Impact of Dupilumab on Allergy Testing in Eczema-Affected Children

Abstract

Dupilumab, an IL-4Rα antagonist that blocks IL-4 and IL-13 signalling, is approved for use from 6 months of age and is prescribed for moderate-to-severe eczema in children. It suppresses Th2-driven immune responses and inhibits IgE class switching, resulting in decreased total and allergen-specific IgE (ssIgE). Children with severe eczema often have concurrent IgEmediated food allergies. Clinicians use both ssIgE and skin prick testing (SPT) to guide food challenge decisions. However, Dupilumab may impact these markers, complicating test interpretation. A 2024 study by van der Rijst et al. found that 40–52 weeks of Dupilumab therapy significantly reduced ssIgE to peanut, egg, milk, and hazelnut in children, but did not evaluate changes in SPT size. By contrast, Huber et al. (2023) found that while Dupilumab reduced ssIgE in adults with allergic rhinitis, SPT wheal sizes remained unchanged—highlighting a potential disconnect between serum(ssIgE) and mast cell–bound (SPT) IgE responses. Despite widespread use of Dupixent (over 17,000 prescriptions in Australia between March 2021 and September 2023), no prospective studies have investigated Dupilumab’s combined effect on both ssIgE and SPT in food-allergic children—leaving a critical gap in allergy monitoring and clinical decision-making.