24972 Exploring the effect of dupilumab on allergic contact dermatitis and patch testing

Abstract

With many patients with allergic contact dermatitis (ACD) having concomitant atopic dermatitis, as well as the pathogenesis of ACD involving the Th2 pathway, there have been numerous reports of use of dupilumab in patients with ACD. To develop a better understanding of the effect of dupilumab on ACD and patch testing results, a systematic review was conducted. The systematic review was submitted to PROSPERO and followed PRISMA guidelines. Medline and EMBASE databases were searched on June 20, 2020 using key terms “dermatitis,” “allergic contact dermatitis,” “hand dermatitis,” “facial dermatitis,” “patch testing,” AND “dupilumab.” Studies reporting at least one patient with ACD receiving dupilumab treatment were included. 72 patients (mean age 54.34 years) from 19 studies were included. All patients had a history of ACD supported by patch testing results. 47/72 reported clinical effects of dupilumab on ACD showing clearance in 9, partial improvement in 31, no improvement for 4, and worsening in 3 patients. 28/72 had additional post dupilumab patch testing results. Of the 144 pairs of allergens tested both pre and during dupilumab treatment, 17 were lost, 8 were newly positive, and 71 were persistent (48 unknown). This review demonstrates the potential for dupilumab use in patients with recalcitrant ACD. It is important to note that the use of dupilumab for ACD is not currently approved by the FDA. Larger trials are required to better isolate the effects of dupilumab on patients with ACD and delineate if there are potential patterns of allergen-specific responses to dupilumab.