3132 House Dust Mites Sublingual Immunotherapy Can Influence the Long-Term Evolution of Severe Atopic Dermatitis and the Progression to Respiratory Allergy.

Friday, 16 October 2015
Hall D1 Foyer (Floor 3) (Coex Convention Center)

Maurizio Marogna, MD , Ospedale Di Cuasso Al Monte, Cuasso al Monte, Varese, Italy

Enrico Compalati, MD, PhD , University of Genoa, Irccs Aou San Martino-IST, Allergy and Respiratory Diseases Clinic, Genoa, Italy

Background.The role of allergen immunotherapy (AIT) in the treatment of patients with atopic dermatitis (AD) is quite controversial, since its efficacy has been poorly investigated in the past years and eczema exacerbations have been reported following AIT. We investigated the tolerability of hypoallergenic AIT, its benefit on eczema and its influence on the progression of the allergic disease.

Methods. This study included 12-55-year-old patients with severe AD (SCORAD >36) monosensitized to house dust mites (HDM) but without diagnostic criteria for rhinitis, asthma and food allergy at baseline. 22 subjects were treated in a continuous way for 5 years with sublingual tablets of carbamylated monomeric allergoid extract of HDM (2000 AU/week) and compared with 21 subjects treated with cetirizine 10mg daily. Topical and short course of oral steroids on demand were allowed and counted. The main endpoint was the change in SCORAD score at different time-points up to 10 years after AIT discontinuation. In addition, to assess the disease progression, data on respiratory symptoms and related medications were collected during mite exposition period, with lung function, bronchial hypereactivity, nasal eosinophils, onset of on new sensitizations. The occurrence of local or systemic adverse reactions was registered.

Results. No systemic serious reactions occurred during the 5 years. Adherence to the AIT regimen was good till the end of the treatment period and 20 subjects in AIT group and 18 in the control group reached the final observation at 15 years from baseline: the mean SCORAD index in AIT group decreased from 59.72 to 44.55,  in control group from 57,04 to 55,55; the use of topical corticosteroids was halved in AIT group vs. control group; the use of oral corticosteroids was decreased only in AIT group; 2/20 patients in AIT group developed rhinitis and asthma, in control group 14/18 developed rhinitis and 9/18 asthma, requiring regular pharmacotherapy; only 2 patients in AIT group developed new sensitizations, whereas all controls resulted polysensitized.

Conclusion. AIT tablets of HDM  carbamylated monomeric allergoid were well tolerated and provided sustained and long lasting partial improvement of the severity of atopic eczema, with remarkable reduction in the use of corticosteroids and preventive effect on the progression to respiratory allergy and onset of new allergic sensitizations.