Repeat patch testing in a patient with allergic contact dermatitis improved on dupilumab

Zhu, Gefei Alex; Chen, Jennifer K.; Chiou, Albert S.; Ko, Justin; Honari, Golara

doi:10.1016/j.jdcr.2019.01.023

Cited by 19 publications

(15 citation statements)

References 6 publications

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“…Case reports [109,110] have described positive patch tests with various allergens (methylisothiazolinone, lanoline, black rubber mix, carba mix) in patients receiving dupilumab for AD, thus showing that the reaction was not inhibited by blocking the IL-4 and IL-13 receptor. Other case reports and case series [111][112][113][114] compared patch testing results before and during dupilumab therapy for AD (Table 2). Raffi et al [114] recently published a retrospective review comparing the results of patch tests performed before and after initiation of dupilumab for treatment of AD (n=23) and found that a minority of patch test reactions were "missed" with dupilumab (10.4%).…”

Section: Prurigo Nodularismentioning

confidence: 99%

Dupilumab: A Review of Present Indications and Off-Label Uses

Muñoz-Bellido¹,

Moreno²,

Dávila³

2022

J Investig Allergol Clin

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Recent advances in understanding T2 inflammation have broadened the diseases in which T2 inflammation can be involved. Dupilumab is a recently developed monoclonal antibody blocking the signaling of both IL-4 and IL13, two crucial cytokines of the T2 responses. New possible indications are increasingly exploring. Among them are skin diseases, such as prurigo nodularis, nummular eczema, allergic contact dermatitis, chronic hand eczema, spontaneous chronic urticaria, bullous pemphigoid, alopecia areata, and Netherton syndrome, among other several cutaneous diseases. Also, respiratory diseases, such as allergic bronchopulmonary aspergillosis, chronic eosinophilic pneumonia, and allergic rhinitis. In addition, eosinophilic gastrointestinal disorders, particularly eosinophilic esophagitis, and food allergy are two more research fields. Here we review the published data and clinical trials about the use of dupilumab in these disorders.

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Section: Prurigo Nodularismentioning

confidence: 99%

Dupilumab: A Review of Present Indications and Off-Label Uses

Muñoz-Bellido¹,

Moreno²,

Dávila³

2022

J Investig Allergol Clin

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“…After full-text review, 16 studies were included for analysis. [3][4][5][9][10][11][12][13][14][15][16][17][18][19][20][21] Of these, 3 were cohort studies, 6 were retrospective chart reviews, 6 were case reports, and 1 was a case series.…”

Section: Literature Search Resultsmentioning

confidence: 99%

“…Five studies, consisting of 28 patients with dermatitis, evaluated patch tests before and during treatment with dupilumab. 3,[9][10][11][12] The most common dose was 300 mg every other week. The duration of immunosuppression before patch testing was not reported for the largest study (n = 23) 9 but ranged from 2 to 9 months with a mean of 5 months for the remaining 5 patients.…”

Section: Patch Testing Results Before and During Immunosuppressant Usementioning

confidence: 99%

Patch Testing During Immunosuppressive Therapy: A Systematic Review

Mufti

Sachdeva

et al. 2021

Dermatitis

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Patch testing, used in the assessment of allergic contact dermatitis, is ideally avoided in patients receiving immunosuppressive therapy because of concerns with reductions in accuracy; however, this is not well characterized in the literature. This systematic review summarizes patch testing results in patients receiving immunosuppressive therapy. We identified 16 studies, comprising 195 patients with dermatitis or psoriasis, who were patch tested while receiving immunosuppressants. Of these, 7 studies, comprising 85 patients with dermatitis, patch tests were performed before and during immunosuppression. Overall, 67.9% (n = 19) of the dermatitis patients receiving dupilumab maintained positive reactions to an allergen that previously graded as a 2+/3+ reaction. Several immunosuppressants were also associated with positive patch test results for various allergens. These include dupilumab, cyclosporine, and low-dose prednisone (≤10 mg/d) for dermatitis, and tumor necrosis factor α inhibitors, ustekinumab, and methotrexate for psoriasis. Ideally, it is preferable to patch test when patients are not receiving oral immunosuppressants or immunomodulators. However, clinicians may choose to assess the risks and benefits of patch testing for each patient given the impact of allergic contact dermatitis on patient quality of life.

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“…Crepy and colleagues reported a case in which an AD patient had ACD that was driven primarily by type 1 inflammation and was not improved with dupilumab, suggesting that, even in AD patients, dupilumab is ineffective against classic TH1triggered ACD. 25 Stout and Silverberg provided further evidence that dupilumab is not always an effective treatment for ACD in AD patients. They presented seven cases: four patients no longer experienced flares of ACD with allergen contact, while three patients continued to develop flares with allergen exposure.…”

Section: Not All Patients With Acd Respond To Dupilumabmentioning

confidence: 99%

The role of dupilumab in managing allergic contact dermatitis

Desrosiers¹,

Huynh²,

Helms³

2019

J of Skin

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Recently, there has been vigorous debate about the value of using dupilumab, a biologic that targets TH2-mediated processes, in the management of recalcitrant allergic contact dermatitis. A review of the current literature found the following: 1) The cytokine polarity of the immunologic response in ACD depends upon the inciting allergen, so the therapeutic approach to ACD must be individualized; 2) a single allergen can elicit different immunological responses in patients with and without underlying AD; 3) there is limited evidence in support of using dupilumab for ACD in patients without concomitant AD; 4) the cost of this drug further argues against its use in all patients with ACD; 5) dupilumab’s benign side effect profile, particularly its lack of immunosuppression, relative to other systemic therapies make it a reasonable option in AD patients with systemic ACD to certain allergens known to elicit a significant type 2 immune response who have failed other treatments.

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Repeat patch testing in a patient with allergic contact dermatitis improved on dupilumab

Cited by 19 publications

References 6 publications

Dupilumab: A Review of Present Indications and Off-Label Uses

Dupilumab: A Review of Present Indications and Off-Label Uses

Patch Testing During Immunosuppressive Therapy: A Systematic Review

The role of dupilumab in managing allergic contact dermatitis

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