Biologics and biomarkers for asthma, urticaria, and nasal polyposis.

Many patients with allergic disorders continue to have uncontrolled symptoms despite new and better pharmacologic options. Novel biologic agents that target specific and critical pathophysiologic pathways have been developed to better manage these patients. The utility of biologic agents for the management of allergic diseases has been facilitated by recent advances in better characterizing patients, including identification of relevant biomarkers that predict clinical responsiveness. This has led to the ability to phenotype and endotype patients, allowing for a more rational approach to picking a specific biologic agent for a specific patient. In this review I focus on point-of-care biomarkers that enhance the usefulness of biologics to manage uncontrolled asthma, urticaria, and nasal polyposis. I discuss biologic agents already approved for the management of allergic and respiratory disorders and biologics currently in development or recently abandoned because of a lack of efficacy or intolerable side effects. The successes and failures of biologics in clinical trials have facilitated our ability to better understand which molecules and pathways are most important in the pathogenesis of allergic diseases and in the development of symptoms and impairment in individual patients.