Subcutaneous Immunotherapy with a Depigmented Polymerized Birch Pollen Extract – A New Therapeutic Option for Patients with Atopic Dermatitis

Abstract

Background: Birch pollen is an important outdoor allergen able to aggravate symptoms in atopic dermatitis (AD). Specific immunotherapy (SIT), an established procedure for allergic airway diseases, might also represent an attractive therapeutic option for the causal treatment of allergen-triggered cutaneous symptoms in these patients. Studies with house dust mite SIT have already shown beneficial effects in AD patients, whereas the safety and efficacy of SIT with birch pollen extract in AD patients have not been studied so far. The aim of this study was to evaluate for the first time the safety and efficacy of SIT with a depigmented polymerized birch pollen extract in AD patients. Methods: Fifty-five adult patients with moderate-to-severe AD and clinically relevant sensitization to birch pollen received SIT for 12 weeks. SIT was continued during birch pollen season. The assessment of safety, the total SCORAD value, and the Dermatology Life Quality Index (DLQI) were evaluated. Results: The median total SCORAD value was reduced by 34% (p < 0.001) during the course of treatment and the mean DLQI improved by 49% (p < 0.001) despite strong simultaneous birch pollen exposure. Eight patients (14.5%) developed systemic reactions and 19 patients (34.5%) developed local reactions which were of mild intensity in most cases. No patient discontinued the study prematurely due to adverse drug reactions. Coseasonal treatment was well tolerated. Conclusion: SIT with a depigmented polymerized birch pollen extract leads to significant improvement of the SCORAD value and the DLQI in patients suffering from moderate-to-severe AD sensitized to birch pollen.

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

“…The observed frequencies were similar to those seen in other studies. 25 Treatment of AD with HDM allergens was also shown to be safe in an uncontrolled study that used a rush protocol (3-day protocol) in contrast to a ultra-rush build-up protocol (1-day protocol). 26 In conclusion, this study shows the treatment of patients with AD with depigmented polymerized mite extract is effective and safe and should be considered as a valuable add-on treatment especially in severely affected patients sensitized to HDM.…”

Atopic dermatitis - from new pathophysiologic insights to individualized therapy

“…Nevertheless, a recent study conducted in adult patients sensitized against house dust mites revealed promising results in terms of efficacy of SIT in AD (43). Moreover, in parallel with a decrease in AD severity of and reduction in concomitant medications, the quality of life improved upon SIT in patients with AD sensitized to birch pollen allergen (44). In addition to allergen-specific tolerance, a reduction in allergenspecific IgE and increase in allergen-specific IgG4 as well as decrease in serum factors correlating with the severity of AD such as IL-16, CCL18 or CCL22 has been observed (45,46).…”

Immunotherapies in Dermatologic Disorders

“…6 There are examples of its application in dermatology, mainly for atopic dermatitis (AD). 7,8 The other group of immunomodulators is the biologics. Biologics are complex preparations of organic substances obtained from animals or modified organisms isolated by biotechnological methods or assays.…”