Allergen immunotherapy improves disease severity in atopic dermatitis

October 06, 2022

3 minute read

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According to a review published in The Journal of Allergy and Clinical Immunology.

Based on these findings, treatment of AD would benefit from shared decision-making and a multidisciplinary approach, Derek K. Chu, MD, PhD, assistant professor in the department of medicine at McMaster University, Hamilton, Ontario, Canada, and colleagues wrote.

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“Allergen immunotherapy — also called specific desensitization, allergen-specific immunotherapy, or hyposensitization — involves the administration of increasing amounts of a specific allergen to an allergic patient to induce tolerance to it,” Chu told Healio.

Derek K Chu

Subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) have been established as safe and effective in treating aeroallergen allergies for allergic rhinitis and allergic asthma, Chu said, adding that they also have potential long-term benefits on the disease.

“Previous studies of allergen immunotherapy for atopic dermatitis, however, have shown mixed results,” Chu said. “Therefore, its advantages and disadvantages remain uncertain.”

Study design, results

As part of the American Academy of Allergy, Asthma & Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters 2022 AD guideline update, researchers reviewed the efficacy and safety of SCIT and SLIT compared to placebo or standard care for patients with AD.

The researchers reviewed 23 randomized controlled trials (RCTs) conducted in 13 countries and published up to August 2021. These trials included 1,957 adults and children (median study age, 19 years; range of means, 4-34 years) sensitized primarily to house dust mites with moderate to severe AD initially treated with allergen immunotherapy (AIT).

In 22 of the RCTs (n=1801), researchers found with moderate certainty that AIT probably improved the likelihood of reducing the severity of baseline AD by at least 50% compared to not using AIT. AIT (40% versus 25%; RR=1.53; 95% CI, 1.31-1.78). SCIT and SLIT had similar effects in these trials.

Analysis of eight of the RCTs (n=629) found with moderate certainty that AIT probably improved dermatological quality of life index scores by four or more points compared with no use of AIT. TIA (56% vs 39%; RR=1.44; 95% CI, 1.03-2.01).

A review of three RCTs (n=113) found with uncertain evidence that AIT can reduce itching by 50% from baseline compared to no AIT use (25% versus 19 %; RR=1.29; 95% CI, 0.084-1.98).

The results also showed highly uncertain effects of AIT for improving sleep loss (mean difference between groups, -0.07; 95% CI, -1.28 to 1.14) and treating flare-ups that led to the administration of systemic corticosteroids (20% versus 22%; RR = 0.94; 95% CI, 0.3-2.94).

By integrating safety data from trials of AIT for allergic rhinitis and asthma, the researchers found with high certainty that AIT increased local adverse events (RR = 1.65; 95% CI, 1.48-1.64), mainly at the injection site with SCIT and in the oropharyngeal region with SLIT; with moderate certainty that AIT increased systemic reactions compared to placebo ( RR = 1.37; 95% CI, 1.15-1.64); and with moderate certainty that AIT probably increased adverse events leading to discontinuation compared to placebo ( RR = 1.39; 95% CI 0.94-2.05).

Conclusions, next steps

With moderate certainty, the researchers concluded that AIT improves the severity of AD and the quality of life of patients with the disease, particularly if they receive AIT for house dust mites compared to other environmental allergens.

“The relative benefits were similar between SCIT or SLIT, children or adults, and according to the severity of atopic dermatitis,” Chu said.

Chu further noted that SCIT likely and significantly increases adverse events, primarily injection site reactions followed by systemic reactions and adverse events large enough to cause discontinuation of treatment.

However, he continued, the small increase in adverse events with SLIT, which were mostly transient oropharyngeal reactions, may be unimportant on average.

In addition, the impact of immunotherapy on long-term AD control, patient-reported flare-ups and severity of AD, and specific domains of itching and sleep quality are less certain.

“Overall evidence is best for immunotherapy against house dust mites rather than other environmental allergens, although specific species (Der P, Der f or both) and formulations did not alter observed effects,” Chu said.

Considering the burdens of TIA, including adverse events and time commitments, the researchers said multidisciplinary care may best achieve optimal outcomes in Alzheimer’s disease.

“This systematic review and meta-analysis provides moderate-certainty evidence that adjunctive AIT results in significant improvements in atopic dermatitis severity and quality of life,” Chu said. “This supports a multidisciplinary, shared decision-making approach to optimal atopic dermatitis care.”

These findings will also be incorporated into upcoming AAAAI/ACAAI AD guidelines, Chu said.

“We will also issue directed calls for future research, including providing sample size estimates for future RCTs aimed at answering now open questions,” Chu said.

For more information:

Derek K. Chu, MD, PhD, can be reached at [email protected]

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