Allergen immunotherapy for atopic dermatitis: Systematic review and meta-analysis of benefits and harms

Yepes-Núñez, Juan José; Guyatt, Gordon; Gomez-Escobar, Luis; Pérez-Herrera, Lucía C.; Chu, Alexandro; Ceccaci, Renata; Acosta-Madiedo, Ana Sofía; Wen, Aaron; Moreno‐López, Sergio; MacDonald, Margaret; Barrios, Mónica; Chu, Xiajing; Islam, Nazmul; Gao, Ya; Wong, Melanie; Couban, Rachel; García, Elizabeth; Chapman, Edgardo; Oykhman, Paul; Chen, Lina; Winders, Tonya; Asiniwasis, Rachel Netahe; Boguniewicz, Mark; Benedetto, Anna De; Ellison, Kathy; Frazier, Winfred; Greenhawt, Matthew; Huynh, Joey; BscPhm, Elaine Kim; LeBovidge, Jennifer; Lind, Mary Laura; Lio, Peter; Martin, Stephen A.; O’Brien, Monica; Ong, Peck Y.; Silverberg, Jonathan I.; Spergel, Jonathan M.; Wang, Julie; Wheeler, Kathryn E.; Schneider, Lynda C.; Chu, Derek K.

doi:10.1016/j.jaci.2022.09.020

Cited by 37 publications

(32 citation statements)

References 85 publications

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“…Clinical presentation and the natural developmental process of AA will likely be affected differently by different subtypes of AD. Dust mite allergy has been implicated in AD, 40,41 as well as in early onset and severe types of AA in our previous study 6 . In AA, it has been suggested that repeated exposure to allergens, eliciting periodically high inflammatory reactions, could promote a more extensive hair loss presentation in sync with changes to seasonal allergen exposure intensity 6,8 .…”

Section: Discussionmentioning

confidence: 68%

Allergen desensitization reduces the severity of relapsed alopecia areata in dust‐mite allergic patients

Zeng

et al. 2023

Experimental Dermatology

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Atopy may be a facilitating factor in some alopecia areata (AA) patients with early disease onset and more severe/extensive AA. The underlying immune mechanisms are unknown, but allergen responses may support a pro‐inflammatory environment that indirectly promotes AA. To investigate the long‐term effect of allergen immunotherapy (AIT) against house dust mite (HDM) allergy on disease severity and prognosis for AA patients. An observational comparative effectiveness study was conducted on 69 AA patients with HDM allergy. 34 patients received conventional/traditional AA treatment (TrAA) plus AIT (AIT‐TrAA), and 35 patients received TrAA alone. Serum total immunoglobulin E (tIgE), HDM specific IgE (sIgE), HDM specific IgG4 (sIgG4) and cytokines (IL‐4, IL‐5, IL‐10, IL‐12, IL‐13, IL‐33, IFNγ) were quantified in these patients, together with 58 non‐allergic AA patients and 40 healthy controls. At the end of the 3‐year desensitization course, the AIT‐TrAA group presented with lower SALT scores than the TrAA group, especially in non‐alopecia totalis/universalis (AT/U) patients and pre‐adolescent AT/U patients (age ≤ 14). In patients with elevated tIgE levels before AIT, a decrease in tIgE was correlated to reduced extent of AA on completion of the AIT course. After desensitization, elevation of IL‐5 and decrease of IL‐33 were observed in HDM allergic‐AA patients. Desensitization to HDM in allergic AA patients reduces the severity of relapse‐related hair loss over the 3‐year AIT treatment course, possibly via opposing Th2 dominance. This adjunctive treatment may help reduce disease severity and curtail the disease process in allergic patients with AA.

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Section: Discussionmentioning

confidence: 68%

Allergen desensitization reduces the severity of relapsed alopecia areata in dust‐mite allergic patients

Zeng

et al. 2023

Experimental Dermatology

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“…In patients with AD accompanied by severe hair loss, AIT may be a suitable treatment option if there is no response to conventional treatments, including systemic immunosuppressants. Although the exact mechanisms remain to be determined, we hypothesize that AA may be improved via Treg-induced allergen-specific im- In a meta-analysis of AIT for AD of 23 randomized controlled trials (RCTs), 13 four RCTs addressed flares requiring steroid therapy during the early AIT period when immune tolerance did not fully develop, therefore physicians should consider the possibility that AD and AA may worsen during the early AIT period.…”

Section: Discussionmentioning

confidence: 99%

“…In a meta‐analysis of AIT for AD of 23 randomized controlled trials (RCTs), 13 four RCTs addressed flares requiring steroid therapy during the early AIT period when immune tolerance did not fully develop, therefore physicians should consider the possibility that AD and AA may worsen during the early AIT period.…”

Section: Discussionmentioning

confidence: 99%

Allergen‐specific immunotherapy improves alopecia totalis in a severe atopic dermatitis patient

Kwon

Park

Kim

et al. 2023

The Journal of Dermatology

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House dust mite (HDM) is the most common allergen exacerbating atopic dermatitis (AD), and allergen‐specific immunotherapy (AIT) using HDM exhibited significant improvements in previous studies. Alopecia can occur as a complication of AD. Alopecia totalis (AT), a severe form of alopecia areata (AA), does not respond well to treatment and the chance of full recovery is less than 10%. For extensive hair loss, topical immunotherapy such as diphenylcyclopropenone (DPCP) is used as the first‐line treatment. However, since DPCP is a kind of contact allergen, it has the potential to exacerbate AD. A 38‐year‐old man with AD and AA visited our clinic with symptoms worsening from 3 months ago. Although taking oral methylprednisolone (8 mg/day) and cyclosporine (100 mg/day) for 3 months, he has lost over 90% of his hair and the Eczema Area and Severity Index (EASI) was 43. Total serum immunoglobulin E (IgE) levels were 4454 kU/L (normal <100 kU/L) and the specific IgE levels for Dermatophagoides pteronyssinus and Dermatophagoides farinae following ImmunoCAP® were 20.8 and 37.4 kU/L, respectively. This patient did not respond well to previous treatment and was reluctant to use long‐term steroids, so subcutaneous AIT using HDM was administered along with oral cyclosporine (100 mg/day). Topical tacrolimus was also applied to the AD lesions throughout the body. To reduce itching, nonsedative antihistamines were used if necessary. Hair loss was almost completely improved 1 year after the AIT initiation and the skin lesions of AD also improved (EASI 2.4). The specific IgE levels for D. pteronyssinus and D. farinae were 3.73 and 7.16 kU/L, respectively. Herein, we report a patient with promising results following AIT for AT with severe AD. In severe alopecic patients with AD refractory to conventional treatment, including immunosuppressants, AIT could be considered as a treatment option.

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“…Although limitedly used in hAD, a recent systematic review of the best evidence has concluded that AIT importantly improves hAD severity and QoL, 4 narrowing the gap between treatment scenarios for both species.…”

Section: Challenging the Norm: Epicutaneous Immunotherapy For Canine ...mentioning

confidence: 99%

Challenging the norm: Epicutaneous immunotherapy for canine atopic dermatitis

Pinto,

Gil,

Ramió‐Lluch

et al. 2023

Allergy

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Allergen immunotherapy for atopic dermatitis: Systematic review and meta-analysis of benefits and harms

Cited by 37 publications

References 85 publications

Allergen desensitization reduces the severity of relapsed alopecia areata in dust‐mite allergic patients

Allergen desensitization reduces the severity of relapsed alopecia areata in dust‐mite allergic patients

Allergen‐specific immunotherapy improves alopecia totalis in a severe atopic dermatitis patient

Challenging the norm: Epicutaneous immunotherapy for canine atopic dermatitis

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