Tina Sindher, MD: Optimal Biologic Use in Allergies

As biologic clinical assessment advances in allergic care, clinicians are following with hope—but a limited expectation.

In an interview with MD Magazine® while at the American College of Allergy, Asthma & Immunology (ACAAI) 2019 Scientific Meeting in Houston, Tina Sindher, MD, clinical assistant professor at Stanford University, explained her expectations for further biologic research and what patients may fare best from its effects.

MD Mag: How has the progression of immunotherapy care influenced other allergy therapies?

Sindher: We have to also keep in mind that whenever we talk about biologics, at this time, we're talking about biologics in addition to oral immunotherapy. So, we haven't really done biologic monotherapy yet. I mean, there are studies underway, but we're not subjecting a patient to just biologic without the oral immunotherapy on board as well.

MD Mag: Do you imagine this could be as equally good benefit?

Sindher: I think that the reason for that is, we're hoping not to subject the patient to a biologic long-term. I mean, when do you stop? So, at least for the Xolair studies, we only have them in the first 16 weeks of their updosing protocol, and then you back off.

For the newer studies where the age is 2 years and up, you're not subjecting a child to a long time with biologics. So with monotherapy, because they're not actually developing the actual interaction with the food, they may not be protected unless they take on the OIT. Or, if they stop the biologic, they're going to go right back to being reactive—which is part of the reason I think oral immunotherapy with biologics makes sense.

That being said, we see so many kids who are just so severe that they cannot use oral immunotherapy at all, and a biologic could be a great way to at least get them started on monotherapy. And then when they get to a spot where they are able to consume, they can kind of bridge into the oral immunotherapy at that time—or maybe use it as an as-needed basis, like they're traveling and get a dose of a biologic a few weeks before going. Then you're protected for a certain amount of time.

MD Mag: Is symptom prevention a feasible potential use for biologics in allergy?

Sindher: Just because we come across so many children and teenagers who are just going to avoid it—'I don't need to eat the food, I don't want to get shots, I don't want to do OIT, I just don't want any aspect of it’—whereas their parents are like, ‘But you need to be protected.’

A lot of times, a lot of my patients who are very under control in the United States, they travel—maybe they go to Asia, they go to Europe—I mean it's a lot easier in Europe now than it was before, I suppose. But it's just a lot harder to be on top of your food intake if you're not actively cooking every ingredient yourself.

So if it's some sort of biologic to block that immune response for a short period of time, I think it would be a great way to use it for certain subsets of patients.