Combined Dupilumab and Allergen-Specific Immunotherapy in Severe Refractory Atopic Dermatitis

Abstract

Although combining allergen immunotherapy with biologics has shown promise in treating atopic diseases such as asthma and allergic rhinitis, atopic dermatitis (AD) remains notably underexplored in this context. This study aimed to investigate the efficacy and safety of combining dupilumab with subcutaneous immunotherapy (SCIT) for severe AD refractory to standard treatments. This was a single-center retrospective analysis assessing patients with severe AD treated with combined dupilumab and SCIT, dupilumab, or SCIT alone at the Severance Hospital, Seoul, Korea. The inclusion criteria encompassed severe AD diagnosis, specific immunoglobulin (Ig) E levels to house dust mite allergens, and treatment follow-up for at least 18 months. Eczema Area and Severity Index (EASI) scores, serum biomarker levels, and adverse event records were regularly collected. Forty-eight patients with AD were analyzed, showing significant improvement in EASI scores and favorable changes in serum biomarkers over 144 weeks. The combination therapy led to a sustained reduction in AD severity, a significant reduction in total IgE and specific IgE levels, and an increment in allergen-specific IgG4. All patients experienced only mild and temporary side effects, not requiring treatment discontinuation. Combining dupilumab with SCIT offers a promising therapeutic option for patients with severe, treatment-refractory AD, reducing disease severity and inducing favorable immunological changes without increasing adverse effects.