{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T11:27:02Z","timestamp":1793273222124,"version":"4.5.0"},"reference-count":24,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,3,29]]},"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:p>The management of atopic diseases has been revolutionised by precision therapies and biological drugs that target specific immune proteins. This report elucidates a unique complication from the use of the monoclonal antibody, dupilumab, that primary care providers and subspecialists need to be aware of. A patient in her 40s consulted us for severe atopic asthma, food allergy and eczema involving the face and body. She had previously failed treatments and was started on dupilumab (which binds to the interleukin-4 [IL4] receptor and inhibits both IL-4 and IL-13). She quickly achieved remission of asthma, rhinitis and eczema. Therapy was, however, complicated by severe blepharoconjunctivitis, dry eyes and periorbital dermatitis, consistent with dupilumab-induced ocular surface disease and dupilumab-associated mucin deficiency. Following aggressive treatment of ocular disease, the patient was able to continue dupilumab injections for asthma and eczema. It is presumed that dupilumab-induced cytokine imbalance results in ocular goblet cell dysfunction, mucin deficiency and ocular disease.<\/jats:p>","DOI":"10.1136\/bcr-2022-249019","type":"journal-article","created":{"date-parts":[[2022,4,12]],"date-time":"2022-04-12T13:21:40Z","timestamp":1649769700000},"page":"e249019","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Dupilumab-induced ocular surface disease: a primer"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3238-5905","authenticated-orcid":false,"given":"Merin Anna","family":"Reji","sequence":"first","affiliation":[{"name":"Internal Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaisha","family":"Haque","sequence":"additional","affiliation":[{"name":"W. G. (Bill) Hefner VA Medical Center, Salisbury, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Supriya","family":"Goyal","sequence":"additional","affiliation":[{"name":"Private Practice, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9848-6197","authenticated-orcid":false,"given":"Guha","family":"Krishnaswamy","sequence":"additional","affiliation":[{"name":"Wake Forest School of Medicine, Winston-Salem, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,4,12]]},"reference":[{"key":"2025082709392093000_15.4.e249019.1","first-page":"488","article-title":"Management of dupilumab\u2010associated conjunctivitis in atopic dermatitis","volume":"17","author":"Aszodi","year":"2019","journal-title":"J Dtsch Dermatol Ges"},{"key":"2025082709392093000_15.4.e249019.2","doi-asserted-by":"publisher","DOI":"10.1186\/1476-7961-8-3"},{"key":"2025082709392093000_15.4.e249019.3","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1146\/annurev-immunol-061020-053702","article-title":"Cytokine regulation and function in T cells","volume":"39","author":"Dong","year":"2021","journal-title":"Annu Rev Immunol"},{"key":"2025082709392093000_15.4.e249019.4","doi-asserted-by":"publisher","DOI":"10.1126\/science.8178175"},{"key":"2025082709392093000_15.4.e249019.5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1804092"},{"key":"2025082709392093000_15.4.e249019.6","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1097\/CCM.0000000000004893","article-title":"Critical care management of the patient with anaphylaxis: a Concise definitive review","volume":"49","author":"Krishnaswamy","year":"2021","journal-title":"Crit Care Med"},{"key":"2025082709392093000_15.4.e249019.7","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1111\/cea.13491","article-title":"Mechanisms of Dupilumab","volume":"50","author":"Harb","year":"2020","journal-title":"Clin Exp Allergy"},{"key":"2025082709392093000_15.4.e249019.8","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.jtos.2020.05.008","article-title":"Ocular surface disease associated with dupilumab treatment for atopic diseases","volume":"19","author":"Utine","year":"2021","journal-title":"Ocul Surf"},{"key":"2025082709392093000_15.4.e249019.9","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1016\/j.jtos.2019.12.006","article-title":"Immune - 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