Allergen Specific Immunotherapy in Cases of Severe Atopic Dermatitis

Abstract

S U N D A Y 366 Allergen Specific Immunotherapy in Cases of Severe Atopic Dermatitis Inmaculada S anchez-Mach in, MD, Paloma Poza, Ruperto Gonz alez, Victor Matheu, MD; Hospital Ofra-T orax, Tenerife, Spain, Hospital Ofra-T orax, santa cruz de tenerife, Spain, Hospital Ofra-T orax, S/C de Tenerife, Spain, Hospital Ofra, Tenerife, Spain. RATIONALE: Allergen sensitization appears to be part of the etiology of Atopic Dermatitis (AD). The effectiveness of allergen specific immunotherapy (SIT) in AD remains controversial, even contraindicated in severe cases. METHODS: Total IgE (T-IgE) and Specific IgE (S-IgE) by CAPFarmacia. Patient 1 (P1): 43-year-old male. Patient 2 (P2): 31-year old woman. Patient 3 (P3): 9-year-old woman. All of them were nonresponders to usual therapeutics including corticosteroids oral (Last year daily for P1, P2, and 6 cycles for P3), cyclosporin (P1, P2) or methotrexate (P1with bloody diarrhea). They hadmild persistent rhinitis and intermitent asthma and positive S-IgE to Dermatophagoidesand storage mites, and P1 also to grass, ragweed pollen and foods without clinical relevance. RESULTS: In a first visit SCORAD and T-IgEwere: P1, 81 and 31,090UI/ ml. P2, 75 and 19,038UI/ml. P3, 36 and 14.897UI/ml.We started treatment with SIT, with cluster administration schedule of 4weeks in Hospital Immunotherapy Unit and subsequent monthly maintenance. The early months P1 and P2 showed improvement. The T-IgE was descending in improved patients to be in the 4 year of SIT: 5,560UI/ml for P1 and 2,500UI/ml for P2 with SCORAD of 11 and 5 respectively. However, since there was no clinical improvement for P3 over the first year and her T-IgE increase to 19,239UI/ml and SCORAD to 40, the SIT was stopped. CONCLUSIONS:Wehave observed a rapid onset of action after initiation of SIT in some cases of Severe AD. Clinical improvement was correlated with the decrease in T-IgE. The SIT may be a therapeutic alternative.