1071 A Case of Persistent Atopic Dermatitis Associated with Parasitic Infection

Wednesday, 14 October 2015
Hall D1 Foyer (Floor 3) (Coex Convention Center)

Rosanna Qualizza, MD , Allergy Departement, Istituti Clinici Di Perfezionamento, Milan, Italy

Cristoforo Incorvaia, MD , Allergy Department, Istituti Clinici Di Perfezionamento, Milan, Italy

Anna Maraschini, MD , Diagnostic Services Department, Irccs Fondazione Ca' Granda Ospedale Maggiore, Milan, Italy

Background Infection from Ascaris lumbricoides may induce high level of IgE and favour the development of clinical allergy. We report the case of a child with atopic dermatitis and asthma cured by anti-helminthic  therapy with mebendazole.

Methods The patient was a 12-year old female suffering from  the age of two months from atopic dermatitis and from the age of 10 months from asthma. Both skin and respiratory symptoms were perennial, with worsening in spring and autumn.  Allergy testing, performed at the age of 18 months, gave positive results to Dermatophagoides pteronyssinus (prick test +++; specific IgE 27 kU/L) and D. Farinae (prick test +++, specific IgE 23 kU/L). Also tomato (++), hen’s egg (++) and cow milk (+) were positive to prick tests, total IgE were 355 kU/L. A mild eosinophilia (7.2%)  was detected in peripheral blood. Following environmental measures to control house dust mites and the elimination of tomato, egg and milk from the diet there was an improvement of asthma but not of atopic dermatitis. At 3 years of age the value of total IgE was 3253 kU/L. At 6 years of age there was a worsening of dermatitis with modest response to topical corticosteroids, while asthma was no longer present. Prick tests confirmed the positive results to Dermatophagoides, tomato and cow milk. A further worsening of atopic dermatitis occurred at 9 years of age, which was treated with oral bethametasone and topical picrolimus.  In September 2014 the patient was referred to our Unit, we found a peripheral eosinophilia of 14.4% and, suspecting parasitic infections, we evaluated specific IgE to Ascaris, which had a value of 32.50 kU/L, while total IgE were 8324 kU/L. Anthelmintic therapy was prescribed using mebendazole (one100 mg 1 tablet b.i.d. for three days), repeated after 20 and 50 days.

Results  One month after the first two cycles of therapy the patient showed a progressive improvement of symptoms, and  eosinophilia was 12%. Six months after the end of therapy the skin was free from dermatitis and a decrease was observed for eosinophilia (10.1%) and Ascaris-specific IgE  (27.50 kU/L).

Conclusion  This case shows that the role of infection from Ascaris lumbricoides in patients with long-lasting dermatitis should not be overlooked. In fact, an adequate anti-helminthic  treatment may result in a complete recovery from the disease.