Atopic Dermatitis (AD). The effectiveness of allergen specific immunother- apy (SIT) in AD remains controversial, even contraindicated in severe cases.
Abstracts AB101
J ALLERGY CLIN IMMUNOL VOLUME 131, NUMBER 2
Allergen Specific Immunotherapy in Cases of Severe Atopic Dermatitis Inmaculada S anchez-Machın, MD1, Paloma Poza2, Ruperto Gonzalez3, Victor Matheu, MD4; 1Hospital Ofra-Torax, Tenerife, Spain, 2Hospital Ofra-T orax, santa cruz de tenerife, Spain, 3Hospital Ofra-Torax, S/C de Tenerife, Spain, 4Hospital Ofra, Tenerife, Spain. RATIONALE: Allergen sensitization appears to be part of the etiology of Atopic Dermatitis (AD). The effectiveness of allergen specific immunotherapy (SIT) in AD remains controversial, even contraindicated in severe cases. METHODS: Total IgE (T-IgE) and Specific IgE (S-IgE) by CAPFarmacia. Patient 1 (P1): 43-year-old male. Patient 2 (P2): 31-year old woman. Patient 3 (P3): 9-year-old woman. All of them were nonresponders to usual therapeutics including corticosteroids oral (Last year daily for P1, P2, and 6 cycles for P3), cyclosporin (P1, P2) or methotrexate (P1 with bloody diarrhea). They had mild persistent rhinitis and intermitent asthma and positive S-IgE to Dermatophagoidesand storage mites, and P1 also to grass, ragweed pollen and foods without clinical relevance. RESULTS: In a first visit SCORAD and T-IgE were: P1, 81 and 31,090UI/ ml. P2, 75 and 19,038UI/ml. P3, 36 and 14.897UI/ml. We started treatment with SIT, with cluster administration schedule of 4weeks in Hospital Immunotherapy Unit and subsequent monthly maintenance. The early months P1 and P2 showed improvement. The T-IgE was descending in improved patients to be in the 4 year of SIT: 5,560UI/ml for P1 and 2,500UI/ml for P2 with SCORAD of 11 and 5 respectively. However, since there was no clinical improvement for P3 over the first year and her T-IgE increase to 19,239UI/ml and SCORAD to 40, the SIT was stopped. CONCLUSIONS: We have observed a rapid onset of action after initiation of SIT in some cases of Severe AD. Clinical improvement was correlated with the decrease in T-IgE. The SIT may be a therapeutic alternative.
367
A Randomized, Open-Label, Parallel Group Study to Evaluate the Efficacy and Safety of Proactive Management in Pediatric Subjects with Moderate to Severe Atopic Dermatitis Tatsuki Fukuie, MD, PhD1,2, Ichiro Nomura, MD, PhD3, Masami Narita, MD, PhD2, Tsukasa Suzuki, MD1, Iwao Tajima, MD1, Osamu Natsume, MD1, Tomohide Taguchi, MD1, Tsutomu Ogata, MD, PhD1, Yoshiki Tokura, MD, PhD4, Kenji Matsumoto, MD, PhD3, Yukihiro Ohya, MD PhD2; 1Department of Pediatrics, Hamamatsu University School of Medicine, Shizuoka, Japan, 2Division of Allergy, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan, 3Department of Allergy and Immunology, National Research Institute for Child Health and Development, Tokyo, Japan, 4 Department of Dermatology, Hamamatsu University School of Medicine, Shizuoka, Japan. RATIONALE: Proactive therapy of atopic dermatitis (AD) is effective to prevent exacerbation, and we have reported long-term control of skin inflammation might be contributed to decrease serum total or food specific IgE levels in patients with severe atopic dermatitis. However, efficacy of proactive therapy for sensitization to foods or inhaled antigens in children with atopic dermatitis has not been enough described prospectively. METHODS: We conducted a randomized, open-label, parallel group study of children diagnosed with moderate to severe AD, who received an AD educational program of the department of pediatrics, Hamamatsu University school of Medicine from April 2011 to July 2012. The subjects with proactive treatment group will continue the intermittent preventive administration of topical corticosteroid over one year. Change of SCORAD, serum TARC, total IgE, egg-, milk-, house dust mite- and pollen-specific IgE are evaluated and compared with the reactive treatment group. RESULTS: A total of 47 children were approached to participate during the study period, and thirty patients were randomized. For each groups 15 children were assigned, and no significant difference was identified between two groups at initial examination. At 12-month study visit, mean decreasing rate of total IgE (%) was significantly higher in the proactive group than in the reactive group (p
