Anti IL4/5/13 for Mast Cell Disorders and Multiple Chemical Sensitivities and ME/CFS by proxy

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Lately several antibodies targeting the receptors IL4, IL13 and IL5 have been approved for a range of conditions : asthma, eczema and chronic rhinosinusitis. These new treatments efficiently down regulate Th2 mediated inflammation and relieve symptoms. They work best for people who have an eosinophils blood count higher than 300 cells/mm3 (0.3 x10^9/L). Another Th2 inflammation suppressing antibody in the work is Lenzilumab, which targets GM-CSF and indirectly reduce the count of several monokines such MCP-1, MIP-1⍺, MIG, IP-10 and IL-1, Some shown to be elevated in ME/CFS serum and/or correlate with ME/CFS severity. Lenzilumab has shown a lot of promise in treating COVID-19 cytokine storm and is currently in phase 3 trial for this condition. Lenzilumab appear to not only relieve the cytokine storm but also speed up viral clearance. (Shifting from Th2 to Th1?)

Seeing that none of the traditional immune suppressants has yet to work for ME/CFS, and the only immune suppressant that has shown any signal to date is the highly potent and non-selective cyclophosphamide, maybe the next step for an attempt at immune suppression for ME/CFS is a cocktail of these new generation Th2 directed immune suppressants. It may not cure ME/CFS but it may reduce symptoms further and relieve some of the fatigue.

What is your blood eosinophils count and do you have some symptoms such as occasional asthma-like difficulty breathing and itching from taking a shower? I certainly do and my eosinophils count is 380.

Anti IL4/13: Dupilumab; Anti-IL5: Benralizumab, Anti-GM-CSF: Lenzilumab. All very expensive.
 
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Omalizumab is another biologic that can effectively downregulate the Th2 immune response. It depletes IgE antigens and reduce activity and cytokine release from mast cells, basophils and eosinophils through IgE receptor downregulation. It's an asthma drugs, but there are several trials showing it works just as well for atopy. It happens to be the cheapest of all the these biologics and has an Indian biosimilar that cost ~120$ per vial. The required maintenance dose is 2 vials per month after IgE depletion is confirmed by blood tests.. In case someone is willing to give it a try.

Apparently there are some case reports for improvements with Omalizumab:
https://forums.phoenixrising.me/thr...mcas-and-xolair-omalizumab.45044/#post-892231
 
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The main issue in modulating inflammatory response such as in atopy is the emergence of new redundant pathways causing the treatment to fail or lose effectiveness eventually. None of the drug mentioned so far in this thread have a 100% response rates and for some people they stop working after some time. For example in the case of Benralizumab, the drug depletes eosinophils but after some time a higher basophils count build up to take on the role of eosinophils in causing certain asthma symptoms..etc

One way to counter this problem is through a poly-pharmacotherapy to attack as multiple pathways to reverse the inflammatory response. There is also a group of drugs in development, known as JAKs inhibitors, that silence the effect of several cytokines at once while still selective to a "class/category" level by targeting the shared JAK-STAT intracellular pathway.

Finally, I feel like I should re-iterate that antihistamines don't quell any kind of inflammation like the drugs I mentioned in this thread. For example they don't have the pleiotropic effect of reducing asthma exacerbation or improving lung capacity. They also don't treat eczema..etc
 

Waverunner

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Received my first shot of Dupilumap yesterday. I have atopic eczema, asthma, and lots of intolerances/allergies. I was diagnosed with eosinophilia and my total IgE counts are always increased. Dupilumab should slowly start working after one to two weeks and should reach maximum efficacy after 16 weeks.