Abstract
Recent reports proposed the application of immunoadsorption (IA) for patients with recalcitrant atopic dermatitis (AD) and high-serum IgE levels. However, experience with this novel treatment approach, especially with the newly available IgE-specific adsorber, is limited and recommendation for its use in clinical practice awaits evidence from more studies. Patients with severe AD (SCORAD ≥ 60) and total serum IgE levels ≥750 kU/L were included in this study. The treatment protocol consisted of two cycles of five consecutive treatments with IgE-selective IA 3 weeks apart. Ten patients were enrolled and four patients completed the study. The mean SCORAD was significantly improved by up to 43% within a few weeks and until the end of a 6-month follow-up period, with 50% of patients achieving an at least 50% individual reduction of the baseline SCORAD. Each IA cycle induced a temporal average decrement of total serum levels of IgE, IgM, IgA, and IgG by 92, 43, 38, and 35%, respectively. Except for one case of Staphylococcus aureus septicemia, no major adverse events occurred. Although limited by a considerable withdrawal rate, our observations strengthen our and other recent results further suggesting that IgE-selective IA is an effective treatment option for patients severely affected by AD with highly elevated IgE levels.
Highlights
Atopic dermatitis (AD) is characterized by pruritic, eczematous skin lesions, and is commonly associated with elevated serum IgE levels
A recent systematic review and meta-analysis of the efficacy of omalizumab in 103 AD patients from 13 studies revealed that serum IgE concentrations of >700 kU/L were associated with less-favorable clinical responses compared with lower levels (2)
We recently reported a successful response of a series of treatment-refractory AD patients with excessively high-serum IgE levels to panimmunoglobulin IA and two such patients to IgE-selective IA (5, 6)
Summary
Atopic dermatitis (AD) is characterized by pruritic, eczematous skin lesions, and is commonly associated with elevated serum IgE levels. The role of IgE in the pathophysiology of AD is not fully understood, sequestering free IgE by the anti-IgE monoclonal antibody omalizumab showed some clinical benefit in AD patients with poor response to traditional therapy (2). Studies of this treatment have yielded controversial results. A recent systematic review and meta-analysis of the efficacy of omalizumab in 103 AD patients from 13 studies revealed that serum IgE concentrations of >700 kU/L were associated with less-favorable clinical responses compared with lower levels (2).
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