The role of dupilumab in managing allergic contact dermatitis

Abstract

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.

Treatment of generalised isobornyl acrylate contact allergy from diabetes pump with Dupilumab

“…3,4 Moreover, it has been shown that the response from dupilumab in treating ACD is heightened in patients with underlying AD as allergic responses in these patients are more often directed towards the TH2 pathway. 3,5 However, there have been some cases which demonstrate the response rate of dupilumab for ACD between patients with and without AD as equivalent. 6 While not all cases of ACD will necessarily respond to dupilumab, it may be an option for recalcitrant disease, e92…”