A case series of dupilumab-treated allergic contact dermatitis patients

Abstract

Atopic dermatitis is characterized by skin barrier abnormalities and immune dysregulation with increased TH2 signaling playing a central role. Investigations of allergic contact dermatitis suggest that certain allergens may also activate particular T cell signatures such as TH2‐dominant responses to fragrance and rubber. We present a case series of patients with allergic contact dermatitis who were successfully treated with dupilumab, a biologic developed for atopic dermatitis that dampens TH2 signaling. In our cohort of three patients, two had extensive allergic contact dermatitis on their torso and extremities primarily due to textile and rubber allergens. The third was a hairdresser with severe hand dermatitis due to occupational allergens. Two of the three patients had no history of atopic dermatitis during childhood. Each patient experienced at least 90% improvement in body surface area involvement and continues to maintain their clinical response on dupilumab (range 6‐13 months). Our hypothesis that dupilumab suppressed contact allergic reactions is supported by the identification of clinically relevant contact allergens on patch testing, acute onset and/or worsening of dermatitis in adulthood, and absence of childhood atopic dermatitis in two cases. Further, larger investigations to understand which factors affect responses of allergic contact dermatitis to dupilumab are warranted.

Eosinophilic Annular Erythema- Successful Treatment with Dupilumab

“…8 Although FDA-approved only for atopic dermatitis, asthma, and chronic rhinosinusitis with nasal polyposis, dupilumab has shown efficacy in several dermatologic diseases of the type 2 inflammatory pathway, including allergic contact dermatitis, bullous pemphigoid, and prurigo nodularis. [9][10][11] In summary, our patient experienced a dramatic and lasting improvement with dupilumab. Although further studies are certainly necessary to assess the true benefit of this medication for EAE and other eosinophilic dermatoses, dupilumab offers a mechanistically compelling therapy for an often refractory condition.…”

Blocking type 2 inflammation by dupilumab does not control classic (type 1‐driven) allergic contact dermatitis in chronic hand eczema

“…Conversely, a few cases of severe ACD have been dramatically improved by dupulimab, and this therapy can influence patch test results in some patients. Goldminz et al reported a case series of three patients with ACD who were successfully treated with dupilumab . Two of them had no history of AD during childhood.…”

Effects of dupilumab treatment on patch test reactions: A retrospective evaluation

“…3 Recent literature about clinical effects of dupilumab on ACD varies from complete clearance of ACD to continuing recalcitrant lesions. 8,9 Although the underlying immunological pathways in ACD and AD are not the same, they are largely overlapping. This might explain why targeting the shared Th2 pathway could reduce ACD severity.…”