IgE Mediation in Pediatric Atopic Dermatitis, Concurrent Immune Disorders: Amy Paller, MD

Dupilumab significantly reduced immunoglobulin E (IgE) levels in pediatric patients with atopic dermatitis, Amy Paller, MD, pediatric dermatologist and clinical researcher at Northwestern Medicine's Feinberg School of Medicine, told The American Journal of Managed Care^® (AJMC^®).

Paller discussed the findings of a study presented at the Society for Pediatric Dermatology 2025 Annual Meeting, “Dupilumab Treatment Significantly Reduces Age-Associated Total IgE Levels in Young Children With Atopic Dermatitis,” which showed that mean IgE levels were reduced by 70% in children treated with dupilumab and topical corticosteroids (P < .001), compared with a 30% increase in IgE levels among those treated with a placebo plus topical corticosteroids (P = .03) in the LIBERTY AD PRESCHOOL study (NCT03346434).

This interview was edited for length and clarity.

Amy Paller, MD | Image credit: Northwestern Medicine

AJMC: What were the main findings of the study, and what are their implications for the treatment of atopic dermatitis and concurrent disorders in pediatric patients?

Paller: The study was pretty simple. It was looking at what happened to the IgE levels in patients on dupilumab who were treated for their atopic dermatitis at different age levels. We can see that, as we know, they go down, but really across the board, they go down—and really dramatically. We're talking about more than 90% when we looked at the youngest age group, and we're talking about an average across age groups of at least 70%. These are really dramatic reductions in IgE levels, and the implications of this may be that even though we don't think that IgE does anything with respect to atopic dermatitis pathogenesis or severity, we know that many of these children have other type 2 immune disorders in which IgE levels and the high IgE levels are central. We think about a disease like asthma, for which we're using dupilumab to reduce total IgE levels as treatment, and dupilumab is a very effective treatment for asthma, as well.

The question that comes up here is not, “Is there a benefit for atopic dermatitis?” Because we don't see differences in clinical response based on how well the IgE level went down. We don't know that the IgE level really does anything [in atopic dermatitis], although many patients with atopic dermatitis have high levels. What we do know is that young children are at risk for developing other allergic disorders with associated total IgE or specific IgE levels. The specifics were not part of this study, but I will say that specific IgE levels—for example, foods and other allergic triggers—also go down. The question is whether there's some relationship between this reduction in IgE and either improvement in other allergic disorders or maybe prevention of severe disease developing or even disease at all developing when we think about the atopic march, especially in younger children.

AJMC: What is the significance of IgE mediation in atopic dermatitis?

[Atopic dermatitis] is not an IgE-mediated disease, but we also know that lowering IgE levels doesn't hurt—it just doesn't seem to be what drives the response in atopic dermatitis. But it may have an added benefit, and I think that remains to be seen through other investigations. Unfortunately, we didn't do a good job, when looking at studies of atopic dermatitis, to pay attention to other comorbidities and what happened to them and how that correlated with the reductions. Just like when doing a study with asthma, there wasn't good attention paid to the atopic dermatitis. But we do know that reduction tends to be associated with improvement in some of these other diseases, particularly asthma and eosinophilic esophagitis, for which there are actual indications, and urticaria is now an indication as well. The question for me, as I mentioned already, is the possibility that by lowering IgE levels or maybe other cytokines, maybe chemokines—the biomarkers need to be further understood—we might be changing the course of other atopic diseases, whether that's their severity or whether that's developing them at all.

I think that's a pretty exciting thing to think about and potentially a differentiator. Other therapies for atopic dermatitis lower IgE levels, but certainly this is not something we see with the JAK inhibitors. So, is that going to be a differentiator? The answer is unknown. I can tell you that I hear about food allergies improving in my patients on dupilumab, but that's not evidence-based; it's anecdotal. We really need to understand that better.