Wegner Joanna, Weinmann-Menke Julia, von Stebut Esther
Department of Dermatology, University Medical Center Mainz, Germany.
1st Department of Medicine, University Medical Center Mainz, Germany.
Atheroscler Suppl. 2017 Nov;30:264-270. doi: 10.1016/j.atherosclerosissup.2017.05.043. Epub 2017 Jun 2.
Atopic dermatitis (AD) is a common disease affecting up to 10-20% of the population with the largest disease burden in childhood. Treatment options include basic emollient treatment, topical as well as systemic immunosuppressants. The pathogenesis is complex and among various triggers, genetic predisposition and immunological alterations contribute to development of disease. Atopy is common in patients with AD and many patients have high levels of Immunoglobulin E (IgE), some of which recognizes exogenous or auto/self-allergens. Treatment options targeting IgE such as specific immunotherapy against e.g. house dust mites or using anti-IgE antibodies (omalizumab) showed variable results that were not convincing. We now review recent data on the application of unspecific and IgE-selective immunoadsorption (IA) in AD. All in all, 53 patients have been treated with non-specific pan Ig IA and 28 patients with IgE-selective IA. Side effects were rarely seen. The efficacy of IgE depletion was generally high (<∼80%) for each IA cycle, but transient and lasted only a few days/weeks. Of note, disease activity appeared to improve in almost all cases and lasted for several weeks. Although the evidence is still weak, these case studies suggest that IgE depletion in AD is effective and helped control the disease. The mechanism of action is not understood yet. Future controlled trials are needed to validate this observation.
特应性皮炎（AD）是一种常见疾病，影响着高达10%-20%的人群，在儿童期疾病负担最重。治疗选择包括基础润肤治疗、局部和全身免疫抑制剂。其发病机制复杂，在各种触发因素中，遗传易感性和免疫改变促成了疾病的发展。特应性在AD患者中很常见，许多患者免疫球蛋白E（IgE）水平较高，其中一些IgE可识别外源性或自身过敏原。针对IgE的治疗选择，如针对屋尘螨的特异性免疫疗法或使用抗IgE抗体（奥马珠单抗），结果不一，缺乏说服力。我们现在回顾关于非特异性和IgE选择性免疫吸附（IA）在AD中应用的最新数据。总体而言，53例患者接受了非特异性全Ig IA治疗，28例患者接受了IgE选择性IA治疗。副作用很少见。每次IA周期中，IgE清除率通常较高（<约80%），但具有短暂性，仅持续数天/数周。值得注意的是，几乎所有病例的疾病活动度似乎都有所改善，且持续数周。尽管证据仍然不足，但这些病例研究表明，AD中的IgE清除是有效的，有助于控制疾病。其作用机制尚不清楚。未来需要进行对照试验来验证这一观察结果。
