Rapid clinical improvement of atopic dermatitis in an Omalizumab treated patient.

Q2 Medicine
Clinical and Molecular Allergy Pub Date : 2019-03-12 eCollection Date: 2019-01-01 DOI:10.1186/s12948-019-0109-z
Susanna Bormioli, Andrea Matucci, Laura Dies, Francesca Nencini, Francesca Grosso, Enrico Maggi, Alessandra Vultaggio
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引用次数: 3

Abstract

Background: Atopic dermatitis is a chronic inflammatory skin disorder, whose symptoms and severity grossly depend on individual trigger factors. The majority of patients are satisfactorily treated with emollients together with topical and systemic therapies. However, treatment failure or long-term side effects with conventional treatment options can be a significant clinical problem. Recently, novel therapeutic approaches focus on targeting skewed immune responses providing a more effective, and less harmful approach. Among them, variable success has been reported using Omalizumab, when used in combination with classic therapies. This report describes an interesting case of severe adult onset difficult-to-treat atopic dermatitis dramatically improved in response to treatment with Omalizumab.

Case presentation: We present a case of an adult male with severe allergic atopic dermatitis, with concomitant involvement of the face, neckline, trunk and forearms and systemic symptoms such as diarrhoea with important decrease of his daily quality of life. The patient had been prescribed oral steroids in addition to anti-histamines to no avail. Due to lack of response to classic therapies, strict diet, as well as to treatment with intravenous corticosteroids, an off-label treatment with Omalizumab based on patient weight and total IgE value was proposed. Clear clinical results were observed after only a few weeks with regards to systemic symptoms, and just after 2 months of treatment in regards to skin involvement.

Conclusions: In the majority of treated patients the clinical improvement of cutaneous manifestations is expected after several months of treatment, as skin manifestations are the consequence of a chronic inflammatory process. The outstanding rapid response observed in this case as well as the persistence of the clinical remission suggests that the block of the IgE pathways modulate functions of cells involved in the pathogenic mechanisms of chronic skin inflammation but also in the acute phases observed in the flare-ups of the disease.

Abstract Image

Abstract Image

奥玛珠单抗治疗患者特应性皮炎的快速临床改善
背景:特应性皮炎是一种慢性炎症性皮肤病,其症状和严重程度很大程度上取决于个体触发因素。大多数患者在局部和全身治疗的同时使用润肤剂治疗效果满意。然而,常规治疗方案的治疗失败或长期副作用可能是一个重大的临床问题。最近,新的治疗方法侧重于针对扭曲的免疫反应,提供了一种更有效,更少有害的方法。其中,当与经典疗法联合使用时,Omalizumab的成功程度不一。本报告描述了一个有趣的病例,严重的成人起病难以治疗的特应性皮炎在使用Omalizumab治疗后显著改善。病例介绍:我们报告一例患有严重过敏性特应性皮炎的成年男性,伴有面部、领口、躯干和前臂的累及,并伴有腹泻等全身症状,其日常生活质量显著下降。除了抗组胺药外,还给病人开了口服类固醇,但没有效果。由于对经典疗法、严格饮食以及静脉注射皮质类固醇治疗缺乏反应,因此提出了基于患者体重和总IgE值的Omalizumab超说明书治疗。仅在几周后就观察到明显的临床结果,就全身症状而言,仅在治疗2个月后就观察到皮肤受累。结论:由于皮肤表现是慢性炎症过程的结果,大多数接受治疗的患者在几个月的治疗后可预期皮肤表现的临床改善。在这种情况下观察到的突出的快速反应以及临床缓解的持久性表明,阻断IgE通路调节了参与慢性皮肤炎症致病机制的细胞的功能,但也在疾病突然发作的急性期观察到。
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来源期刊
Clinical and Molecular Allergy
Clinical and Molecular Allergy Medicine-Immunology and Allergy
CiteScore
8.20
自引率
0.00%
发文量
11
审稿时长
13 weeks
期刊介绍: Clinical and Molecular Allergy is an open access, peer-reviewed, online journal that publishes research on human allergic and immunodeficient disease (immune deficiency not related to HIV infection/AIDS). The scope of the journal encompasses all aspects of the clinical, genetic, molecular and inflammatory aspects of allergic-respiratory (Type 1 hypersensitivity) and non-AIDS immunodeficiency disorders. However, studies of allergic/hypersensitive aspects of HIV infection/AIDS or drug desensitization protocols in AIDS are acceptable. At the basic science level, this includes original work and reviews on the genetic and molecular mechanisms underlying the inflammatory response.
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