Dupilumab-induced hypereosinophilia: review of the literature and algorithm proposal for clinical management

Expert Rev Respir Med. 2022 Jul;16(7):713-721. doi: 10.1080/17476348.2022.2090342. Epub 2022 Jun 23.


Introduction: Dupilumab is a human monoclonal antibody that targets both IL-4 and IL-13 signaling. It is currently indicated for the treatment of asthma, moderate-to-severe atopic dermatitis, and chronic rhinosinusitis with nasal polyps (CRSwNP). Eosinophilia has been reported as a potential adverse event in treated patients.

Areas covered: A selective search on PubMed and Medline up to January 2022 was performed, by focusing on dupilumab-induced hypereosinophilia described in clinical trials, real-life studies, and case reports. The possible mechanisms underlying dupilumab-induced hypereosinophilia and the eosinophil-related morbidity have also been explored.

Expert opinion: Dealing with dupilumab-induced hypereosinophilia represents a clinical challenge for clinicians managing patients on dupilumab therapy. An algorithm for the practical management of dupilumab-induced hypereosinophilia has been proposed, in order to properly investigate potential eosinophil-related morbidity and avoid unnecessary drug discontinuation.

Keywords: Asthma; IL-13; IL-4; algorithm; atopic dermatitis; dupilumab; eosinophils; hyper-eosinophilia; nasal polyps.

Publication types

  • Review

MeSH terms

  • Algorithms
  • Antibodies, Monoclonal, Humanized
  • Eosinophilia*
  • Humans
  • Nasal Polyps*
  • Sinusitis*


  • Antibodies, Monoclonal, Humanized
  • dupilumab