Authors
Sarah Y Afzal, Matthew S MacDougall, Di Lu, Sean A McGhee
Published in
Allergy and asthma proceedings. Volume 47. Issue 5. Pages 328-335. Sep 01, 2026.
Abstract
Background: Current therapies for food allergy prevention, oral immunotherapy and omalizumab, increase reaction threshold, but their curative potential remains unknown. Dupilumab has emerged as a promising treatment for several atopic conditions. We observed that many children with food allergy who are on dupilumab had profound reductions in food-specific immunoglobulin E (sIgE) levels over time. Objective: We sought to determine whether sIgE levels decrease in children with food allergy who are on dupilumab and whether changes over time were influenced by allergen type, race, sex, indication for therapy, or age of initiation of therapy. Methods: A retrospective analysis of 44 children with food allergy who were on dupilumab was conducted for longitudinal assessment of sIgE. Results: A statistically significant decrease in sIgE levels was observed across multiple allergens in the 44 children treated with dupilumab for a mean of 1.4 years. A stratified analysis identified a statistically significant decrease (p < 0.05) in sIgE levels in children receiving treatment for both atopic dermatitis (AD) and eosinophilic esophagitis (EoE). This reduction remained significant across all subgroups regardless of race, sex, or age of initiation of dupilumab. The rate of change in sIgE levels over time was greater in children with AD than with EoE, but this difference did not reach statistical significance. Notably, age < 6 years at dupilumab initiation was associated with steeper declines and greater absolute reductions in sIgE levels over time (-1.281 versus -0.784 log₂ IgE/year), with this difference approaching statistical significance (p = 0.0873), despite the small cohort size. Conclusion: We hypothesize that dupilumab may modify clinical tolerance in younger children during a window of immune plasticity and may increase reaction thresholds in older children. Even if this hypothesis is not confirmed, there is clinical utility in reductions of IgE levels, especially in children who are pansensitized, in whom these reductions likely improve signal-to-noise for clinically relevant sensitization. We advocate for prospective early-intervention trials that evaluate dupilumab as adjunctive therapy in children with comorbid atopy to determine its potential role in preventing food allergy development.
PMID:
42698168
Bibliographic data and abstract were imported from PubMed on 05 Sep 2026.
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