Atopic Dermatitis: Immunotherapy Can Be Effective

Severe atopic dermatitis (AD) symptoms of shorter duration were more likely to improve in allergen sensitized patients receiving desensitizing immunotherapy, than severe symptoms of longer duration or more moderate symptoms, according to a new observational cohort study.

Severe atopic dermatitis (AD) symptoms of shorter duration were more likely to improve in allergen sensitized patients receiving desensitizing immunotherapy, than severe symptoms of longer duration or more moderate symptoms, according to a new observational cohort study.

The study to gauge efficacy of subcutaneous allergen immunotherapy (SCIT) in treating selected patients with AD, and ascertain the clinical characteristics of patients responding to the treatment was published by Dong-Ho Nahm, MD, Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea and colleagues in the November issue of the Yonsei Medical Journal. Clinical Efficacy of Subcutaneous Allergen Immunotherapy in Patients with Atopic Dermatitis

"The clinical usefulness of SCIT for AD is still controversial," Nahm and colleagues indicated. “This controversy is partly due to the lack of knowledge on the degree of clinical efficacy, predictive factor for a favorable clinical response, and selection criteria of patients for the treatment."

The investigators enrolled 251 subjects with AD, who also evidenced sensitivity to house dust mite (HDM) by elevated serum-specific IgE antibody, to receive 12 months of SCIT. Topical corticosteroids and/or topical calcineurin inhibitors were continued as required, but no systemic immunosuppressants, including cyclosporine, were used during the study. Antihistamines were administered before each subcutaneous injection to minimize allergic side effects to the SCIT.

A favorable clinical response at 12 months, determined by 50% or greater decrease in SCORAD (Scoring Atopic Dermatitis) index value from baseline, was observed in 73.6% of the 144 patients who remained for assessment at study end. Among those with severe baseline AD, 90.6% met this improvement criteria, although their symptoms were of significantly shorter duration (12.3±8.5 years) than those with longer term severe AD (20.6±10.9 years) who showed no significant clinical response. Also, 63.7% of patients with mild to moderate symptoms had favorable clinical response.

Subjects with severe AD symptoms also demonstrated statistically significant reductions in HDM serum specific IgE antibody concentrations from baseline, while there was no significant difference observed in those with mild to moderate symptoms.

Nahm and colleagues suggest that the difference in response between patients with severe symptoms of short and longer durations may reflect a natural course of AD, "from nonallergic AD in infants to allergic AD in children and young adults, and eventually to autoallergic AD in adults."

The investigators conclude that early initiation of SCIT is a potentially useful treatment option for patients with severe AD who are also sensitized to HDM.

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