Can Fasenra Be Given During an Active Upper Respiratory Infection?
Yes, Fasenra (benralizumab) can be administered during an active upper respiratory infection (URI), as there are no specific contraindications in the FDA labeling against doing so, and the drug has been safely used during respiratory infections in clinical practice.
Key Considerations from FDA Labeling
The FDA prescribing information for Fasenra does not list active upper respiratory infections as a contraindication or precaution 1. The only absolute contraindication is known hypersensitivity to benralizumab or its excipients 1.
Important Warnings to Consider:
Acute Asthma Symptoms: Fasenra should not be used to treat acute asthma symptoms, acute exacerbations, acute bronchospasm, or status asthmaticus 1. However, this refers to using it as rescue therapy, not to withholding scheduled maintenance doses during a URI.
Helminth Infections: The only infection-related precaution in the FDA label concerns parasitic (helminth) infections, where treatment should be completed before initiating Fasenra, or Fasenra should be discontinued if helminth infection occurs and doesn't respond to anti-helminth treatment 1. This does not apply to viral URIs.
Real-World Evidence Supporting Safety
Clinical experience demonstrates that benralizumab can be safely administered during active respiratory infections:
A case report documented safe administration of benralizumab to a severe asthma patient admitted to the ICU with COVID-19 pneumonia, where the patient developed severe broncho-obstruction and received benralizumab during ICU admission without detrimental effects 2.
Another case described a patient with severe eosinophilic asthma who developed COVID-19 while on benralizumab, was hospitalized for 4 months with bilateral interstitial pneumonia, and successfully resumed benralizumab immediately after discharge with excellent long-term outcomes 3.
Clinical Decision Algorithm
Proceed with scheduled Fasenra administration during URI if:
- The URI is uncomplicated (simple viral upper respiratory symptoms)
- The patient's asthma remains controlled or stable
- There are no signs of acute asthma exacerbation requiring rescue therapy
- The patient has no fever suggesting severe systemic infection requiring immediate medical attention
Consider delaying if:
- The patient has acute asthma exacerbation requiring systemic corticosteroids or emergency care
- There is concern for severe systemic infection requiring hospitalization
- The patient is acutely ill and unable to tolerate the injection
Common Pitfalls to Avoid
Don't confuse maintenance therapy with rescue therapy: The warning about not using Fasenra for acute symptoms 1 doesn't mean you should withhold scheduled maintenance doses during a URI.
Don't assume all infections require holding biologics: Unlike live vaccines or certain immunosuppressants, there's no evidence that continuing Fasenra during a simple URI increases risk or worsens outcomes.
Monitor for hypersensitivity: While hypersensitivity reactions can occur with Fasenra (generally within hours but sometimes delayed over days) 1, having a concurrent URI doesn't increase this risk.
Safety Profile Context
Meta-analysis data shows benralizumab actually reduces the risk of serious adverse events, bronchitis, and sinusitis compared to placebo 4. The most common adverse reactions are headache and pharyngitis (≥5% incidence) 1, which may overlap with URI symptoms but don't represent contraindications.
The bottom line: Continue scheduled Fasenra during uncomplicated URIs to maintain asthma control, as interrupting biologic therapy may lead to loss of disease control and increased exacerbation risk.