Dupixent does not hamper patch testing in atopic dermatitis
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Dupixent does not appear to exert an overarching dampening effect on patch test results, according to research published in Journal of the American Academy of Dermatology.
“Atopic dermatitis with comorbid atopic contact dermatitis was highly prevalent and allergen avoidance resulted in significant improvement in residual dermatitis that had not resolved with dupilumab therapy.” Jenny Murase, MD, of the department of dermatology at Palo Alto Foundation Medical Group, and colleagues wrote.
Researchers compared the reliability of patch tests performed before and after initiation of subcutaneous Dupixent 300 mg (dupilumab, Regeneron/Sanofi) and the prevalence of comorbid atopic contact dermatitis in 48 patch-tested individuals. Dupilumab response was assessed at the first follow-up visit by asking patients how they may have improved as a percentage relative to baseline. Patch testing data were available before dupilumab use in 23 of the 48 patients.
Of 48 adult patients (24 women), 68% reported a high rate of childhood atopic dermatitis. Patients discontinued prednisone for at least 1 month and methotrexate, intramuscular triamcinolone, azathioprine and mycophenolate mofetil for at least 3 months.
The cohort showed a mean 77.8% improvement at first follow-up with an average of 7.8 weeks. In 45.8% of patients (n = 22), eye-related adverse findings such as eyelid dermatitis and blepharitis were most common.
In the 23 patients tested both before dupilumab therapy and during dupilumab therapy, 125 before- and on-dupilumab patch test pairs were performed, of which 64 (51.2%) were determined as a persistent allergy. The researchers found an unknown effect in 48 (38.4%) of the pairs.
In results where the reaction changed from “allergy” to “no allergy,” the effect was labeled as “lost.” Here, 13 pairs (10.4%) in seven patients were labeled as lost.
The 13 lost allergic reactions spanned a wide range of allergen subtypes of four emulsifiers/surfactants, two fragrances, metals and sunscreen agents, and one each of topical medicaments, preservatives and resins.
“This wide and nonspecific range of categories does not align with the recently proposed paradigm that certain allergens elicit specific immune polarizations,” Murase and colleagues wrote.
Among 35 patients with atopic dermatitis, 32 patients (91.4%) had comorbid atopic contact dermatitis, determined by positive patch testing and subsequent improvement with allergen avoidance.
Atopic contact dermatitis should be considered in patients with atopic dermatitis with residual dermatitis while on dupilumab, according to researchers. Additionally, they determined that individual immunodeficiency may contribute to false negatives.
The nonrandomized nature of the study in a small group of patients may have limited the study. Additionally, dupilumab clearance was assessed via subjective patient reports. – by Abigail Sutton
Disclosure: Murase reports she participated in advisory boards for Dermira, Genzyme/Sanofi and UCB, participated in disease statement management talks for Regeneron and UCB, and provided dermatologic consulting services for Ferndale and UpToDate.
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