Can't fill your Xolair prescription? Learn about alternatives like Dupixent, Nucala, Fasenra, and Tezspire that may work for your condition in 2026.
If you've been prescribed Xolair (Omalizumab) and can't get it filled — whether due to supply shortages, insurance issues, or cost — you're probably wondering what else is out there. The good news is that several alternative biologic medications exist that treat similar conditions.
However, it's important to understand that these alternatives aren't identical to Xolair. They work differently, target different parts of the immune system, and are approved for different conditions. Switching medications is a decision you should always make with your doctor.
This guide covers what Xolair does, how it works, and the most common alternatives for each of its approved uses.
Xolair is the brand name for Omalizumab, an injectable biologic medication manufactured by Genentech and Novartis. It's a monoclonal antibody that targets immunoglobulin E (IgE), a protein that plays a central role in allergic reactions.
Here's the simplified version: when you're exposed to an allergen, your body produces IgE antibodies. These IgE molecules bind to mast cells and basophils (types of immune cells). When the allergen appears again, these armed cells release histamine and other chemicals that cause allergic symptoms — wheezing, hives, swelling, and in severe cases, anaphylaxis.
Xolair works by binding to free IgE in your blood before it can attach to those immune cells. With less IgE available, your body's allergic response is dialed down significantly.
For a detailed breakdown, see How Does Xolair Work? Mechanism of Action Explained.
Xolair is FDA-approved for:
It's given as a subcutaneous injection every 2 to 4 weeks, with doses ranging from 75 mg to 375 mg based on your weight and IgE levels.
If you take Xolair for moderate to severe allergic asthma and can't get it, these are the main biologic alternatives your doctor may consider:
Drug class: Anti-IL-4/IL-13 monoclonal antibody
How it works: Dupixent blocks interleukin-4 (IL-4) and interleukin-13 (IL-13), two proteins that drive type 2 inflammation — the same type of inflammation involved in allergic asthma, eczema, and nasal polyps.
Approved for: Moderate to severe asthma (age 6+), atopic dermatitis, CRSwNP, eosinophilic esophagitis, COPD, and prurigo nodularis.
Dosing: Subcutaneous injection every 2 weeks. Can be self-injected at home.
Key difference from Xolair: Dupixent targets a different part of the inflammatory pathway (IL-4/IL-13 rather than IgE). It's particularly effective for patients with elevated eosinophils or type 2 biomarkers. It's also approved for a wider range of conditions.
Cost: Approximately $3,000 to $3,700 per month without insurance.
Drug class: Anti-IL-5 monoclonal antibody
How it works: Nucala blocks interleukin-5 (IL-5), a protein that promotes the production and survival of eosinophils — white blood cells that drive inflammation in certain types of asthma.
Approved for: Severe eosinophilic asthma (age 6+), eosinophilic granulomatosis with polyangiitis (EGPA), and hypereosinophilic syndrome (HES).
Dosing: 100 mg subcutaneous injection every 4 weeks.
Key difference from Xolair: Nucala is specifically for eosinophilic asthma, not allergic asthma broadly. If your asthma is driven by high eosinophil counts rather than IgE-mediated allergies, Nucala may actually be a better fit.
Cost: Approximately $3,000 to $3,500 per month without insurance.
Drug class: Anti-IL-5 receptor alpha monoclonal antibody
How it works: Fasenra binds to the IL-5 receptor on eosinophils, marking them for direct destruction by natural killer cells. This leads to near-complete depletion of eosinophils.
Approved for: Severe eosinophilic asthma (age 12+) and EGPA.
Dosing: 30 mg subcutaneous injection every 4 weeks for the first 3 doses, then every 8 weeks. Can be self-injected.
Key difference from Xolair: Like Nucala, Fasenra targets eosinophilic asthma specifically. Its less frequent dosing schedule (every 8 weeks after loading) is an advantage for some patients.
Cost: Approximately $3,000 to $3,500 per month without insurance.
Drug class: Anti-TSLP monoclonal antibody
How it works: Tezspire blocks thymic stromal lymphopoietin (TSLP), a protein released early in the inflammatory cascade. By acting upstream, it can reduce inflammation regardless of the specific trigger — allergic, eosinophilic, or otherwise.
Approved for: Severe asthma (age 12+) — notably, it does not require a specific biomarker (like eosinophils or IgE) for eligibility.
Dosing: 210 mg subcutaneous injection every 4 weeks.
Key difference from Xolair: Tezspire has the broadest eligibility of any asthma biologic because it doesn't require elevated IgE or eosinophils. If you don't fit neatly into the "allergic" or "eosinophilic" category, Tezspire may be an option.
Cost: Approximately $3,000 to $3,500 per month without insurance.
Xolair is currently the only biologic approved for chronic spontaneous urticaria. If you can't access it, your doctor may consider:
For chronic rhinosinusitis with nasal polyps, the main alternative biologic is:
Xolair is currently the only FDA-approved medication for IgE-mediated food allergy. There is no direct alternative biologic for this indication. If you can't access Xolair for food allergy, your options include:
None of these alternatives are drop-in replacements for Xolair. Each one targets different parts of the immune system and has different eligibility criteria, side effect profiles, and insurance requirements. Always talk to your prescriber before making any changes to your treatment plan.
If you need help finding a specialist who can evaluate alternatives, see How to Find a Doctor Who Can Prescribe Xolair Near You.
Not being able to fill your Xolair prescription is stressful, but you're not without options. For asthma, Dupixent, Nucala, Fasenra, and Tezspire are all proven biologics. For chronic hives, the biosimilar or off-label treatments may bridge the gap. And for any condition, checking availability on Medfinder before assuming Xolair is gone everywhere is always a smart first step.
For more on the current shortage situation, see our Xolair Shortage Update for 2026. And to learn about side effects of these medications, visit Xolair Side Effects: What to Expect.
You focus on staying healthy. We'll handle the rest.
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