Successful simultaneous targeting of IgE and IL-5 in a severe asthmatic patient selected for lung transplantation

We report a case of severe uncontrolled allergic and eosinophilic asthma in which omalizumab had led to a fast remission. After 18 months, mepolizumab was added to omalizumab because of increased blood eosinophils and a deterioration of asthma control. Asthma was then under control for the next 18 months. Discontinuation of mepolizumab in the ensuing 6 months led to a decrease in asthma control and an increased eosinophilia. The introduction of benralizumab resulted in an immediate increase of lung function, asthma control test (ACT), and symptom relief. Before the introduction of biologics, the patient was on the list for transplantation due to respiratory insufficiency. High-resolution CT scans before and after biologic therapy demonstrated a reduction of bronchial wall thickening and mucous plugging as well as an increase in bronchial caliber. The patient did therefore not need a transplant. We conclude that the dual use of biologics may be efficient in some cases of severe asthma.