The experience with subcutaneous allergen-specific immunotherapy with pollen allergens in patients with atopic dermatitis

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Abstract

BACKGROUND: Atopic dermatitis is a chronic inflammatory skin disease, the key pathogenetic mechanisms of which include activation of T2-immune inflammation, IgE-specific sensitization to various allergens, and disruptions of epidermal barrier functions. Allergen-specific immunotherapy is the only pathogenetic treatment method that can prevent the progression of the disease and the development of the atopic march. Currently, clinical experience has been accumulated in using allergen-specific immunotherapy for atopic dermatitis, yet the existing evidence base does not allow for definitive conclusions regarding the indications for conducting allergen-specific immunotherapy, especially in atopic dermatitis associated with pollen allergy.

AIMS: Determination of the clinical significance of sensitization to pollen allergens in atopic dermatitis, determination of indications for allergen-specific immunotherapy with pollen allergens and assessment of the effectiveness and safety of this method in atopic dermatitis patients.

MATERIALS AND METHODS: A comparative controlled study to evaluate the effectiveness of subcutaneous allergen-specific immunotherapy with pollen allergens of birch or cereal grasses in 78 adult atopic dermatitis patients was conducted. A single course of subcutaneous allergen-specific immunotherapy with water-salt solutions of tree pollen allergens was administered to 33 patients, and grass pollen allergens were administered to 21 patients with atopic dermatitis. The comparison group ― patients with atopic dermatitis who received standard therapy for the disease without allergen-specific immunotherapy ― 24 patients. The primary endpoints of the study were to evaluate the effectiveness of therapy based on the reduction in the severity of atopic dermatitis symptoms, based on the absolute and relative number of patients who achieved a reduction in SCORAD score by 75% and IGA 1/0.

RESULTS: In patients receiving one course of subcutaneous allergen-specific immunotherapy with tree pollen allergens, SCORAD 50 achieved 26, 33, 47% and SCORAD 75 achieved 10, 20 and 33% after 16, 32 and 52 weeks, respectively. In patients who received one course of subcutaneous allergen-specific immunotherapy with grass pollen allergens, SCORAD 50 reached 31, 40, 58% and SCORAD 75 ― 14, 28 and 43% after 16, 32 and 52 weeks, respectively. In the comparison group, the number of such patients was significantly smaller: SCORAD 50 reached 24, 32, 37% and SCORAD 75 ― 13, 22 and 26% after 16, 32 and 52 weeks, respectively. Similar results were obtained when studying the IGA. In all study groups, an improvement in the quality of life of patients was noted, which was reflected in a decrease in the DLQI index by 4 or more points in 12, 25 and 37% of patients receiving one course of subcutaneous allergen-specific immunotherapy with tree pollen allergens, in 14, 28 and 43% in patients after 16, 32 and 52 weeks, respectively. However, the number of such patients in the comparison group was significantly lower: 13, 22 and 26%, respectively.

CONCLUSION: Allergen-specific immunotherapy is an effective way to treat atopic dermatitis patients, provided there is proven sensitization to pollen allergens.

About the authors

Olga G. Elisyutina

National Research Center--Institute of Immunology Federal Medical-Biological Agency of Russia; Peoples' Friendship University of Russia

Author for correspondence.
Email: el-olga@yandex.ru
ORCID iD: 0000-0002-4609-2591

MD, Dr. Sci. (Med)

Russian Federation, Moscow; Moscow

Alla O. Litovkina

National Research Center--Institute of Immunology Federal Medical-Biological Agency of Russia; Peoples' Friendship University of Russia

Email: dr.litovkina@gmail.com
ORCID iD: 0000-0002-5021-9276

MD

Russian Federation, Moscow; Moscow

Evgeniy V. Smolnikov

National Research Center--Institute of Immunology Federal Medical-Biological Agency of Russia; Peoples' Friendship University of Russia

Email: qwertil2010@yandex.ru
ORCID iD: 0000-0003-1302-4178

MD

Russian Federation, Moscow; Moscow

Elena S. Fedenko

National Research Center--Institute of Immunology Federal Medical-Biological Agency of Russia

Email: efedks@gmail.com
ORCID iD: 0000-0003-3358-5087

MD, Dr. Sci. (Med), Professor

Russian Federation, Moscow

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2. Fig. 1. Graphical design of subcutaneous allergen-specific immunotherapy with pollen allergens in patients with atopic dermatitis taking into account the results of molecular allergodiagnostics in a comparative controlled study. АтД ― atopic dermatitis; ТГКС ― topical glucocorticoids; ТИК ― topical calcineurin inhibitors; пкАСИТ ― subcutaneous allergen-specific immunotherapy.

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3. Fig. 2. Change in SCORAD index values (median) before the start and at the end of treatment after 16, 32 and 52 weeks in patients with atopic dermatitis who received one course of subcutaneous allergen-specific immunotherapy with tree pollen allergens (group 1) or cereal grass allergens (group 2), compared to the control group.

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4. Fig. 3. SCORAD 50 and SCORAD 75 scores after 16, 32 and 52 weeks in patients with atopic dermatitis who received a single course of subcutaneous allergen-specific immunotherapy with tree pollen allergens during flowering (group 1) or cereal grasses (group 2), compared with the control group.

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5. Fig. 4. IGA 0/1 values after 16, 32 and 52 weeks in patients with atopic dermatitis who received one course of subcutaneous allergen-specific immunotherapy with tree pollen allergens during flowering (group 1) or cereal grasses (group 2), compared with the control group.

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6. Fig. 5. Reduction of DLQI score by 4 points or more after 16, 32 and 52 weeks in patients with atopic dermatitis who received one course of subcutaneous allergen-specific immunotherapy with tree pollen allergens during flowering (group 1) or cereal grass allergens (group 2), compared with the control group.

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