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Sublingual immunotherapy may help mite allergic patients with atopic dermatitis

Published: November 09, 2021

Atopic dermatitis (AD) is one of the most common inflammatory skin diseases, characterized by recurrent eczema and intense itching. It usually starts in childhood, and may persist to adult life, but it may also start in adulthood. Many patients with AD have other allergic conditions including asthma, rhinoconjunctivitis, and food allergies. Sleep disturbance and psychological symptoms including anxiety, depression, and attention deficit are also common in patients with AD, leading to a decreased quality of life for patients and their families. The role of allergen immunotherapy in the management of patients with AD is considered investigational or under debate, and allergen immunotherapy is not routinely recommended as a treatment option for AD by current guidelines.

In a recent article in The Journal of Allergy and Clinical Immunology: In Practice, Langer et al. reported that sublingual immunotherapy with house dust mite extract (HDM SLIT) was effective in improving the signs and symptoms of AD in mite sensitized patients after 18 months of treatment. The authors conducted a randomized, double-blind, placebo-controlled trial to investigate whether adding HDM SLIT to the current treatment regimen of HDM allergic patients with AD would provide benefit, as compared to placebo. Patients were stratified according to age (<12 and ≥12 years), and HDM SLIT was administered as liquid drops. Efficacy was evaluated by extensively validated, standardized tools to assess severity of the disease and quality of life. A major strength of the study was the fact that the same investigator (SSL) evaluated all patients throughout the trial.

Among the 91 patients initially enrolled, 66 (35 HDM SLIT, 31 placebo) completed the study.  Patients’ ages ranged from 3-62 years-old, 38% were children < 12 years and 71% were female. After 18 months of treatment, more patients in the HDM SLIT group had clear or almost clear skin, as compared to those on placebo, as recorded by the Investigator’s Global Assessment IGA 0/1 (40% and 16.1% respectively). Also, there was a reduction in the SCORing Atopic Dermatitis (SCORAD) parameter, which measures extension and severity of disease, and objective-SCORAD (without the sleep and pruritus subjective components of SCORAD) in the HDM SLIT group as compared to placebo, in the order of approximately a 20 point drop from baseline values.  These differences were statistically significant, indicating the benefit of HDM SLIT in reducing the clinical signs and symptoms of AD. In conclusion, the results suggested that HDM SLIT may be effective in HDM sensitized patients as an add-on treatment for AD. HDM SLIT was well tolerated, and no severe systemic reactions were observed, allowing for unsupervised administration at home.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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