Early Dupilumab in Pediatric EoE Tied to Lower Incident Asthma

Children with eosinophilic esophagitis (EoE) treated with dupilumab before age 6 years had about half the incidence of asthma 3.5 years later compared with matched children who never received the biologic, according to a retrospective cohort study presented at the American College of Allergy, Asthma & Immunology (ACAAI) 2026 Annual Scientific Meeting in Phoenix, held November 12 to 16, 2026.¹

Dupilumab, a monoclonal antibody inhibiting interleukin 4 and interleukin 13 signaling, is the only FDA-approved biologic for EoE and is approved for patients as young as 1 year, but its asthma indication begins at age 6 years.^1,2 Kayla J. Steinberger, MD, PhD, resident physician, Department of Pediatrics at West Virginia University, used this gap between approved ages to assess whether dupilumab given for EoE early in childhood was associated with later asthma.¹

"Targeting the shared T2 inflammatory pathway early may influence subsequent atopic disease development, not just treat individual conditions," Steinberger wrote.¹

TriNetX cohort design and propensity matching

Using the TriNetX network, Steinberger identified children diagnosed with EoE at age 6 years or younger between January 1, 2016, and January 1, 2026.¹ The treated group received dupilumab for EoE and then was off the drug for at least 1 year, and the comparator group had never received dupilumab. Children with an asthma diagnosis at age 6 years or younger were excluded.¹

After 1:1 propensity score matching on age, sex, race, asthma diagnosis, and atopic dermatitis diagnosis, each group included 698 children.¹ Mean age at index was 3.2 years in both groups, about 74% were male, and 46.0% of each group had atopic dermatitis.¹

Incident asthma after early dupilumab

At 3.5 years after the index event, incident asthma occurred in 8.1% of dupilumab-treated children vs 16.0% of never-treated children.¹ This corresponded to an absolute risk reduction of 7.9 percentage points (95% CI, 3.8–12.1; P = .0002).¹

Steinberger noted the lower incidence persisted 3.5 years after the index event even though treated children had been off dupilumab for at least 1 year.¹ She concluded early targeted biologic therapy may reduce incident asthma in children with EoE and may modify the trajectory of atopic disease.¹

The study was retrospective and relied on electronic health record data, so it cannot establish causation. The poster did not report dupilumab dosing, treatment duration, EoE severity, or safety outcomes, and residual confounding by indication between treated and untreated children cannot be excluded.

References

1. Steinberger KJ. Early dupilumab treatment for pediatric eosinophilic esophagitis is associated with reduced incident asthma. Presented at: American College of Allergy, Asthma & Immunology 2026 Annual Scientific Meeting; November 12-16, 2026; Phoenix, AZ.

2. Chehade M, Dellon ES, Spergel JM, et al. Dupilumab for eosinophilic esophagitis in patients 1 to 11 years of age. N Engl J Med. 2024;390(24):2239-2251. doi:10.1056/NEJMoa2312282