Efficacy of allergen-specific immunotherapy for atopic dermatitis: A systematic review and meta-analysis of randomized controlled trials

Bae, Jung Min; Choi, Yoon Young; Park, Chang Ook; Chung, Kee Yang; Lee, Kwang Hoon

doi:10.1016/j.jaci.2013.02.044

Cited by 180 publications

(135 citation statements)

References 31 publications

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“…19 However, current use in the UK and throughout the world remains limited because of the lack of evidence from large randomised controlled trials.…”

Section: Atopic Dermatitismentioning

confidence: 99%

An update on allergen immunotherapy

Arshad

2016

Clinical Medicine

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AAllergen-specific immunotherapy (AIT) has been used to treat allergic diseases for over a century. It is the only treatment that addresses immune dysfunction underlying allergic responses rather than simply treating symptoms or suppressing inflammation. Its safety and efficacy in allergic rhinitis, asthma and insect allergy has been documented in a number of systematic reviews but its cost effectiveness is less clear. AIT reduces symptoms and requirement for medication, while improving quality of life. Further, the effect continues for years after discontinuation of treatment. However, evidence regarding cost effectiveness is limited. During AIT, allergen extracts are administered through a subcutaneous or sublingual route for 3-5 years. Subcutaneous immunotherapy is more effective in inducing long-term remission but systemic reactions do occur occasionally. Sublingual immunotherapy is safer and more convenient for the patient but evidence regarding its long-term efficacy is patchy. AIT is used widely in western Europe and the USA. In the UK, subcutaneous immunotherapy is often used for bee and wasp allergy, while both subcutaneous and sublingual immunotherapies are used for severe allergic rhinitis and occasionally for house dust mite and pet allergies. In conclusion, AIT is safe and effective and should be considered as a treatment option for those with allergic diseases.

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“…19 However, current use in the UK and throughout the world remains limited because of the lack of evidence from large randomised controlled trials.…”

Section: Atopic Dermatitismentioning

confidence: 99%

An update on allergen immunotherapy

Arshad

2016

Clinical Medicine

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“…The results showed that SIT had a significantly positive effect on AD for all 8 RCTs analyzed. Although the previous findings are based on an analysis of a small number of RCTs, with considerable heterogeneity among trials, the review provides physicians with evidence necessary to consider allergen-SIT for patients with AD, especially those with severe uncontrolled disease [65].…”

Section: Allergen Specific Immunotherapy For Admentioning

confidence: 99%

Atopic Dermatitis: Insights on Pathogenesis, Evaluation and Management

S¹

2014

J Allergy Ther

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Background: Atopic Dermatitis (AD) is a highly pruritic chronic inflammatory skin disease that commonly presents during early childhood. Several studies indicate that the disease is very common in western world with lifetime prevalence in children of 10% to 20%. Data sources:We make recommendations regarding the evaluation and management of AD in children based on systematic literature searches using the best-available evidence from PubMed, Medline, Google Scholar, NICE, the American Academy of Dermatology and the World Allergy Organization.Results: AD has an immunologic basis. Both innate and adaptive immune responses are impaired in AD patients. Intense pruritus is a hallmark of the disease which leads to extensive scratching and further breakdown of the skin barrier. Treatment of AD may be topical or systemic. Topical corticosteroids and calcineurin inhibitors are used as topical anti-inflammatory agents. Patients should be carefully instructed in the use of topical glucocorticoids to avoid side effects. Conclusions:Treatment of atopic eczema should be based on a "stepped-care plan" where treatments are stepped up or down depending on the assessment of the state of the child's skin by the physician. Physicians who treat children with mild to moderate AD should tell children and their caregivers that AD is a lifelong illness.

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“…In AD patients who are refractory or do not clinically respond to conventional treatment approaches, a number of alternative strategies may be used including cyclosporine, methotrexate, azathioprine, IL-6 blockade, dust mite immunotherapy when indicated, Wet Wrap therapy and ultraviolet light (90)(91)(92)(93)(94). Recent studies with broad based targeting therapeutics (69-70) have used disease-related cellular and molecular biomarkers to: i) show that the chronic AD phenotype can be reversed to a non-lesional state, as has been shown for psoriasis patients treated with effective therapeutics and ii) map inflammatory disease-related pathways.…”

Section: Implications Of Ad Pathobiology For General Management Appromentioning

confidence: 99%

Deciphering the complexities of atopic dermatitis: Shifting paradigms in treatment approaches

2014

Journal of Allergy and Clinical Immunology

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Atopic dermatitis (AD) is the most common chronic inflammatory skin disease. It often precedes the development of food allergy and asthma. Recent insights into AD reveal abnormalities in terminal differentiation of the epidermal epithelium leading to a defective stratum corneum, which allows enhanced allergen penetration and systemic IgE sensitization. Atopic skin is also predisposed to colonization or infection by pathogenic microbes, most notably Staphylococcus aureus and herpes simplex virus (HSV). Causes of this abnormal skin barrier are complex and driven by a combination of genetic, environmental and immunologic factors. These factors likely account for the heterogeneity of AD onset, severity and natural history of this skin disease. Recent studies suggest prevention of AD can be achieved by early interventions protecting the skin barrier. Onset of lesional AD requires effective control of local and systemic immune activation for optimal management. Early intervention may improve long term outcomes for AD and reduce the systemic allergen sensitization leading to associated allergic diseases in the gastrointestinal and respiratory tract.

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Efficacy of allergen-specific immunotherapy for atopic dermatitis: A systematic review and meta-analysis of randomized controlled trials

Cited by 180 publications

References 31 publications

An update on allergen immunotherapy

An update on allergen immunotherapy

Atopic Dermatitis: Insights on Pathogenesis, Evaluation and Management

Deciphering the complexities of atopic dermatitis: Shifting paradigms in treatment approaches

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