Spezifische Immuntherapie bei der Behandlung von Patienten mit atopischer Dermatitis – Ergebnisse einer plazebokontrollierten Doppelblindstudie

Abstract

Background: Specific immunotherapy (SIT) is the only causative method of treatment in the case of IgE-mediated allergic disease. There is extensive literature on the use of SIT in the management of respiratory allergies and insect venom hypersensitivity, but there is a paucity of published data concerning its use as a therapeutic approach in atopic dermatitis (AD). Objective: A double-blind placebo-controlled trial was conducted over a period of 12 months in order to evaluate the efficacy of SIT in the management of atopic dermatitis attributable to house dust mites or grass pollens. Methods: A total of 20 patients (5 - 40 years old) with AD and monovalent sensitization to airborne allergens (house dust mites or grass pollens) were enrolled in the study. SIT was performed using aluminum hydroxide-adsorbed allergen preparations administered by subcutaneous injection. Clinical efficacy of the treatment was assessed using the clinical score W-AZS index. Serum concentration of total IgE and allergen-specific IgE were measured, as were various immunological parameters including ECP, SIL-2R, IFN-y, IL-4, IL-5 and IL-10. Results: The mean value of W-AZS index in the SIT group before treatment was 87.6 ± 15.8 patients, and this decreased to 38.8 ± 34.4 patients after 12 months of therapy (p < 0.01). In the placebo group, the mean W-AZS index before treatment was 86.3 ± 15.7 patients and after 12 months of therapy it increased to 111.9 ± 41.7 patients. Comparative statistical analysis indicated a significant difference between the 2 groups in favor of patients treated with the active allergy vaccines (p < 0.01). Serum levels of specific IgE in the SIT group showed a tendency to decrease, whilst those in the placebo group tended to increase. Serum concentrations of selected immunological parameters including ECP, SIL-2R, IFN-y, IL-4, IL-5 and IL-10 were monitored before and after treatment, but did not show significant differences. Conclusion: Allergen-specific immunotherapy appeared to be an effective method of treatment for atopic dermatitis as judged by significant improvement in clinical index in cases with well-documented IgE-mediated allergic disease.