Review on the Application of Biologic Factors in Atopic Dermatitis and Chronic Spontaneous Urticaria.

Abstract

Purpose: The use of biologic factors in atopic dermatitis (AD) and chronic spontaneous urticaria (CSU).

Methods: Data from different phase clinical trials, including RCTs and observational and real-world evidence, which were published in PubMed, were classified according to parameters evaluating AD and CSU. The keywords included the scientific names of different biological factors, AD and CSU.

Results: Recalcitrant cases of AD and chronic CSU are rare, but they impose a burden on the lives of patients and a significant treatment cost. Monoclonal antibodies are currently used to treat a variety of autoimmune skin disorders. However, direct application of previous experience to AD and CSU was not applicable, because AD etiology involves a number of cytokine networks, and CSU seems to be related to a disorganized cytokine background.

Conclusions: Dupilumab is ans FDA- and EMA-approved monoclonal antibody, which is effective in 40%-60% of severe AD cases. FDA/EMA-approved are also baricitinib, upadacitinib, and tralokinumab, which could be used as an alternative option. As our knowledge of the endotypes of the disease expands, precision medicine will be applied for the best results. Omalizumab has been used in clinical trials and real-life cases to treat CSU, but a debate on the efficacy of the monoclonal is frequently reported. However, EACCI's current guidelines for the disease include omalizumab as an add-on treatment for recalcitrant cases.