New research offers reassurance to asthma patients and their doctors: commonly prescribed biologic medications do not appear to increase the risk of respiratory infections, and may even offer some protection against pneumonia. The findings, presented at the 2026 American Academy of Allergy, Asthma & Immunology (AAAAI) Annual Meeting, address longstanding concerns about the potential for these therapies—which target specific components of the immune system—to inadvertently weaken the body’s defenses against viruses and bacteria. Here’s particularly relevant as asthma biologics grow increasingly common in managing severe asthma, a condition affecting millions worldwide.
The study, conducted by researchers using data from the TriNetX US Collaborative Network, involved a retrospective analysis of patients with moderate to severe persistent asthma. Researchers compared outcomes for those receiving asthma biologics – including dupilumab, omalizumab, anti-IL-5 agents, and tezepelumab – with a control group not using these medications. The analysis focused on the incidence of upper respiratory infections, sinusitis, pneumonia, and other lower respiratory infections over a three-year period. The core finding is that asthma biologics were not associated with a higher probability of developing a respiratory tract infection. In fact, a trend toward a *reduced* risk of pneumonia was observed.
Biologics and the Immune System: Addressing Previous Concerns
Asthma biologics represent a relatively new class of asthma treatments, targeting specific pathways involved in inflammation. These medications have revolutionized care for many patients with severe asthma, but questions about their impact on overall immune function have persisted. Previous concerns centered on the idea that suppressing certain aspects of the immune system—specifically type 2 inflammation—might leave patients more vulnerable to respiratory infections. “It is reassuring that real-world data confirm findings from clinical trials, showing no increased risk of infection associated with biologic therapies,” said Shane Stone, DO, lead author of the study. “This is encouraging news for patients with asthma who require treatment with biologics.”
The study’s design aimed to mimic real-world clinical practice. Researchers included patients aged 12 and under who were already receiving standard asthma treatment—medium-to-high dose inhaled corticosteroids plus long-acting beta agonists—before initiating biologic therapy. This approach helps to isolate the effect of the biologic medication itself, rather than comparing it to a group of patients with less severe disease or different treatment regimens.
Specific Biologics Showed Potential Protective Effects
While the overall analysis showed no increased risk, researchers identified specific biologics associated with a lower probability of pneumonia. Dupilumab, an interleukin-4 receptor alpha (IL-4Rα) antagonist, was linked to a statistically significant 19% reduction in pneumonia risk (HR=0.81, 95% CI: 0.69-0.95; p=0.010). It similarly showed a trend toward reduced risk of other lower respiratory infections (HR=0.79, 95% CI: 0.65-0.97; p=0.020). Anti-IL-5 agents, which target interleukin-5, also demonstrated a statistically significant association with lower pneumonia risk (HR=0.87, 95% CI: 0.78-0.97; p=0.01). No increased infection risk was observed with omalizumab or tezepelumab.
The researchers assessed ocular allergic symptoms in response to antigen challenge, specifically citing ocular itch and conjunctival redness, each described as evaluated versus placebo. Skin prick reactivity was also assessed one week after treatment, again described in comparison with placebo. These findings suggest a potential for these biologics to modulate immune responses beyond the lungs, impacting allergic reactions in other parts of the body.
Study Details and Future Research
The retrospective matched cohort study utilized the TriNetX US Collaborative Network, a large database of electronic health records. Researchers employed one-to-one propensity score matching to ensure the biologic and non-biologic groups were comparable in terms of demographics and pre-existing health conditions (comorbidities). This statistical technique helps to minimize bias and strengthen the validity of the findings. The research presented at the 2026 AAAAI Annual Meeting, February 27 – March 2 in Philadelphia, PA, is published in an online supplement to The Journal of Allergy and Clinical Immunology (JACI).
Further research is needed to fully understand the mechanisms behind these observed effects and to determine whether the protective effects against pneumonia extend to other respiratory infections. The researchers also plan to investigate the long-term impact of biologic therapy on immune function and susceptibility to infections. The American Academy of Allergy, Asthma & Immunology (AAAAI), established in 1943, remains a leading resource for information on asthma and allergic diseases.
Disclaimer: This article provides information for general knowledge and informational purposes only, and does not constitute medical advice. It is essential to consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.
The findings presented at the AAAAI meeting offer valuable insights for clinicians and patients alike, reinforcing the safety profile of asthma biologics and potentially opening new avenues for research into their broader immunological effects. The U.S. Food and Drug Administration is scheduled to issue a decision on a supplemental Biologics License Application (sBLA) for AFRS on February 28, 2026, which could further expand treatment options for patients with severe asthma.
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