There are controversial issues on the use of SIT in atopic eczema.
I believe that SIT can have a role in specific cases, but just like an additional treatment, never alone. I have more experience with sublingual immunotherapy and sometimes it is useful
There are some recent studies where it has been demonstrated that in selected groups of patients (when allergens for which positive tests are found clinically cause exacerbations of eczema) SIT or other desesibilisations can improve atopic eczema, this is also our experience. Moreover there is a recent review on the subject (J Allergy Clin Immunol. 2013 Jul;132(1):110-7 ).
No, in severe atopic dermatitis - which is not a simple atopic disease - there is not a place for allergen immunotherapy.
Martin Hrubisko.
I agree with Mario that ASI has an additive role in for better control of atopic eczema.
a patient of eczema, if having a positive SPT (Skin Prick Test) and positive history of exposure to a particular allergen, substantiated with raised specific IgE levels against that allergen, the Specific Allergen Immunotherapy definitely works. However, Very young and very old persons usually do not respond to immunotherapy.
tSIT can have a role in specific cases about % 10, also ptient's age is important. Immunotherapy sometimes may be useful.
The topic is widely reviewed and results are confounding.
- Bussmann C, Bockenhoff A, Henke H, Werfel T, Novak N. Does allergen-specific
immunotherapy represent a therapeutic option for patients with atopic dermatitis? J Allergy Clin Immunol 2006 December; 118: 1292–8.
The general impression is that larger randomized placebo-controlled studies with large numbers of patients are needed to assess the effectiveness of SIT in patients with AD. One is planned in Spain.
Flares of atopic dermatitis due to specific allergens mostly involved in IgE-mediated allergic reactions have many simmilarities with allergic contact dermatitis and they are associated with allergen-specific T-cell responses. For their pathogenesis and clinical appearance they could be considered a form of systemic allergic dermatitis.
The role of allergy in eliciting eczematous skin lesions is controvesial. These allergens produce flares in some patients with atopic dermatitis, but not in all sensitized individuals. The classic tests for IgE –mediated hypersensitivity like the prick test and the measurement of specific IgE lack of specificity. Atopy patch test was developed as a diagnostic tools in such cases, but the results are often contradicting.
A distinction between different allergens should be made: house dust mite, grass pollens and food proteins. It has been shawn that flares can be induced by bronchial house dust mite exposure. Dermatophagoides pteronyssinus is a perennial allergen while grass pollens are seasonal allergens. It is well known that in some cases flares of atopic dermatitis can be induced by oral provocation with some food allergens, but the causative importance of food allergy in atopic dermatitis is still debatable. Some authors even think that easy and uncontrolled use of elimination diets for atopic dermatitis might have increased food allergy.
Allergen specific immunotherapy is considered a possibility for improvement of the course of atopic dermatitis in some very selected patients, but it has still to be proven in controlled clinical trials.
So far as no »gold standard« to determine the role of an allergen in induction and maintenance of atopic dermatitis exists, the history of allergen –specific exacerbation is crucial for the evaluation of its clinical relevancy. The avoidance of the specific allergen remains the basic therapeutic measure.
The allergen isolation is easier for respiratory allergies. Atopic dermatitis have various causes including allergy - IgE mediated or IgG mediated contact dermatitis. History is very important and if avoidance is possible, it is the best solution. Certain food items can produce skin allerg and also can cross react with aoeo-allergens. Even occupational exposure produces skin allergy. At present the method of detection of allergen is by SPT, IgE estimation of food challenge These tests are not absolutely confirmative, because of multiple factors involved in atopic dermatitis. However, if the allergen is isolated and found to correlate well with history, the ASI definitely provide relief.
I do not think that there is any important role for specific allergen immunotheraphy in severe atopic dermatitis. The reason for that is eczema is not solely an IGE-mediated disease in atopic patients. Actually, an increase in IGE is rather the cause not the specific treatment of this disease. However, there is a definitive role, from my own clinical experience for allergen immunotherapy for diseases such as allergic rhinitis or hay fever provided that the number of allergens is not high and that the duration is not too long.
To believe, to think: That's not science. Serious studies should answer that question.
ASI in atopic dermatitis mediated by Ige is observed to be having prolonged benefit . However it should not be confused with IgG mediated or Type 4 eczema. which is cell mediated
The hyposensitization with allergen Dermatophagoides pteronissmus passes successfully at patients AD. However, we do it only for treatment professional ekzem.
ASI is successful only in some cases with severe AD. The decision to innitiate that kind of therapy has to be made on a case-by-case basis.
I agree with Marta and as I elaborated a little bit previously as to where ASI should be give and where it should not be recommended. The decision is therefore definitely on case to case basis with definite evidence of IgE involvement.
I agree with Martha, has to be selected on a case, but in some cases of severe atopic dermatitis have had very good results with specific immunotherapy, even after failure of cyclosporine and methotrexate.
In our experience the proper patient selectión is the real challenge. The treatment works really well in those (mainly youngsters) sensitised to perennial allergens (i.e. dust mites)
This discussion is puntuated with anecdote, belief and thought rather than evidence. The facts based on previous study are that inhalant allergen exposure as well as direct skin contact can cause exacerbations of eczema. Trials of allergen immunotherapy even in carefully selected patients to treat allergic eczema have suggested benefit but were not sufficiently powered to give a defintive result. Thus, the only conclusion is that large properly controlled trials are still required and at present allergen immunotherapy cannot be recommended.
please read:
Allergy
Volume 61, Issue 2, pages 202–205, February 2006,
www.medscape.org/viewarticle/568216
I have some monosensitized patients with atopic dermatitis treated succesfully with specific allergen immunotherapy and a lot of polysensitized patients with atopic dermatitis treated succesfully with sublingual/swallow group-specific multiallergen immunotherapy. I my personal experience, a well indicated and properly applied IT is an effective treatment for AD from light to severe forms.
I have applied sublingual monosensitized immunotherpy by ALBIO. My patients has performed prick test and sublingual immunotherapy remained symptom-free from 3 years to 10 years. But some atopic patients have not type 1 allergic response, have only type 4 allergic response, I have choosed ketotifen for these patients.
thank you Binnur
please write complete your article address .
or more explain it.
I have some patients with non-IgE mediated hypersensitivity who evolved over the years to IgE-mediated allergy. In fact there are studies that associated the contact dermatitis with atopic dermatitis pathophysiology with several common features. The diagnosis of IgE-mediated allergy is not so easy, since the absence of seric IgE does not eliminates the diagnosis and the cutaneous tests does not have 100% sensitivity. The improvement with ketotifen is sugestive of mast cell degranulation (besides tipe I hypersensitivity the mast cell may degranulate by tipe II and tipe III reactions (complement activation with production of anaphylatoxins - C3a, C4a and C5a). I suggest to re-investigate these patients periodicaly to evidence IgE-mediated mechanisms that may suggest a desensitizaton therapy.
In a systematic review using the GRADE system, the strength of recommendation is weak for use of SIT in patients with AD.
Annals of Allergy, Asthma & Immunology
Volume 111, Issue 6 , Pages 555-561, December 2013
I agree with then. Subcutaneous allergen-specific IT is not the best choice for AD. There are promissing results coming soon with group-specific sublingual/swallow IT.
If patient can pay Prick test I have performed this test and If I define one or two allergens I have prescribed sublingual immunotherapy.. sometimes prick test showed negative results to 20 allergens includes airborne and foodborne allergens.
İn clinical examination some patients have urticarial papule and plaques with oedematous but some of them not. I suppose some patients show only type4 reactions generally atopic dermatitis shows both of type I and type 4 allergic reactions.
everybody can positive skin prick test(sensetive) but not definite allergy. I think , it must be relation between positive skin test and exposure to allergen. then SIT may be effective. they need more accurate clinical trial studies.
The diagnosis of allergy is better done by provocation test. The cutaneous test is useful to choose the allergens that will be applied in the provocation tests. In the case of airborne allergens you can use the nasal provocation test. For food allergens you begin an exclusion diet and then re-introduce the suspected food. You must pay attention to the possibities of cross-reactivity, for instance mite-shrimp-cockroach or the pollen-fruit-latex syndrome. For these cases and with polisensitization we had great improvement of Quality of Live in patients with rhinitis and atopic dermatitis treated with group-specific sublingual/swallow multiallergen immunotherapy.
for example, in the north of Iran HDM(Mites) is the most common airoallergens. its mean is more people has sensitization with them. we need a high correlation between allergen and allergic disease till we have start SIT. perhaps if we test normal people then they have positive skin prick test with HDM.
please read our article:
Hypersensitivity to house dust mite and cockroach is the most common allergy in north of iran. Javad Ghaffari, Mohammad Khademloo, Mohammad Jafar Saffar, Alireza Rafiei, Farzad Masiha Iranian journal of immunology: IJI 12/2010; 7(4):234-9.
specific immunotherapy including: Sublingual or subcutaneous or oral and .....
Dear Binnur
Do is positive skin prick test equal definite allergy due to it. or it is only a sensitization.
selection of an allergen for immunotherapy is very important and also is more problem. I think , Vaccine failures are often related to failure to select the correct allergen.
SIT may be a short for "Subcutaneus Immunotherapy" , or "Specific Immunotherapy", we found both uses, but as the majority of americans does nor perform SLIT (sublingual immunotherapy), usually SIT refer only to the subcutaneus IT. sometimes we found SCIT to refer to "subcutaneus immunotherapy".