Ann Dermatol.  2015 Feb;27(1):82-86. 10.5021/ad.2015.27.1.82.

Treatment of Patients with Refractory Atopic Dermatitis Sensitized to House Dust Mites by Using Sublingual Allergen Immunotherapy

• Choi JS
• Ryu HR
• Yoon CH
• Kim JH
• Baek JO
• Roh JY
• Lee JR

• KMID: 2264843
• DOI: http://doi.org/10.5021/ad.2015.27.1.82

Abstract

Even though atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases, its treatment remains a challenge in clinical practice, with most approaches limited to symptomatic, unspecific anti-inflammatory, or immunosuppressive treatments. Many studies have shown AD to have multiple causes that activate complex immunological and inflammatory pathways. However, aeroallergens, and especially the house dust mite (HDM), play a relevant role in the elicitation or exacerbation of eczematous lesions in many AD patients. Accordingly, allergen-specific immunotherapy has been used in AD patients with the aim of redirecting inappropriate immune responses. Here, we report three cases of refractory AD sensitized to HDM who were treated with sublingual immunotherapy.

Keyword

Atopic dermatitis; Pyroglyphidae; Sublingual immunotherapy

MeSH Terms

Dermatitis, Atopic*
Desensitization, Immunologic*
Humans
Immunotherapy
Pyroglyphidae*
Skin Diseases
Sublingual Immunotherapy

Figure

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  Fig. 1 Severe vesicular eczematous nodules and plaques on lower legs in the patients with refractory atopic dermatitis (case 1) at baseline.

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  Fig. 2 Sublingual immunotherapy consists of a build up phase and maintenance phase. IR is biological unit, and a concentration of 100 IR defined by the capacity of the allergen to elicit by skin prick test a geometric mean wheal size of 7 mm diameter in 30 patients sensitive to the corresponding allergen.

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  Fig. 3 After 12 months with sublingual immunotherapy, marked improved lesions on both lower leg with brownish patch and crust.

Reference

1. Scalabrin DM, Bavbek S, Perzanowski MS, Wilson BB, Platts-Mills TA, Wheatley LM. Use of specific IgE in assessing the relevance of fungal and dust mite allergens to atopic dermatitis: a comparison with asthmatic and nonasthmatic control subjects. J Allergy Clin Immunol. 1999; 104:1273–1279.

2. Moingeon P, Batard T, Fadel R, Frati F, Sieber J, Van Overtvelt L. Immune mechanisms of allergen-specific sublingual immunotherapy. Allergy. 2006; 61:151–165.

3. Werfel T, Breuer K, Ruáff F, Przybilla B, Worm M, Grewe M, et al. Usefulness of specific immunotherapy in patients with atopic dermatitis and allergic sensitization to house dust mites: a multi-centre, randomized, dose-response study. Allergy. 2006; 61:202–205.

4. Nahm DH, Kim ME. Treatment of severe atopic dermatitis with a combination of subcutaneous allergen immunotherapy and cyclosporin. Yonsei Med J. 2012; 53:158–163.

5. Bousquet J, Van Cauwenberge P, Khaltaev N. Aria Workshop Group. World Health Organization. Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol. 2001; 108:5 Suppl. S147–S334.

6. Frew AJ, Smith HE. Sublingual immunotherapy. J Allergy Clin Immunol. 2001; 107:441–444.

7. Novak N, Simon D. Atopic dermatitis - from new pathophysiologic insights to individualized therapy. Allergy. 2011; 66:830–839.

8. Agostinis F, Tellarini L, Canonica GW, Falagiani P, Passalacqua G. Safety of sublingual immunotherapy with a monomeric allergoid in very young children. Allergy. 2005; 60:133.

9. Grosclaude M, Bouillot P, Alt R, Leynadier F, Scheinmann P, Rufin P, et al. Safety of various dosage regimens during induction of sublingual immunotherapy. A preliminary study. Int Arch Allergy Immunol. 2002; 129:248–253.

10. Mastrandrea F, Serio G, Minelli M, Minardi A, Scarcia G, Coradduzza G, et al. Specific sublingual immunotherapy in atopic dermatitis. Results of a 6-year follow-up of 35 consecutive patients. Allergol Immunopathol (Madr). 2000; 28:54–62.

11. Petrova SIu, Berzhets VM, Al'banova VI, Bystritskaia TF, Petrova NS. Immunotherapy in the complex treatment of patients with atopic dermatitis with sensitization to house dust mites. Zh Mikrobiol Epidemiol Immunobiol. 2001; (1):33–36.

12. Pajno GB, Caminiti L, Vita D, Barberio G, Salzano G, Lombardo F, et al. Sublingual immunotherapy in mitesensitized children with atopic dermatitis: a randomized, double-blind, placebo-controlled study. J Allergy Clin Immunol. 2007; 120:164–170.

13. Akdis CA, Barlan IB, Bahceciler N, Akdis M. Immunological mechanisms of sublingual immunotherapy. Allergy. 2006; 61:Suppl 81. 11–14.

14. Allam JP, Stojanovski G, Friedrichs N, Peng W, Bieber T, Wenzel J, et al. Distribution of Langerhans cells and mast cells within the human oral mucosa: new application sites of allergens in sublingual immunotherapy? Allergy. 2008; 63:720–727.

15. Cadario G, Galluccio AG, Pezza M, Appino A, Milani M, Pecora S, et al. Sublingual immunotherapy efficacy in patients with atopic dermatitis and house dust mites sensitivity: a prospective pilot study. Curr Med Res Opin. 2007; 23:2503–2506.