A case has been reported of an adult patient with nasal polyposis who experienced facial angioedema after therapy with dupilumab.
The report, published in Cureus, stated that the patient developed no rashes or respiratory distress, and had only facial and labial swelling that resolved after discontinuation of dupilumab.
“Our case report presents a 47-year-old woman with a history of nasal polyposis who developed angioedema after being treated with dupilumab for recurrent polyposis,” the authors wrote. “This report may be instructional for prescribers providing patients with anticipatory guidance or evaluating otherwise unexplained angioedema.”
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Dupilumab is a monoclonal antibody used to treat moderate to severe eczema, asthma, and nasal polyposis. It binds to the interleukin (IL)-4 receptor alpha subunit, which is shared by both IL-4 and IL-13 receptors, thereby inhibiting signaling of IL-4 and IL-13 and reducing the type 2 inflammatory response.
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To date, only one case of angioedema associated with dupilumab has been published in the literature, and it involved a child.
This patient had a medical history of nasal polyposis and only had temporary relief with polypectomy 10 years earlier. She tolerated the first dose of dupilumab without a reaction, but 10 days after the second injection, she experienced facial and labial swelling. Corticosteroids resolved the swelling, but after the third dose, the swelling recurred, and she was given corticosteroids again, which resolved the swelling.
After a fourth dose and a return of the swelling, dupilumab was finally discontinued and she was tested and found to have normal C3, C4, and C2 esterase inhibitor levels, ruling out hereditary angioedema.
She was started on fluticasone nasal spray and has had improvement in her symptoms, with no further swelling 10 months after the last dose of dupilumab. The authors recommend clinicians consider adding dupilumab in cases of unexplained angioedema.
Reference
Hodson T, Shah D, Wong D. Dupilumab-associated angioedema in an adult: a case report of an adverse event and literature review. Cureus. Published online July 05, 2023. doi:10.7759/cureus.41406
