A recent study has investigated the efficacy of dupilumab, a monoclonal antibody that targets interleukin (IL)-4 and IL-13 signaling pathways, in reducing food-specific immunoglobulin E (IgE) levels among pediatric patients suffering from moderate to severe atopic dermatitis (AD) and concurrent food allergies (FA). According to researchers, AD and FA significantly impact quality of life and carry substantial socio-economic implications. The study underscores the close association between AD and IgE-mediated FA, where allergen-specific T helper type 2 cells trigger the release of pro-inflammatory cytokines such as IL-4 and IL-13, leading to the production of specific IgE (sIgE) by B cells.
Dupilumab, which is approved for treating moderate to severe AD in patients as young as 6 months old, has previously shown effectiveness in lowering sIgE levels to various food allergens in adults with AD and FA. However, its impact on pediatric patients, who often develop FA early in life, has remained uncertain. Hence, this study aimed to evaluate how dupilumab influences sIgE levels for 10 common food allergens among children aged 4 to 17 years with moderate to severe AD.
The research utilized data from the BioDay registry spanning from August 2019 to July 2023. A covariance pattern model was employed to analyze changes in sIgE levels over a 1-year follow-up period. Eligible patients had clinical histories suggestive of FA and positive sIgE (≥0.35 kU/L) to specified foods at baseline, including those who had avoided certain foods due to severe reactions or parental concerns.
In total, the study enrolled 36 pediatric patients with a mean age of 12.5 years (±3.6). Researchers identified 120 food allergies and analyzed 1008 corresponding sIgE samples. Peanut (18.3%) and hazelnut (16.7%) were the most prevalent sensitizing foods. Notably, 5.6% of patients discontinued dupilumab treatment after a mean duration of 16.5 weeks.
During the first year of treatment, researchers observed a significant percentage decrease in sIgE levels across all food allergens, with the most substantial reductions occurring within the initial 16 weeks. Reductions ranged from 70.5% (95% CI: 37.1–86.1, for apple) to 82.5% (95% CI: 75.0–87.7, for cashew nut). The study found no significant differences in the rate of decrease between patients sensitized to one food versus multiple foods, nor did baseline sIgE levels predict the speed of reduction.
The findings highlighted a marked reduction in sIgE levels to 10 common food allergens among pediatric patients with moderate to severe AD treated with dupilumab. Compared to previous reports in adults, where reductions ranged from 53.0% to 62.9% after 1 year of treatment, the pediatric cohort exhibited more pronounced decreases. Researchers suggested that higher baseline sIgE levels in children and age-related factors may contribute to this variance.
While lowering sIgE levels is associated with improved clinical food tolerance, the study cautioned that achieving a specific threshold does not guarantee tolerance. Although one case of food tolerance development during dupilumab treatment in an adult was confirmed by oral food challenge, further studies are needed to assess whether dupilumab can elevate the tolerance threshold and sustain this effect post-treatment.
In conclusion, the study emphasized the potential of dupilumab in managing FA alongside AD in pediatric patients. Researchers called for additional investigations into its clinical and immunological effects, particularly when initiated at younger ages (>6 months), which may impact FA development by enhancing early skin barrier function and reducing pro-inflammatory cytokine release.
This research underscores the promising role of dupilumab in pediatric dermatology, advocating for continued exploration of its therapeutic potential in managing AD and associated food allergies.
