Mast Cell Stabilizers & Monoclonal Antibodies

• Mast cell stabalizer
• indications: prophylactic treatment! of bronchial asthma, prevention of exercise-induced bronchospasm, allergic rhinitis, food allergies

MOA: an anti-inflammatory agent that has NO intrinsic bronchodilators, antihistaminic, anticholinergic, vasoconstrictive or glucocorticoid activity--it inhibits the degranulation of mast cells that occurs after exposure to antigens. It prevents release of SRSA, histamine and other inflammatory mediators

Can NOT be used for a acute attack, for prophylactic use it may take up to 4 weeks for results

Do NOT discontinue use abruptly without consent of MD

Mast cell stabilizer

Indications: Prophylactic Maintenance therapy in management of mild to moderate asthma

MOA: An anti-inflammatory agent that has NO intrinsic bronchdilator, antihistaminic, anticholinergic, vasoconstricitve, or glucocorticoid activity

Can NOT be used for a acute attack, Drug must be used even during attack free periods

Recombinant humanized monoclonal anti-IgE antibody

Indication: severe asthma unresponsive to other conventional therapies

MOA: binds free the Fc region of circulating IgE (regardless of antigen specificity) and blocks its attachment to the surface of mast cells and basophils which prevents them from responding (no degranulation and release of inflammatory mediators). Down regulates the production of allergen specific high affinity receptors

• Side effects: Anaphylaxis and or an anaphylactoid reactions possible-patients should carry an EpiPen
• Possible cancer risk long term
• possible interference with clearance of parasitic infections

Indications: add-on maintenance treatment of patients with severe asthma aged 12 years and older, and with an eosinophilic phenotype

MOA: an interleukin-5 antagonist (IgG1 kappa). IL-5 is the major cytokine responsible for the growth and differentiation, recruitment, activation, and survival of eosinophils. Mepolizumab, by inhibiting IL-5 signaling, reduces the production and survival of eosinophils; however, the mechanism of mepolizumab action in asthma has not been definitively established