Dupilumab Reduces Food-Allergen sIgE in Children with Atopic Dermatitis

A recent study revealed that the longer patients with food allergies remained on dupilumab, the more their specific IgE (sIgE) levels reduced.1

“Our study showed that dupilumab induced a significant reduction in food sIgE in pediatric patients with [atopic dermatitis] and concomitant [food allergy] over a median of 17 months,” wrote investigators, led by Alexander G. Emerson, MD, from the division of pediatric allergy, immunology, & pulmonary medicine at Monroe Carell Jr. Children’s Hospital, Vanderbilt University Medical Center.1 “This is in keeping with prior studies in adult patients with atopic dermatitis and food allergy and in patients with aeroallergen sensitization.”

The US Food and Drug Administration (FDA) approved dupilumab, a monoclonal antibody that blocks IL-4 receptor alpha (IL4Rα) to reduce inflammation, for multiple atopic and inflammatory conditions. Approved indications include atopic dermatitis, bullous pemphigoid, chronic spontaneous urticaria, chronic obstructive pulmonary disease (COPD), chronic rhinosinusitis with nasal polyps, and eosinophilic esophagitis. 2,3,4,5,6

Dupilumab is not indicated for food allergy, an atopic disorder rising in prevalence. Research has begun examining dupilumab as both a monotherapy and an adjunct to oral immunotherapy for the treatment of peanut allergy in children. A phase 2 multicenter, single-arm study of dupilumab as a monotherapy for peanut allergy desensitization found only 8% of participants could pass a 24-week double-blind, placebo-controlled oral food challenge of dupilumab 444 mg taken every 2 weeks.7

In this retrospective study, investigators sought to assess the effect of dupilumab on food allergy by reviewing electronic medical records of 60 children aged 6 months to 18 years receiving dupilumab at a single center for their comorbid atopic dermatitis.1 All patients were treated at Vanderbilt University Medical Center between June 2019 and July 2024. During routine clinical care, patients received a skin prick test, SIgE, and oral food challenges.

Linear regression analyses showed that with each additional month of dupilumab treatment, sIgE levels reduced by 0.3% (95% confidence interval [CI] –0.8% to –0.4%, P < .001). The overall mean percentage decrease in patients receiving dupilumab was greater for sIgE (-66.4%; 95% CI, -74.9% to -57.9%) compared to the skin prick test (-28%; 95% CI -39.4% to -16.5%) (P < .001).1

Patients receiving dupilumab had significant percent decreases in SIgEs for 6 foods: almond, Brazil nut, cashew, egg, peanut, and walnut—showed statistically significant percent decreases in SIgEs.

“Only 2 foods (hazelnut and pecan) did not show a statistically significant reduction in sIgE with a 95% CI crossing slightly over 0,” investigators noted.1 “We attribute this finding to skewing by outliers in whom sIgE increased to these nuts after the start of dupilumab.”

Only 3 foods—almond, pecan, and walnut—showed significant decreases in skin prick test wheal size. The study showed that increased time on dupilumab was not linked to a statistically significant change in skin prick test wheal size (0.1%; 95% CI, -0.6% to 0.7%; P = .8).1

Among 50 food challenges that took place, 38 (76%) passed (i.e., no reaction), which was a similar pass rate to previous cohorts. Participants who passed either received dupilumab every 4 weeks (n = 13) or every 2 weeks (n = 11).1

Moreover, 8% resulted in Consortium for Food Allergy Research (CoFAR) grade 1 – 2 allergic reactions treated with antihistamines only, and 12% resulted in anaphylaxis (CoFAR grade 3 – 4 severity).1 Four patients received epinephrine; all of them had ingested more than half of the challenge goal before a reaction was observed. A single accidental home exposure to both baked egg and milk in a cookie, counting as 2 challenges (4%), led to oral itching.

“In this retrospective review of children receiving dupilumab for [atopic dermatitis] with comorbid [food allergy], we showed that [skin prick test] wheal size to food allergens is more preserved over time on dupilumab therapy while sIgE values decline with continued dupilumab use,” investigators concluded.1 “Interestingly, this finding has also been observed in aeroallergen testing with dupilumab use in CRSwNP and suggests that [skin prick test] may potentially be a more reliable marker of ongoing sensitization to follow in patients’ food allergy clinical course.”

References

1. Emerson AG, Krantz MS, Robison RG. Food Allergy Clinical Course in Children and Adolescents Treated with Dupilumab for Atopic Dermatitis. Ann Allergy Asthma Immunol. Published online July 27, 2025. doi:10.1016/j.anai.2025.07.023

2. Smith, T. FDA Approves Dupilumab (Dupixent) for Bullous Pemphigoid in Adult Patients. HCPLive. June 20, 2205. https://www.hcplive.com/view/fda-approves-dupilumab-dupixent-for-bullous-pemphigoid-in-adult-patients. Accessed August 4, 2025.

3. Smith, T. FDA Approves Dupilumab (Dupixent) for Chronic Spontaneous Urticaria. HCPLive. April 18, 2025. https://www.hcplive.com/view/fda-approves-dupilumab-dupixent-for-chronic-spontaneous-urticaria. Accessed August 4, 2025.

4. Smith, T. FDA Approves Dupilumab (Dupixent) for Treatment of COPD. HCPLive. September 27, 2024. https://www.hcplive.com/view/fda-approves-dupilumab-dupixent-for-treatment-of-copd. Accessed August 4, 2025.

5. Smith, T. FDA Approves Dupilumab for Adolescents with Chronic Rhinosinusitis with Nasal Polyps. HCPLive. September 13, 2024. https://www.hcplive.com/view/fda-approves-dupilumab-for-adolescents-chronic-rhinosinusitis-with-nasal-polyps. Accessed August 4, 2025.

6. Butera, A. FDA Approves Dupilumab for Eosinophilic Esophagitis. HCPLive. May 20, 2022. https://www.hcplive.com/view/fda-approves-dupilumab-for-eosinophilic-esophagitis. Accessed August 4, 2025.

7. Sindher SB, Nadeau KC, Chinthrajah RS, Leflein JG, Bégin P, Ohayon JA, et al. Efficacy and Safety of Dupilumab in Children With Peanut Allergy: A Multicenter, Open-Label, Phase II Study. Allergy. 2025 Jan;80(1):227-237. 10.1111/all.16404. Epub 2024 Dec 14. PMID: https://pubmed.ncbi.nlm.nih.gov/39673452/; PMCID: PMC11724241.