Dupilumab doesn't blunt reproducibility of patch tests in atopic dermatitis

In a significant breakthrough, a recent study has shed light on the utility of patch tests in the context of Dupilumab treatment for patients whose atopic dermatitis (AD) remained uncontrolled or deteriorated while on this medication. The study underscores the reliable reproducibility of patch-test outcomes thus suggesting Atopic dermatitis patients treated with DUPI undergo patch-testing to investigate the possibility of contact sensitization.

The study results were published in the Journal of the American Academy of Dermatology. 

There is a scarcity of consistent data concerning the impact of dupilumab (DUPI) on patch-test (PT) outcomes and its efficacy in managing allergic contact dermatitis (ACD). Hence, researchers on behalf of the FRench Atopic DErmatitis Network from the GREAT Research group and the DAG Research group conducted a study to analyze PT reactivities and relevance on DUPI, to see whether they could detect ACD in patients whose atopic dermatitis (AD) was uncontrolled or worsened on this agent.

The researchers conducted a prospective, multicenter study, involving 76 DUPI-treated patients who had undergone PTs. Relevant data were collected over three separate visits.

Key findings: 

• Among the participants, 36 patients (47%) displayed more than one positive PT reaction, resulting in 142 positive PTs.
• Moreover, 23 patients (30%) exhibited at least one positive PT that was also clinically relevant.
• Notably, five of these individuals experienced improvements in clinical eczema following allergen avoidance.
• The study compared the PT results of 36 patients before and during DUPI treatment, encompassing a total of 1230 paired PT allergens.
• Of these, 1022 remained consistent, 34 yielded positive results, 44 could not be interpreted, and 130 were lost.

This study has far-reaching implications for the treatment of AD, especially in patients receiving DUPI therapy. The study's findings offer hope and new insights for individuals struggling with AD and allergic contact dermatitis while undergoing DUPI treatment. Moreover, the research suggests that AD patients on DUPI who experience partial responses or worsening of symptoms should undergo PTs as part of their treatment regimen to assess the possibility of contact sensitization.

The researchers do acknowledge that the study's scope was somewhat limited, involving a specific number of participants. Thus, the findings should ideally be validated and confirmed through further investigations that encompass a larger and more diverse sample.

Further reading: Impact of dupilumab on patch-test results and allergic contact dermatitis: A prospective multicenter study. Published: October 21, 2023. DOI:https://doi.org/10.1016/j.jaad.2023.10.029