Successful treatment of a patient with severe atopic dermatitis and severe asthma by centrifugal therapeutic plasma exchange

Abstract

This is a case of a 42-year-old atopic man with severe atopic dermatitis and asthma who despite long-term immunosuppression was not well controlled. He had a very high IgE at 7897 Iu/mL prior to treatment. He underwent two therapeutic plasma exchanges (TPEs) through two peripheral lines in our outpatient department, which led to an absolute decrease of 44.1% and 37% in his plasma IgE for each exchange, and immediate sustained improvement in shortness of breath, and atopic dermatitis, and hence led to a vast improvement in his quality of life. TPE offers a new exciting adjunctive treatment option for severe atopic individuals, where it may provide a novel role to reduce health burden and improve clinical symptoms. Further studies need to be performed to establish an optimal protocol and potential maintenance with recently available targeted anti-IgE biologics.

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“…The mean reduction rate of immunoglobulin E was 29%. 16 TPE performed with SPO due to severe hypertriglyceridemia rapidly reduced the level of serum triglyceride. 18 Autoantibodies associated with crescentic glomerulonephritis and small vessel vasculitis were removed efficiently.…”

“…3,8 In a recent PubMed search, we found 12 reports on cTPE using SPO. [8][9][10][11][12][13][14][15][16][17][18][19] In these publications, different data were analyzed. The most important data, such as plasma removal efficiency and utilization of citrate, are listed in Table 2.…”

“…17 Regarding the clinical outcome, and IgG reduction of TPE treatment using SPO, only 4 reports were available. 8,9,16,17 Hafer et al showed the reduction of mean IgG from 5.88g/L (3.42-8.84g/L) baseline to 1.89g/L (1.21-3.52g/L) when exchanging the patients plasma volume 1.2 times in one TPE procedure. 9 In TPE, it is difficult to calculate the removal efficiency of IgG by using fresh frozen plasma as replacement fluid.…”