Detection and Management of Eosinophilia in Asthmatic Adults and Children Receiving Dupilumab Treatment: A Focused Review

Dupilumab is a monoclonal antibody which targets IL-4 and IL-13 receptor providing a safe and effective treatment option for several T2 conditions, including severe asthma in adult and children. In the adult population, both trials and real-life studies, report a usually transient, spontaneously resolving and clinical irrelevant blood eosinophils fluctuation has been reported in a proportion of patients, whilst the occurrence of hypereosinophilia and eosinophils-related adverse reactions is rare. In children, data are limited so far to the clinical trials setting. However, on a clinical ground the phenomenon needs to be considered and properly managed/followed-up in order to prevent or early detect potential eosinophil-related events but on the other side to avoid unnecessary treatment exclusion or discontinuation. So far, some operational algorithms have been proposed addressing the issue in adult populations, including either CRSwNP patients or patients with respiratory impairment more in general. In the present narrative and focused review, the authors aimed to provide a state of the art related to eosinophils increase occurring in asthma children and adults prescribed with dupilumab. In addition, relying on the available evidence, some practical insights on baseline assessment and follow-up are provided.