T Helper 2 Inhibitors in Allergic Contact Dermatitis

Abstract

Clinical trials are currently underway to evaluate the benefit of dupilumab in treating allergic contact dermatitis (ACD). Dupilumab use has been reported to improve ACD reactions in some patients, but not all. Varying clinical responses to T helper 2 (T_H2) inhibition challenge the classical view that ACD proceeds through a T_H1-dominant pathway. Selective T_H2 inhibitors, such as dupilumab, may attenuate ACD when the delayed hypersensitivity response is due to T_H2-predominate activation; conversely, it may have no effect on ACD if it is elicited via T_H1 or T_H17 pathways. We hypothesize that allergen-specific T-cell responses and patient-specific factors both play an important role in determining which pathways are recalled in delayed hypersensitivity reactions.