What Is an Immunomodulator?
An immunomodulator is a relatively new class of asthma medication that is indicated for patients with difficult-to-control asthma. As an add-on therapy for your asthma, an immunomodulator is a controller medication, rather than a short acting medication for the acute relief of asthma symptoms. For the nearly one third of asthmatic patients who either do not respond to inhaled steroids or have a poor response, an immunomodulator may offer some hope for better asthma control.
Xolair, a monoclonal antibody, is the only currently approved immunomodulator therapy available for asthma. This immunomodulator is appropriate for moderate persistent or severe persistent asthma patients with:
- A positive skin test or other blood test indicating allergy to a known asthma trigger such as dust mites, dog, cat or cockroach dander.
- Symptoms that are inadequately controlled with inhaled corticosteroids.
The other immunomodulator commonly used in allergy and immunology practices today is Cinryze, a treatment for a recurring swelling in the face and neck called hereditary angoedema.
How Does an Immunomodulator Work?
Immunomodulators decrease asthma symptoms and decrease the need for systemic corticosteroids. Needing systemic corticosteroids more than twice per year is a sign of poor asthma control. Immunomodulators decrease inflammation by impacting a number of different places in the pathophysiology of asthma, including:
An immunomodulator binds to IgE and prevents it from binding to basophils and mast cells. Additionally, an immunomodulator decreases the number of circulating basophils and prevents mast cells from releasing substances that will make your symptoms worse.
How Will an Immunomodulator Help Me?
An immunomodulator is sometimes referred to as a steroid-sparing drug that improves airway and lung function. Additionally, an immunomodulator will decrease asthma symptoms such as:
Treatment with an immunomodulator has been associated with a decreased frequency of asthma exacerbations, emergency room visits and improvements in lung function and quality of life.
An immunomodulator will generally not replace your other asthma treatment, but will be added to it. Addition of an immunomodulator has been associated with as much as a 25% decrease in steroid use.
Potential Immunomodulator Side Effects
While your immunomodulator should be well tolerated, there are a number of common side effects and uncommon side effects you should be aware of:
- Urticaria and anaphylactic reactions- Urticaria or hives is an allergic reaction that can have serious consequences if not treated promptly and appropriately. Your doctor will require that you be monitored for a period of time in the office after each injection. While most reactions occur within one to two hours after one of the initial injections, allergic reactions have occurred after many injections and after many hours after receiving the injection.
- Cancer- While not totally clear at this point, cancers were more common among patients receiving Xolair. However, the reason why this relationship between cancer and the immunomodulator was seen is not yet totally understood.
- Injection site pain- As with any injection, pain at the injection site is a known side effect and may occur in up to 20% of patients receiving an immunomodulator.
- Upper respiratory tract infections- Make sure that you discuss with your doctor what to do and when it is appropriate to seek care if you experience these symptoms.
- Sore throat and headache- If these symptoms do not resolve with conservative measures like fluid and over-the-counter pain medication than you should talk with your doctor.
Impact of an Immunomodulator on Asthma
- Everything You Need To Know About Xolair (Omalizumab)
- What Xolair Side Effects Should I Be Concerned With?
- What Is Xolair Anaphylaxis?
- Does Xolair Increase Cancer Risk?
National Heart, Lung, and Blood Institute. Accessed: October 5, 2011. Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma
Dimov VV, Casale TB. Immunomodulators for Asthma. Allergy Asthma Immunol Res. 2010 October; 2(4): 228–234.