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Doctors use a medicine called dupilumab to help children with atopic conditions, like eczema and asthma. This study used information from 10 children’s hospitals in the PEDSnet network to learn more about autoimmune diseases in children with atopic conditions and whether these diseases were linked to dupilumab treatment. Researchers looked at children ages 6 to 17 who did or did not take dupilumab.
They found that children with atopic diseases such as eczema and asthma had a higher chance of developing autoimmune diseases than children without these conditions, whether or not they received dupilumab. Among children treated with dupilumab, there was a small increase in skin-related autoimmune diseases (like psoriasis and alopecia), but not for other non-skin autoimmune diseases. This finding is reassuring because it suggests that broader autoimmune problems were not more common in children taking the medicine.
The study helps doctors better understand the long-term safety of dupilumab in children. The results suggest that autoimmune diseases may be related to underlying atopic conditions themselves, while only a small increase in certain skin autoimmune diseases was observed among children taking dupilumab. These findings support what doctors already do for children on medications like dupilumab: continue to monitor whether it is helping, and whether there are any side effects.
Takeaways
Why does this matter?
It helps doctors learn more about how autoimmune diseases and atopic conditions may be connected, while continuing to monitor the safety of medicines used to treat children.
What does this mean for patients and families?
Children with eczema and asthma may have a higher risk of autoimmune diseases regardless of whether they take dupilumab. Apart from skin autoimmune conditions, this study did not find an increase in most autoimmune diseases among children treated with dupilumab. Large research networks like PEDSnet help doctors track medicine safety over time so families can make informed decisions about care.
The lay abstract for this publication was generated using an AI model and reviewed by the lead author and the PEDSnet Engagement Core team.
Background: The type 2 inflammation-blocking agent dupilumab has gained traction as an effective treatment of multiple atopic diseases. New-onset autoimmune manifestations have been infrequently reported in dupilumab-treated atopic patients, primarily among adults. Autoimmune outcomes in atopic children on dupilumab are less clear.
Objective: We aimed to determine if dupilumab treatment of atopic children is associated with increased autoimmune or autoinflammatory disease diagnosis risk.
Methods: Using a multi-institutional electronic health record database composed of 10 PEDSnet academic health systems, we performed a retrospective cohort study of children aged 6-17 with atopy (ie, moderate-to-severe atopic dermatitis and/or persistent asthma, as defined by diagnosis codes and prescriptions) with or without (n = 4,189 and n = 4,195 in inverse-probability-of-treatment-weighted cohorts, respectively) dupilumab prescription between October 1, 2018, and November 29, 2023. Poisson regression estimated autoimmune disease incidence rates and rate differences, and Cox proportional hazards models estimated relative associations between dupilumab exposure and disease diagnosis.
Results: Among atopic children, the adjusted incidence rate difference (dupilumab-treated minus untreated) for any autoimmune disease was 2.47 (95% confidence interval, 0.82, 4.30) per 1,000 person-years, driven primarily by cutaneous autoimmune diseases (rate difference, 2.20 [95% confidence interval 0.77, 3.70] per 1,000 person-years). The rates of any or cutaneous autoimmune disease within 4 years of dupilumab treatment were 1.45-fold and 1.57-fold higher, respectively, in treated compared with untreated atopic children.
Conclusion: We detected a modest association between dupilumab and cutaneous autoimmune disease diagnosis in atopic children. These findings help address knowledge gaps about clinical outcomes in atopic children treated with this biologic.
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Gabryszewski SJ, Hirabayashi K, Botdorf M, Maltenfort M, Forrest CB, Guilbert TW, Schutt M, Morizono H, Vazquez Garcia G, Garza-Mayers AC, Hernandez JD, Anvari S, Rao S, Spergel JM. “Incidence of autoimmune diseases in children with atopy treated with dupilumab.” J Allergy Clin Immunol. 2026 Aug;158(2):533-541.
DOI: 10.1016/j.jaci.2026.03.010.
Epub 2026 Mar 25. PMID: 41895450; PMCID: PMC13403167.