Dust Mite-Related Atopic Dermatitis Lessened With Sublingual Immunotherapy
Presented at ACAAI
Source: DGNews
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By Brian Hoyle
BALTIMORE, Md -- November 13, 2013 -- A 12-month programme of standardised sublingual allergen immunotherapy (SLIT) was effective in significantly reducing the severity of atopic dermatitis in children monosensitised to D. pteronyssinus (the dust mite), noted researchers speaking here on November 10 at the 2013 Annual Meeting of the American College of Allergy, Asthma & Immunology (ACAAI). The improvement was more evident from month 6, mainly in the subgroup with severe atopic dermatitis.
Jorge Agustin Luna Pech, MD, private practice, Guadalajara, Jalisco, Mexico and colleagues examined 249 children ages 4 to 10 years who were seeking treatment for moderate-to-severe atopic dermatitis at a tertiary referral hospital in Guadalajara. The team randomised 68 children who were determined to be monosensitised to D.pteronnyssinus (the dust mite species with the highest prevalence in the study locale) to receive drops of lyophilised powder of a standardised allergen diluted in glycerine (175 UBE/ml) (n = 34) or a glycerine-solution placebo (n = 34) during a 12-month period.
The allergen and placebo were both administered as drops placed under the tongue and then swallowed. All procedures were carried out in each participant’s residence, with parental help as needed. The main outcome variable was the change in the severity of the SCORing Atopic Dermatitis (SCORAD) index score respect to baseline (change in SCORAD).
Three subjects in the treatment arm and 6 subjects in the placebo arm did not complete the full 12 months (drop-out rate of 9% and 18%, respectively). The final analysis involved 31 subjects in the treatment arm and 28 in the placebo arm.
Clinical variability of the severity of atopic dermatitis demonstrated statistical differences both in inter-group (change in SCORAD -18.4 in the SLIT group vs -6.6 in the placebo group, P = .008) and the paired intra-group comparisons (P = .02 in SLIT group, P = .10 in the placebo group).
This clinical effect in the SLIT-treated group was greater in patients with severe atopic dermatitis (change in SCORAD -22.5 in the SLIT group vs -5.5 in the placebo group, P = .002). Change in SCORAD variance between the treatment and placebo arms was evident at 6 months, but was not statistically significant. The differences at 8, 10, and 12 months reached significance (P = .05, .01, and .008, respectively).
Complementary analysis showed that the SLIT group needed significantly fewer rescue medications than did the control subjects. In the placebo arm, 18 cycles of rescue topical corticosteroids were necessary, compared with 12 cycles in the SLIT arm (P = .08). The calculation of the necessary number of patients to treat to gain benefit from the intervention was 1.7 patients (95% confidence interval: 1.2 to 2.6 patients).
Age, sex, and level of D.pteronnyssinus specific immunoglobulin E were similar in both arms at baseline. Total serum immunoglobulin E (IgE) in the subjects in the SLIT arm (143 U/L) was significantly less than in subjects in the placebo arm (132 U/L) at baseline (P = .09).
The study did not examine real-life benefits, such as quality of life, Dr. Luna-Pech noted. He commented that patients appeared to be improved in attitude and comfort, but acknowledged that this purely subjective information requires the weight of experimental data.
“The study has advanced our knowledge. It was not meant to be stand-alone or definitive, but was intended to provide evidence to help guide further studies,” Dr. Luna-Pech concluded.
[Presentation title: Efficacy of Sublingual Immunotherapy in the Severity of Atopic Dermatitis in Children With Allergic Sensitization to Dermatophagoides Pteronyssinus. Abstract 22]