Department of Dermatology and Allergology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht University, Utrecht, The Netherlands.
Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Pediatr Allergy Immunol. 2024 Jun;35(6):e14178. doi: 10.1111/pai.14178.
Atopic dermatitis (AD) is frequently associated with asthma and allergic rhinitis (AR). Dupilumab is an effective treatment for pediatric AD, although the effect on atopic comorbidities in pediatric AD patients is limited.
To investigate the prevalence of asthma and AR in pediatric AD patients starting dupilumab treatment and to evaluate the effect of dupilumab on these comorbidities.
This study included pediatric AD patients (aged 3-17 years) treated with dupilumab between 2019 and 2023. Patients were screened at baseline by a pulmonologist for the presence of asthma and AR. Screening included evaluation of medical history and current symptoms, spirometry (including Forced Expiratory Volume in 1 s (FEV)), Fractional exhaled Nitric Oxide (FeNO), and measurement of aeroallergen-specific IgE levels. In patients diagnosed with comorbid asthma and/or AR, measurements were repeated at weeks 16 and 52. Spirometry measurements, FeNO, and aeroallergen-specific IgE levels during treatment were analyzed using a covariance pattern model.
Eighty-four patients were included. Asthma was diagnosed in 50 patients (59.5%) and AR in 72 patients (85.7%). Baseline FeNO levels were elevated in both patients with (29.0 ppb (95% CI 22.0-54.0)) and without asthma (26.0 ppb (95% CI 22.0-30.0)). During treatment, FeNO levels decreased (p < .001) and FEV scores increased (p < .001) in patients with asthma. In patients with asthma and/or AR, all aeroallergen-specific IgE levels decreased between 61.3% and 89.1% at 52 weeks of treatment.
One year of dupilumab treatment, primarily indicated for AD, resulted in a significant improvement in comorbid asthma and a profound decrease in aeroallergen-specific IgE levels in patients with asthma and/or AR.
特应性皮炎（AD）常伴有哮喘和过敏性鼻炎（AR）。度普利尤单抗是治疗儿童 AD 的有效药物，尽管其对儿童 AD 患者的特应性合并症的疗效有限。
调查开始接受度普利尤单抗治疗的儿童 AD 患者中哮喘和 AR 的患病率，并评估度普利尤单抗对这些合并症的影响。
本研究纳入了 2019 年至 2023 年期间接受度普利尤单抗治疗的儿科 AD 患者（年龄 3-17 岁）。在基线时，由肺病学家对患者进行筛查，以确定是否存在哮喘和 AR。筛查包括评估病史和当前症状、肺功能（包括 1 秒用力呼气量（FEV1））、呼出气一氧化氮分数（FeNO）和测量变应原特异性 IgE 水平。在诊断出合并哮喘和/或 AR 的患者中，在第 16 周和第 52 周时重复进行这些测量。使用协方差模式模型分析治疗期间的肺功能测量、FeNO 和变应原特异性 IgE 水平。
共纳入 84 例患者。50 例（59.5%）患者诊断为哮喘，72 例（85.7%）患者诊断为 AR。有哮喘和无哮喘的患者的基础 FeNO 水平均升高（分别为 29.0 ppb（95%CI 22.0-54.0）和 26.0 ppb（95%CI 22.0-30.0））。在治疗期间，哮喘患者的 FeNO 水平降低（p<0.001），FEV 评分升高（p<0.001）。在合并哮喘和/或 AR 的患者中，在治疗 52 周时，所有变应原特异性 IgE 水平均降低 61.3%-89.1%。
在主要用于 AD 治疗的 1 年治疗期间，度普利尤单抗治疗导致合并哮喘的患者的哮喘和对变应原特异性 IgE 水平有显著改善。
