[Specific immunotherapy in the treatment of patients with atopic dermatitis--results of double blind placebo controlled study].

BACKGROUND: Specific immunotherapy (SIT) is the only causative method of treatment in the case of IgE-mediated allergic disease. There is extensive literature on the use of SIT in the management of respiratory allergies and insect venom hypersensitivity, but a paucity of published data concerning its use as a therapeutic approach in atopic dermatitis (AD).

OBJECTIVE: A double blind placebo controlled trial was conducted over a period of 12 months in order to evaluate the efficacy of SIT in the management of atopic dermatitis attributable to house dust mites or grass pollens.

METHODS: A total of 20 patients (5-40 years) with AD and monovalent sensitization to airborne allergens (house dust mites or grass pollens) were enrolled in the study. SIT was performed using aluminium hydroxide adsorbed allergen preparations administered by subcutaneous injection. Clinical efficacy of the treatment was assessed using the clinical score--W-AZS index. Serum concentration of total IgE and allergen specific IgE were measured, as were various immunological parameters including ECP, sIL-2R, IFN-gamma, IL-4, IL-5 and IL-10).

RESULTS: The mean value of W-AZS index in the SIT group before treatment was 87.6 +/- 15.8 pts, and this decreased to 38.8 +/- 34.4 pts after 12 months of therapy (p < 0.01). In the placebo group the mean W-AZS index before treatment was 86.3 +/- 15.7 pts and after 12 months of therapy it increased to 111.9 +/- 41.7 pts. Comparative statistical analysis indicated a significant difference between the two groups in favour of patients treated with the active allergy vaccines (p < 0.01). Serum levels of specific IgE in the SIT group showed a tendency to decrease, whilst those in the placebo group tended to increase. Serum concentrations of selected immunological parameters including ECP, sIL-2R, IFN-gamma, IL-4, IL-5 and IL-10 were monitored before and after treatment, but did not show significant differences.

CONCLUSION: Allergen specific immunotherapy appeared to be an effective method of treatment for atopic dermatitis as judged by significant improvement in clinical index in cases with well documented IgE-mediated allergic disease.