Can subcutaneous or sublingual allergen immunotherapy help with atopic dermatitis?

Published: September 30. 2022

Atopic dermatitis (AD, eczema) is driven by a combination of skin barrier defects, immune dysregulation, and extrinsic stimuli (e.g., allergens, irritants, microbes). The role of environmental allergens (aeroallergens) in triggering AD remains unclear.

Published in The Journal of Allergy and Clinical Immunology (JACI), Dr. Chu from McMaster University and an international group of investigators report the most comprehensive systematic review and meta-analysis examining the therapeutic role of allergen immunotherapy for atopic dermatitis. The authors searched multiple databases for randomized controlled trials (RCTs) to systematically review the effectiveness and safety of allergen immunotherapy (AIT) including both subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT), against placebo or standard of care for patient-important outcomes, including AD severity, itch, AD-related quality of life, flares, and adverse events. The investigators independently screened, extracted data and assessed risk of bias, and used the GRADE approach to determine the quality of the evidence.

Among the 23 RCTs, including 1957 adult and pediatric patients sensitized primarily to house dust mite, add-on SCIT and SLIT led to similar and important improvements in AD severity, defined as a 50% reduction in severity, and quality of life (both outcomes moderate certainty evidence). Both routes of allergen immunotherapy increased adverse events (high certainty evidence), though the increase was smaller for SLIT compared to SCIT. AIT’s effect on sleep disturbance and eczema flares were uncertain.

Representing the most comprehensive analysis to date on the topic and linked to the upcoming AAAAI/ACAAI guidelines for AD, this systematic synthesis of the best available evidence supports a shared decision making and multidisciplinary approach to using allergen immunotherapy for optimal AD care.

For quantitative estimates of effects, expanded methods, context and discussion, read the full open-access publication at Allergen Immunotherapy for Atopic Dermatitis: A Systematic Review and Meta-Analysis of Benefits and Harms in The Journal of Allergy and Clinical Immunology.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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