Asthma biologics — advanced therapies used for moderate to severe asthma — do not raise the risk of respiratory tract infections. In fact, several biologics may reduce the likelihood of pneumonia, according to findings from the paper, “Risk of Respiratory Tract Infections With Asthma Biologics – A Retrospective Population-Based Study,” recently published in The Journal of Allergy and Clinical Immunology.
The large retrospective study was presented at the 2026 American Academy of Allergy, Asthma & Immunology (AAAAI) Annual Meeting and offered real‑world evidence of its protective benefits. Researchers analyzed data from the TriNetX US Collaborative Network, focusing on patients aged 12 years and older with moderate or severe persistent asthma, who were receiving medium‑ to high‑dose inhaled corticosteroids plus long‑acting beta agonists. The study compared patients who received FDA‑approved biologics — dupilumab, omalizumab, anti–IL‑5 agents or tezepelumab — with similar patients who did not receive biologic treatments.
Despite longstanding concerns that therapies targeting type 2 inflammation could make patients more vulnerable to infections, the authors said they found no increased risk of upper or lower respiratory tract infections among biologic users. Moreover, a noteworthy trend emerged: biologic therapy was associated with a lower overall risk of pneumonia.
The study’s findings indicated that dupilumab showed some of the strongest protective trends, with patients experiencing significantly fewer pneumonia cases (HR 0.81) and fewer lower respiratory infections (HR 0.79). Anti–IL‑5 agents also demonstrated a reduced pneumonia risk (HR 0.87). No increased risk was found with omalizumab or tezepelumab.
The paper’s lead author Shane Stone, DO, told Respiratory Therapy that the results are encouraging. Dr. Stone is a PGY-4 fellow in allergy and immunology at Penn State College of Medicine in Hershey, Pennsylvania.
“It is reassuring that real‑world data confirm findings from clinical trials, showing no increased risk of infection associated with biologic therapies. This is encouraging news for patients with asthma who require treatment with biologics,” Dr. Stone said.
The researchers used a rigorous one-to-one propensity score matching method to ensure comparable cohorts, accounting for both demographic factors and pre‑existing conditions. They then evaluated three‑year probabilities of several respiratory outcomes, including sinusitis, upper respiratory infections, pneumonia and other lower respiratory infections.
They said the results strengthen confidence in the safety profile of biologics, which are increasingly used for patients who do not respond adequately to traditional asthma medications, and should provide reassurance to clinicians and families who may worry about potential infection risks related to immune‑targeting therapies.
