Patient with asthma and chronic hives. Hives responded well to xolair, asthma did not. Asthma responds well to Nucala. Can the patient be treated with both biologics simultaneously?


Omalizumab and mepolizumab are biologics that have different mechanism of actions - omalizumab impact IgE and IgE receptor and mepolizumab impacting eosinophils. A recent article in JACI IP utilized both these medications to treat ABPA (http://www.jaci-inpractice.org/article/S2213-2198(17)30022-3/pdf) suggesting, at least in one patient, it appears safe to use these medications concomitantly. I suspect the challenge will be to have the insurer provide coverage for these very expensive medications.

I hope this is helpful

Andrew Murphy MD FAAAAI


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