Treatment of patients with atopic dermatitis and extremely high immunoglobulin E: world experience and own clinical observation

Abstract

Atopic dermatitis is a chronic inflammatory skin disease characterized by a recurrent course, difficulty in individual selection of therapy, especially in patients with severe course. When examining and treating such patients, one of the routine diagnostic methods is to determine the level of total immunoglobulin E in the blood serum. The article is devoted to the analysis of available world practice data on published clinical cases of the use of biological therapy with dupilumab in real clinical practice in patients with severe atopic dermatitis, in whom high and very high levels of immunoglobulin E. The appointment of biological therapy for this cohort of patients often raises significant concerns. However, the use of a monoclonal antibody against IL-4/IL-13 proved effective, did not lead to serious adverse reactions in such patients and was accompanied by a decrease in the level of immunoglobulin E during treatment. It was noted that immunosuppressive treatment prior to biological therapy led to the development of adverse events in these patients. A separate group of patients with genetically determined hyper-IgE syndrome and severe atopic dermatitis is described, in which the positive experience of using dupilumab is also noted. The author presents his own clinical case of a patient with severe atopic dermatitis and a high level of immunoglobulin E receiving successful targeted therapy after a preliminary thorough examination except for lymphoproliferative and autoimmune diseases. Against the background of dupilumab therapy, there was a pronounced clinical regression of skin symptoms, a decrease in the level of immunoglobulin E, an increase in the patient’s quality of life, and the absence of side effects.