When one is not enough: combined biologic therapy in severe asthma and refractory T2 comorbidities

We report a case of severe asthma with refractory atopic dermatitis in a 47-year-old female, illustrating the challenges of managing overlapping immune-mediated diseases. Despite long-standing asthma control, the patient experienced progressive deterioration requiring escalation to GINA step 5, with frequent exacerbations and impaired quality of life. Initial treatment with omalizumab was ineffective, and benralizumab achieved eosinophil depletion and functional improvement but failed to control her dermatitis. Switching to dupilumab induced rapid dermatological remission, but resulted in asthma deterioration within weeks. A dual approach, combining benralizumab and dupilumab, was therefore implemented. After 12 months, the patient achieved excellent overall control, with improved lung function, normalization of biomarkers, stable skin disease, and no adverse effects. This case underscores the potential role of combined biologic therapy when monotherapy fails in patients with severe asthma and coexisting T2 comorbidities, highlighting the importance of multidisciplinary care and careful patient selection.