000389 - Use of Dupilumab as Adjuvant Treatment in Oral Food Desensitization: A Case Report

Egg hypersensitivity is a common food allergy in pediatric populations, but canalso manifest later in life, with a prevalence of approximately 0.2% in adults.In recent years, protocols for oral immunotherapy (OIT) have been developed forvarious foods to induce tolerance. When OIT cannot be completed due to poortolerance, biological treatments like omalizumab have been introduced as adjuvanttherapies to reduce side effects and facilitate faster up-dosing.

We report a 26-yr-old woman with a medical history of rhinoconjunctivitis, severeatopic dermatitis, and poorly controlled severe asthma due to sensitization tomites and pollens. She also reported recurrent episodes of egg-inducedanaphylaxis (generalized urticaria, rhinitis, bronchospasm, hypotension, andvomiting) which have required admission to the intensive care unit. Some episodesoccurred following the ingestion of egg traces, with cofactors were involved.

An allergy workup was performed, including skin prick tests with commercialextracts, yielding the following results in mm: egg (9x8), egg white (6x7), egg yolk(6x7), ovalbumin (5x7), and ovomucoid (8x6). In vitro testing by ImmunoCAP(ThermoFisher) revealed (kU/L) a total IgE level of 724 ,and specific IgE levels asfollows: egg white, 10.40; egg yolk, 3.22; combined egg white and yolk, 10.70;ovalbumin, 5.03; ovomucoid, 15.20; and lysozyme, 0.15. Baseline tryptase was 2.9μg/L.

Due to the poor control of her asthma and dermatitis, treatment with dupilumab300 mg every two weeks was initiated, resulting in significant clinicalimprovement in both conditions. After four months of dupilumab therapy, weattempted to initiate an egg oral OIT using a protocol with dehydrated egg whiteprotein (Ovo-Des © ) and weekly dose escalation(10–30–75–125–250–500–1000–2000 mg). This was followed by maintenancewith egg white albumin (Ovo-Pro © ) at 4000 mg.An oral provocation test with egg yolk was performed with good tolerance. She isnow able to consume baked, fried eggs and omelettes, achieving a significantlyimproved quality of life.

This is the first reported case of an adult with severe egg-induced anaphylaxis whoachieved tolerance to egg through oral desensitization facilitated by dupilumab.Further research is needed to clarify dupilumab’s role in food allergy management,validate its efficacy, and identify patients most likely to benefit from its use in OITprotocols.