Allergen-sensitive atopic dermatitis is improved by injections of allergen combined with F(ab′)2 fragments of specific antibodies

Abstract

Summary Symptoms of atopic dermatitis (AD) can be provoked by exposure to airborne allergens. We have previously shown that patients hypersensitive to D. pteronyssinus (Dpt) allergens were improved by administration of complexes composed of specific antibodies and allergen, which reduce the allergen‐specific immune response. We now report that similar results can be achieved by using F(ab′)2 fragments of specific antibodies instead of whole antibody molecules. Eight adult patients with severe AD were included in a single‐blind study. During the first 11 months patients were maintained on injections of carrier buffer alone, in an effort to evaluate the extent of spontaneous improvement. They were then treated with intradermal injections of allergen‐F(ab′)2 complexes made from autologous specific antibodies and Dpt allergens. The majority of the patients improved spontaneously during the summer months, with an average 30% reduction of symptoms. However, a much more pronounced improvement was observed after 3 months on active therapy, corresponding to a cumulative amount of 60 μg F(ab′)2 and 15 μg allergens. The patients continued to improve over the next 5 months, showing an average 83% reduction of severity scores. The use of F(ab′)2 antibody fragments reduces the risk of inducing an anti‐allotypic immune response, and raises the possibility of adding adjuvants to allergen‐antibody complexes and/or using specific antibodies isolated from pooled gammaglobulins.

Guidelines of care for atopic dermatitis

“…There is insufficient evidence in the peer-reviewed literature to support the use of leukotriene inhibitors, desensitization injections, allergy-antibody complexes of house dust mites, thymopentin, theophylline, and papaverine for the treatment of AD. [157][158][159][160][161][162][163][164][187][188][189][196][197][198] Although of interest, clinical trials regarding the possible use of methotrexate, biologic agents such as etanercept, infliximab, and oral pimecrolimus in the treatment of AD are not currently available. Therefore, these agents are outside the scope of this report.…”

Treatment of Eczema

“…They concluded that this is a potentially effective means of treatment of atopic eczema and that exposure to house dust mite is indeed a factor in eczema exacerbations [82,83]. They subsequent showed that the same effect can be achieved by preparing complexes of D. pteronyssinus antibodies and the F(ab)2 fragment of specific antibodies instead of whole antibody molecules [84]. A more recent study of 89 adults with chronic atopic dermatitis, a SCORAD score greater than or equal to 40, and a positive skin prick sensitivity to dust mite was conducted in which the subjects were randomized to either a placebo group or one of three groups receiving immunotherapy with maintenance doses of house dust mite extract of 20, 2,000, and 20,000 per week for 1 year.…”