- Atopic dermatitis, or eczema, affects an estimated 7.3% of adults in the United States.
- The condition can significantly impact the quality of life.
- Using allergen immunotherapy might be an effective treatment option for people with eczema who are also sensitive to house dust mites.
Atopic dermatitis, commonly called eczema, is a chronic skin condition. It causes itchiness and irritated, inflamed skin.
Over recent years, scientists have started to untangle the complex mechanisms that underpin it. This has helped them develop a range of new topical and systemic drugs that target the immune system.
However, experts do not know whether the effects of these drugs will change over the course of a lifetime. Also, some of these new drugs are relatively expensive.
Because people with eczema are often sensitive to other allergens, some researchers are continuing to explore the potential use of allergy immunotherapy. This technique involves gradually exposing people to their allergy triggers.
A recent study, which appears in the Journal of Allergy and Clinical Immunology, investigated allergy immunotherapy involving dust mite extract as a treatment for eczema.
As the study authors point out, allergy immunotherapy has been used for more than 100 years; it has proven effective in treating “asthma, allergic rhinitis and conjunctivitis, anaphylaxis to Hymenoptera insect venom, and food allergy.”
However, they also note that currently, “The role of allergen immunotherapy in the management of patients with atopic dermatitis is considered controversial.”
Atopic dermatitis and allergy immunotherapy
People with atopic dermatitis, or eczema, develop areas of irritated, inflamed, itchy skin. And itching these areas can lead to swelling and scaling.
The symptoms may flare up and resolve periodically. Triggers vary from person to person, but they can include dust mites, dry air, pet dander, cold, heat, pollen, and pollution.
People with eczema often have other conditions, such as allergies or asthma. This connection has prompted experts to explore allergy immunotherapy as a treatment option.
Gradually exposing a person to their allergen over time helps the body tolerate the substance, and the allergic response slowly reduces.
Doctors can provide this therapy through injections or sublingually, by placing small doses of the allergen under the tongue.
Sensitivity to dust mites
People with eczema often have sensitivity to house dust mites, microscopic parasites that eat dead human skin.
The authors of the recent study explored whether sublingual immunotherapy using house dust mite extract might help improve eczema symptoms and quality of life measures in people with both eczema and dust mite sensitivity.
It was a randomized, double-blind, placebo study. This means that neither the participants nor the researchers knew who was in the treatment or control groups until after the study’s completion.
All the participants had confirmed eczema and sensitivity to dust mites. Over 18 months, 66 participants received either the treatment or the placebo.
The scientists evaluated any improvement in eczema symptoms using a scoring system in which a higher score indicated a greater severity of symptoms.
They demonstrated that symptoms of eczema decreased more in the treatment group than in the control group.
After receiving the immunotherapy, the scores in the treatment group reduced by 55.6%. Interestingly, the eczema scores decreased by 34.5% in the placebo group. This indicates that the treatment may be an effective add-on therapy for people with eczema who also have a sensitivity to dust mites.
Marsha Willis-Karp, Ph.D., an allergy and immunology specialist at Johns Hopkins University, explained to Medical News Today:
“The study […] adds to the mounting evidence for a beneficial
effect of sublingual administration of allergen-specific immunotherapy for the
treatment of atopic dermatitis in those patients who are sensitive to the common house
Study limitations and continued research
The researchers acknowledged that their study had several limitations, including that:
- The treatment may have been more effective over a longer period.
- The dosing was lower than that of previous studies.
- The treatment’s effectiveness might differ depending on age.
- The study had a high dropout rate — only 66 of 91 participants completed it.
- They did not observe an overall difference in quality of life scores between the placebo and treatment groups.
There was also a sizeable decline in symptoms among the placebo group, which calls into question the effectiveness of the treatment.
Dermatologist Dr. Yu-Chuan Jack Li explained to MNT that “[Sublingual administration of allergen-specific immunotherapy] may have limited effectiveness [for] the treatment of atopic dermatitis, except in few cases,” based on the reduction in scores among the placebo group, the limited sample size, and the fact that eczema can be caused by more than one allergen.
He also offered the following recommendation:
“I would suggest a future study with more stringent inclusion criteria, larger sample size, and lab follow-ups during the trial period. In addition, a period of ‘after-treatment’ follow-up will be helpful, too.”
Regardless, the study demonstrated improvements in eczema among people who received the treatment, suggesting that it might be helpful. As the authors note in their conclusion:
“Sublingual immunotherapy with house dust mite extract could be considered as a safe and effective add-on treatment for mite-sensitized patients with atopic dermatitis.”
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