Dupilumab across allergic diseases: Indications, clinical efficacy, and future directions

: Dupilumab is a human monoclonal antibody targeting the IL-4 receptor alpha subunit, thereby inhibiting both IL-4 and IL-13 signaling pathways central to type 2 inflammation. Since its initial approval for atopic dermatitis in 2017, dupilumab has gained multiple FDA-approved indications across allergic and eosinophilic diseases, including asthma, chronic rhinosinusitis with nasal polyps, eosinophilic esophagitis, prurigo nodularis, chronic spontaneous urticaria, chronic obstructive pulmonary disease with type 2 inflammation, bullous pemphigoid, and allergic fungal rhinosinusitis. This review summarizes the immunologic mechanisms, pharmacologic properties, clinical efficacy, biomarker effects, and safety profile of dupilumab across approved indications, while also discussing its role within the broader landscape of type 2 biologics. Landmark clinical trials consistently demonstrate significant reductions in disease severity, exacerbation frequency, corticosteroid dependence, and symptom burden, with improvements in quality of life across multiple organ systems. Biomarker studies show suppression of type 2 inflammatory mediators, including thymus activation-regulated chemokine (TARC), eotaxin-3, FeNO, and IgE, although eosinophil dynamics vary among diseases. Dupilumab has generally demonstrated a favorable long-term safety profile, with conjunctivitis and transient eosinophilia representing the most commonly recognized adverse events. Emerging evidence also supports potential roles in biomarker-guided precision therapy, disease modification, and combination biologic strategies. Given its efficacy across multiple indications and expanding indications, dupilumab has become an important therapeutic option for patients with overlapping type 2 inflammatory comorbidities and continues to reshape the management of allergic and eosinophilic diseases.