SIT beyond respiratory diseases.
OBJECTIVE
The goal was to assess the effectiveness of specific immunotherapy (SIT) in reduction of symptoms and medication score in patients with immunoglobulin E (IgE) mediated extrinsic form of atopic dermatitis (AD); and to assess the effectiveness of oral immunotherapy (OIT) as "active" treatment to achieving tolerance for food(s) in patients with IgE mediated food allergy.


METHODS
Computerized bibliographic searches of MEDLINE (1998-2010) were supplemented by hand searches of reference lists. Studies were included if they were double-blind randomized controlled trials comparing subcutaneous immunotherapy (SCIT) or sublingual immunotherapy (SLIT) or OIT with placebo. However uncontrolled studies and case reports were also included.


METHODS
Thirty-two studies were analyzed. Because of the high heterogeneity of the AD studied only results of 2 placebo controlled studies 1-SCIT and 1-SLIT respectively were comparable. Among OIT studies: 4 carried out with control groups were analyzed.


RESULTS
From 36% to 92% of patients treated with OIT reached tolerance to cow's milk or egg; a rate of 8% to 53% reached partial tolerance. The patients had either clinical history of severe systemic reactions to foods: anaphylaxis, or mild to moderate reactions. Regarding SIT for AD: 72% of patients treated with house dust mite SCIT and 54% treated with SLIT had a significant improvement of SCORAD-Index.


CONCLUSIONS
This review found that OIT with cow's milk or egg is effective in achieving full tolerance or partial tolerance in the majority of patients with IgE mediated food allergy. SIT may represent an additional therapeutic tool for the treatment of extrinsic AD in properly selected patients.
Department of Pediatrics, Allergy Unit, University of Messina, Italy. Giovanni.Pajno@unime.it
Giovanni B
GB
Pajno
Ira
I
Finegold
D000485:Allergens / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology; D000818:Animals; D002417:Cattle; D003876:Dermatitis, Atopic / Q000188:drug therapy* / Q000276:immunology* / Q000503:physiopathology; D003888:Desensitization, Immunologic; D004333:Drug Administration Routes; D004527:Egg Proteins / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology; D005512:Food Hypersensitivity / Q000188:drug therapy* / Q000276:immunology* / Q000503:physiopathology; D006801:Humans; D007108:Immune Tolerance; D007073:Immunoglobulin E / Q000276:immunology; D008894:Milk Proteins / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology; D016032:Randomized Controlled Trials as Topic
D000485:Allergens; D004527:Egg Proteins; D008894:Milk Proteins; D007073:Immunoglobulin E