Young children treated with dupilumab for eosinophilic esophagitis faced a lower risk of subsequent asthma in a retrospective study presented on Nov. 12, 2026, at the American College of Allergy, Asthma and Immunology Annual Scientific Meeting in Phoenix, Arizona, HCPLive reported.
The multicenter observational analysis examined electronic health records from 2016 through early 2026 to track pediatric patients diagnosed with eosinophilic esophagitis, commonly known as EoE. Investigators evaluated whether administering the biologic therapy early in life altered the progression of atopic disease in susceptible young patients, according to ACAAI.
“Children with EoE are at higher risk for other allergic diseases, including asthma,” said immunologist and ACAAI member Kayla Steinberger, MD, PhD.eloping additional allergic conditions, such as asthma, because both disorders share interleukin 4 and interleukin 13-mediated type 2 inflammation. Researchers sought to determine if interrupting these inflammatory pathways early could modify that trajectory.
Among 698 propensity-matched pairs of young children, incident asthma at 3.5 years occurred in 8.1% of patients treated early with dupilumab, compared to 16.0% of never-treated children, HCPLive reported. This yielded an absolute risk reduction of 7.9 percentage points, with a 95% confidence interval ranging from 3.8 to 12.1 and a P value of .0002.
When compared specifically against children who received oral budesonide—a swallowed steroid medicine designed to coat the esophagus—the divergence remained clear.
Abstract R052 presented at the ACAAI meeting showed that about 11 out of every 100 children taking dupilumab later developed asthma, compared with about 16 out of every 100 children taking budesonide, according to American College of Allergy Asthma and Immunology.
The mean number of asthma diagnoses during follow-up was 0.743 events per patient for those treated with budesonide, compared to 0.369 events for those receiving dupilumab (P = .028).
The investigation utilized global health records to compare children aged 6 and younger who had EoE but lacked an initial asthma diagnosis. Following 1:1 propensity score matching on age, sex, race, asthma diagnosis, and atopic dermatitis diagnosis, each group contained 698 children with a mean index age of 3.2 years, where approximately 74% were male and 46.0% had atopic dermatitis, HCPLive reported. Study author Kayla Steinberger, MD, PhD, immunologist and ACAAI member, said that early dupilumab treatment for pediatric eosinophilic esophagitis was associated with reduced incident asthma, stating, “[W]e need more research to know for sure.”
It may also lower the chance that asthma will be the next allergic condition to develop.”
Because the analysis relied on a retrospective electronic health record design, it cannot establish direct causation. The conference poster did not detail specific dupilumab dosing, treatment duration, EoE disease severity, or safety outcomes, leaving open the possibility of residual confounding by indication.
Dupilumab is approved by the U.S. Food and Drug Administration for eosinophilic esophagitis in patients aged 1 year and older weighing at least 15 kg, following the phase 3 EoE KIDS trial, Contemporary Pediatrics reported. It is also approved to treat moderate-to-severe asthma and other type 2 inflammatory conditions.
Additional unmeasured variables, such as food allergies, aeroallergen sensitization, family history of asthma, or differential access to biologic therapies and subspecialty care, could influence both treatment selection and subsequent asthma diagnoses. Investigators emphasized that prospective studies following children over time are required to determine whether early biologic intervention genuinely alters the long-term natural history of the atopic march.
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