What They Are:
Immunomodulators are a new class of asthma medications that are used as an add-on therapy in people who have severe persistent asthma with allergies that has not responded adequately to a combination of inhaled steroids and long-acting beta agonists. This type of medicine is used for long-term control (or prevention) of asthma symptoms.How They Work:
Immunomodulators are drugs that provide what is known as a steroid-sparing effect. That is, using them provides an opportunity to take smaller doses of steroids. Chemically, the main type of immunomodulator available currently (Xolair) is a type of antibody called monoclonal. It binds to a portion of the IgE antibody to prevent it, in turn, from binding to receptor sites on mast cells and basophil cells. IgE, mast cells and basophils are all involved in the inflammatory process in your airways. So blocking them from working together decreases inflammation and both allergy and asthma symptoms.The Effects:
Using an immunomodulator along with an inhaled steroid for people with severe persistent allergic asthma results in significant improvements in airway and lung function. As a result, there is a lessening of asthma flares and less frequent asthma attacks. In some cases, the dose of the steroid can also be decreased – by as much as 25% in studies – and still produces positive results.Examples:
Currently, only one immunomodulator drug is approved for use in treating asthma, though several others are being studied. The term "immunomodulator" is used to loosely describe drugs that provide long-term control of asthma with steroid-sparing. Presently, Xolair is the only available immunomodulator. Experts have also studied the immunomodulator effectiveness of antibiotics and several other drugs, but so far none have proved to be worth going further.Although some of these drugs may have showed promise initially, all carry significant risk of toxicity. The bottom line is that any possible benefits of the other drugs do not outweigh the risks. So, apart from Xolair, the current guidelines for the treatment of asthma do not recommend the use of any of the other experimental immunomodulators.Comparison to Inhaled Steroids:
Immunomodulators are not a substitute for inhaled steroids in most cases. For one thing, they are only recommended for use in severe persistent asthma. Inhaled steroids can be used for all levels of severity, as well as for exercise-induced asthma. However, any steroid carries a certain amount of risk of side effects. In addition, not everyone will tolerate steroids well. So, immunomodulators can be given in combination with an inhaled steroid. And they can, in some cases, enable a reduction in the dose of the inhaled steroid, which can be helpful in reducing the risk of side effects from the steroids.Other Important Facts:
Even Xolair carries a certain amount of risk, although in many cases the benefits for Xolair do outweigh the risks. This will always be an individual decision, however, made on a case by case basis between you and your doctor.Xolair carries what is known as a "black box warning" from the U.S. Food and Drug Administration (FDA for short). The FDA requires that this warning be part of the prescribing information and on patient information materials supplied with the drug.What this warning means is that Xolair represents a certain amount of risk to your safety and health.
It should be emphasized that these adverse reactions have occurred in very small numbers of people who have taken Xolair. However, because these reactions are so serious, they cannot be ignored. If you and your doctor decide that Xolair is the right choice for you, then it will be important to understand the signs and symptoms of anaphylaxis, as well as what actions to take to prevent serious harm or death.
In Summary:
Immunomodulators represent an important opportunity to improve quality of life in people with severe persistent asthma who have not been able to achieve adequate asthma control through other methods. But the decision whether to use them will need to consider the specific risks vs. benefits for your situation. So, if this is a treatment you would like to explore, be sure to take the time to discuss it thoroughly with your doctor first, in order to make the most informed decision possible.Source:
"Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma." NHLBI Guidelines for the Diagnosis and Treatment of Asthma. 28 Aug 2007. National Heart Lung and Blood Institute. 18 Dec. 2007 <http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf>
