Molecular profiling of allergen-antibody IgE might decide about the efficacy of allergen immunotherapy in a patient with atopic dermatitis and allergy to house dust mites

Introduction:
Allergen immunotherapy (AIT) has no clear recommendation for atopic dermatitis (AD).

Aim:
To evaluate the effect of AIT on house dust mites (HDM) in AD patients sensitised to HDM with different baseline molecular profiles of antigens.

Material and methods:
In this placebo-controlled study, 61 patients with moderate-to-severe AD allergy symptoms and HDM allergy were included. They received a 12 months’ AIT with the use of HDM allergen extract or placebo. The authors adopted their AD improvement criterion after 1 year of AIT as a reduction of all examined indicators by at least 50% from the baseline for %BSA, TMS, and EASI scores. Additionally, the influence of individual HDM molecules on the final AIT effect was analysed.

Results:
Finally, from the 24 desensitised patients, 15 achieved a positive expected effect after 12 months of HDM AIT. None of the patients who received a placebo had an improvement in AD of at least 50% after 1 year of follow-up. Patients with polysensitisation less frequently achieved the expected HDM AIT effect than patients monosensitised to mites (p < 0.05). The presence of sensitisation to rDer p 1 (odds ratio = 4.35, 95% CI: 4.01–4.56) and/or rDer p 2 (OR = 2.16, 95% CI: 1.98–2.33) and/or rDer f 2 (OR = 1.41, 95% CI: 1.55–1.78) molecules significantly increased the efficacy of AIT. HDM AIT could be helpful for patients with moderate-to-severe AD and sensitised to HDM as an add-on therapy. Various HDM molecules may affect the effectiveness of the expected AIT effect. The presence of sensitisation to rDer p 1 (OR = 4.35, 95% CI: 4.01–4.56) and/or rDer p 2 (OR = 2.16, 95% CI: 1.98–2.33) and/or rDer f 2 (OR = 1.41, 95% CI: 1.55–1.78) molecules significantly increased the efficacy of AIT.

Conclusions:
HDM AIT could be helpful for patients with moderate-to-severe AD and sensitised to HDM as an add-on therapy. Various HDM molecules may affect the effectiveness of the expected AIT.