Injection of Allergen-Antibody Complexes Is an Effective Treatment of Atopic Dermatitis

Abstract

Atopic dermatitis (AD) can be exacerbated by contact with airborne allergens, amongst which Dermatophagoides pteronyssinus (Dpt) appears to be potentially important. Specific IgE antibodies towards Dpt are often found in AD and it can therefore be speculated that suppression of the production of anti-Dpt IgE might result in a significant clinical improvement. Complexes of antigen and specific antibodies have been shown to suppress the production of antibody in other systems; we report here the evaluation in an open trial of the capacity of such complexes to improve symptoms of AD. Ten adult patients were enrolled in this study. In addition to satisfying the criteria of AD, they all suffered from a severe disease (more than 20% of the body surface involved) that had been stable for at least the last 2 years. The patients had high titers of total IgE antibodies and specific anti-Dpt antibodies. Allergen-antibody complexes were prepared from Dpt allergens and an excess of autologous specific anti-Dpt antibodies obtained by immunoadsorption. The patients received regular injections of these complexes throughout 1 year, during which clinical parameters of disease intensity, percentage of body surface affected and intensity of pruritus were regularly monitored. A significant clinical improvement was obtained after 3–4 months of therapy and was maintained through the 9th month. After 1 year of treatment 2 patients were completely free of disease 4 had residual lesions which continued to improve and 4 patients had a partial recurrence of dermatitis. In addition to the demonstration that injection of antigen-antibody complexes results in a clinical benefit, these results suggest that the immune response towards Dpt is a relevant factor in AD.

Correlation of Eosinophils, Eosinophil Cationic Protein and Soluble lnterleukin-2 Receptor with the Clinical Activity of Atopic Dermatitis

“…In addition, it is wished to find a consensus about a clinical score system in AD, which would allow to compare AD patients of different clinical trials [2,3,5,11,[22][23][24],…”

Specific Hyposensitization for Atopic Dermatitis: A New Era?

“…In this issue of Dermatológica, Leroy et al [6] report on a novel approach of specific hyposensitization that induced an impressive improvement within 3-4 months in 10 patients with AD. The method used by Leroy et al consists in injecting to the patient not the allergen alone but a mixture of the allergen plus the patient's own anti bodies to this allergen, i.e.…”

“…Whichever the mechanism of clinical improvement in AD is (Leroy et al [6] not only discuss idiotypic suppres sion but also modulation of T cell function and functional inactivation of B cells through binding of antigen-anti body complexes), the therapeutic value appears such that anyone dealing with AD patients would think: 'When could I try this method?' The study presented by Leroy et al is an open one, and although convincing, we should await the results of ongoing double-blind trials.…”

“…One is the patient selection: In their study Leroy et al [6] have selected patients with positive prick tests and RAST to D. pteronyssinus and reasoned that this allergen is the principal airborne allergen in areas of temperate cli mate. This allergen was then chosen for preparing the allergen-antibody complexes.…”

“…Obviously, the technique proposed by Leroy et al [6] would be difficult to use, and many efforts should be made before it may reach our practice. This field has been so disappointing in the past that even those who never pre scribed 'specific hyposensitization' in AD (like the author of this Editorial) should consider that there might now be a 'hole in the wall'.…”