Delayed onset localized urticarial reactions to Dupilumab

Dupilumab is an anti-IL-4 receptor monoclonal antibody used to treat persistent uncontrolled asthma. We characterize a previously undescribed injection-site urticarial reaction in patients receiving Dupilumab. Case series of two evaluated at Emory University Hospital 2019-2020 who developed urticaria after Patient 1 31-year-old female with history asthma, allergic rhinitis 200mg biweekly. Her first was 16 doses treatment and lasted 1-2 weeks. It required topical triamcinolone 0.1% cream manage symptoms. blood eosinophil count 30/mcL the time prior therapy 80/mcL. The spontaneously remitted over 6 weeks despite continued dupilumab. 2 72-year-old male nasal polyps, chronic sinusitis, asthma Duupilumab 300mg He experienced large pruritic wheal injection site 9 treatment. His symptoms started self-resolved 3-4 days each time. Symptoms were unresponsive oral antihistamines, requiring clobetasol 0.05%. Initial more severe improved time, however remained persistent. Early onset, dose dependent reactions have been documented Dupilumab; however, our unreported delayed localized months uneventfully. Topical steroid alleviated allowed for continuation therapy.