Eosinophilic otitis media (EOM) is a rare, treatment-resistant middle ear condition characterised by eosinophilic secretions and a risk of irreversible hearing loss. The condition is often seen in patients with asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) and is driven by type-2 inflammation. We describe two patients in this case with severe EOM and concomitant asthma and CRSwNP, in whom conventional treatment had limited efficacy. Treatment with the IL-5 inhibitor mepolizumab resulted in marked improvement in ear symptoms, improved hearing, and reduced need for systemic steroids.

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.

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic vasculitis characterized by asthma, chronic rhinosinusitis with nasal polyps, eosinophil-driven tissue inflammation, and necrotizing small- to medium-sized vessel vasculitis. Myeloperoxidase - Anti-Neutrophil Cytoplasmic Antibody (MPO-ANCA) is detectable in approximately 30%-40% of patients, and ANCA-positive and ANCA-negative diseases exhibit distinct yet overlapping clinical patterns. Type 2 immune responses are predominant, with interleukin-5 (IL-5) driving eosinophil differentiation and survival, and IL-4 and IL-13 promoting eosinophil recruitment and IgE-associated pathways. Activated eosinophils contribute to tissue injury through degranulation and eosinophil extracellular trap formation (EETosis). Glucocorticoids remain the foundation of therapy, but they are often insufficient to achieve a sustained remission as monotherapy. Conventional immunosuppressants are used for severe disease, and B-cell-targeted therapy may be considered for selected vasculitic presentations. Biological agents targeting the IL-5/IL-5 receptor axis have been shown to prolong remission, reduced relapse risk, and enabled glucocorticoid sparing. However, some patients remain symptomatic, and reliable biomarkers to guide individualized therapy are lacking. Ongoing research focuses on biomarker panels and cell-free DNA to clarify the role of EETosis and define molecular endotypes to support precision-medicine approaches.

Depemokimab is a monoclonal antibody that targets interleukin-5 with enhanced binding affinity and an extended terminal elimination half‑life of 6-8 weeks. The unique pharmacodynamic features of depemokimab enable sustained suppression of type 2 inflammation with twice‑yearly subcutaneous dosing. This narrative review provides details of depemokimab's molecular profile, pharmacokinetics, and pharmacodynamics and results regarding the clinical efficacy and safety of depemokimab from recently published Phase 3 clinical trials for the treatment of chronic rhinosinusitis with nasal polyposis (CRSwNP). In 528 severe adult CRSwNP patients (ANCHOR‑1/‑2 trials), depemokimab achieved Δ total endoscopic nasal polyp score by -0.70 (p < .001) and Δ nasal obstruction verbal response scale by -0.24 (p = .003) at week 52, compared to placebo. Twice‑yearly 100 mg depemokimab provides durable eosinophil suppression and with a safety profile comparable to placebo in Phase 3 trials for CRSwNP. Future work should refine biomarkers and assess comparative cost‑effectiveness and long‑term adherence, safety, and effectiveness.