Severe asthma, biologic hypersensitivity and inefficacy: overcoming treatment barriers with tezepelumab

Severe asthma is a heterogeneous disease involving multiple inflammatory pathways, with significant therapeutic challenges. Biologic therapies targeting T2 inflammation improve outcomes but may, in rare cases, trigger hypersensitivity reactions due to anti-drug antibodies, excipients, or protein structure. Additionally, some patients exhibit suboptimal or no response. Tezepelumab, a thymic stromal lymphopoietin inhibitor, offers a novel upstream approach, addressing diverse endotypes.

We present a 30-year-old female with severe T2-high asthma, multiple allergies, and poor disease control despite optimal therapy. She experienced an allergic reaction with omalizumab and dupilumab and had inadequate response to benralizumab. Enrolled in an early access program for tezepelumab, she showed remarkable clinical improvement, with significant FEV1 increase and FeNO reduction, allowing discontinuation of systemic corticosteroids and supplemental oxygen.