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Understanding Asthma Medications (cont.)

Mast Cell Inhibitors for Asthma: Use, Side Effects, and Interactions

Cromolyn sodium (Intal) and nedocromil (Tilade) are used to prevent allergic symptoms like runny nose, itchy eyes, and asthma. The response is not as potent as that of corticosteroid inhalers.

How mast cell inhibitors work

These drugs prevent the release of histamine and other chemicals from mast cells that cause asthma symptoms when you come into contact with an allergen (for example, pollen). The drug is not effective until four to seven days after you begin taking it.

Who should not use these medications

Individuals who are allergic to any components of the inhaled product should not take these drugs.

Use

Frequent dosing is necessary, since the effects last only six to eight hours. Mast cell inhibitors are available as a liquid to be used with a nebulizer, a capsule that is placed in a device that releases the capsule powder to inhale, and handheld inhalers.

Drug or food interactions

Since these drugs have little or no effect beyond the area applied, they are unlikely to interact with other drugs. Mast cell inhibitors may cause a cough, irritation or unpleasant taste.

Side effects

These drugs are only effective for prevention and are not to be used to treat an acute asthma attack.

Monoclonal Antibodies for Asthma: Use, Side Effects, and Interactions

Omalizumab (Xolair) is one of the newer asthma medications. It may be considered for individuals with persistent, moderate to severe asthma due to seasonal allergies that is not controlled by inhaled corticosteroids. The cost of omalizumab is estimated at $12,000-$15,000 per year.

Mepolizumab (Nucala) is another monoclonal antibody that is also used for moderate to severe asthma not controlled with standard care, including inhaled steroids.

How monoclonal antibodies work

Omalizumab binds to human immunoglobulin E (IgE) on the surface of mast cells and basophils (cells that release chemicals that cause allergic symptoms). By binding to IgE, omalizumab reduces the release of the allergy-inciting chemicals.

Mepolizumab binds to interleukin 5, which results in a decrease certain inflammatory cells (eosinophils). These eosinophils contribute to the development of asthma attacks.

Who should not use these medications

Individuals who are allergic to omalizumab or mepolizumab or its contents should not use it.

Use

For omalizumab, the dose depends on the IgE levels in the blood.

Adults and children older than 12 years of age are given an injection every two to four weeks.

For mepolizumab, adults and children older than 12 years of age who have elevated eosinophils (a specific inflammatory white blood cell) receive 100 mg by injection every four weeks.

Drug or food interactions

Drug interactions have not been reported.

Side effects

Omalizumab and mepolizumab are not effective in treating acute asthma attacks. Inhaled corticosteroids should not be suddenly stopped when initiating these medications. Swelling or pain at the area of injection may be experienced.

REFERENCES:

Fanta, Christopher H. "An overview of asthma management." May 31, 2016. UpToDate.com. <https://www.uptodate.com/contents/an-overview-of-asthma-management>.

Lee, S.L., et al. "Regulatory considerations for approval of generic inhalation drug products in the US, EU, Brazil, China, and India." AAPS J 17.5 Sept. 2015: 1285-1304.

United States. Food & Drug Administration (FDA). "FDA Approves Nucala to Treat Severe Asthma." Nov. 4, 2015. <https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm471031.htm>.


Medically Reviewed by a Doctor on 7/20/2017

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