A 30-year-old asthmatic woman on inhaled corticosteroid + LABA has FEV1 65% predicted and 3 exacerbations in the past year requiring oral steroids. Serum IgE is 450 IU/mL and she has documented perennial aeroallergen sensitization. Which add-on biologic therapy is most appropriate?

• A Mepolizumab (anti-IL-5), as this is eosinophilic asthma
• B Dupilumab (anti-IL-4Rα), indicated only for AD
• C Benralizumab (anti-IL-5Rα), suitable for any severe asthma type
• D Omalizumab (anti-IgE), given elevated IgE and aeroallergen sensitization ✓

Explanation

Omalizumab targets free IgE and is indicated for moderate-to-severe allergic asthma in patients with sensitization to a perennial aeroallergen and IgE within the dosing range (30–1500 IU/mL). It is the appropriate biologic for allergic phenotype based on elevated IgE plus sensitization. Mepolizumab and benralizumab target the eosinophilic (Type 2) pathway and are indicated when blood eosinophils are elevated (≥300 cells/μL). Dupilumab is also approved for severe asthma but is more broadly indicated.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.