Kasperkiewicz Michael, Mook Sophie-Charlotte, Knuth-Rehr Diana, Vorobyev Artem, Ludwig Ralf J, Zillikens Detlef, Muck Philip, Schmidt Enno
Department of Dermatology, University of Lübeck, Lübeck, Germany.
Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.
Front Med (Lausanne). 2018 Feb 12;5:27. doi: 10.3389/fmed.2018.00027. eCollection 2018.
Recent reports proposed the application of immunoadsorption (IA) for patients with recalcitrant atopic dermatitis (AD) and high-serum IgE levels. However, experience with this novel treatment approach, especially with the newly available IgE-specific adsorber, is limited and recommendation for its use in clinical practice awaits evidence from more studies.
Patients with severe AD (SCORAD ≥ 60) and total serum IgE levels ≥750 kU/L were included in this study. The treatment protocol consisted of two cycles of five consecutive treatments with IgE-selective IA 3 weeks apart.
Ten patients were enrolled and four patients completed the study. The mean SCORAD was significantly improved by up to 43% within a few weeks and until the end of a 6-month follow-up period, with 50% of patients achieving an at least 50% individual reduction of the baseline SCORAD. Each IA cycle induced a temporal average decrement of total serum levels of IgE, IgM, IgA, and IgG by 92, 43, 38, and 35%, respectively. Except for one case of septicemia, no major adverse events occurred.
Although limited by a considerable withdrawal rate, our observations strengthen our and other recent results further suggesting that IgE-selective IA is an effective treatment option for patients severely affected by AD with highly elevated IgE levels.
最近的报告提出将免疫吸附（IA）应用于顽固性特应性皮炎（AD）和高血清IgE水平的患者。然而，这种新型治疗方法的经验，尤其是使用新上市的IgE特异性吸附剂的经验有限，其在临床实践中的应用建议有待更多研究的证据支持。
本研究纳入了重度AD（SCORAD≥60）且血清总IgE水平≥750 kU/L的患者。治疗方案包括两个周期，每个周期连续进行五次IgE选择性IA治疗，间隔3周。
10名患者入组，4名患者完成研究。在几周内直至6个月随访期结束，平均SCORAD显著改善高达43%，50%的患者个体基线SCORAD降低至少50%。每个IA周期分别使血清总IgE、IgM、IgA和IgG水平暂时平均下降92%、43%、38%和35%。除1例败血症外，未发生重大不良事件。
尽管受到相当高的退出率限制，但我们的观察结果进一步支持了我们以及其他近期的研究结果，表明IgE选择性IA是治疗受AD严重影响且IgE水平高度升高患者的有效选择。
