In a randomized, double-blind trial, sublingual immunotherapy (SLIT) with house dust mite (HDM) extract appeared to be effective in improving symptoms of atopic dermatitis (AD) in HDM-sensitive patients after 18 months of treatment without serious side effects, as judged by scoring atopic dermatitis (SCORAD) tests. The study was published in The Journal of Allergy and Clinical Immunology: In Practice.
The study’s lead author, Sarah Sella Langer, MD, noted that, under current guidelines, allergen immunotherapy is not recommended as a general treatment option for AD. However, the findings from this study potentially indicate that, “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,” according to Langer.
The researchers enrolled 91 patients aged three or more years with SCORAD scores of 15 or more, and a positive skin test and/or IgE to Dpt. Participants were stratified according to age to receive HDM SLIT or placebo over 18 months. Background therapy was maintained. The primary outcome tracked was a more than 15-point decrease in SCORAD score.
Secondary outcomes were reductions in SCORAD, objective SCORAD (O-SCORAD), Eczema Area and Severity Index (EASI), visual analog scale (VAS), and pruritus scale scores, as well as Investigator’s Global Assessment (IGA) 0/1, and decreases of four or more points in Dermatology Life Quality Index (DLQI).
Sixty-six patients completed the study (35 HDM SLIT, 31 placebo). After 18 months, 74.2% and 58% patients in HDM SLIT and placebo groups displayed a more than 1-point decrease in SCORAD score (relative risk [RR] = 1.28, 95% confidence interval [CI] 0.89–1.83).
Additional results observed at 18 months included:
- Significant decreases from SCORAD baseline of 55.6% and 34.5% in HDM SLIT and placebo groups (mean difference = 20.4, 95% CI 3.89–37.3), respectively.
- Notable O-SCORAD decreases of 56.8% and 34.9% in HDM SLIT and placebo groups (mean difference = 21.3, 95% CI 0.66–41.81), respectively.
- More patients in the HDM SLIT group (14/35) with IGA 0/1 versus the placebo group (5/31, RR = 2.63, 95% CI 1.09–6.39)
The authors ultimately concluded that their results supported the potential efficacy of HDM SLIT as an add-on treatment for patients with AD that are HDM sensitized.
Source: The Journal of Allergy and Clinical Immunology: In Practice