Upload
marianna-betty-jennings
View
216
Download
1
Embed Size (px)
Citation preview
SLIT and Atopic Dermatitis
George F. Kroker, MD
©2008 Allergychoices, Inc. All Rights Reserved.
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
©2008 Allergychoices, Inc. All Rights Reserved.
SLIT and Atopic Dermatitis
©2007 Allergychoices, Inc. All Rights Reserved.
Pajno, Caminiti et al: SLIT in mite-sensitized children with AD: A randomized, double-blind, placebo controlled study. JACI 120: 164-170, 2007.
©2008 Allergychoices, Inc. All Rights Reserved.
Study Design
56 childrenAges 5-16 yrs1 month observ
SCORAD classifiedHDM +spt, RAST
SLIT (28)
Placebo (28)
2 dropouts:Systemic rxn
6 dropouts: 1 moved 3 noncompliant 2 lost to f/u
26 SLIT
22 Placebo
14 mild-mod AD
12 severe AD
18 month f/u
18 month f/u SCORADVASMed Rescue
Pajno, Caminiti et al: SLIT in mite-sensitized children with AD: A randomized, double-blind, placebo controlled study. JACI 120: 164-170, 2007.
©2008 Allergychoices, Inc. All Rights Reserved.
100 RAST U/ml
#drops1 drop = 50ul
12
34
5
1000 RAST u/ml 10,000 RAST u/ml
12
34
5
12
34
5
15 day buildup
Maintenance5 drops 3x/wkFor 18 mos(24/26 pts)
Pajno, Caminiti et al: SLIT in mite-sensitized children with AD: A randomized, double-blind, placebo controlled study. JACI 120: 164-170, 2007.
©2008 Allergychoices, Inc. All Rights Reserved.
Caculations for monthly Der p1 & Der f1 dosing:
5 drops 3x/wk = 15 drops/wk x 4 weeks = 60 drops/month
1 drop = 50 uL60 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/month1 month = 3ml x 3.5 ug/ml Der f1 = 10.5 ug Der f1/month
SLIT/SCIT ratio approximately 9
©2008 Allergychoices, Inc. All Rights Reserved.
Pajno, Caminiti et al: SLIT in mite-sensitized children with AD: A randomized, double-blind, placebo controlled study. JACI 120: 164-170, 2007.
©2008 Allergychoices, Inc. All Rights Reserved.
Pajno, Caminiti et al: SLIT in mite-sensitized children with AD: A randomized, double-blind, placebo controlled study. JACI 120: 164-170, 2007.
©2008 Allergychoices, Inc. All Rights Reserved.
Pajno, Caminiti et al: SLIT in mite-sensitized children with AD: A randomized, double-blind, placebo controlled study. JACI 120: 164-170, 2007.
©2008 Allergychoices, Inc. All Rights Reserved.
Pajno, Caminiti et al: SLIT in mite-sensitized children with AD: A randomized, double-blind, placebo controlled study. JACI 120: 164-170, 2007.
©2008 Allergychoices, Inc. All Rights Reserved.
Pajno, Caminiti et al: SLIT in mite-sensitized children with AD: A randomized, double-blind, placebo controlled study. JACI 120: 164-170, 2007.
SCORAD Improv VAS improv Rescue Med improv
All AD P=.0025* NS P=.03*
Mild/Mod AD P<.0005* P=.002* P=.01*
Severe AD NS NS NS
©2008 Allergychoices, Inc. All Rights Reserved.
Pajno, Caminiti et al: SLIT in mite-sensitized children with AD: A randomized, double-blind, placebo controlled study. JACI 120: 164-170, 2007
Clinical Efficacy: Parameter Measurements
Pajno, Caminiti et al: SLIT in mite-sensitized children with AD: A randomized, double-blind, placebo controlled study. JACI 120: 164-170, 2007.
©2008 Allergychoices, Inc. All Rights Reserved.
Side Effect SLIT Placebo
Fatigue 6 1
Headache 1 -
Local ENT swelling during buildup phase
4 -
Adverse Events
(2 patients dropped out of Rx group due to Generalized itching and skin flareup on SLIT)
Pajno, Caminiti et al: SLIT in mite-sensitized children with AD: A randomized, double-blind, placebo controlled study. JACI 120: 164-170, 2007.
©2008 Allergychoices, Inc. All Rights Reserved.
“…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…”
Question: Were the results biased against improvement because of: Infrequent use (3x/wk SLIT) Total load effect:
5 active/2 placebo had concomitant pollen sensitization
©2008 Allergychoices, Inc. All Rights Reserved.
Pajno, Caminiti et al: SLIT in mite-sensitized children with AD: A randomized, double-blind, placebo controlled study. JACI 120: 164-170, 2007
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?
©2008 Allergychoices, Inc. All Rights Reserved.
Pajno, Caminiti et al: SLIT in mite-sensitized children with AD: A randomized, double-blind, placebo controlled study. JACI 120: 164-170, 2007