A 34-year-old woman has severe persistent asthma despite high-dose ICS plus LABA, with two exacerbations requiring oral steroids in the past year. Total serum IgE is 320 IU/mL, skin prick testing is positive to house dust mite, and she has perennial allergic sensitisation. Which add-on therapy is most appropriate?
- A Montelukast
- B Theophylline sustained release
- C Omalizumab ✓
- D Long-term low-dose oral prednisolone
Correct answer: C. Omalizumab
Explanation
Omalizumab, a recombinant humanised monoclonal antibody against the Fc portion of IgE, is indicated as add-on Step 5 therapy in severe persistent allergic asthma uncontrolled on high-dose ICS-LABA, with elevated IgE and documented sensitisation to a perennial aeroallergen. Montelukast and theophylline are weaker add-ons used earlier in the stepwise ladder, and chronic oral steroids carry unacceptable toxicity when a licensed biologic option exists.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.