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TOPLINE
Among pediatric patients with food allergy, dupilumab was associated with declining food-specific immunoglobulin E (IgE) levels. However, oral food challenges (OFCs) performed during or after treatment had higher rates of reactions and anaphylaxis than those done before treatment, indicating that falling IgE levels did not reflect clinical tolerance.
METHODOLOGY
- Researchers retrospectively reviewed records of pediatric patients with food allergy (November 2014-November 2024) who were prescribed dupilumab to treat other atopic conditions to assess whether dupilumab was linked to reduced reaction rates during OFCs.
- The analysis included 129 patients (median age, 13 years; 62.8% male). Dupilumab was prescribed mostly for atopic dermatitis (72.1%), followed by eosinophilic esophagitis (14.7%) and asthma (13.2%). The median duration of treatment was 25 months.
- Food-specific IgE levels and skin-prick test wheal sizes were compared before and after dupilumab. OFC reactions were graded with the modified Bock/PRACTALL score and the Severity Grading Score for Acute Reactions (SGSAR), with higher scores indicating more severe reactions.
- Of 290 OFCs offered, 107 were completed in 50 patients: 67 before dupilumab and 40 during or after treatment. Egg was the most frequently challenged food.
TAKEAWAY
- Food-specific IgE levels fell a median of 49%-89% from baseline after dupilumab treatment began, depending on the food (49% for milk; 70% for peanut; 78% for egg; 89% for soy).
- OFCs conducted during or after dupilumab treatment had higher rates of reactions (47.5% vs 20.9%) and anaphylaxis (25.0% vs 9.0%; P < .05 for both) than those done before treatment.
- In adjusted analyses, dupilumab exposure was associated with about threefold higher odds of falling in a higher score category on the SGSAR (odds ratio [OR], 3.09) and the Bock/PRACTALL scale (OR, 3.21; P < .05 for both).
IN PRACTICE
"[O]ur findings suggest that despite decreases in food sIgE [specific IgE], dupilumab may not be efficacious in clinically desensitizing patients to food allergies and is likely not an effective food allergy therapeutic option. Clinicians should account for dupilumab treatment when interpreting patients' food sIgE results and in deciding whether or not to offer OFCs," the authors wrote.
SOURCE
Abigail Lang, MD, MSCI, with Ann and Robert H. Lurie Children's Hospital of Chicago in Chicago, was the corresponding author of the study, which was published online on September 24 in The Journal of Allergy and Clinical Immunology: In Practice.
LIMITATIONS
This was a single-center, retrospective study with a relatively small sample and no paired within-patient OFCs before and after dupilumab treatment. Allergists decided how OFCs were dosed and when to halt them, so procedures differed from patient to patient. Many different foods were challenged; therefore, results may not apply equally to every allergen.
DISCLOSURES
This study was supported by a charitable donation from The Buckeye Foundation. The authors declared having no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
