Although both dupilumab and omalizumab would also have been a reasonable option, several factors supported the selection of tezepelumab: a plug-dominant disease with persistently high FeNO/IgE levels despite IL-5 blockade; trial-level evidence that anti-TSLP concurrently lowers eosinophils, FeNO, and IgE levels while reducing mucus plugs [14,15]; concerns regarding dupilumab-associated transient hypereosinophilia in asthma and rare eosinophilic pneumonia in ABPA [16,17]; and practical constraints on omalizumab dosing in patients with very high IgE levels [3]. The gene discussed is IGHE; the disease is asthma.