Why do Australian dermatologists screen for Strongyloides stercoralis before dupilumab?

We examined why the majority (86%) of Australian dermatologists screen universally for Strongyloides prior to commencing dupilumab, despite the low seroprevalence of Strongyloides infection (1.4% in our cohort) and absence of cases of hyperinfection across 887 person-years of dupilumab exposure. This work includes an audit of 325 patients prescribed dupilumab for atopic dermatitis and a national survey of Australian dermatologists to determine screening practices. We found that universal screening occurs due to concern regarding the mechanism of action of dupilumab conferring high risk of disseminated Strongyloidiasis, peer practice and lack of screening guidelines. The strongest motivator to change this practice would be the introduction of screening guidelines.