The following is a patient described in New England Journal of Medicine, 2006, vol. 354, pages 2689-2695.
A 17 year-old boy with a 15-year history of asthma .... and two visits to the emergency department in the past year presents for evaluation. He reports symptoms consistent with those of severe, persistent asthma (including awakening from sleep five of seven nights) while taking a high-dose inhaled corticosteroid (fluticasone, 100ug per day) in combination with a long-acting bronchodilator. Skin testing is positive for two species of house-dust mites, several molds, and pollen. The total serum IgE level is 436 IU per milliliter (normal range for age, 6 to 97).....
QUESTION: Given that his asthma is "severe", does he nonetheless have an adequate level of control?
QUESTION: Considering that he is already being given a high-dose corticosteroid and a long-acting bronchiodilator, what would be an initial step before adding to the medications?
QUESTION: What is the significance of the skin testing for allergens and the measurement of the serum IgE level?
QUESTION: Does omalizumab inactivate plasma IgE, IgE bound to mast cells, or both?
QUESTION: Is there another possibility if they decide not to use omalizumab?