The role of dupilumab in diverse allergic pathologies

Abstract

Allergic responses represent a significant health problem due to the ineffectiveness of current treatments, as they attempt to decrease the immune response triggered but are unable to create immune memory that reduces the intensity of such response, so the intensity of the response will always be the same as the first time. An allergic response is characterized by the exacerbated and prolonged release of immunoglobulin E (IgE) that triggers innate immune responses due to the activation of T lymphocytes towards a Th2 phenotype, responsible for the release of interleukins 3 and 4 (IL-3 and IL-4), and the activation of B lymphocytes towards IgE-producing plasma cells. Currently, monoclonal antibodies (mAbs) are used as treatment for various allergic pathologies as they can be used to inhibit the signaling pathways of various interleukins, inactivating the differentiation of T lymphocytes, B lymphocytes, and the production of IgE. One of the most versatile mAbs in the treatment of various allergic responses is Dupilumab, which is designed to inhibit the signaling chain of IL-3 and IL-4, more specifically, it binds to the α receptor of IL-4 and the cytokine-induced receptor complex IL-13. Dupilumab inhibits IL-4 and IL-13 through receptor 1, stopping the release of IgE and proinflammatory cytokines. This treatment can be used to control the inflammatory response caused by allergens. On the other hand, the use of Dupilumab is not patented as the treatment of choice for allergic pathologies. Therefore, in this review, we compile the results of clinical studies of Dupilumab and other mAbs in atopic dermatitis (AD), eosinophilic esophagitis (EoE), chronic rhinosinusitis with nasal polyps (CRSwNP), and asthma, with the aim of determining which of the mAbs has provided better results.