Impact of Dupilumab on Patch Test Results and Allergic Contact Dermatitis
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersBACKGROUND
Limited and conflicting data have been reported on the impact of dupilumab (DUPI) on patch test (PT) results and its efficacy against allergic contact dermatitis (ACD).
OBJECTIVE
This study was undertaken to analyze PT reactivities and relevance during treatment with DUPI to determine whether they could detect ACD in patients with uncontrolled or worsened atopic dermatitis (AD) who were receiving this agent.
METHODS
This prospective, multicenter study examined 76 DUPI-treated patients who had undergone PTs. The relevant information was collected during 3 visits.
RESULTS
Overall, 36 patients (47%) had ≥1 positive PT reaction, and 142 PT results were positive. Twenty-three patients (30%) had ≥1 positive and clinically relevant PT result. Five of them had clinical eczema improvement after allergen avoidance. We compared the PT results of 36 patients before and during DUPI therapy, representing 1230 paired PT allergens, of which 1022 were the same, 34 were positive, 44 were lost, and 130 were uninterpretable.
LIMITATIONS
Because the number of patients included remains limited, our findings should be confirmed with a larger sample.
CONCLUSION
Our results confirmed the usefulness of PTs for patients receiving DUPI, with good PT reproducibility. We suggest that all DUPI-treated patients with AD developing partial responses or experiencing symptom worsening should undergo PTs to look for contact sensitization.
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Additional Info
Disclosure statements are available on the authors' profiles:
Impact of dupilumab on patch test results and allergic contact dermatitis: A prospective multicenter study
J Am Acad Dermatol 2023 Oct 21;[EPub Ahead of Print], S Bocquel, A Soria, N Raison-Peyron, A Badaoui, P Marcant, C Bara, F Giordano-Labadie, E Amsler, B Milpied, J Delaunay, AS Darrigade, P Pralong, C Boulard, MC Ferrier Le Bouedec, M Tauber, J Pasteur, A Valois, A Le Thuaut, MN Crépy, C BernierFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Patch testing while on biologics and other immunosuppressants has been a hot topic of discussion. Ideally, patch testing is completed prior to the initiation of medications that can impact a patient’s response. However, sometimes patch testing is not possible, given the extent of a patient’s disease process. This study looked at patch testing patients who were on dupilumab for atopic dermatitis and assessed patch test positivity and relevance in those whose atopic dermatitis was uncontrolled or worsened while on dupilumab. The authors also compared the results of patch testing prior to the initiation of dupilumab and those patch tested while on dupilumab. They found that positive patch tests were common while on dupilumab, with 47% of the patients having at least one or more positive patch test reaction. They also found that, of those compared before and after the initiation of dupilumab, there was reproducibility in 83% of the patch test reactions. Overall, 30% of the patients were also identified with allergic contact dermatitis and relevant allergens while on dupilumab. Although it is recommended that patch testing be performed prior to initiating systemic medications, these findings support patch testing as a useful tool in patients who are on dupilumab. Atopic dermatitis patients on dupilumab should be patch tested when there is a partial or no response to dupilumab to help identify a contact allergen.