Combined application of dupilumab and mite allergen-specific immunotherapy in children with moderate to severe atopic dermatitis

Abstract

Background: Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease that manifests in skin dryness, severe itching, and eczema, and can significantly impact a patient’s quality of life. Current treatment regimens do not prevent the recurrence of the disease and are associated with adverse effects. Here, we report two cases of moderate-to-severe AD in children that were treated with dupilumab, a dual inhibitor of IL-4 and IL-13 signaling, in combination with mite allergen-specific immunotherapy.Case summary: Both patients presented with the diagnosis of AD that was not adequately controlled by the conventional treatment regimen, including topical corticosteroids (TCS), topical calcineurin inhibitors, emollients, and the traditional Chinese medicine treatments. In both patients, AD-associated skin irritation impacted the quality of life, disturbed sleep patterns, and caused stress and anxiety. Patients received treatment with dupilumab and mite allergen-specific immunotherapy in addition to the baseline treatment regimen of external glucocorticoids (TCS) and oral antihistamines. Nine months after beginning of treatment, clinical symptoms, signs, medication scores, and evaluation scale scores of both children significantly improved, and the treatment was associated with an overall good tolerance.Conclusion: A combination of dupilumab and mite allergen-specific immunotherapy in addition to the standard anti-AD treatment improves clinical symptoms and is not associated with increased incidence of adverse effects.

Allergen-specific immunotherapy in children. Consensus document of the Association of Pediatric Allergologists and Immunologists of Russia (positional pаper)

“…Могут использоваться разные моноклональные препараты, однако вопросы эффективности АСИТ остаются открытыми. Для дупилумаба получены данные о возможности его сочетания АСИТ при АтД [29]. Исследования предварительного введения омализумаба при высоком риске анафилаксии АСИТ пищевыми аллергенами дали положительные результаты по переносимости аллергена, возможности увеличения его стартовой дозы и уменьшению риска нежелательных явлений (НЯ) [30].…”

An updated reappraisal of dupilumab in children and adolescents with moderate–severe atopic dermatitis

“…92 The study collected US nationwide claims data. Ding et al 93 performed an interesting study concerning the combination of dupilumab plus mite allergen-specific immunotherapy. There is evidence that most children with AD have allergic comorbidities, mainly concerning allergic rhinitis and asthma.…”

“…Ding et al 93 . performed an interesting study concerning the combination of dupilumab plus mite allergen‐specific immunotherapy.…”