SLIT and Atopic Dermatitis George F. Kroker, MD ©2008 Allergychoices, Inc. All Rights Reserved.

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Presentation transcript:

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, 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: , ©2008 Allergychoices, Inc. All Rights Reserved. Study Design 56 children Ages 5-16 yrs 1 month observ SCORAD classified HDM +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 SCORAD VAS Med Rescue

Pajno, Caminiti et al: SLIT in mite-sensitized children with AD: A randomized, double-blind, placebo controlled study. JACI 120: , ©2008 Allergychoices, Inc. All Rights Reserved. 100 RAST U/ml #drops 1 drop = 50ul RAST u/ml10,000 RAST u/ml day buildup Maintenance 5 drops 3x/wk For 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: , ©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 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

©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: , 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: , 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: , 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: , 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: , 2007.

SCORAD ImprovVAS improvRescue Med improv All ADP=.0025*NSP=.03* Mild/Mod ADP<.0005*P=.002*P=.01* Severe ADNS ©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: , 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: , ©2008 Allergychoices, Inc. All Rights Reserved. Side EffectSLITPlacebo Fatigue61 Headache1- 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: , ©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: , 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: , 2007