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Dermbits

Do you patch test patients while on dupilumab?

Atopic Dermatitis

You. This is a really neat question, and there are a few papers in literature that talk about this, and they kind of go back and forth to some degree. The big issue is that we know with historical or conventional immunosuppressant agents that patch testing probably is really not a great idea on those because you really could suppress the response and thus miss get, in other words, get some false negatives, important allergens. With dupliumab, we're not exactly sure which allergens might use the Il four and IL 13 pathway, and it may even vary from person to person. It's not maybe just that it's nickel, for example, or some particular specific allergen, like cocometal probylbutane, but it may be in an individual. This pathway is the one that's sensitized. That being said, I think that pragmatically, we can say if a patient has atopic dermatitis and is doing well on dupliumab, except they're having some breakthroughs, and we suspect that there is a contact allergen that's playing a role to me. We wrote a paper about this recently, just this past year. We said we think it's very reasonable to do it, because in that case, if the dupliumab is not enough to protect them from environmental exposure, it's very likely not enough to protect them from showing the sign when you do the patch testing on their back. And I've personally seen many patients patch test positive to a clinically relevant allergen while on dupiliumab, and then we remove that and they do better. So I think this is a real thing, but we have to go in with the caveat that we may be missing some things and we don't know all the details. So it's kind of an interesting area. And I just try to do it with full disclosure to the patient, especially because I say, usually we don't have to patch test somebody more than once in their life. Sometimes you do it again five or ten years later, but it's not something you're doing a lot. This is a situation, though, where we may say, if we don't find it, maybe later, when you're off of duplimab, we would try it again.