Exacerbations of Severe Asthma While on Anti-IL-5 Biologics.

Abstract	Anti-interleukin 5 (IL-5) and anti-IL-5 receptor α monoclonal antibodies markedly decrease airway and peripheral blood eosinophil numbers and are thus highly effective in reducing asthma exacerbations. Nonetheless, these biologics do not completely resolve exacerbations. There is very little information on the cellular nature of exacerbations during treatment with biologics. Using illustrative clinical case scenarios, we highlight the importance of carefully characterizing asthmatics at the time of exacerbation and recognizing neutrophilic causes of exacerbations to ensure optimal management. While an eosinophilic exacerbation may improve with more corticosteroids or by switching to another anti-IL-5 monoclonal antibody, a noneosinophilic exacerbation will likely not. An infective exacerbation needs to be recognized, and the pathogen must be identified and treated with the appropriate antimicrobial agent.
Authors	A Bhalla, N Zhao, D D Rivas, T Ho, L Perez de Llano, M Mukherjee, P Nair
Journal	Journal of investigational allergology & clinical immunology (J Investig Allergol Clin Immunol) Vol. 30 Issue 5 Pg. 307-316 ( 2020) ISSN: 1018-9068 [Print] Spain
PMID	32573459 (Publication Type: Case Reports, Journal Article, Review)
Chemical References	Anti-Asthmatic Agents Antibodies, Monoclonal Antibodies, Monoclonal, Humanized IL5 protein, human Interleukin-5 Receptors, Interleukin-5 benralizumab
Topics	Aged Aged, 80 and over Animals Anti-Asthmatic Agents (administration & dosage, adverse effects, therapeutic use) Antibodies, Monoclonal (administration & dosage, adverse effects, therapeutic use) Antibodies, Monoclonal, Humanized (administration & dosage, adverse effects, therapeutic use) Asthma (complications, diagnosis, drug therapy) Disease Management Disease Progression Eosinophils (drug effects, immunology, metabolism) Female Humans Interleukin-5 (antagonists & inhibitors, metabolism) Leukocyte Count Male Middle Aged Receptors, Interleukin-5 (antagonists & inhibitors, metabolism) Respiratory Function Tests Sputum (immunology, metabolism, microbiology) Tomography, X-Ray Computed Treatment Outcome

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