[Dupilumab for severe asthma complicated with chronic spontaneous urticaria refractory to omalizumab and mepolizumab: a case report].

Biological targeted drugs play an important role in the treatment of severe bronchial asthma. According to the Global Initiative for Asthma (GINA) 2025 Report and the Chinese Guidelines for the Diagnosis and Management of Bronchial Asthma (2024 Edition), for patients with poorly controlled symptoms despite treatment with high-dose inhaled corticosteroids (ICS) combined with long-acting β2-agonists (LABAs), approved biological targeted agents are recommended as add-on therapy. In addition, some of these agents are also indicated for allergic and immune-mediated conditions, including chronic spontaneous urticaria, atopic dermatitis, chronic rhinosinusitis with nasal polyps, and allergic rhinitis. However, in clinical practice, the precise selection of biological targeted drugs remains challenging in patients with severe asthma complicated by comorbidities. Although biologics can substantially improve the prognosis of some patients with severe asthma, a notable proportion still show a suboptimal initial response. Therefore, switching between biologics has become a common clinical strategy. Here, we report a patient with severe asthma complicated with chronic spontaneous urticaria who received three different biological agents sequentially. By analyzing the evolution of clinical characteristics and the adjustment made to the therapeutic regimens, we ultimately identified an effective treatment strategy. This case is intended to provide a reference for the selection of biologics and individualized treatment in patients with severe asthma and concomitant comorbidities.