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Cited by 20Contact Dermatitis and AllergiesDermatology and Skin DiseasesDrug-Induced Adverse Reactions

Dupilumab for Allergic Contact Dermatitis: An Overview of Its Use and Impact on Patch Testing.

Open access
Johnson, Hadley·2022·Current Psychiatry
DOI 10.12788/cutis.0519
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Abstract

Allergic contact dermatitis (ACD) has been estimated to affect up to 20% of the general population. Patch testing is the gold standard for identification of causative allergens. When allergen avoidance fails, current treatment options include topical and oral corticosteroids, systemic immunosuppressants, and phototherapy. Dupilumab, a monoclonal antibody targeting IL-4/IL-13, is approved by the US Food and Drug Administration for the treatment of moderate to severe atopic dermatitis. It also has been used off label with some success in the treatment of ACD. This article discusses the evidence for using dupilumab to treat ACD as well as considerations for patch testing in patients who are taking this medication.

Integrity signals

Registry

Crossref · 10.12788/cutis.0519

Cites

32 of 32 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

7 of 48 cited sources checked · 5 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Through inhibition of the IL-4Rα subunit, dupilumab prevents activation of the IL-4/IL-13 signaling cascade.

    “Through inhibition of the IL-4Rα subunit, it prevents activation of the IL-4/IL-13 signaling cascade.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [1] 1. Harb H, Chatila TA. Mechanisms of dupilumab. Clin Exp Allergy. 2020;50:5-14. doi:10.1111/cea.13491 source
    • cites [2] 2. Gooderham MJ, Hong HC, Eshtiaghi P, et al. Dupilumab: a review of its use in the treatment of atopic dermatitis. J Am Acad Dermatol. 2018;78(3 suppl 1):S28-S36. doi:10.1016/j.jaad.2017.12.022 source
  • Premisecitation

    There have been multiple reports demonstrating the effectiveness of dupilumab in the treatment of ACD.

    “There have been multiple reports demonstrating the effectiveness of dupilumab in the treatment of ACD (eTable).[12][13][14][15][16][17][18][19][20]”
    Quote in the paperSubstantial claim1 of 9 sources checked
    • cites [12] 12. Joshi SR, Khan DA. Effective use of dupilumab in managing systemic allergic contact dermatitis. Dermatitis. 2018;29:282-284. doi:10.1097/ DER.0000000000000409 source
    • cites [13] 13. Goldminz AM, Scheinman PL. A case series of dupilumab-treated allergic contact dermatitis patients. Dermatol Ther. 2018;31:E12701. doi:10.1111/dth.12701 source
    • cites [14] 14. Chipalkatti N, Lee N, Zancanaro P, et al. Dupilumab as a treatment for allergic contact dermatitis. Dermatitis. 2018;29:347-348. doi:10.1097/ DER.0000000000000414 source
    • cites [15] 15. Zhu GA, Chen JK, Chiou A, et al. Repeat patch testing in a patient with allergic contact dermatitis improved on dupilumab. JAAD Case Rep. 2019;5:336-338. doi:10.1016/j.jdcr.2019.01.023 source

      The Report of case describes significant improvement in one patient’s ACD during dupilumab therapy, so this paper is one relevant report among the cited references. The Discussion calls the benefit potential and says more investigation is necessary; this single case does not establish dupilumab’s effectiveness for ACD generally. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [16] 16. Machler BC, Sung CT, Darwin E, et al. Dupilumab use in allergic con- tact dermatitis. J Am Acad Dermatol. 2019;80:280-281.e1. doi:10.1016/j. jaad.2018.07.043 source
    • cites [17] 17. Chipalkatti N, Lee N, Zancanaro P, et al. A retrospective review of dupi- lumab for atopic dermatitis patients with allergic contact dermatitis. J Am Acad Dermatol. 2019;80:1166-1167. doi:10.1016/j.jaad.2018.12.048 source
    • cites [18] 18. Jacob SE, Sung CT, Machler BC. Dupilumab for systemic allergy syndrome with dermatitis. Dermatitis. 2019;30:164-167. doi:10.1097/ DER.0000000000000446 source
    • cites [19] 19. Ruge IF, Skov L, Zachariae C, et al. Dupilumab treatment in two patients with severe allergic contact dermatitis caused by sesquiterpene lactones. Contact Dermatitis. 2020;83:137-139. doi:10.1111/cod.13545 source
    • cites [20] 20. Wilson B, Balogh E, Rayhan D, et al. Chromate-induced allergic contact dermatitis treated with dupilumab. J Drugs Dermatol. 2021;20:1340-1342. doi:10.36849/jdd.6246 source
  • Premisecitation

    Findings from these studies show that dupilumab can improve recalcitrant dermatitis caused by a broad range of contact allergens, including nickel.

    “The findings from these studies show that dupilumab can improve recalcitrant dermatitis caused by a broad range of contact allergens, including nickel.”
    Quote in the paperSubstantial claim1 of 9 sources checked
    • cites [12] 12. Joshi SR, Khan DA. Effective use of dupilumab in managing systemic allergic contact dermatitis. Dermatitis. 2018;29:282-284. doi:10.1097/ DER.0000000000000409 source
    • cites [13] 13. Goldminz AM, Scheinman PL. A case series of dupilumab-treated allergic contact dermatitis patients. Dermatol Ther. 2018;31:E12701. doi:10.1111/dth.12701 source
    • cites [14] 14. Chipalkatti N, Lee N, Zancanaro P, et al. Dupilumab as a treatment for allergic contact dermatitis. Dermatitis. 2018;29:347-348. doi:10.1097/ DER.0000000000000414 source
    • cites [15] 15. Zhu GA, Chen JK, Chiou A, et al. Repeat patch testing in a patient with allergic contact dermatitis improved on dupilumab. JAAD Case Rep. 2019;5:336-338. doi:10.1016/j.jdcr.2019.01.023 source

      The Report of case describes one patient whose dermatitis improved on dupilumab after several treatments failed; he had positive patch tests to nickel and several other allergens. The Discussion describes this as a potential benefit for chronic allergic contact dermatitis, not evidence that dupilumab improves dermatitis caused by a broad range of allergens across patients. Page numbers are not available in the supplied copy. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [16] 16. Machler BC, Sung CT, Darwin E, et al. Dupilumab use in allergic con- tact dermatitis. J Am Acad Dermatol. 2019;80:280-281.e1. doi:10.1016/j. jaad.2018.07.043 source
    • cites [17] 17. Chipalkatti N, Lee N, Zancanaro P, et al. A retrospective review of dupi- lumab for atopic dermatitis patients with allergic contact dermatitis. J Am Acad Dermatol. 2019;80:1166-1167. doi:10.1016/j.jaad.2018.12.048 source
    • cites [18] 18. Jacob SE, Sung CT, Machler BC. Dupilumab for systemic allergy syndrome with dermatitis. Dermatitis. 2019;30:164-167. doi:10.1097/ DER.0000000000000446 source
    • cites [19] 19. Ruge IF, Skov L, Zachariae C, et al. Dupilumab treatment in two patients with severe allergic contact dermatitis caused by sesquiterpene lactones. Contact Dermatitis. 2020;83:137-139. doi:10.1111/cod.13545 source
    • cites [20] 20. Wilson B, Balogh E, Rayhan D, et al. Chromate-induced allergic contact dermatitis treated with dupilumab. J Drugs Dermatol. 2021;20:1340-1342. doi:10.36849/jdd.6246 source
  • Premisecitation

    Jo et al found in a systematic review that patch test reactions may remain positive, change to negative, or become newly positive after dupilumab initiation.

    “Although this would suggest that dupilumab has little impact on patch testing, Jo et al 27 found in a systematic review that patch test reactions may remain positive, change to negative, or become newly positive after dupilumab initiation.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [27] 27. Jo CE, Mufti A, Sachdeva M, et al. Effect of dupilumab on allergic contact dermatitis and patch testing. J Am Acad Dermatol. 2021; 84:1772-1776. doi:10.1016/j.jaad.2021.02.044 source
  • Premisecitation

    There were no clear trends according to the immune polarity of the allergens in de Wijs et al's series.

    “there were no clear trends according to the immune polarity of the allergens.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [30] 30. de Wijs LEM, van der Waa JD, Nijsten T, et al. Effects of dupilumab treatment on patch test reactions: a retrospective evaluation. Clin Exp Allergy. 2021;51:959-967. doi:10.1111/cea.13892 source
  • May combine two claims. 9
  • Classified as probably not a substantial claim. 5

  • May combine two claims.

    Premisecitation

    Dupilumab dampens the TH2 inflammatory response, thereby improving symptoms associated with atopic dermatitis.

    “This dampens the T H 2 inflammatory response, thereby improving the symptoms associated with atopic dermatitis.1,2”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [1] 1. Harb H, Chatila TA. Mechanisms of dupilumab. Clin Exp Allergy. 2020;50:5-14. doi:10.1111/cea.13491 source
    • cites [2] 2. Gooderham MJ, Hong HC, Eshtiaghi P, et al. Dupilumab: a review of its use in the treatment of atopic dermatitis. J Am Acad Dermatol. 2018;78(3 suppl 1):S28-S36. doi:10.1016/j.jaad.2017.12.022 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Other systemic treatments for ACD include methotrexate, cyclosporine, mycophenolate mofetil, and azathioprine.

    “Other systemic treatments for ACD include methotrexate, cyclosporine, mycophenolate mofetil, and azathioprine.6”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] 6. Sung CT, McGowan MA, Machler BC, et al. Systemic treatments for allergic contact dermatitis. Dermatitis. 2019;30:46-53. doi:10.1097/ DER.0000000000000435 source

  • Classified as probably not a substantial claim.

    Premisecitation

    Some have questioned whether patch testing on dupilumab is accurate or feasible.

    “Consequently, some have questioned whether patch testing on dupilumab is accurate or feasible.24”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [24] 24. Shah P, Milam EC, Lo Sicco KI, et al. Dupilumab for allergic contact dermatitis and implications for patch testing: irreconcilable differences. J Am Acad Dermatol. 2020;83:E215-E216. doi:10.1016/j. jaad.2020.05.036 source

  • May combine two claims.

    Interpretationreasoning

    Given its overall excellent safety profile, dupilumab may be a feasible off-label option for patients with ACD that does not respond to allergen avoidance or for those who experience adverse effects from traditional therapies.

    “Given its overall excellent safety profile, dupilumab may be a feasible off-label option for patients with ACD that does not respond to allergen avoidance or for those who experience adverse effects from traditional therapies; however, it remains difficult to obtain through insurance because it is not yet FDA approved for ACD.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Allergen avoidance is the mainstay of ACD treatment.
    • Rests on an assumption: In some patients, allergen avoidance does not improve ACD symptoms.

  • May combine two claims.

    Interpretationreasoning

    Targeting specific immune components may not always result in improvement of ACD symptoms, likely because its pathophysiology involves several pathways.

    “which suggests that targeting specific immune components may not always result in improvement of ACD symptoms, likely because its pathophysiology involves several pathways.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Narrowband UVB and psoralen plus UVA have both been used.

    “Narrowband UVB and psoralen plus UVA have both been used.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [7] 7. Chan CX, Zug KA. Diagnosis and management of dermatitis, includ- ing atopic, contact, and hand eczemas. Med Clin North Am. 2021;105: 611-626. doi:10.1016/j.mcna.2021.04.003 source
    • cites [8] 8. Simons JR, Bohnen IJ, van der Valk PG. A left-right comparison of UVB phototherapy and topical photochemotherapy in bilateral chronic hand dermatitis after 6 weeks' treatment. Clin Exp Dermatol. 1997;22:7-10. doi:10.1046/j.1365-2230.1997.1640585.x source

  • May combine two claims.

    Premisecitation

    Molecular profiling has revealed that nickel primarily induces a TH1/TH17 response, while allergens such as fragrance and rubber primarily induce a TH2 response.

    “Molecular profiling has revealed that nickel primarily induces a T H 1/T H 17 response, while allergens such as fragrance and rubber primarily induce a T H 2 response.4”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] 4. Dhingra N, Shemer A, Correa da Rosa J, et al. Molecular profil- ing of contact dermatitis skin identifies allergen-dependent differ- ences in immune response. J Allergy Clin Immunol. 2014;134:362-372. doi:10.1016/j.jaci.2014.03.009 source

  • May combine two claims.

    Premisecitation

    Psoralen plus UVA tends to have more side effects; therefore, narrowband UVB often is preferred.

    “Psoralen plus UVA tends to have more side effects; therefore, narrowband UVB often is preferred.7,8”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [7] 7. Chan CX, Zug KA. Diagnosis and management of dermatitis, includ- ing atopic, contact, and hand eczemas. Med Clin North Am. 2021;105: 611-626. doi:10.1016/j.mcna.2021.04.003 source
    • cites [8] 8. Simons JR, Bohnen IJ, van der Valk PG. A left-right comparison of UVB phototherapy and topical photochemotherapy in bilateral chronic hand dermatitis after 6 weeks' treatment. Clin Exp Dermatol. 1997;22:7-10. doi:10.1046/j.1365-2230.1997.1640585.x source

  • Classified as probably not a substantial claim.

    Premisecitation

    There is ongoing debate among contact dermatitis experts regarding the diagnostic accuracy of patch testing for those on immunomodulators or immunosuppressants, as these medications can dampen positive results and increase the risk for false-negative readings.

    “There is ongoing debate among contact dermatitis experts regarding the diagnostic accuracy of patch testing for those on immunomodulators or immunosuppressants, as these medications can dampen positive results and increase the risk for false-negative readings.23”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [23] 23. Levian B, Chan J, DeLeo VA, et al. Patch testing and immunosuppression: a comprehensive review. Curr Derm Rep. 2021;10:128-139. source

  • May combine two claims.

    Premisecitation

    These agents are used for severe ACD and typically are chosen as a last resort due to their immunosuppressive activity.

    “These agents are used for severe ACD and typically are chosen as a last resort due to their immunosuppressive activity.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] 6. Sung CT, McGowan MA, Machler BC, et al. Systemic treatments for allergic contact dermatitis. Dermatitis. 2019;30:46-53. doi:10.1097/ DER.0000000000000435 source

  • May combine two claims.

    Interpretationreasoning

    Because dupilumab is not yet FDA approved for ACD, insurance companies may deny coverage, making it likely to be unaffordable for most patients.

    “Because it is not yet FDA approved for the treatment of ACD, insurance companies may deny coverage, making it likely to be unaffordable for most patients.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Dupilumab is not FDA approved for the treatment of ACD.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Historically, ACD was thought to be primarily driven by the TH1 inflammatory response; however, it is now known that TH2, TH9, TH17, and TH22 also may play a role in its pathogenesis.

    “Historically, ACD was thought to be primarily driven by the T H 1 inflammatory response; however, it is now known that T H 2, T H 9, T H 17, and T H 22 also may play a role in its pathogenesis.4,5”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [4] 4. Dhingra N, Shemer A, Correa da Rosa J, et al. Molecular profil- ing of contact dermatitis skin identifies allergen-dependent differ- ences in immune response. J Allergy Clin Immunol. 2014;134:362-372. doi:10.1016/j.jaci.2014.03.009 source
    • cites [5] 5. Owen JL, Vakharia PP, Silverberg JI. The role and diagnosis of allergic contact dermatitis in patients with atopic dermatitis. Am J Clin Dermatol. 2018;19:293-302. doi:10.1007/s40257-017-0340-7 source
12 of 12

  • The paper relies on this without support.

    Dupilumab is not FDA approved for the treatment of ACD.

    “it is not yet FDA approved for ACD”

  • The paper relies on this without support.

    Allergen avoidance is the mainstay of ACD treatment.

    “Allergen avoidance is the mainstay of ACD treatment”

  • The paper relies on this without support.

    In some patients, allergen avoidance does not improve ACD symptoms.

    “however, in some patients, this approach does not always improve symptoms.”

  • The paper relies on this without support.

    Eliminating the source of the allergen may not be possible in those with certain occupational, environmental, or medical exposures.

    “In addition, eliminating the source of the allergen may not be possible in those with certain occupational, environmental, or medical exposures.”

  • The paper relies on this without support.

    There are no FDA-approved treatments for ACD.

    “There are no FDA-approved treatments for ACD.”

  • The paper relies on this without support.

    Patch testing is the gold standard for identifying causative allergens in ACD.

    “patch testing remains the gold standard when it comes to identifying the source of the contact allergen(s).”
6 of 6

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Authors
Johnson, H.
Affiliations
University of Southern California (US)
Corresponding author
Johnson, Hadley
Venue
Current Psychiatry
Publisher
Frontline Medical Communications, Inc.
Published
2022-05-01
Volume
21
Issue
6
Pages
265-267
DOI
10.12788/cutis.0519
OpenAlex
W4281755412
Cited by
20
References
31
Citations by year
2025: 8 · 2024: 2 · 2023: 7 · 2022: 2 · 2021: 1
FWCI
4.64
Type
journal article
Language
en
Open access
Locations
  • Current Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Dermatology › Contact Dermatitis and Allergies
  • Health Sciences › Medicine › Dermatology › Dermatology and Skin Diseases
  • Health Sciences › Medicine › Pharmacology › Drug-Induced Adverse Reactions
Keywords
dupilumab, allergic contact dermatitis, patch testing, IL-4/IL-13 signaling, off-label drug use, allergen sensitization, allergen avoidance, delayed-type hypersensitivity, type 2 inflammation, atopic dermatitis, drug-induced contact dermatitis, adverse drug reactions, adverse drug reaction reporting, adverse drug reaction monitoring, adverse drug reaction management
MeSH terms
Allergens, Humans, Patch Tests, Dermatitis, Allergic Contact, Antibodies, Monoclonal, Humanized

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