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Dual biologic therapy in a patient with severe asthma and other allergic disorders
  1. Joshua Ray Caskey1 and
  2. David Kaufman2
  1. 1Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
  2. 2Section of Allergy/Immunology, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
  1. Correspondence to Dr David Kaufman; dkauf1{at}


Severe asthma is very difficult to manage in many individuals, and systemic corticosteroids are often used to prevent or manage acute exacerbations. Furthermore, comorbid allergic conditions may render standard therapies inadequate. A 51-year-old man presented with severe eosinophilic asthma requiring nearly constant oral corticosteroid usage despite using high-dose inhaled corticosteroids and secondary asthma controllers. His condition was complicated by aspirin-exacerbated respiratory disease, including severe nasal polyposis, chronic rhinosinusitis, as well as chronic idiopathic urticaria. Mepolizumab was initiated and led to dramatic improvement of asthma over 6 months. However, he continued to experience exacerbations of chronic idiopathic urticaria not responsive to H1-antihistamines. Omalizumab was added, and the patient’s urticaria attained marked improvement with only an occasional breakthrough rash. Dual biologic therapies can be a unique and useful steroid-sparing treatment option for patients with uncontrolled severe asthma and chronic idiopathic urticaria.

  • asthma
  • drugs: respiratory system
  • immunology
  • dermatology

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  • Contributors JRC conceived of the presented idea. DK encouraged JRC and supervised the findings of this work. Both authors discussed the results and contributed to the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests DK reports speaker bureau fees from GSK outside the submitted work. JRC reports no conflicts of interest.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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