IgE-Selective Immunoadsorption for Severe Atopic Dermatitis

Abstract

IntroductionRecent reports proposed the application of immunoadsorption (IA) for patients with recalcitrant atopic dermatitis (AD) and high-serum IgE levels. However, experience with this novel treatment approach, especially with the newly available IgE-specific adsorber, is limited and recommendation for its use in clinical practice awaits evidence from more studies.Materials and methodsPatients with severe AD (SCORAD ≥ 60) and total serum IgE levels ≥750 kU/L were included in this study. The treatment protocol consisted of two cycles of five consecutive treatments with IgE-selective IA 3 weeks apart.ResultsTen patients were enrolled and four patients completed the study. The mean SCORAD was significantly improved by up to 43% within a few weeks and until the end of a 6-month follow-up period, with 50% of patients achieving an at least 50% individual reduction of the baseline SCORAD. Each IA cycle induced a temporal average decrement of total serum levels of IgE, IgM, IgA, and IgG by 92, 43, 38, and 35%, respectively. Except for one case of Staphylococcus aureus septicemia, no major adverse events occurred.ConclusionAlthough limited by a considerable withdrawal rate, our observations strengthen our and other recent results further suggesting that IgE-selective IA is an effective treatment option for patients severely affected by AD with highly elevated IgE levels.

Single‐use IgE‐selective immunoadsorber column for the treatment of severe atopic dermatitis

“…[12][13][14]16,17,20 Such protocols applied reusable adsorbers that are designed for 10-20 treatments. [12][13][14]16,17,20 Such protocols applied reusable adsorbers that are designed for 10-20 treatments.…”

“…In addition, based on the vascular status of our probands, IA in this study could be performed using just peripheral instead of central venous catheters, the latter which harbor an increased risk for Staphylococcus aureus septicemia 12,16 or air embolism. This favorable outcome-also with regard to IA-imminent infectious events 13,21 -may be attributed to the IgE selectivity of the tested column.…”

“…All courses were performed on a monthly regimen (9-weeks intervention phase) This schedule was defined in an attempt to evaluate the therapeutic impact of IA as well as means to reduce the patients' treatment burden by reducing the duration of an IA-course compared to previous studies with reusable IA-columns over five consecutive days. 12,14,16,17 In all study participants IA procedures were performed via peripheral venous accesses. Patients' plasma was separated from blood cells by centrifugation with an apheresis device (Spectra Optia, Terumo BCT, Lakewood, Colorado) processing the 2-fold calculated plasma volume during each treatment.…”

“…Their distinct role in the complex pathogenesis of AD, however, remains unknown. While different protocols have been used applying IA either with pan-Ig (four studies, 53 patients) [12][13][14][15] or IgE-selective adsorbers (three studies, 38 patients) 13,16,17 as well as in combination with omalizumab (one study, 10 patients), all these regimes were reported to induce a significant improvement of disease severity in the majority of patients (and partly irrespective of IgE load) for at least 3-6 months beyond therapy. Thus, omalizumab failed to improve AD symptoms or revealed nonsuperiority to placebo in several clinical trials.…”

“…[5][6][7][8][9][10][11] Immunoadsorption (IA), aiming at an immunomodulatory depletion of pathogenic serum mediators, was previously reported to cause disease amelioration paralleled by normalization of cutaneous inflammatory parameters (ie, density of CD3 + , CD4 + , CD1a + cellular infiltrates) in AD patients refractory to multiple conventional treatment strategies including cyclosporine A. While different protocols have been used applying IA either with pan-Ig (four studies, 53 patients) [12][13][14][15] or IgE-selective adsorbers (three studies, 38 patients) 13,16,17 as well as in combination with omalizumab (one study, 10 patients), all these regimes were reported to induce a significant improvement of disease severity in the majority of patients (and partly irrespective of IgE load) for at least 3-6 months beyond therapy.…”