engleski

Specific immunotherapy in atopic dermatitis patients- our experience

Specific immunotherapy (hyposensitization) is in practice based on repeated subcutaneous or oral (swallow or sublingual) application of specific allergens (concentrations in elevation). This responsible allergens for the allergic symptoms in patients are used in immunotherapy till the maintained doses is obtained or symptoms disappeared. The mechanism of immunotherapy in atopic dermatitis patients is based on decreasing of specific IgE antibodies, at the same time increasing of specific IgG. We have diagnosed patients with pure atopic dermatitis (AD) and mixture AD patients with concomitant allergy: allergic rhinitis (AR), allergic rhinoconjunctivitis (AC), allergic bronchitis (AB). All patients were sensitive to inhalant allergens proved by in vivo and in vitro tests. During 1985-2003 (19 years) in the Allergy Clinic of the Department of Dermatology and Venereology University Hospital Center Zagreb, Croatia, there were reveled 218 patients. All patients were skin prick tested (SPT) according the European standard and White paper 2003. Patients with: immunodeficiency, with immunoinflammatory disease, malignancies, nonstabile asthma, cardiovascular manifestations, children under five years, elderly patients, during pregnancy and lactation were excluded from the study. The allergens used for hyposensitization were: Dermatophagoides pteronyssinus, house dust mite (together or separately), pollen mixtures (grass, tree, weed), or single allergens (Cocksfoot, Timothy, Meadow - grass ; Birch, Hazel -tree ; Ragweed, Mugwort - weed) from Institute of Immunology Zagreb ; from Bencard ; Allergopharm ; Stallergè ns. For the control of usefulness of specific immunotherapy values of immunoglobulins, especially total and specific IgE values were used. For total and specific IgE determination we used Pharmacia UniCAP system FEIA and Upjohn reagents (kU/l). The concentration of the specific IgE were in classes from 0 to 6 from Pharmacia UniCAP system FEIA and Upjohn reagents (kUA/l). Results: All 218 atopic patients (AP) underwent specific subcutaneous immunotherapy for two or three years. In four of AR patients with sublingual immunotherapy good result was achieved too. Three of 218 patients had adverse reaction (worsening of the atopic disease) during one year of immunotherapy, and they were withdrawn from the study. In all of 215 atopic patients improvement was revealed ; 77 with atopic dermatitis (AD), 29 with combination of AD and AR, 13 with AC and 12 with AB improvement has been seen in the high percentage. After 19 years of experience with specific immunotherapy in the Allergy Clinic we had very good results in atopic patients (AP) using inhalant allergens. The best results were with allergens: grass pollen mixture, house dust mite (Dermatophagoides pteronyssinus) and Ragweed (Ambrosia elatior). The highest level of improvement has been seen in patients with AD+AR , or AD+AC. Specific immunotherapy in our 215 patients was successful according to clinical findings and specific IgE results. Patients who have coexistence of AD with mucosal disease had better outcome then the patients with pure AD.

Atopic dermatitis; specific immunotherapy; hyposensitization; decreasing of specific IgE antibodies; pure and mixed atopic dermatitis

nije evidentirano