Management of Atopy with Dupilumab and Omalizumab in CADINS Disease

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Natalie M Diaz-Cabrera - , University of South Florida (Author)
  • Bradly M Bauman - , Henry M. Jackson Foundation (Author)
  • Mildred A Iro - , University of Southampton (Author)
  • Gina Dabbah-Krancher - , Henry M. Jackson Foundation (Author)
  • Vered Molho-Pessach - , Hadassah Medical Center (Author)
  • Abraham Zlotogorski - , Hadassah Medical Center (Author)
  • Oded Shamriz - , Hebrew University of Jerusalem (Author)
  • Yael Dinur-Schejter - , Hadassah Medical Center (Author)
  • Tatyana Dubnikov Sharon - , Hadassah Medical Center (Author)
  • Polina Stepensky - , Hadassah Medical Center (Author)
  • Yuval Tal - , Hadassah Medical Center (Author)
  • Eli M Eisenstein - , Hadassah Medical Center (Author)
  • Leonora Pietzsch - , Department of Paediatrics, University Hospital Carl Gustav Carus Dresden (Author)
  • Catharina Schuetz - , Department of Paediatrics, University Hospital Carl Gustav Carus Dresden, University Center for Rare Diseases (Author)
  • Damien Abreu - , Washington University St. Louis (Author)
  • Carrie C Coughlin - , Washington University St. Louis (Author)
  • Megan A Cooper - , Washington University St. Louis (Author)
  • Joshua D Milner - , Columbia University Irving Medical Center (CUMC) (Author)
  • Anthony Williams - , University of Southampton (Author)
  • Gil Armoni-Weiss - , Hadassah Medical Center (Author)
  • Andrew L Snow - , Uniformed Services University of the Health Sciences (Author)
  • Jennifer W Leiding - , Johns Hopkins Medicine (Author)

Abstract

The caspase activation and recruitment domain 11 (CARD11) gene encodes a scaffold protein required for lymphocyte antigen receptor signaling. Dominant-negative, loss-of-function (LOF) pathogenic variants in CARD11 result in CARD11-associated atopy with dominant interference of NF-κB signaling (CADINS) disease. Patients with CADINS suffer with severe atopic manifestations including atopic dermatitis, food allergy, and chronic spontaneous urticaria in addition to recurrent infections and autoimmunity. We assessed the response of dupilumab in five patients and omalizumab in one patient with CADINS for the treatment of severe atopic symptoms. CARD11 mutations were validated for pathogenicity using a T cell transfection assay to assess the impact on activation-induced signaling to NF-κB. Three children and three adults with dominant-negative CARD11 LOF mutations were included. All developed atopic disease in infancy or early childhood. In five patients, atopic dermatitis was severe and recalcitrant to standard topical and systemic medications; one adult suffered from chronic spontaneous urticaria. Subcutaneous dupilumab was initiated to treat atopic dermatitis and omalizumab to treat chronic spontaneous urticaria. All six patients had rapid and sustained improvement in atopic symptoms with no complications during the follow-up period. Previous medications used to treat atopy were able to be decreased or discontinued. In conclusion, treatment with dupilumab and omalizumab for severe, refractory atopic disease in patients with CADINS appears to be effective and well tolerated in patients with CADINS with severe atopy.

Details

Original languageEnglish
Article number48
JournalJournal of clinical immunology
Volume44
Issue number2
Publication statusPublished - Feb 2024
Peer-reviewedYes

External IDs

Scopus 85182440194
ORCID /0009-0003-6519-0482/work/175757944

Keywords

Keywords

  • Adult, Antibodies, Monoclonal, Humanized, Child, Child, Preschool, Chronic Urticaria, Dermatitis, Atopic/drug therapy, Humans, NF-kappa B, Omalizumab/therapeutic use, CADINS, CARD11, Dupilumab, Omalizumab, Urticaria, atopic dermatis, eczema

Library keywords