab), has been available for the past several years. It reduces the numbers of IgE antibodies which play a crucial role in causing exacerbations of asthma. In selective patients who meet certain criteria, it has been found to be very useful in reducing the frequency of asthma symptoms and the need for emergency treatments.
A second drug in this class, called Nucala (mepolizumab), was recently approved by the FDA for the treatment of severe asthma. It is a monoclonal antibody produced by recombinant DNA technology which targets and blocks a protein mediator called IL-5 (interleukin 5). IL-5 causes an increase in the number of a particular type of white blood cell called an eosinophil which contributes to tissue damage in the lungs. Since Nucala blocks the effect of IL-5, the resulting number of eosinophils decreases which reduces the tissue damage in the lungs of asthmatics.
In clinical trials, Nucala has shown to decrease the numbers of asthma exacerbations, emergency room visits and hospitalizations compared to a placebo. It has been approved to treat severe and persistent asthma in adolescents above 12 years of age and adults who are still symptomatic despite the regular use of other controller medications.
While the dose and the frequency of administration of Xolair is determined by the weight of the patient and the serum IgE level, Nucala is given in a standard dose of 100 mg. every 4 weeks. It can be injected under the skin in the arms, thighs, or abdomen. The only criterion for the use of Nucala is a blood eosinophil count of more than 150 cells/mcL (which can be measured in a routine CBC) in patients with uncontrolled asthma. The most common side effects of Nucala include headache, injection site reactions (pain, redness, swelling, itching, and/or a burning feeling at the injection site), back pain, and/or fatigue.
This new medication is a welcome addition to our armamentarium in our battle with uncontrolled asthma. It has the potential to greatly benefit certain selective patients whose asthma is predominantly mediated by harmful eosinophils. Being allergists in Centerville, we are happy to see additional alternative therapeutic options for the treatment of asthma.
In addition to the above treatment modalities for asthma, allergy shots (i.e., allergy injections, allergy immunotherapy, allergy desensitization) are a very effective in the treatment of asthma. It should be noted that Xolair as well as Nucala can be given in combination with allergy shots.
The board certified allergists at Black and Kletz Allergy in the Washington, DC, Northern Virginia, and Maryland metropolitan area will gladly answer any questions and concerns about this new treatment modality. Dr. Michael Kletz and Dr. Appaji Gondi, Centreville allergists at Black and Kletz Allergy, have been treating both adults and children with hay fever, with hay fever, asthma, sinus problems, insect sting allergies, eczema, hives, swelling episodes, food and medication allergies, and immunological problems for more than 50 years. We have an office in Washington, DC and 2 offices in Northern Virginia with locations in McLean, VA (Tysons Corner, VA) and Manassas, VA. All 3 office locations offer on-site parking and the Washington, DC and McLean, VA locations are also Metro accessible. There is a free shuttle that runs between our McLean office and the Spring Hill metro station on the silver line. For an immediate appointment, please call us or you may click Request an Appointment and we will respond within 24 hours by the next business day.