Background: Atopic dermatitis is a chronic inflammatory skin condition that appears to involve a genetic defect in the proteins supporting the epidermal barrier. The goals of treatment are to reduce symptoms, prevent exacerbations, and minimize therapeutic risks. It includes general measures, antihistamines, topical or systemic corticosteroids, topical calcineurin inhibitors and management of infections. In severe cases, systemic immunosuppressive agents like cyclosporine may be useful, but not exempt of important adverse effects. Although there has been some controversy with regard to the role of allergy in atopic dermatitis, the bulk of the data indicate that allergy plays a role in selected patients. Dust mites are consistently the most common positive aeroallergen, and also appear to be the most clinically relevant. However, specific immunotherapy is not generally take into account as a therapeutic tool for atopic dermatitis. Patients and Methods: A 10-years-old male patient with history of persistent rhinitis and mild asthma is referred to our unit with severe atopic dermatitis, presenting intense pruritus, lichenified plaques, scaly and excoriated papules with huge affectation of quality of life (bad sleep, impossibility to practice sports). Laboratory tests showed IgE levels of 12457 UI/ml with dust mite specific levels >100 kU/ml (Dermatophagoides pteronyssinus, Blomia tropicalis). Treatment with antihistamines, topical and oral corticosteroids showed only partial response. We started specific subcutaneous immunotherapy (ALK-ABELLO, Dermatophagoides pteronyssinus 60%, Blomia tropicalis 40%) in addition to antihistamines and short course of systemic corticosteroids. After three months, our patient showed spectacular improvement of symptoms score and quality of life. Now, he continues with monthly immunotherapy with very good tolerance. He practices judo without affectation of the skin. Rhinitis and asthma have showed improvement on symptoms scores and functional tests, too. Conclusion: We present a case of severe atopic dermatitis in a dust-mite sensitization patient with excellent response to specific immunotherapy. Although immunotherapy is not considered a first line treatment for atopic eczema (indeed, in severe cases is considered a contraindication), we thought that may be a good alternative in patients with demonstrated allergy to environmental agents before the introduction of more aggressive therapies like cyclosporine.
Martínez-Tadeo, J. A., Hernández-Santana, G., Rodríguez-Plata, E., González-Pérez, R., & Sánchez-Machín, I. (2011, September). Case report: Specific immunotherapy with dust mite allergens in a child with severe atopic dermatitis. Allergologia et Immunopathologia. https://doi.org/10.1016/j.aller.2010.09.007