Original article
The impact of dupilumab on patch testing and the prevalence of comorbid allergic contact dermatitis in recalcitrant atopic dermatitis: A retrospective chart review

https://doi.org/10.1016/j.jaad.2019.09.028Get rights and content

Background

It is unclear whether the type 2 T helper cell–specific immunosuppressive action of dupilumab interferes with patch testing.

Objectives

We sought to evaluate the reliability of patch testing on dupilumab and the contribution of allergic contact dermatitis (ACD) to complex dermatitis in patients with residual dermatitis on dupilumab.

Methods

This is a retrospective chart review of 48 patients with atopic dermatitis (AD) who were treated with dupilumab. We compare the results of patch tests performed before and after the initiation of dupilumab and the prevalence of comorbid ACD in patch-tested individuals.

Results

A minority of patch test reactions were “lost” on dupilumab (13/125; 10.4%). Five of 13 lost reactions occurred in individuals with documented immunodeficiency. Thirty-two of 35 patch-tested patients (91.4%) had comorbid ACD; 92.3% of individuals patch tested on dupilumab experienced further clinical improvement with allergen avoidance.

Limitations

This is a nonrandomized study in a small cohort of patients. The clearance of dupilumab was assessed by subjective patient reports.

Conclusions

Dupilumab does not appear to exert a dampening effect on patch test results. AD with comorbid ACD was highly prevalent and allergen avoidance resulted in significant improvement in residual dermatitis that had not resolved without dupilumab therapy.

Section snippets

Study population

This study involved retrospective data collection from electronic medical records of patients receiving 300 mg subcutaneous dupilumab for the management of AD between 2017 and 2019. Only patients with a primary dermatologic diagnosis of moderate-to-severe AD were studied. We collected demographics and relevant medical history, including age, sex, history of conjunctivitis or blepharitis, childhood atopy, comorbid dermatologic diagnoses, and treatment history of AD.

Effectiveness of dupilumab in our study population

The effectiveness of dupilumab

Study population

Forty-eight patients were receiving dupilumab at the time of data collection. The population consisted of adults between 17 and 92 years of age (average 45 years of age; 24 males, 24 females) and a high rate of childhood atopy (68%), defined in this study as the presence of AD, asthma, or hay fever in childhood. Six (12.5%) patients had a comorbid diagnosis of lichen simplex chronicus or prurigo nodularis (LSC/PN), 5 (10.4%) patients had nummular dermatitis (ND), and 4 (8.3%) patients had

The effect of dupilumab on patch testing

Dupilumab did not appear to overtly affect patch test results. An allergic reaction was lost—meaning definitively positive before dupilumab and definitively negative while on dupilumab—in only 13 (10.4%) patch tests pairs out of 125 (Table IV). Although a few reactions were not nonreproduced on dupilumab, most reactions were conserved, suggesting that dupilumab does not usually exert a uniformly dampening effect on ACD.

No particular allergen or allergen class appeared to be dependably blocked

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    Funding sources: None.

    Conflicts of interest: Dr Murase has participated in advisory boards for Genzyme/Sanofi, Dermira, and UCB, participated in disease statement management talks for Regeneron and UCB, and has provided dermatologic consulting services for Ferndale and UpToDate.

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