Dupilumab
A very effective biologic for AE treatment seems to be dupilumab
[75], a human monoclonal antibody that binds IL-4Rα thereby blocking
type 2 inflammation and restoring epidermal barrier [129, 130]. It
has been shown that dupilumab improves symptoms and severity of disease,
as well as AE-related serum biomarkers even in a subset of very
difficult-to-treat AE patients [131]. Dupilumab has been recently
approved as the first biologic treatment for children with moderate and
severe AE. Albeit current data suggest no harmful effects of dupilumab
on animal fetus, possible risks associated with exposure of the biologic
during pregnancy in women have to be still further investigated
[132]. Overall, the acceptance of the biologic agent seems high as
reflected in the very long drug survival or compliance time of the
patients [133]. This is strongly connected with the benefit of
improving symptoms and disease severity, reducing the use of rescue
medications and improving the quality of life and in parallel with a low
risk for adverse events [134, 135]. Ocular (conjunctivitis) and
local reactions have been reported as the major adverse effects in
dupilumab-treated patients [127]. Dupilumab has also proved efficacy
in a study with another systemic Th2 disease, chronic rhinosinusitis
with nasal polyposis: Treatment with the antibody resulted in reduction
of multiple biomarkers of type 2 inflammation in nasal secretions and
polyp tissues [136], but also perennial allergic rhinoconjunctivitis
and perennial allergic asthma symptoms [137].