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Transient eosinophilia is not uncommon in patients with moderate-to-severe atopic dermatitis (AD) treated with dupilumab. A retrospective, single center, observational study was conducted to assess the difference in terms of absolute eosinophil count (AEC) change at 4 months and at 12 months, relative to the baseline, in predefined subgroups of patients affected by moderate-to-severe AD treated with dupilumab. Complete data for 373, 289 and 210 patients were available at the baseline, 4 months and 12 months, respectively. Patients with a history of conjunctivitis ( n  = 152) had greater increases in AEC at 4 months as compared with those ( n  = 137) who did not (+16%vs0%, p  = 0.01). Patients with food allergies ( n  = 46) showed similar increases (+39%vs + 5%,  p  = 0.01). Patients experiencing facial redness dermatitis on dupilumab ( n  = 46) had greater increases in AEC at 4 months than those ( n  = 243) who did not (+40%vs + 5%,  p  = 0.03). Patients that had dupilumab-induced ocular surface disease ( n  = 44) had greater increases in AEC at 4 months than those ( n  = 245) who did not (+43%vs + 5%,  p  = 0.01). Atopic comorbidities are associated with a paradoxical increase in AEC at 4 months in AD patients treated with dupilumab. Patients experiencing dupilumab-related ocular surface disease or facial redness dermatitis also have remarkable increases in AEC at 4 months.

journal of dermatological treatment

Elevation of peripheral blood eosinophils during dupilumab treatment for atopic dermatitis is associated with baseline comorbidities and development of facial redness dermatitis and ocular surface disease