Efficacy and safety of subcutaneous allergen-specific immunotherapy with depigmented polymerized mite extract in atopic dermatitis

Novak, Natalija; Bieber, Thomas; Hoffmann, Matthias; Fölster‐Holst, Regina; Homey, Bernhard; Werfel, Thomas; Sager, Angelika; Zuberbier, Torsten

doi:10.1016/j.jaci.2012.08.004

Cited by 99 publications

(92 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The trial by Novak and colleagues 413 reported no significant differences between the treatment groups in disease severity measured by SCORAD scores, quality of life measured by the DLQI or use of basic medication during the trial. Post hoc analysis performed in the severe subgroup of patients (SCORAD score of > 50 at baseline) found a statistically significant reduction in the median total SCORAD score over time, with the immunotherapy plus standard care group having a 21% improvement compared with standard treatment only (p = 0.02).…”

Section: Benefitsmentioning

confidence: 96%

“…In the trial by Novak and colleagues, 413 local reactions of mild intensity were reported in 39% of participants in the immunotherapy group and 35% in the placebo group.…”

Section: Harmsmentioning

confidence: 96%

“…The largest did not find any benefit for the addition of house dust mite-specific immunotherapy in sensitised adult patients, except in a post hoc subgroup of only those with severe eczema. 413 Two smaller trials in children contradict each other. In one trial of sublingual immunotherapy treatment 414 the results from 9 to 18 months do provide evidence of benefit, but there is a lack of evidence of benefit over the entire 18 months.…”

Section: Overall Implications For Research and Practicementioning

confidence: 99%

“…A trial by Novak and colleagues, 413 reported in 2012, compared specific immunotherapy using subcutaneous house dust mite allergens every 6 weeks plus standard treatment (emollients, topical steroids, pimecrolimus and oral steroids if needed) for 18 months with standard treatment alone in 168 adults with moderate to severe eczema and sensitisation to house dust mite allergens (two common species). Participants were randomised 2 : 1 to immunotherapy plus standard treatment or standard treatment alone.…”

Section: -414mentioning

confidence: 99%

See 3 more Smart Citations

Scoping systematic review of treatments for eczema

Nankervis

Kim

Delamere

et al. 2016

Programme Grants Appl Res

View full text Add to dashboard Cite

BackgroundEczema is a very common chronic inflammatory skin condition.ObjectivesTo update the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) systematic review of treatments for atopic eczema, published in 2000, and to inform health-care professionals, commissioners and patients about key treatment developments and research gaps.Data sourcesElectronic databases including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Skin Group Specialised Register, Latin American and Caribbean Health Sciences Literature (LILACS), Allied and Complementary Medicine Database (AMED) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from the end of 2000 to 31 August 2013. Retrieved articles were used to identify further randomised controlled trials (RCTs).Review methodsStudies were filtered according to inclusion criteria and agreed by consensus in cases of uncertainty. Abstracts were excluded and non-English-language papers were screened by international colleagues and data were extracted. Only RCTs of treatments for eczema were included, as other forms of evidence are associated with higher risks of bias. Inclusion criteria for studies included availability of data relevant to the therapeutic management of eczema; mention of randomisation; comparison of two or more treatments; and prospective data collection. Participants of all ages were included. Eczema diagnosis was determined by a clinician or according to published diagnostic criteria. The risk of bias was assessed using the Cochrane Collaboration risk-of-bias tool. We used a standardised approach to summarising the data and the assessment of risk of bias and we made a clear distinction between what the studies found and our own interpretation of study findings.ResultsOf 7198 references screened, 287 new trials were identified spanning 92 treatments. Trial reporting was generally poor (randomisation method: 2% high, 36% low, 62% unclear risk of bias; allocation concealment: 3% high, 15% low, 82% unclear risk of bias; blinding of the intervention: 15% high, 28% low, 57% unclear risk of bias). Only 22 (8%) trials were considered to be at low risk of bias for all three criteria. There was reasonable evidence of benefit for the topical medications tacrolimus, pimecrolimus and various corticosteroids (with tacrolimus superior to pimecrolimus and corticosteroids) for both treatment and flare prevention; oral ciclosporin; oral azathioprine; narrow band ultraviolet B (UVB) light; Atopiclair™ and education. There was reasonable evidence to suggest no clinically useful benefit for twice-daily compared with once-daily topical corticosteroids; corticosteroids containing antibiotics for non-infected eczema; probiotics; evening primrose and borage oil; ion-exchange water softeners; protease inhibitor SRD441 (Serentis Ltd); furfuryl palmitate in emollient; cipamfylline cream; andMycobacterium vaccaevaccine. Additional research evidence is needed for emollients, bath additives, antibacterials, specialist clothing and complementary and alternative therapies. There was no RCT evidence for topical corticosteroid dilution, impregnated bandages, soap avoidance, bathing frequency or allergy testing.LimitationsThe large scope of the review coupled with the heterogeneity of outcomes precluded formal meta-analyses. Our conclusions are still limited by a profusion of small, poorly reported studies.ConclusionsAlthough the evidence base of RCTs has increased considerably since the last NIHR HTA systematic review, the field is still severely hampered by poor design and reporting problems including failure to register trials and declare primary outcomes, small sample size, short follow-up duration and poor reporting of risk of bias. Key areas for further research identified by the review include the optimum use of emollients, bathing frequency, wash products, allergy testing and antiseptic treatments. Perhaps the greatest benefit identified is the use of twice weekly anti-inflammatory treatment to maintain disease remission. More studies need to be conducted in a primary care setting where most people with eczema are seen in the UK. Future studies need to use the same core set of outcomes that capture patient symptoms, clinical signs, quality of life and the chronic nature of the disease.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

show abstract

Section: Benefitsmentioning

confidence: 96%

“…In the trial by Novak and colleagues, 413 local reactions of mild intensity were reported in 39% of participants in the immunotherapy group and 35% in the placebo group.…”

Section: Harmsmentioning

confidence: 96%

Section: Overall Implications For Research and Practicementioning

confidence: 99%

Section: -414mentioning

confidence: 99%

See 2 more Smart Citations

Scoping systematic review of treatments for eczema

Nankervis

Kim

Delamere

et al. 2016

Programme Grants Appl Res

View full text Add to dashboard Cite

show abstract

“…In AD patients who are refractory or do not clinically respond to conventional treatment approaches, a number of alternative strategies may be used including cyclosporine, methotrexate, azathioprine, IL-6 blockade, dust mite immunotherapy when indicated, Wet Wrap therapy and ultraviolet light (90)(91)(92)(93)(94). Recent studies with broad based targeting therapeutics (69-70) have used disease-related cellular and molecular biomarkers to: i) show that the chronic AD phenotype can be reversed to a non-lesional state, as has been shown for psoriasis patients treated with effective therapeutics and ii) map inflammatory disease-related pathways.…”

Section: Implications Of Ad Pathobiology For General Management Appromentioning

confidence: 99%

Deciphering the complexities of atopic dermatitis: Shifting paradigms in treatment approaches

2014

Journal of Allergy and Clinical Immunology

View full text Add to dashboard Cite

Atopic dermatitis (AD) is the most common chronic inflammatory skin disease. It often precedes the development of food allergy and asthma. Recent insights into AD reveal abnormalities in terminal differentiation of the epidermal epithelium leading to a defective stratum corneum, which allows enhanced allergen penetration and systemic IgE sensitization. Atopic skin is also predisposed to colonization or infection by pathogenic microbes, most notably Staphylococcus aureus and herpes simplex virus (HSV). Causes of this abnormal skin barrier are complex and driven by a combination of genetic, environmental and immunologic factors. These factors likely account for the heterogeneity of AD onset, severity and natural history of this skin disease. Recent studies suggest prevention of AD can be achieved by early interventions protecting the skin barrier. Onset of lesional AD requires effective control of local and systemic immune activation for optimal management. Early intervention may improve long term outcomes for AD and reduce the systemic allergen sensitization leading to associated allergic diseases in the gastrointestinal and respiratory tract.

show abstract

Specific allergen immunotherapy for the treatment of atopic eczema

Tam

Calderón

Manikam

et al. 2016

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

Comparison 1 Immunotherapy versus control, Outcome 6 Use of other medications for eczema.. .. Analysis 2.1. Comparison 2 Planned subgroup analyses: immunotherapy versus control, Outcome 1 Participant-or parentreported specific symptoms of eczema-SCORAD part C by route of immunotherapy.. .. .. .. .. Analysis 2.2. Comparison 2 Planned subgroup analyses: immunotherapy versus control, Outcome 2 Participant-or parentreported specific symptoms of eczema-severity of sleep disturbance by route of immunotherapy.. .. .. Analysis 2.3. Comparison 2 Planned subgroup analyses: immunotherapy versus control, Outcome 3 Participant-or parentreported specific symptoms of eczema-SCORAD part C by allergen type.. .. .. .. .. .. .. Analysis 2.4. Comparison 2 Planned subgroup analyses: immunotherapy versus control, Outcome 4 Participant-or parentreported specific symptoms of eczema-severity of sleep disturbance by allergen type.. .. .. .. .. Analysis 2.5. Comparison 2 Planned subgroup analyses: immunotherapy versus control, Outcome 5 Participant-or parentreported specific symptoms of eczema-SCORAD part C by participant age.. .. .. .. .. .. . Analysis 2.6. Comparison 2 Planned subgroup analyses: immunotherapy versus control, Outcome 6 Participant-or parentreported specific symptoms of eczema-itch severity by participant age.. .. .. .. .. .. .. . Analysis 2.7. Comparison 2 Planned subgroup analyses: immunotherapy versus control, Outcome 7 Participant-or parentreported specific symptoms of eczema-severity of sleep disturbance by participant age.. .. .. .. . Analysis 2.8. Comparison 2 Planned subgroup analyses: immunotherapy versus control, Outcome 8 Participant-or parentreported specific symptoms of eczema-itch severity by severity at randomisation.. .. .. .. .. . Analysis 2.9. Comparison 2 Planned subgroup analyses: immunotherapy versus control, Outcome 9 Participant-or parentreported specific symptoms of eczema-severity of sleep disturbance by severity at randomisation.. .. .. Analysis 2.10. Comparison 2 Planned subgroup analyses: immunotherapy versus control, Outcome 10 Adverse events: any local reaction by route of immunotherapy.

show abstract

Efficacy and safety of subcutaneous allergen-specific immunotherapy with depigmented polymerized mite extract in atopic dermatitis

Cited by 99 publications

References 27 publications

Scoping systematic review of treatments for eczema

Scoping systematic review of treatments for eczema

Deciphering the complexities of atopic dermatitis: Shifting paradigms in treatment approaches

Specific allergen immunotherapy for the treatment of atopic eczema

Contact Info

Product

Resources

About