Biologicals in atopic disease in pregnancy: An EAACI position paper

Birgit Pfaller¹, Juan José Yepes-Nuñez², Ioana Agache³, Cezmi A Akdis⁴, Mohammad Alsalamah^{5

6

7}, Sevim Bavbek^{8

9}, Apostolos Bossios^{10

11}, Onur Boyman^{12

13}, Adam Chaker¹⁴, Susan Chan^{15

16}, Alexia Chatzipetrou^{17

18

19

20}, George du Toit²¹, Marek Jutel^{22

23}, Paula Kauppi²⁴, Antonios Kolios^{12

13}, Carmen Li⁵, Andrea Matucci²⁵, Alanna Marson⁵, Sarah Bendien²⁶, Oscar Palomares²⁷, Barbara Rogala²⁸, Zsolt Szepfalusi²⁹, Eva Untersmayr³⁰, Alessandra Vultaggio²⁴, Thomas Eiwegger^{5

31

32}

Affiliations

¹ Division of Cardiology, Department of Medicine, University of Toronto Pregnancy and Heart Disease Research Program, Mount Sinai and Toronto General Hospitals, Toronto, ON, Canada.
² School of Medicine, Universidad de los Andes, Bogotá, D.C., Colombia.
³ Faculty of Medicine, Department of Allergy and Clinical Immunology, Transylvania University Brasov, Brasov, Romania.
⁴ Swiss Institute of Allergy and Asthma Research (SIAF), Davos, Switzerland.
⁵ Division of Immunology and Allergy, Food Allergy and Anaphylaxis Program, The Hospital for Sick Children, Toronto, ON, Canada.
⁶ College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
⁷ Clinical Immunology and Allergy Division, Pediatrics Department, King Abdullah Specialists Children's Hospital, Riyadh, Saudi Arabia.
⁸ Division of Immunology and Allergy, Department of Chest Disease, School of Medicine, Ankara University, Ankara, Turkey.
⁹ Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Huddinge, Sweden.
¹⁰ Department of Medicine, Huddinge, Stockholm, Sweden.
¹¹ Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.
¹² Department of Immunology, University Hospital Zurich, Zurich, Switzerland.
¹³ Faculty of Medicine, University of Zurich, Zurich, Switzerland.
¹⁴ Department of Otolaryngology and Center for Allergy and Environment, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany.
¹⁵ Guy's and St. Thomas' NHS Foundation Trust, London, UK.
¹⁶ King's College London School of Life Course Sciences, School of Immunology, Microbial Sciences, King's Health Partners, UK.
¹⁷ Allergy Unit "D. Kalogeromitros, Department of Dermatology and Venereology, Medical School, Attikon" University Hospital, University of Athens, Athens, Greece.
¹⁸ Paediatric Allergy Group, Department of Women and Children's Health, King's College London, London, UK.
¹⁹ Paediatric Allergy Group, Peter Gorer Dept of Immunobiology, School of Immunology & Microbial Sciences, King's College London, Guys' Hospital, London, UK.
²⁰ Children's Allergy Service, Evelina Children's Hospital, Guy's and St, Thomas' Hospital NHS Foundation Trust, London, UK.
²¹ Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK.
²² Department of Clinical Immunology, Wroclaw Medical University, Wrocław, Poland.
²³ ALL-MED Medical Research Institute, Wroclaw, Poland.
²⁴ Department of Allergy, Skin and Allergy Hospital, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
²⁵ Immunoallergology Unit, Careggi University Hospital, Florence, Italy.
²⁶ Department of respiratory medicine, Haga Teaching Hospital, The Hague, The Netherlands.
²⁷ Department of Biochemistry and Molecular Biology, Chemistry School, Complutense University of Madrid, Madrid, Spain.
²⁸ Department of Internal Diseases, Allergology & Clinical Immunology Medical, University of Silesia, Katowice, Poland.
²⁹ Division of Ped. Pulmonology, Allergology and Endocrinology, Dpt. of Pediatrics, Medical University of Vienna, Vienna, Austria.
³⁰ Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.
³¹ Department of Immunology, University of Toronto, Toronto, ON, Canada.
³² Translational Medicine Program, Research Institute, Hospital for Sick Children, Toronto, ON, Canada.

PMID: 32189356
DOI: 10.1111/all.14282

Biologicals in atopic disease in pregnancy: An EAACI position paper

Birgit Pfaller et al. Allergy. 2021 Jan.

. 2021 Jan;76(1):71-89.

doi: 10.1111/all.14282.

Authors

Affiliations

¹ Division of Cardiology, Department of Medicine, University of Toronto Pregnancy and Heart Disease Research Program, Mount Sinai and Toronto General Hospitals, Toronto, ON, Canada.
² School of Medicine, Universidad de los Andes, Bogotá, D.C., Colombia.
³ Faculty of Medicine, Department of Allergy and Clinical Immunology, Transylvania University Brasov, Brasov, Romania.
⁴ Swiss Institute of Allergy and Asthma Research (SIAF), Davos, Switzerland.
⁵ Division of Immunology and Allergy, Food Allergy and Anaphylaxis Program, The Hospital for Sick Children, Toronto, ON, Canada.
⁶ College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
⁷ Clinical Immunology and Allergy Division, Pediatrics Department, King Abdullah Specialists Children's Hospital, Riyadh, Saudi Arabia.
⁸ Division of Immunology and Allergy, Department of Chest Disease, School of Medicine, Ankara University, Ankara, Turkey.
⁹ Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Huddinge, Sweden.
¹⁰ Department of Medicine, Huddinge, Stockholm, Sweden.
¹¹ Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.
¹² Department of Immunology, University Hospital Zurich, Zurich, Switzerland.
¹³ Faculty of Medicine, University of Zurich, Zurich, Switzerland.
¹⁴ Department of Otolaryngology and Center for Allergy and Environment, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany.
¹⁵ Guy's and St. Thomas' NHS Foundation Trust, London, UK.
¹⁶ King's College London School of Life Course Sciences, School of Immunology, Microbial Sciences, King's Health Partners, UK.
¹⁷ Allergy Unit "D. Kalogeromitros, Department of Dermatology and Venereology, Medical School, Attikon" University Hospital, University of Athens, Athens, Greece.
¹⁸ Paediatric Allergy Group, Department of Women and Children's Health, King's College London, London, UK.
¹⁹ Paediatric Allergy Group, Peter Gorer Dept of Immunobiology, School of Immunology & Microbial Sciences, King's College London, Guys' Hospital, London, UK.
²⁰ Children's Allergy Service, Evelina Children's Hospital, Guy's and St, Thomas' Hospital NHS Foundation Trust, London, UK.
²¹ Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK.
²² Department of Clinical Immunology, Wroclaw Medical University, Wrocław, Poland.
²³ ALL-MED Medical Research Institute, Wroclaw, Poland.
²⁴ Department of Allergy, Skin and Allergy Hospital, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
²⁵ Immunoallergology Unit, Careggi University Hospital, Florence, Italy.
²⁶ Department of respiratory medicine, Haga Teaching Hospital, The Hague, The Netherlands.
²⁷ Department of Biochemistry and Molecular Biology, Chemistry School, Complutense University of Madrid, Madrid, Spain.
²⁸ Department of Internal Diseases, Allergology & Clinical Immunology Medical, University of Silesia, Katowice, Poland.
²⁹ Division of Ped. Pulmonology, Allergology and Endocrinology, Dpt. of Pediatrics, Medical University of Vienna, Vienna, Austria.
³⁰ Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.
³¹ Department of Immunology, University of Toronto, Toronto, ON, Canada.
³² Translational Medicine Program, Research Institute, Hospital for Sick Children, Toronto, ON, Canada.

PMID: 32189356
DOI: 10.1111/all.14282

Abstract

Biologicals have transformed the management of severe disease phenotypes in asthma, atopic dermatitis, and chronic spontaneous urticaria. As a result, the number of approved biologicals for the treatment of atopic diseases is continuously increasing. Although atopic diseases are among the most common diseases in the reproductive age, investigations, and information on half-life, pharmacokinetics defining the neonatal Fc receptors (FcRn) and most important safety of biologicals in pregnancy are lacking. Given the complex sequence of immunological events that regulate conception, fetal development, and the intrauterine and postnatal maturation of the immune system, this information is of utmost importance. We conducted a systematic review on biologicals in pregnancy for indications of atopic diseases. Evidence in this field is scarce and mainly reserved to reports on the usage of omalizumab. This lack of evidence demands the establishment of a multidisciplinary approach for the management of pregnant women who receive biologicals and multicenter registries for long-term follow-up, drug trial designs suitable for women in the reproductive age, and better experimental models that represent the human situation. Due to the very long half-life of biologicals, preconception counseling and healthcare provider education are crucial to offer the best care for mother and fetus. This position paper integrates available data on safety of biologicals during pregnancy in atopic diseases via a systematic review with a detailed review on immunological considerations how inhibition of different pathways may impact pregnancy.

Keywords: allergy; asthma; atopic dermatitis; biologicals; pregnancy.

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References

REFERENCES

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Biologicals in atopic disease in pregnancy: An EAACI position paper

Affiliations

Biologicals in atopic disease in pregnancy: An EAACI position paper

Authors

Affiliations

Abstract

References

REFERENCES

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LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Research Materials