Allergen immunotherapy and dupilumab in atopic dermatitis: Clinical efficacy and disparities in immunological indicators

Jin Liu, MM; Lin Yang, MD, PhD; Qingxiu Xu, MD; Qing Jiang, PhD; Nan Huang, MD; Wenjing Li, PhD; Yaqi Yang, MD; Dongxia Ma, MD; Le Li, MM; Yangxue Fu, PhD; Hao Chen, PhD; Rongfei Zhu, MD, PhD

doi:10.1016/j.waojou.2025.101043

World Allergy Organization Journal (Mar 2025)

Allergen immunotherapy and dupilumab in atopic dermatitis: Clinical efficacy and disparities in immunological indicators

Jin Liu, MM,
Lin Yang, MD, PhD,
Qingxiu Xu, MD,
Qing Jiang, PhD,
Nan Huang, MD,
Wenjing Li, PhD,
Yaqi Yang, MD,
Dongxia Ma, MD,
Le Li, MM,
Yangxue Fu, PhD,
Hao Chen, PhD,
Rongfei Zhu, MD, PhD

Affiliations

Jin Liu, MM: Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China
Lin Yang, MD, PhD: Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China
Qingxiu Xu, MD: Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China
Qing Jiang, PhD: Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China
Nan Huang, MD: Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China
Wenjing Li, PhD: Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China
Yaqi Yang, MD: Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China
Dongxia Ma, MD: Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China
Le Li, MM: Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China
Yangxue Fu, PhD: Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China
Hao Chen, PhD: Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China
Rongfei Zhu, MD, PhD: Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China; Institute of Allergy and Clinical Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095, Jiefang Avenue, Wuhan, 430030, China; Corresponding author. Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Institute of Allergy and Clinical Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095, Jiefang Avenue, Wuhan, 430030, China.

DOI: https://doi.org/10.1016/j.waojou.2025.101043
Journal volume & issue: Vol. 18, no. 3
p. 101043

Abstract

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Objective: Allergen immunotherapy (AIT) and dupilumab have been confirmed to improve symptoms of atopic dermatitis (AD); however, the precise immune mechanisms underlying their efficacy and whether they can elicit synergistic immune effects remain not fully elucidated. We aimed to investigate the clinical efficacy and immunological changes in AD patients undergoing AIT, dupilumab, and a combination of AIT and dupilumab treatment. Methods: Clinical data, serum samples, and peripheral blood mononuclear cells (PBMC) were collected from house dust mite (HDM)-sensitized AD patients receiving AIT and/or dupilumab at baseline and 6 months. Changes in clinical efficacy, HDM-specific IgE and IgG4, serum cytokines, and lymphocyte subgroups were compared among the treatment groups. Results: A total of 77 AD patients were included, with 39 in the AIT group, 19 in the dupilumab group, and 19 in the AIT combined dupilumab group. The SCORAD scores significantly improved in all groups after 6 months. Levels of HDM-specific IgE and total IgE remained stable in the AIT group but decreased in the dupilumab and combination groups. Levels of IgG4 against major mite components Der p1 and Der p23 increased in the AIT group and combined treatment group. Serum cytokine levels showed no significant changes, except for a decrease in CCL17 in the dupilumab group. Th1/Th2 and Th17/Th2 ratios increased after dupilumab treatment. There were notable differences in T cell subpopulations when PBMCs were stimulated with HDM extracts after 6-month treatment, tSNE analysis showed the proportion of IL-4+IL-13+CRTH2+T cells increased in the dupilumab group but had no changes in the AIT and combination group. Conclusions: AIT, dupilumab, and their combination improved clinical symptoms and quality of life in AD patients. AIT promoted allergen-specific IgG4 production, while dupilumab modulated T cell responses and reduced allergen-specific IgE synthesis. The combination of AIT and dupilumab exhibited the immunological parameter changes characteristic of both treatments but did not result in a significantly greater improvement in AD symptoms.

Published in World Allergy Organization Journal

ISSN: 1939-4551 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Immunologic diseases. Allergy
Website: https://www.sciencedirect.com/journal/world-allergy-organization-journal

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