ArticleFrontiers in allergy2026
Case Report: Multisystem response to dupilumab in a child with atopic dermatitis, asthma, eosinophilic esophagitis, and other gastrointestinal manifestations.
Article in Frontiers in allergy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Atopic dermatitis (AD), asthma, and eosinophilic esophagitis (EoE) may coexist because they share type 2 inflammatory pathways. Evidence for dupilumab in children with EoE and other gastrointestinal manifestations remains limited. Case presentation: A 7-year-old girl had poorly controlled AD, recurrent asthma, EoE (>100 eosinophils/high-power field), and lower-density eosinophilic infiltration in gastric, ileal, and colonic biopsies. These extraesophageal findings did not uniformly satisfy proposed thresholds for definite non-EoE eosinophilic gastrointestinal disease. Severe AD despite topical therapy was the primary indication for dupilumab; the coexisting type 2 inflammatory disorders supported selection of a pathway-directed systemic treatment. Dupilumab was administered as a 600-mg loading dose followed by 300 mg subcutaneously every 4 weeks. Over 48 weeks, pruritus resolved, skin lesions markedly improved, wheezing did not recur, inhaled salmeterol/fluticasone was reduced, appetite improved, and vomiting ceased. Follow-up endoscopy showed a smooth esophagus and no obvious duodenal abnormality, although gastric inflammation and small ulcers persisted and repeat histology was unavailable. Total IgE decreased from >2,000 to 211.2 IU/mL; peripheral eosinophils decreased from 0.64 to 0.30 × 10⁹/L. No treatment-related adverse events occurred. Conclusion: This case suggests that IL-4/IL-13 blockade may provide coordinated clinical benefit across multiple type 2 inflammatory organs. The gastrointestinal findings should be interpreted cautiously because symptom improvement was not confirmed by repeat biopsy.
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