Allergen Immunotherapy and Atopic Dermatitis: Updated Guidance

Authors

  • Derek K. Chu, MD McMaster University, Hamilton, ON

DOI:

https://doi.org/10.58931/cait.2024.4269

Abstract

Atopic dermatitis (AD), also commonly referred to as atopic eczema, is the most common chronic inflammatory skin disease. Research over the past 30 years has revealed that it affects approximately 13% of children and 7% of adults worldwide. Among the growing number of treatment options for AD, the role of allergy to aeroallergens, such as house dust mite (HDM) pollens or animal dander, in driving this condition has remained uncertain for a long time. Consequently, so too has been the therapeutic role of allergen immunotherapy (AIT) for AD. The American Academy of Allergy, Asthma & Immunology (AAAAI)/American College of Allergy, Asthma and Immunology (ACAAI) Joint Task Force (JTF) on Practice Parameters recently updated their AD guidelines. This update included a systematic review of the effectiveness and safety of AIT, including subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) versus no AIT for patients with AD. This article summarizes the systematic review findings, guideline update, and future directions.

Author Biography

Derek K. Chu, MD, McMaster University, Hamilton, ON

Dr. Derek Chu is a Clinician Scientist and Assistant Professor in Allergy and Clinical Immunology at McMaster University, Department of Medicine and Department of Health Research Methods, Evidence, & Impact. Dr. Chu serves on the Joint Task Force for Allergy Practice Parameters, and multiple international initiatives to improve outcomes in Allergy-Immunology.

References

Odhiambo JA, Williams HC, Clayton TO, Robertson CF, Asher MI, ISAAC Phase Three Study Group. Global variations in prevalence of eczema symptoms in children from ISAAC Phase Three. J Allergy Clin Immunol. 2009;124(6):1251-1258.e1223. doi:10.1016/j.jaci.2009.10.009

Bridgman AC, Fitzmaurice C, Dellavalle RP, Karimkhani Aksut C, Grada A, Naghavi M, et al. Canadian burden of skin disease From 1990 to 2017: results from the Global Burden of Disease 2017 Study [Formula: see text]. J Cutan Med Surg. 2020;24(2):161-173. doi:10.1177/1203475420902047

AAAAI/ACAAI JTF Atopic Dermatitis Guideline Panel, Chu DK, Schneider L, Asiniwasis RN, Boguniewicz M, De Benedetto A, et al. Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE- and Institute of Medicine-based recommendations. Ann Allergy Asthma Immunol. 2024;132(3):274-312. doi:10.1016/j.anai.2023.11.009

Yepes-Nuñez JJ, Guyatt GH, Gómez-Escobar LG, Pérez-Herrera LC, Chu AWL, Ceccaci R, et al. Allergen immunotherapy for atopic dermatitis: systematic review and meta-analysis of benefits and harms. J Allergy Clin Immunol. 2023;151(1):147-158. doi:10.1016/j.jaci.2022.09.020

Schmitt J, Langan S, Deckert S, Svensson A, von Kobyletzki L, Thomas K, et al. Assessment of clinical signs of atopic dermatitis: a systematic review and recommendation. J Allergy Clin Immunol. 2013;132(6):1337-1347. doi:10.1016/j.jaci.2013.07.008

Dykewicz MS, Wallace DV, Amrol DJ, Baroody FM, Bernstein JA, Craig TJ, et al. Rhinitis 2020: A practice parameter update. J Allergy Clin Immunol. 2020;146(4):721-767. doi:10.1016/j.jaci.2020.07.007

Cox L, Li JT, Nelson H, Lockey R. Allergen immunotherapy: a practice parameter second update. J Allergy Clin Immunol. 2007;120(3):S25-S85. doi:10.1016/j.jaci.2007.06.019

Cox L, Nelson H, Lockey R, Calabria C, Chacko T, Finegold I, et al. Allergen immunotherapy: a practice parameter third update. J Allergy Clin Immunol. 2011;127(1 Suppl):S1-55. doi:10.1016/j.jaci.2010.09.034

Greenhawt M, Oppenheimer J, Nelson M, Nelson H, Lockey R, Lieberman P, et al. Sublingual immunotherapy: a focused allergen immunotherapy practice parameter update. Ann Allergy Asthma Immunol. 2017;118(3):276-282 e272. doi:10.1016/j.anai.2016.12.009

de Blay F, Gherasim A, Casale TB, Doyen V, Bernstein D. Which patients with asthma are most likely to benefit from allergen immunotherapy? J Allergy Clin Immunol. 2022;149(3):833-843. doi:10.1016/j.jaci.2022.01.011

Nygaard U, Hvid M, Johansen C, Buchner M, Folster-Holst R, Deleuran M, et al. TSLP, IL-31, IL-33 and sST2 are new biomarkers in endophenotypic profiling of adult and childhood atopic dermatitis. J Eur Acad Dermatol Venereol. 2016;30(11):1930-1938. doi:10.1111/jdv.13679

Chu DK, Llop-Guevara A, Walker TD, Flader K, Goncharova S, Boudreau JE, et al. IL-33, but not thymic stromal lymphopoietin or IL-25, is central to mite and peanut allergic sensitization. J Allergy Clin Immunol. 2013;131(1):187-200 e181-188. doi:10.1016/j.jaci.2012.08.002

Marschall P, Wei R, Segaud J, Yao W, Hener P, German BF, et al. Dual function of Langerhans cells in skin TSLP-promoted TFH differentiation in mouse atopic dermatitis. J Allergy Clin Immunol. 2021;147(5):1778-1794. doi:10.1016/j.jaci.2020.10.006

Traidl S, Werfel T. [Allergen immunotherapy for atopic dermatitis]. [Article in German] Hautarzt. 2021;72(12):1103-1112. doi:10.1007/s00105-021-04909-y

Caminiti L, Panasiti I, Landi M, De Filippo M, Olcese R, Ciprandi G, et al. Allergen immunotherapy in atopic dermatitis: light and shadow in children. Pediatr Allergy Immunol. 2020;31 Suppl 26:46-48. doi:10.1111/pai.13390

Golebski K, Layhadi JA, Sahiner U, Steveling-Klein EH, Lenormand MM, Li RCY, et al. Induction of IL-10-producing type 2 innate lymphoid cells by allergen immunotherapy is associated with clinical response. Immunity. 2021;54(2):291-307.e297. doi:10.1016/j.immuni.2020.12.013

Devasenapathy N, Chu A, Wong M, Srivastava A, Ceccacci R, Lin C, et al. Cancer risk with topical calcineurin inhibitors, pimecrolimus and tacrolimus, for atopic dermatitis: a systematic review and meta-analysis. Lancet Child Adolesc Health. 2023;7(1):13-25. doi:10.1016/S2352-4642(22)00283-8Chu DK, Chu AWL, Rayner DG, Guyatt GH, Yepes-Nuñez JJ, Gomez-Escobar L, et al. Topical treatments for atopic dermatitis (eczema): systematic review and network meta-analysis of randomized trials. J Allergy Clin Immunol. 2023;152(6):1493-1519. doi:10.1016/j.jaci.2023.08.030

Bakaa L, Pernica JM, Couban RJ, Tackett KJ, Burkhart CN, Leins L, et al. Bleach baths for atopic dermatitis: a systematic review and meta-analysis including unpublished data, Bayesian interpretation, and GRADE. Ann Allergy Asthma Immunol. 2022;128(6):660-668.e669. doi:10.1016/j.anai.2022.03.024

Oykhman P, Dookie J, Al-Rammahy H, de Benedetto A, Asiniwasis RN, LeBovidge J, et al. Dietary elimination for the treatment of atopic dermatitis: a systematic review and meta-analysis. Journal of Allergy and Clinical Immunology: In Practice. 2022;10(10):2657-2666.e2658. doi:10.1016/j.jaip.2022.06.044

Chu AWL, Wong MM, Rayner DG, Guyatt GH, Martinez JPD, Ceccacci R, et al. Systemic treatments for atopic dermatitis (eczema): systematic review and network meta-analysis of randomized trials. J Allergy Clin Immunol. 2023;152(6):1470-1492. doi:10.1016/j.jaci.2023.08.029

Chu DK, Golden DBK, Guyatt GH. Translating Evidence to Optimize Patient Care Using GRADE. J Allergy Clin Immunol Pract. 2021;9(12):4221-4230. doi:10.1016/j.jaip.2021.09.035

Maleki-Yazdi KA, Heen AF, Zhao IX, Guyatt GH, Suzumura EA, Makhdami N, et al. Values and preferences of patients and caregivers regarding treatment of atopic dermatitis (eczema): a systematic review. JAMA Dermatol. 2023;159(3):320-330. doi:10.1001/jamadermatol.2022.6045

Downloads

Published

2024-09-23

How to Cite

1.
Chu DK. Allergen Immunotherapy and Atopic Dermatitis: Updated Guidance. Can Allergy Immunol Today [Internet]. 2024 Sep. 23 [cited 2024 Oct. 10];4(2):31–37. Available from: https://canadianallergyandimmunologytoday.com/article/view/4-2-Chu

Issue

Section

Articles