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The role of dupilumab in managing allergic contact dermatitis

Recently, there has been vigorous debate about the value of using dupilumab, a biologic that targets TH2-mediated processes, in the management of recalcitrant allergic contact dermatitis.  A review of the current literature found the following:  1) The cytokine polarity of the immunologic response in ACD depends upon the inciting allergen, so the therapeutic approach to ACD must be individualized; 2) a single allergen can elicit different immunological responses in patients with and without underlying AD; 3) there is limited evidence in support of using dupilumab for ACD in patients without concomitant AD; 4) the cost of this drug further argues against its use in all patients with ACD; 5) dupilumab’s benign side effect profile, particularly its lack of immunosuppression, relative to other systemic therapies make it a reasonable option in AD patients with systemic ACD to certain allergens known to elicit a significant type 2 immune response who have failed other treatments.