Dupilumab in Eosinophilic Esophagitis Refractory to Conventional Management in Pediatrics: Report of Two Cases

Abstract

Introduction: This publication aims to show the clinical, endoscopic, and histological responses of two pediatric patients who received dupilumab as a management strategy for eosinophilic esophagitis. Dupilumab is a monoclonal antibody that inhibits the alpha chain of the interleukin (IL)-4 and IL-13 receptors involved in the T_h2 inflammatory response. The potential therapeutic role of this biological drug has been demonstrated in pediatric clinical trials in other allergic pathologies, such as atopic dermatitis and asthma, with an adequate safety and effectiveness profile.

Clinical cases: Two children with a personal history of atopy, allergic rhinitis, asthma, atopic dermatitis, and food allergy began with gastrointestinal symptoms that confirmed the diagnosis of eosinophilic esophagitis. Despite the different management strategies, adequate control of the disease was not achieved, and it is considered that they benefited from management with dupilumab due to the disease evolution and the coexistence of uncontrolled atopic dermatitis.

Conclusions: In recent years, various management strategies in pediatrics have been published, particularly high-dose proton pump inhibitors, topical corticosteroids, and elimination diets. However, despite these strategies, at least one-third of patients may fail to achieve remission with initial treatment, making this entity a therapeutic challenge for the gastroenterologist and pediatric allergist. Our patients received the dose recommended for their weight and age and approved for asthma and atopic dermatitis, resulting in clinical and histological remission. The improvement in gastrointestinal symptoms was accompanied by better control of asthma, rhinitis, and dermatitis. None of the patients had adverse effects of the medication.