Efficacy and safety of specific immunotherapy with aeroallergens in the management of atopic dermatitis
A systematic review and meta-analysis
Keywords:
Atopic dermatitis, specific immunotherapy, aeroallergens, SCORAD, VAS, vaccineAbstract
Specific immunotherapy with standardized aeroallergens can reduce symptoms and increase the quality of life in some atopic diseases. This therapy is still controversial for atopic dermatitis (AD). Hence, a meta-analysis to assess efficacy and safety of specific immunotherapy with aeroallergens on patients with AD could provide an oversight on advantages and limitations of the therapy. We systematically searched several databases for relevant studies published Randomized controlled trials (RCTs) up to October 2020. Studies involving all ages and gender with AD who treated with specific immunotherapy employing aeroallergens compared with placebo/control. Seven studies RCTs were identified with 832 participants. Significantly decreased of SCORAD values favoring immunotherapy were observed (MD: -5.42; 95% CI -10.31, - 0.52; p=0.03). VAS score was significantly decreased (MD: -1.21; 95% CI -2.10, -0.31; p=0.008). However, immunotherapy showed no significant local and systemic adverse events ((RR 1.77; 95% CI 0.98, 3.19, p=0.06); (RR 0.69; 95% CI 0.16, 3.01, p=0.62)) and IgG4 Dermatophagoides farinae (MD: 92.36, 95% CI -89.14, 273.87; p=0.32). Our meta-analysis reported moderate-level evidence of specific aeroallergen immunotherapy that effective and safe for AD patients.
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Al Robaee, A. A., & Shahzad, M. (2010). Impairment quality of life in families of children with atopic dermatitis. Acta dermatovenerologica Croatica : ADC, 18(4), 243–247.
Antico, A., & Fante, R. (2014). Esophageal hypereosinophilia induced by grass sublingual immunotherapy. The Journal of allergy and clinical immunology, 133(5), 1482–1484. https://doi.org/10.1016/j.jaci.2014.01.030
Blumberga, G., Groes, L., & Dahl, R. (2011). SQ-standardized house dust mite immunotherapy as an immunomodulatory treatment in patients with asthma. Allergy, 66(2), 178–185. https://doi.org/10.1111/j.1398-9995.2010.02451.x
Bonita, laissa, Prakoeswa, C. R. S., & Hidayati, A. N. (2019). Efektivitas Lactobacillus plantarum terhadap Serum Imunoglobulin E Total dan Indeks Scoring Atopic Dermatitis (SCORAD) Pasien Dermatitis Atopik Dewasa. Berkala Ilmu Kesehatan Kulit dan Kelamin, 31(3), 178–184.
Brunner, P. M., Guttman-Yassky, E., & Leung, D. Y. (2017). The immunology of atopic dermatitis and its reversibility with broad-spectrum and targeted therapies. The Journal of allergy and clinical immunology, 139(4S), S65–S76. https://doi.org/10.1016/j.jaci.2017.01.011
Cardona, R., Lopez, E., Beltrán, J., & Sánchez, J. (2014). Safety of immunotherapy in patients with rhinitis, asthma or atopic dermatitis using an ultra-rush buildup. A retrospective study. Allergologia et immunopathologia, 42(2), 90–95. https://doi.org/10.1016/j.aller.2012.07.005
Chen, J., Zhou, Y., Wang, Y., Zheng, Y., Lai, X., Westermann-Clark, E., Cho, S. H., & Kong, W. (2017). Specific immunoglobulin E and immunoglobulin G4 toward major allergens of house-dust mite during allergen-specific immunotherapy. American journal of rhinology & allergy, 31(3), 156–160. https://doi.org/10.2500/ajra.2017.31.4434
Darsow, U., Forer, I., & Ring, J. (2011). Allergen-specific immunotherapy in atopic eczema. Current allergy and asthma reports, 11(4), 277–283. https://doi.org/10.1007/s11882-011-0194-7
Di Rienzo, V., Cadario, G., Grieco, T., Galluccio, A. G., Caffarelli, C., Liotta, G., Pecora, S., & Burastero, S. E. (2014). Sublingual immunotherapy in mite-sensitized children with atopic dermatitis: a randomized, open, parallel-group study. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology, 113(6), 671–673.e1. https://doi.org/10.1016/j.anai.2014.09.009
Durham, S. R., & Penagos, M. (2016). Sublingual or subcutaneous immunotherapy for allergic rhinitis?. The Journal of allergy and clinical immunology, 137(2), 339–349.e10. https://doi.org/10.1016/j.jaci.2015.12.1298
Endaryanto, A. (2019). The build-up phase outcome of subcutaneous immunotherapy for pediatric allergic asthma: A retrospective cohort study from Surabaya, Indonesia. Bali Med J, 8(1), 341-346. https://doi.org/10.15562/bmj.v8i1.1481
Endaryanto, A. & Irmawati, M. (2018). Enhanced Efficacy of Sublingual Immunotherapy in Childhood Allergic Asthma by Probiotics. Folia Medica Indonesiana, 54(1), 64. https://doi.org/10.20473/fmi.v54i1.8055
Feng, M., Su, Q., Lai, X., Xian, M., Shi, X., Wurtzen, P. A., Qin, R., Zeng, X., & Li, J. (2018). Functional and Immunoreactive Levels of IgG4 Correlate with Clinical Responses during the Maintenance Phase of House Dust Mite Immunotherapy. Journal of immunology (Baltimore, Md. : 1950), 200(12), 3897–3904. https://doi.org/10.4049/jimmunol.1701690
Garnacho-Saucedo, G., Vallejo, R. S., Giménez J. C. M. (2013). Actualización en dermatitis atópica. Propuesta de algoritmo de actuación. Actas Dermosifiliogr, 104(1):4–16.
Głobińska, A., Boonpiyathad, T., Satitsuksanoa, P., Kleuskens, M., van de Veen, W., Sokolowska, M., & Akdis, M. (2018). Mechanisms of allergen-specific immunotherapy: Diverse mechanisms of immune tolerance to allergens. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology, 121(3), 306–312. https://doi.org/10.1016/j.anai.2018.06.026
Inoue, Y., Kambara, T., Murata, N., Komori-Yamaguchi, J., Matsukura, S., Takahashi, Y., Ikezawa, Z., & Aihara, M. (2014). Effects of oral administration of Lactobacillus acidophilus L-92 on the symptoms and serum cytokines of atopic dermatitis in Japanese adults: a double-blind, randomized, clinical trial. International archives of allergy and immunology, 165(4), 247–254. https://doi.org/10.1159/000369806
Irwanto, I., Ningtiar, H. W., Hidayat, T., Putera, A. M., Hikmah, Z., & Endaryanto, A. (2019). Sleep problems in 0-36 months old Indonesian children with atopic dermatitis. Dermatology Reports, 11(s1). https://doi.org/10.4081/dr.2019.8039
Jutel, M., Akdis, M., Budak, F., Aebischer-Casaulta, C., Wrzyszcz, M., Blaser, K., & Akdis, C. A. (2003). IL-10 and TGF-beta cooperate in the regulatory T cell response to mucosal allergens in normal immunity and specific immunotherapy. European journal of immunology, 33(5), 1205–1214. https://doi.org/10.1002/eji.200322919
Jutel, M., Jaeger, L., Suck, R., Meyer, H., Fiebig, H., & Cromwell, O. (2005). Allergen-specific immunotherapy with recombinant grass pollen allergens. The Journal of allergy and clinical immunology, 116(3), 608–613. https://doi.org/10.1016/j.jaci.2005.06.004
Karim, A., Setyaningrum, T., Prakoeswa, C. R. S. (2019). Efek Pemberian Lactobacillus plantarum IS-10506 terhadap Indeks Scoring Atopic Dermatitis (SCORAD) Pasien Dermatitis Atopik Dewasa Derajat Ringan-Sedang: Uji Klinis Acak Terkontrol, Tersamar Ganda (Effect of Lactobacillus plantarum IS-10506 Supplementation on Scoring Atopic Dermatitis (SCORAD) Index in Adult With Mild-Moderate Atopic Dermatitis: A Randomized, Double Blind, Controlled Trial). Berkala Ilmu Kesehatan Kulit dan Kelamin, 31(3), 185–192.
Kaufman, B. P., Guttman-Yassky, E., & Alexis, A. F. (2018). Atopic dermatitis in diverse racial and ethnic groups-Variations in epidemiology, genetics, clinical presentation and treatment. Experimental dermatology, 27(4), 340–357. https://doi.org/10.1111/exd.13514
Leung D. Y. (2015). Atopic dermatitis: Age and race do matter!. The Journal of allergy and clinical immunology, 136(5), 1265–1267. https://doi.org/10.1016/j.jaci.2015.09.011
Leung, D. Y., Eichenfield, L. F. & Boguniewicz, M. (2011). Atopic Dermatitis (Atopic Eczema). In Wolff, K., Goldsmith, L., Katz, S., Gilchrest, B., Paller, AS., & Leffell, D. Eds.). Fitzpatrick's Dermatology in General Medicine. (8th ed., Vol. 1, pp. 165-182). McGraw-Hill.
Li, K., Oh, W. J., Park, K. Y., Kim, K. H., & Seo, S. J. (2016). FLG mutations in the East Asian atopic dermatitis patients: genetic and clinical implication. Experimental dermatology, 25(10), 816–818. https://doi.org/10.1111/exd.13063
Liu, L., Chen, J., Xu, J., Yang, Q., Gu, C., Ni, C., Li, L., Lu, X., Yao, Z., Tao, J., Guo, Y., Fang, H., Ding, Y., Qian, Q., Zhou, N., Wang, M., Deng, D., Xie, H., Li, S., Huang, Y., Zhao, N., Zheng, M. (2019). Sublingual immunotherapy of atopic dermatitis in mite-sensitized patients: a multi-centre, randomized, double-blind, placebo-controlled study. Artificial cells, nanomedicine, and biotechnology, 47(1), 3540–3547. https://doi.org/10.1080/21691401.2019.1640709
Ma, X. P., & Muzhapaer, D. (2010). Zhongguo dang dai er ke za zhi = Chinese journal of contemporary pediatrics, 12(5), 344–347.
Marciniak, J., Reich, A., & Szepietowski, J. C. (2017). Quality of Life of Parents of Children with Atopic Dermatitis. Acta dermato-venereologica, 97(6), 711–714. https://doi.org/10.2340/00015555-2633
Monti, F., Agostini, F., Gobbi, F., Neri, E., Schianchi, S., & Arcangeli, F. (2011). Quality of life measures in Italian children with atopic dermatitis and their families. Italian journal of pediatrics, 37, 59. https://doi.org/10.1186/1824-7288-37-59
Mueller, R. S., Jensen-Jarolim, E., Roth-Walter, F., Marti, E., Janda, J., Seida, A. A., & DeBoer, D. (2018). Allergen immunotherapy in people, dogs, cats and horses - differences, similarities and research needs. Allergy, 73(10), 1989–1999. https://doi.org/10.1111/all.13464
Ng, M. S., Tan, S., Chan, N. H., Foong, A. Y., & Koh, M. J. (2018). Effect of atopic dermatitis on quality of life and its psychosocial impact in Asian adolescents. The Australasian journal of dermatology, 59(2), e114–e117. https://doi.org/10.1111/ajd.12632
Novak, N. (2007). Allergen specific immunotherapy for atopic dermatitis.
Current Opinion in Allergy and Clinical Immunology, 7(6):542–556.
https://doi:10.1097/ACI.0b013e3282f1d66c
Novak, N., Bieber, T., Hoffmann, M., Fölster-Holst, R., Homey, B., Werfel, T., Sager, A., & Zuberbier, T. (2012). Efficacy and safety of subcutaneous allergen-specific immunotherapy with depigmented polymerized mite extract in atopic dermatitis. The Journal of allergy and clinical immunology, 130(4), 925–31.e4. https://doi.org/10.1016/j.jaci.2012.08.004
Pajno, G. B., Bernardini, R., Peroni, D., Arasi, S., Martelli, A., Landi, M., Passalacqua, G., Muraro, A., La Grutta, S., Fiocchi, A., Indinnimeo, L., Caffarelli, C., Calamelli, E., Comberiati, P., Duse, M., & Allergen-specific Immunotherapy panel of the Italian Society of Pediatric Allergy and Immunology (SIAIP). (2017). Clinical practice recommendations for allergen-specific immunotherapy in children: the Italian consensus report. Italian journal of pediatrics, 43(1), 13. https://doi.org/10.1186/s13052-016-0315-y
Pajno, G. B., Caminiti, L., Vita, D., Barberio, G., Salzano, G., Lombardo, F., Canonica, G. W., & Passalacqua, G. (2007). Sublingual immunotherapy in mite-sensitized children with atopic dermatitis: a randomized, double-blind, placebo-controlled study. The Journal of allergy and clinical immunology, 120(1), 164–170. https://doi.org/10.1016/j.jaci.2007.04.008
Pajno, G. B., Peroni, D. G., Barberio, G., & Boner, A. L. (2003). Efficacy of sublingual immunotherapy in asthma and eczema. Chemical immunology and allergy, 82, 77–88. https://doi.org/10.1159/000071542
Prakoeswa, C., Bonita, L., Karim, A., Herwanto, N., Umborowati, M. A., Setyaningrum, T., Hidayati, A. N., & Surono, I. S. (2020). Beneficial effect of Lactobacillus plantarum IS-10506 supplementation in adults with atopic dermatitis: a randomized controlled trial. The Journal of dermatological treatment, 33(3), 1491–1498. https://doi.org/10.1080/09546634.2020.1836310
Prameswari, R., Astari, L., Hidayati, A. N., Prakoeswa, C. R. S. (2017). Efek Lactobacillus plantarum terhadap Imunoglobulin E Serum Total dan Indeks Scoring Atopic Dermatitis (SCORAD) Pasien Dermatitis Atopik Anak (Effect of Lactobacillus plantarum on Total Immunoglobulin E Serum and Scoring Atopic Dermatitis (SCORAD) Index in Children With Atopic Dermatitis), Berkala Ilmu Kesehatan Kulit dan Kelamin. 29(2), 91-97.
Qin, Y. E., Mao, J. R., Sang, Y. C., & Li, W. X. (2014). Clinical efficacy and compliance of sublingual immunotherapy with Dermatophagoides farinae drops in patients with atopic dermatitis. International journal of dermatology, 53(5), 650–655. https://doi.org/10.1111/ijd.12302
Ridolo, E., Martignago, I., Riario-Sforza, G. G., & Incorvaia, C. (2018). Allergen immunotherapy in atopic dermatitis. Expert review of clinical immunology, 14(1), 61–68. https://doi.org/10.1080/1744666X.2018.1401469
Ring J. (1982). Successful hyposensitization treatment in atopic eczema: results of a trial in monozygotic twins. The British journal of dermatology, 107(5), 597–602. https://doi.org/10.1111/j.1365-2133.1982.tb00412.x
Sánchez Caraballo, J. M., & Cardona Villa, R. (2012). Clinical and immunological changes of immunotherapy in patients with atopic dermatitis: randomized controlled trial. ISRN allergy, 2012, 183983. https://doi.org/10.5402/2012/183983
Schmitt, J., Langan, S., Williams, H. C., & European Dermato-Epidemiology Network (2007). What are the best outcome measurements for atopic eczema? A systematic review. The Journal of allergy and clinical immunology, 120(6), 1389–1398. https://doi.org/10.1016/j.jaci.2007.08.011
Shaw, T. E., Currie, G. P., Koudelka, C. W., & Simpson, E. L. (2011). Eczema prevalence in the United States: data from the 2003 National Survey of Children's Health. The Journal of investigative dermatology, 131(1), 67–73. https://doi.org/10.1038/jid.2010.251
Sihaloho, K., Indramaya, D. M. (2015). Penelitian Retrospektif : Dermatitis Atopik pada Anak (Retrospective Study: Atopic Dermatitis in Childhood). Berkala Ilmu Kesehatan Kulit dan Kelamin, 27(3), 176–182.
Silverberg, J. I., & Hanifin, J. M. (2013). Adult eczema prevalence and associations with asthma and other health and demographic factors: a US population-based study. The Journal of allergy and clinical immunology, 132(5), 1132–1138. https://doi.org/10.1016/j.jaci.2013.08.031
Tackett, K. J., Jenkins, F., Morrell, D. S., McShane, D. B., & Burkhart, C. N. (2020). Structural racism and its influence on the severity of atopic dermatitis in African American children. Pediatric dermatology, 37(1), 142–146. https://doi.org/10.1111/pde.14058
Tam, H. H., Calderon, M. A., Manikam, L., Nankervis, H., Núñez, I. G., Williams, H. C., Durham, S. R., & Boyle, R. J. (2016). Specific allergen immunotherapy for the treatment of atopic eczema: a Cochrane systematic review. Allergy, 71(9), 1345–1356. https://doi.org/10.1111/all.12932
Umborowati, M.A., Nurasrifah, D., Indramaya, D. M., Anggraeni, S., Damayanti, Prakoeswa, C. R. S. (2020). The role of ceramide, menthol, and polidocanol on pruritus, skin barrier function, and disease severity of mild atopic dermatitis. J Pakistan Assoc Dermatology, 30(1), 98-105.
Vickery, B. P., Scurlock, A. M., Kulis, M., Steele, P. H., Kamilaris, J., Berglund, J. P., Burk, C., Hiegel, A., Carlisle, S., Christie, L., Perry, T. T., Pesek, R. D., Sheikh, S., Virkud, Y., Smith, P. B., Shamji, M. H., Durham, S. R., Jones, S. M., & Burks, A. W. (2014). Sustained unresponsiveness to peanut in subjects who have completed peanut oral immunotherapy. The Journal of allergy and clinical immunology, 133(2), 468–475. https://doi.org/10.1016/j.jaci.2013.11.007
Vitaliti, G., Pavone, P., Guglielmo, F., Spataro, G., & Falsaperla, R. (2014). The immunomodulatory effect of probiotics beyond atopy: an update. The Journal of asthma : official journal of the Association for the Care of Asthma, 51(3), 320–332. https://doi.org/10.3109/02770903.2013.862259
Warner, J. O., Price, J. F., Soothill, J. F., & Hey, E. N. (1978). Controlled trial of hyposensitisation to Dermatophagoides pteronyssinus in children with asthma. Lancet (London, England), 2(8096), 912–915. https://doi.org/10.1016/s0140-6736(78)91630-6
Werfel, T., Breuer, K., Ruéff, F., Przybilla, B., Worm, M., Grewe, M., Ruzicka, T., Brehler, R., Wolf, H., Schnitker, J., & Kapp, A. (2006). Usefulness of specific immunotherapy in patients with atopic dermatitis and allergic sensitization to house dust mites: a multi-centre, randomized, dose-response study. Allergy, 61(2), 202–205. https://doi.org/10.1111/j.1398-9995.2006.00974.x
Yolanda, Prabowo, G. I., Damayanti. (2018). The Systemic Therapy of Atopic Dermatitis in Outpatient Clinic Division of Allergy and Immunology at Dr. Soetomo General Hospital in 2013. Ann Clin Exp Immunol, 2(1), 1003s.
You, H. S., Yang, M. Y., Kim, G. W., Cho, H. H., Kim, W. J., Mun, J. H., Song, M., Kim, H. S., Ko, H. C., Kim, M. B., & Kim, B. S. (2017). Effectiveness of Specific Sublingual Immunotherapy in Korean Patients with Atopic Dermatitis. Annals of dermatology, 29(1), 1–5. https://doi.org/10.5021/ad.2017.29.1.1
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