ArticleThe journal of allergy and clinical immunology. Global2026
Dupilumab opens a therapeutic window in food protein-induced enterocolitis syndrome by unlicensing dendritic cells.
Article in The journal of allergy and clinical immunology. Global, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Food-protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated reaction to food antigens for which no disease-modifying treatment exists. The mechanistic heterogeneity of FPIES-spanning multiple incompletely understood immune pathways-has hindered the prioritization of therapies in clinical trials. Objective: In this observational study, we sought to determine whether dupilumab, an mAB that is an IL-4 receptor-alpha antagonist, can induce clinical remission in FPIES. Methods: We describe (1) a detailed single-patient case of wheat-triggered, endoscopy-confirmed colitic FPIES treated with dupilumab 300 mg subcutaneously every 2 weeks and (2) a prospective follow-up of 7 additional patients with FPIES all of whom initiated dupilumab for FDA approved comorbidities as a part of their clinical care. Serial flow cytometry quantified dendritic-cell OX40-ligand (OX40L) and CD8 Results: Conclusions: Dupilumab rapidly and durably abrogated food reactivity across diverse FPIES phenotypes associated with downregulated dendritic-cell OX40L. These findings identify the IL-4/IL-13-OX40L axis as a tractable therapeutic target and support formal trials of dupilumab-including high-dose "rescue" regimens-in acute and chronic FPIES.
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