Retrospective chart review examining how dupilumab treatment (prescribed for other atopic conditions) affects oral food challenge (OFC) reaction rates and food-specific IgE (sIgE) levels in pediatric patients with co-morbid food allergy at a single center (2014–2024).
Despite median reductions in food sIgE of 49–89% on dupilumab, OFC reaction rates were significantly higher post-dupilumab than pre-dupilumab (47.5% vs 20.9%, p=0.018), and anaphylaxis during OFCs was more than twice as common post-treatment (25.0% vs 9.0%, p=0.030).
Retrospective single-center design limits generalizability; the comparison is within-group (pre- vs post-treatment) rather than a randomized parallel-group design, introducing potential selection and confounding bias; sample size is not explicitly reported in the abstract.
Do not use a drop in food-specific IgE alone to justify offering an oral food challenge in patients on dupilumab — the reduction in sIgE does not reflect clinical tolerance and may be misleading. Clinicians should apply extra caution and have full anaphylaxis management resources ready if OFCs are pursued in this population.
