Atopic Disease Hypersensitivity Reactions Vary by Biologic Type, with Valerie Jaroenpuntaruk, MD

A study found reslizumab had the greatest rate of hypersensitivity reactions among patients with atopic diseases, followed by omalizumab. This retrospective cohort study, presented at the 2025 American Academy of Allergy, Asthma, & Immunology (AAAAI) annual meeting in San Diego from February 28 – March 3, reported the severity and prevalence of hypersensitivity reactions to specific biologics for atopic diseases.

Investigators reviewed Mayo Clinic Health System records from January 2009 and August 2024, identifying 65 patients (mean age: 45.2 years; 60 females) with hypersensitivity reactions to biologics. The team examined the reactions of patients taking the following biologics: benralizumab, dupilumab, mepolizumab, omalizumab, reslizumab, and tezepelumab. 2 patients reacted to multiple biologics.

Most patients (74%) had ≥ 1 atopic condition, such as asthma, chronic urticaria, atopic dermatitis, idiopathic anaphylaxis, chronic rhinosinusitis with nasal polyps, eosinophilic esophagitis, and mast cell disorders. The mean documentation of allergies per person was 16.7.

Ahead of AAAAI, HCPLive spoke with investigator Valerie Jaroenpuntaruk, MD, from the Mayo Clinic, on what these findings mean for clinicians.

“I would say the big takeaway for this study's finding is that we found that while hypersensitive reactions to biologics are generally uncommon, the prevalence varies by agent overall,” Jaroenpuntaruk said.

Jaroenpuntaruk and colleagues found 2.2% of patients on biologic therapy for atopic diseases experience hypersensitivity reactions, with reslizumab having the greatest reaction rate, followed by omalizumab. Most reactions occurred within the first 2 doses; the most common manifestations were cutaneous, respiratory, and other symptoms, in that order. The study also demonstrated that reactions were more common in females, in which 83% had a history of drug allergies.

The findings also highlight the feasibility of switching between biologic therapies, with a 97.2% success rate for the 81.8% of participants who switched a biologic. Moreover, 75% of participants successfully switched to the same biologic.

“Biologics have changed so many lives, and it could make so much a big difference in patients’ atopic or underlying atopic conditions,” Jaroenpuntaruk said. “In general, just be aware that while these [reactions] are low, it can happen, but essentially it comes down to [a] risk-benefit discussion with the patient to guide kind of more at the final decision on the therapy.”

A relevant disclosure for Jaroenpuntaruk includes GlaxoSmithKline, LLC.