Abstract
Immunoglobulin E (IgE) plays an essential role in many allergic diseases. This review highlights the role of IgE in atopic dermatitis (AD), a common, chronic, and complex skin inflammation, and the available therapeutic approaches that target IgE in AD. We examine the existing data showing the use of omalizumab, the only biologic anti-IgE therapy available in clinical use, plasma apheresis, and a combination of both therapeutic approaches for the treatment of AD. Existing data on the efficacy of omalizumab in AD are inconclusive. A limited number of randomised controlled studies, few uncontrolled prospective and retrospective reports, as well as multiple case series and case reports observed varying degrees of the efficacy of omalizumab in AD. Omalizumab displays a trend of higher efficacy in AD patients with low IgE levels compared with those with very high-to-extremely high serum IgE concentrations. Plasma apheresis and its combination with omalizumab show good efficacy, even in patients with unusually high serum IgE concentrations. Combining apheresis and anti-IgE treatment may serve as a comprehensive therapeutic approach for patients with elevated levels of IgE. Dedicated clinical studies with robust study designs are needed to establish the therapeutic efficacy of omalizumab in AD.
Highlights
Atopic dermatitis (AD) is a common, chronic, and complex skin inflammation that involves a combination of genetic factors affecting the skin barrier, environmental factors, and immunological response
The study investigated the efficacy of omalizumab in 8 paediatric and adult patients with high baseline immunoglobulin E (IgE) levels, over 24 weeks of treatment, and showed 20–50% improvement in the scoring atopic dermatitis (SCORAD) index and 50–75% reduction in thymic stromal lymphopoietin in all patients treated with omalizumab
IgE seems to play a role in the pathogenesis of AD
Summary
Atopic dermatitis (AD) is a common, chronic, and complex skin inflammation that involves a combination of genetic factors affecting the skin barrier, environmental factors, and immunological response. AD affects nearly 15–20% of children and 1–3% of adults, with 95% of those affected experiencing an early onset below the age of 5.1,2 It is estimated that within the past few decades, the incidence of AD may have increased 2–3 fold in the industrialised world.[1] The prevalence of AD varies with an estimated 230 million patients affected worldwide.[3] Recent data show a 2.2–8.1% prevalence across Europe and the United States.[4,5] data from Asia show an increasing prevalence in countries such as India and China.[3]. AD is most common in young children and resolves before adulthood. The role of IgE in AD and appraisal of the existing evidence on targeting IgE for treatment is discussed in this review
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