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SLIT and Atopic Dermatitis

SLIT and Atopic Dermatitis. George F. Kroker, MD. SLIT and Atopic Dermatitis. SLIT has been poorly studied in pediatric AD Results mixed: 2 open-controlled studies with improvement

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SLIT and Atopic Dermatitis

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  1. SLIT and Atopic Dermatitis George F. Kroker, MD

  2. SLIT and Atopic Dermatitis • SLIT has been poorly studied in pediatric AD • Results mixed: • 2 open-controlled studies with improvement • Mastrandrea, F; Sergio G et al: Specific sublingual immunotherapy in atopic dermatitis. Allergol Immunopathol 28:54-62, 2000 • Petrova, SI; Berzhets, VM et al: Immunotherapy in the complex treatment of patients with atopic dermatitis with sensitization to house dust mites. Zh Mikrobiol Immunobiol 1:33-36, 2001. • 1 open-controlled study without improvement • Galli, E; Chini, L et al: Use of oral hyposensitization therapy to Dermatophagoides pteronyssinus in children with atopic dermatitis. Allergol Immunopathol 22:18-24, 1994

  3. SLIT and Atopic Dermatitis

  4. Pajno, Caminiti et al: SLIT in mite-sensitized children with AD: A randomized, double-blind, placebo controlled study. JACI 120: 164-170, 2007. Study Design 2 dropouts: Systemic rxn 14 mild-mod AD 56 children Ages 5-16 yrs 1 month observ SLIT (28) 26 SLIT 18 month f/u SCORAD VAS Med Rescue 12 severe AD SCORAD classified HDM +spt, RAST Placebo (28) 22 Placebo 18 month f/u 6 dropouts: 1 moved 3 noncompliant 2 lost to f/u

  5. Pajno, Caminiti et al: SLIT in mite-sensitized children with AD: A randomized, double-blind, placebo controlledstudy. JACI 120: 164-170, 2007. Maintenance 5 drops 3x/wk For 18 mos (24/26 pts) 15 day buildup #drops 1 drop = 50ul 5 5 5 4 4 4 3 3 3 2 2 2 1 1 1 100 RAST U/ml 1000 RAST u/ml 10,000 RAST u/ml

  6. Pajno, Caminiti et al: SLIT in mite-sensitized children with AD: A randomized, double-blind, placebo controlledstudy. JACI 120: 164-170, 2007. Caculations for monthly Der p1 & Der f1 dosing: 5 drops 3x/wk = 15 drops/wk x 4 weeks = 60 drops/month 1 drop = 50 uL 60 drops = 3000 ul = 3 ml/month High concentration vial = 4.3ug/ml Der p1, 3.5 ug/ml Der fl 1 month = 3x 4.3 ug/ml Der p1 = 12.9 ug Der p1/month 1 month = 3ml x 3.5 ug/ml Der f1 = 10.5 ug Der f1/month SLIT/SCIT ratio approximately 9

  7. Pajno, Caminiti et al: SLIT in mite-sensitized children with AD: A randomized, double-blind, placebo controlledstudy. JACI 120: 164-170, 2007.

  8. Pajno, Caminiti et al: SLIT in mite-sensitized children with AD: A randomized, double-blind, placebo controlledstudy. JACI 120: 164-170, 2007.

  9. Pajno, Caminiti et al: SLIT in mite-sensitized children with AD: A randomized, double-blind, placebo controlledstudy. JACI 120: 164-170, 2007.

  10. Pajno, Caminiti et al: SLIT in mite-sensitized children with AD: A randomized, double-blind, placebo controlledstudy. JACI 120: 164-170, 2007.

  11. Pajno, Caminiti et al: SLIT in mite-sensitized children with AD: A randomized, double-blind, placebo controlledstudy. JACI 120: 164-170, 2007.

  12. Pajno, Caminiti et al: SLIT in mite-sensitized children with AD: A randomized, double-blind, placebo controlledstudy. JACI 120: 164-170, 2007 Clinical Efficacy: Parameter Measurements

  13. Pajno, Caminiti et al: SLIT in mite-sensitized children with AD: A randomized, double-blind, placebo controlledstudy. JACI 120: 164-170, 2007. Adverse Events (2 patients dropped out of Rx group due to Generalized itching and skin flareup on SLIT)

  14. Pajno, Caminiti et al: SLIT in mite-sensitized children with AD: A randomized, double-blind, placebo controlledstudy. JACI 120: 164-170, 2007. “…We conclude that SLIT with a standardized mite extract can be considered effective in children with mild-moderate Allergic AD, whereas the benefit was inconsistent in the severe form…”

  15. Pajno, Caminiti et al: SLIT in mite-sensitized children with AD: A randomized, double-blind, placebo controlledstudy. JACI 120: 164-170, 2007 • Question: Were the results biased againstimprovement because of: • Infrequent use (3x/wk SLIT) • Total load effect: • 5 active/2 placebo had concomitant pollen sensitization

  16. Questions for the future… • SLIT for AD in adult patients? • SLIT for AD with other inhalant allergens? • SLIT for AD with food allergens? • SLIT for AD with inhalant and food allergens? • SLIT for other skin diseases?: • urticaria from inhalants and/or foods? • Contact dermatitis? Pajno, Caminiti et al: SLIT in mite-sensitized children with AD: A randomized, double-blind, placebo controlledstudy. JACI 120: 164-170, 2007

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