Q:

10/1/2013
I have a 35 year-old new female patient with a strong history of atopic disease who suffers from allergic rhinoconjunctivitis, eczema, and mild asthma. Her symptoms were very severe as a young child and she was started on IT to inhalants (I do not know the specifics of exactly what she received) at age 4 and received treatment until she went off to college.

She had done reasonably well until approximately 5 years ago when she developed severe palmoplantar eczema (dishydrotic eczema-skin was biopsied) which has been poorly controlled with topical steroids and really all other standard treatments. Oral steroids, when given for a few weeks (by her dermatologist), alleviate her symptoms, however, they return quickly after she's completed the treatment. She was patch tested by a dermatologist who found her to be positive to methyldibromoglutaronitrile, however, the patch testing was somewhat limited and so I will be performing some patch testing to common allergens that were omitted.

My question is...supposing that no new patch tests are positive (which they may be but we will not find out next week after they are applied and then removed and read), and that she has completely eliminated any exposure to methyldibromoglutaronitrile, would there be a role for immunotherapy to dust mites and molds? I tested her today and she is strongly positive. She has already instituted dust control measures and has HEPA filters.

A:

Thank you for your inquiry.

A history of childhood atopic dermatitis is often associated with the development of palmoplantar eczema later in life. However, there is no definitive evidence that palmoplantar eczema itself has an atopic pathogenesis. In addition, there is no evidence in the literature that allergen immunotherapy would be an effective therapy in this disorder.

Thank you again for your inquiry and we hope this response is helpful to you.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology