Erfolgreiche spezifische Immuntherapie (SIT) bei Rhinoconjunctivitis allergica und persistierendem atopischem Handekzem

Abstract

Specific immunotherapy (SIT) is the only causal treatment for an IgE-mediated allergy such as allergic rhinoconjunctivitis. In patients with concomitant atopic eczema (AE) and allergic rhinoconjunctivitis, it is still applied restrainedly. A 44-year-old man working in a sheltered workshop had been suffering from AE since childhood, and seasonal allergic rhinoconjunctivitis experiencing frequent bouts of eczema also during adulthood, which after several years of working were increasingly dominating as severe hand eczema. Various therapies such as medical rehabilitation, various topical therapies and implementation of protective measures on the job reduced the severity of hand eczema, but complete absence of eczema, however, could not be achieved. At the same time, seasonal rhinoconjunctival symptoms severely exacerbated, particularly pronounced during spring as well as during the summer months. By application of a short-time SIT (grasses-rye) with the adjuvant monophosphoryl lipid A (Pollinex Quattro), almost complete absence of symptoms of seasonal rhinoconjunctivitis could be achieved during the following summer. Interestingly, the patient had a 1-time eczema response at the injection site after the first application which disappeared after 14 days. During the following months, a distinct improvement of the hand eczema occurred and, to date, the patient is free of eczema lesions except ofxerosis cutis primarily of the hands, occurring mainly during winter. Until now, the patient has remained in his job without any sick leave. In the meantime, SIT with the same adjuvant preparation was also applied against the pollen of trees (birch, hazel, alder). This case report demonstrates that SIT containing the adjuvant monophosphoryl lipid A is well-tolerated and is able to positively affect the course of eczema in AE patients including severe form of atopic hand eczema.