The Impact of Dupilumab Treatment on the Management of Co-Morbid Food Allergy.

BACKGROUND: Studies demonstrate that dupilumab treatment decreases food-specific IgE (sIgE) but this has not been shown to correlate with clinical desensitization. Decreased food sIgE may prompt allergists to offer oral food challenges (OFCs) to assess tolerance. There is a lack of evidence on the real-world outcomes of dupilumab treatment on clinical food allergy management. OBJECTIVE: We sought to examine how treatment with dupilumab for other atopic conditions impacts reaction rates during OFCs in patients with co-morbid food allergies. METHODS: A retrospective chart review of pediatric patients with confirmed diagnosis of food allergy and an outpatient prescription for dupilumab at Ann and Robert H. Lurie Children's Hospital of Chicago from 2014 to 2024 was conducted. Comparison of food sIgE and OFC outcomes was performed between pre- and post- dupilumab treatment groups. RESULTS: Median decreases in food sIgE from baseline following dupilumab treatment ranged from 49-89%. Across all OFCs, there were higher reaction rates to OFCs in the dupilumab post-treatment group versus the pre-treatment group (47.5 vs 20.9%, p=0.018). A higher proportion of patients in the post-treatment group had anaphylaxis during OFCs compared to the pre-treatment group (25.0 vs 9.0%, p=0.030). CONCLUSION: Although dupilumab is associated with decreased food sIgE over time, this does not translate into tolerance for food allergens. Increased reaction rates and anaphylaxis occurred during OFCs performed while on dupilumab as compared to pre-dupilumab treatment OFCs. It is important that clinicians account for dupilumab treatment when interpreting patients' food sIgE results and in deciding whether or not to offer OFC.