Dupilumab linked to lower risk of new allergic conditions in children with atopic dermatitis | 2026 Fall Clinical Derm

Children with atopic dermatitis (AD) who started Dupixent (dupilumab) had a 33% to 52% lower risk of developing food allergy, asthma or other allergic conditions than matched children treated with systemic corticosteroids (SCS), according to a poster presented at the Fall Clinical Dermatology Conference this week.

AD is a chronic inflammatory skin condition. Children with more severe AD face a greater risk of developing other allergic conditions, including food allergy, asthma, allergic rhinitis and eosinophilic esophagitis, a pattern known as the atopic march. Dupilumab, manufactured by Regeneron Pharmaceuticals and Sanofi, is approved in the U.S. for moderate-to-severe AD in patients 6 months and older, as well as for asthma and other type 2 inflammatory conditions.

The FDA approved the drug for AD in adolescents in March 2019, in children ages 6 to 11 in May 2020 and in children ages 6 months to 5 years in June 2022.

The study was led by Eric L. Simpson, M.D., professor of dermatology at the Oregon Health & Science University School of Medicine in Portland, with assistance from his team members hailing from numerous other universities and Regeneron. The authors wrote that earlier research suggests dupilumab could reduce atopic march progression, but data across the full pediatric age range remain limited, particularly in very young children.

Researchers used the Inovalon Insights Real-World Database, a U.S. insurance claims database covering more than 150 health plans in all 50 states, with data from January 2016 through December 2025. They identified children with AD who started dupilumab or received SCS and split them into four age groups: younger than 2, 2 to 5, 6 to 11 and 12 to 17. Each group's enrollment window opened when dupilumab was approved for that age. Children were excluded if they had used dupilumab before or already had a diagnosis of food allergy, asthma, allergic rhinitis or eosinophilic esophagitis.

Each child who started dupilumab was matched to a similar child treated with SCS based on demographics, prior steroid use and other AD treatment history, for a total of 2,897 children in each group. Follow-up lasted up to two years for children younger than 6 and up to three years for older children. In the primary analysis, a new allergic condition was counted after a single inpatient or outpatient claim with that diagnosis. A sensitivity analysis used a stricter definition, requiring one inpatient claim or two outpatient claims at least 30 days apart. Researchers used hazard ratios (HRs) to compare risk between the groups over time.

In the primary analysis, dupilumab was associated with a significantly lower risk of new allergic conditions in every age group. The largest difference was in children ages 2 to 5. In that group, 231 of 1,055 children on dupilumab developed a new allergic condition, compared with 423 of 1,055 children in the SCS group, a 52% lower risk (HR, 0.48; 95% confidence interval [CI], 0.40-0.56). Risk was 33% lower among children younger than 2 (HR, 0.67), 34% lower among children ages 6 to 11 (HR, 0.66) and 36% lower among adolescents ages 12 to 17 (HR, 0.64).

In the sensitivity analysis, the gap widened in the youngest children, with a 71% lower risk in children ages 2 to 5 (HR, 0.29) and a 61% lower risk in children younger than 2 (HR, 0.39). Adolescents on dupilumab had a 35% lower risk (HR, 0.65). The 29% lower risk among children ages 6 to 11 in the sensitivity analysis was not statistically significant (HR, 0.71; 95% CI, 0.48-1.05).

Most children had already used topical steroids in the year before they started treatment, ranging from about 82% of children 6 and older to nearly 98% of children younger than 2. Between about 22% and 36% of children in each group had used SCS in that same year. In all four age groups, cumulative rates of new allergic conditions over time were lower in the dupilumab group than in the SCS group.

“These findings support the potential of early dupilumab intervention to modify the development of additional atopic comorbidities in pediatric patients with AD,” the authors wrote, adding that follow-up was limited to three years at most, and two years for children younger than 6.

The authors said longer-term studies are needed to determine whether the lower rate of atopic march progression holds up after children stop taking dupilumab.