Combined biologic therapy for asthma and atopic dermatitis

There are no data to my knowledge to answer your question since published trials have not been performed. However, I am aware of many individual patients who have received more than one biologic, monoclonal therapy at the same time. Most of these are anti-IL5 therapy combined with omalizumab. I am not aware of any potential interaction in combining monoclonal therapies since these targeted treatments would not interact, although the modulation of the immune response would be increased.

Your question was shared with Dr. Tom Casale, Professor of Medicine at the Morsani College of Medicine, University of South Florida, who has extensive experience in the clinical trials with biologic therapies of asthma. Dr. Casale's response is as follows:

"I agree but would add you may consider discontinuing omalizumab if asthma symptoms improve and FEV1 increases. Allegen immunotherapy is a greater risk with low lung function and omalizumab reduces the likelihood of systemic reactions to immunotherapy (1,2)."

In summary, I do not think your patient needs to stop the omalizumab or the allergen immunotherapy if dupilumab is started, assuming your patient can afford all of these treatments.

1.Casale, Thomas B., et al. "Omalizumab pretreatment decreases acute reactions after rush immunotherapy for ragweed-induced seasonal allergic rhinitis." Journal of Allergy and Clinical Immunology 117.1 (2006): 134-140.
2. Massanari, Marc, et al. "Effect of pretreatment with omalizumab on the tolerability of specific immunotherapy in allergic asthma." Journal of Allergy and Clinical Immunology 125.2 (2010): 383-389.

All my best.
Dennis K. Ledford, MD, FAAAAI