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Table 1
Summary of biological agents used in the treatment of asthma and allergic rhinitis
Biological agent	Disease studied	Target	Mechanisms	Safety	Efficacy

SCIT	AR & asthma	Specific aeroallergens or venom	Several immune changes including↑IL-10 & TGF-β. isotype switch to IgG	Surveys suggest; fatality rate of 1 in 2.5 million injections^34-36& near fatal reaction rate of 5.4 per 1 million injections³⁷	Appears to depend on dose
SLIT	AR & asthma	Specific aeroallergens	Probably similar to SCIT	Most common AEs oral-mucosal symptoms AE less common than SCIT but cases of anaphylaxis have been reported	A consistent relationship with dose and efficacy has not been established³⁹
MPL	AR	TRL4	Shift toward Th1 response	SRs reported in 1.6% of the 1736 patients in postmarking surveillence survey⁵⁰	Clinical efficacy seen in first treat season after 4 injection treatment course
CpG	AR	TRL9	Shift toward Th1 response	No serious treatment-related effects⁴⁶	Clinical efficacy seen in 1^st& 2^ndtreatment season after one 4 injection course⁴⁶
Omalizumab	Asthma & AR	IgE	Prevents binding of IgE to mast cells and basophils, downregulatuion of IgE receptor on these cells	Anaphylaxis in 0.09 to 0.2% of patients^19,20	Efficacy in medication reduction & exacerbation in asthma, clinical improvement in AR
Mepolizumab	Asthma	IL-5	Blocks binding of IL-5 to α receptor on eosinophils	One episode of hypotension after infusion in EE study⁵⁷	No significant improvement in asthma⁵⁵
Pintrakinra⁵⁸	Asthma	IL-4Rα receptor	Competes with IL-4 and IL-13 for binding to the receptor	Non-neutralizing IgG anti- pintrakinra antibodies in ~30% of pts	Increased PD_{20 in}methacholine challenge & asthma AE & beta-agonist use
Etanercept	Asthma	TNF-alpha	soluble TNF-alpha receptor	No significant treatment-related AE is asthma ⁵⁹but increased risk of serious & opportunistic infection in rheumatologic disease	Increased markers of TNF-alpha activity & improved clinical outcomes in refractory asthma ⁵⁹

SCIT = subcutaneous immunotherapu, SLIT = sublingual immunotherapy, AR = allergic rhinitis, MPL = -deacylated monophospholipid A, CpG = immunostimulatory oligonucleotide sequence of DNA containing a CpG motif, TNF-alpha = tumor necrosis factor alpha, AE = adverse event, SAE = serious adverse event, EE = eosinophilic esophagitis, PD₂₀= Provocative Dose, which produces a decrease in FEV1 by 20% from the initial value or baseline value
Cox Allergy, Asthma & Clinical Immunology 2009 5:4 doi:10.1186/1710-1492-5-4

Table 1