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Today, the Austin Animal Services Office launched a community survey to gather feedback on what we, as Austinites, prioritize for our animals.
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Tag: effective
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Biologics for CSU: When Is it Time to Try?
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Is It Time to Try a Biologic for CSU?
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Biologics for CSU: When Is it Time to Try?
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If you have chronic spontaneous urticaria (CSU), also called chronic hives, and treatments like antihistamines and steroids aren’t helping, you may be a good candidate for biologics.
What Are Biologics?
Biologics are medicines that target specific antibodies, molecules, and cell receptors that cause inflammation and may trigger an allergic reaction like CSU.
Omalizumab (Xolair) is the only FDA-approved biologic for CSU. It’s approved for adolescents and adults 12 years and older who have chronic hives. It’s a shot you get about once a month. It blocks IgE, the antibody that causes allergies.
When you first try a biologic, your doctor gives you the shot to make sure everything goes smoothly. “There’s about a 1 in 2,000 risk of having an allergic reaction to the medication, so the first several doses are administered in a physician’s office or [an] infusion clinic,” says Kara Wada, MD, an allergist and immunologist at the Ohio State University Wexner Medical Center in Columbus.
Your doctor may recommend that you keep taking your other CSU medicines at the same time.
Do Biologics Work Well?
Research suggests biologics are an effective treatment for CSU with a low risk of side effects.
In one study, more than 70% of the participants felt better within 24 weeks of taking a biologic. If a biologic helps with your CSU symptoms, you may also see improvements in your sleep quality, stress levels, and quality of life.
Biologics are considered low–risk for side effects, compared with immunosuppressant and anti-inflammatory drugs for CSU.
When to Try a Biologic
Your doctor may recommend a biologic if traditional CSU treatments aren’t working for you.
“Typically, I start considering a biologic if a patient is having daily symptoms that aren’t responding well to antihistamine medications,” Wada says.
With CSU, it’s best to take a step-by-step approach. The first step may be over-the-counter antihistamines. Your doctor may recommend higher doses of antihistamines than you would take for other allergies.
Your doctor may also recommend steroids or other immunosuppressive medicines for a short time.
“It may take a few weeks to have improvement,” says Viktoryia Kazlouskaya, MD, PhD, a dermatologist and dermatopathologist at Khrom Dermatology & Aesthetics in Brooklyn, NY. “Patience is key.”
If your body is resistant to high doses of antihistamines, your doctor may recommend a biologic.
What Biologics Are Available Now
Although omalizumab is the only biologic approved for treating CSU right now, there are more on the horizon. “Other biologics are being studied, but aren’t yet FDA-approved,” Kazlouskaya says.
Some doctors may use biologics that are approved to treat other conditions. This is called off-label use. They may try biologics like benralizumab (Fasenra), dupilumab (Dupixent), mepolizumab (Nucala), reslizumab (Cinqair), and secukinumab (Cosentyx) to treat CSU.
Researchers are studying the following biologics to see how well they treat CSU:
- Benralizumab (Fasenra), mepolizumab (Nucala), and reslizumab (Cinqair). These medicines are approved to treat asthma, but not CSU.
- Dupilumab (Dupixent). In a small study, this medicine helped people who didn’t respond to omalizumab.
- Ligelizumab (QGE031). Like omalizumab, this is an antibody that binds to IgE.
- Secukinumab (Cosentyx). This medicine may help people with chronic hives who don’t get relief from other treatment options.
Doctors hope to have more options as studies continue. With more biologics to choose from, doctors can use predictive biomarkers to choose which one is most likely to work for you.
What to Consider With Biologics
Though proven to have many benefits, biologics have also been shown to have several downsides.
Inconvenience. You may have to go to a doctor’s office every month to get your shot or IV. “If you’re low-risk, you may be able to do it at home,” Wada says, “but that’s less common.”
High costs. “Biologics also have a high price point,” Wada says. “Most people will need insurance coverage or will have to rely on the drug company’s copay assistance programs to help offset the costs.” On top of the biologic’s cost, you may also have to pay your doctor’s office or IV center for administrative costs if they charge any.
Long-term effect. Even though studies suggest biologics improve CSU symptoms, it’s unclear if they can change the long-term course of your CSU. If you take a biologic and decrease your dose or stop taking it altogether, it’s possible for your symptoms to come back. You might need to take a biologic for a long time to trigger remission.
Health Insurance Considerations
“Unfortunately, it’s very challenging to get biologics for patients with CSU, especially if they don’t have private insurance coverage,” Kazlouskaya says.
You may have to wait a few months for approval. Your health insurance company may require you to try a less expensive medicine first, even if it’s not effective for CSU.
Even if your health insurance approves a biologic, you may still have high out-of-pocket costs, depending on the type of plan you have. “Some high-deductible health care plans require that patients meet their out-of-pocket costs before coverage kicks in,” Wada says.
If you have Medicare, you may not qualify for copay assistance programs.
Biologics may work well and give you relief from CSU symptoms. But they’re not for everyone. Talk to your allergist about what’s right for you and whether it’s time to try a biologic.
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Which Atopic Dermatitis Treatments Work Best?
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There are many tools to treat atopic dermatitis (AD), both over-the-counter and prescription. You can try ointments and creams, or your doctor might suggest light therapy, or medications you take by mouth or get as a shot.
“There are constantly new treatments arising for atopic dermatitis that help lessen the burden and make treatment more effective,” says Geeta Patel, DO, founder of River Oaks Dermatology in Houston.
“Topical steroids are currently the mainstay of treatment, but they’re not always the most effective,” she says. What works well for one person doesn’t always work well for another. It may take time to find the right treatment.
Your doctor will make recommendations based on how severe your AD is and what areas of your body it are affects.
Best Treatments for Mild AD
“Mild atopic dermatitis usually involves topical therapy,” Patel says. If you have mild AD, your doctor may recommend one of these topical treatments:
Topical steroids. These creams or ointments relieve itch and ease inflammation. You put them on red or inflamed skin.
Topical steroids come in different strengths. Prescription steroids are usually more effective than over-the-counter products. The stronger it is, the more effective it may be to control inflamed skin. But it may have more side effects, like thinning your skin. Never use high-strength steroids on your face, armpits, or groin. For long-term use, get the lowest strength you can.
Topical calcineurin inhibitors. These creams and ointments have drugs that target your immune system to suppress inflammation and ease symptoms of itching in mild to moderate AD. They’re safe to use long-term. You put them on after you moisturize your skin, but some have rules about how soon you can use them afterward, so check the prescribing info. Examples are pimecrolimus (Elidel) and tacrolimus (Protopic).
Topical PDE4 inhibitors. These topical medications put the brakes on inflammation by blocking PDE4, an enzyme that triggers it. They reduce itching, redness, thickened skin, and oozing in mild to moderate AD. Right now there’s only one FDA-approved PDE4 inhibitor. It’s called crisaborole (Eucrisa). It’s approved for people ages 3 months and older, and you can use it long-term on all body parts.
If you have mild AD, your doctor may also tell you to:
- Avoid triggers
- Moisturize after bathing
- Eat well
- Manage stress
- Sleep well
Best Treatments for Moderate to Severe AD
If you have moderate or severe AD, your doctor may recommend:
Wet wrap therapy. With this treatment, you wrap the affected skin with wet bandages after you apply moisturizers or topical corticosteroids. “Wet dressings help relieve itching, heal your skin, and help your creams or ointments to be more effective,” Patel says.
Your doctor will tell you how to do it and how often.
Oral medications. If creams don’t work, your doctor may recommend oral medication. “These work by slowing your immune system response, which can help to reduce the severity of symptoms,” Patel says.
Ultraviolet light or phototherapy. “Light therapy is often used to treat severe eczema that doesn’t respond to creams,” Patel says. The treatment exposes your skin to a controlled amount of natural sunlight, UVA, or UVB light to help with symptoms.
It usually involves going to your dermatologist’s office 2-3 times a week. Try to be patient. “It can sometimes take 1-2 months to take effect,” Patel says.
Dupilumab (Dupixent). This new lab-made medication can lessen inflammation, itching, how severe the disease is, and how far it has spread. You get it as a shot. Your doctor may recommend it if other treatments don’t work or if you can’t use products you rub onto your skin.
“Trials have shown that most people experienced clear skin and reduced itching after about 16 weeks,” Patel says.
Complementary Treatments for AD
These treatments may help ease your symptoms:
Mind-body practices. “Stress can worsen atopic dermatitis,” Patel says. Managing it can help cut down on flares. Try mindfulness meditation, yoga, tai chi, acupressure, hypnosis, or biofeedback, where you learn how to control things your body does, like your heart rate, to help you relax. These practices may also help if you scratch a lot.
Massage therapy. Massage is known to relieve stress, so it may cut back on flares. Choose a therapist who’s accredited and has experience working with people who have similar skin conditions. Make sure they don’t use oils or lotions that might trigger your AD or make it worse.
Coconut oil. Studies suggest applying coconut oil to your skin may lower staph bacteria and help prevent infection. “Apply it once or twice a day to damp skin,” Patel says. Choose virgin or cold-pressed oils, which don’t have chemicals.
Sunflower oil. “Sunflower oil boosts the skin’s barrier function, helping it retain moisture. It also has anti-inflammatory properties,” Patel says. Put it on twice a day, once after bathing so your skin is wet.
You may have heard that vitamins, supplements, and probiotics help with AD. But there’s not enough research to support taking them, and they may be harmful if you’re taking certain medications.
Lifestyle Tips for AD
Take these steps to help your treatments work better and relieve symptoms:
Take a lukewarm bath. Keep it to 10-15 minutes. Then pat your skin dry and apply moisturizer while it’s still damp.
Moisturize twice a day. Apply moisturizing cream at least twice a day to strengthen your skin’s barrier.
Prevent scratching. If your skin is itchy, try pressing it instead of scratching. “Covering the itchy area also helps stop you from scratching it,” Patel says.
Use a humidifier. “Hot, dry indoor air can dry out sensitive skin and worsen itching and flaking. A portable home humidifier or one attached to your furnace adds moisture to the air inside your home,” Patel says.
Avoid irritants. Choose mild soaps and detergents without dyes or perfumes. Avoid fragrances and cosmetics with chemicals, wool and synthetic clothes, and smoke. Keep your home clear of dust mites. Avoid foods that might trigger a flare.
Take allergy medication. Over-the-counter antihistamines like cetirizine (Zyrtec) and fexofenadine (Allegra) may help with itching. If your itch is severe, you can try diphenhydramine (Benadryl). It may make you drowsy, so take it at bedtime.
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