SLIT and Atopic Dermatitis George F Kroker MD

SLIT and Atopic Dermatitis n SLIT has been poorly studied in pediatric AD n Results mixed: n 2 open-controlled studies with improvement n n n 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, 2001. 1 open-controlled study without improvement n 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.

Pajno, Caminiti et al: SLIT in mite-sensitized children with AD: A randomized, double-blind, placebo controlled study. JACI 120: 164 -170, 2007. Study Design 2 dropouts: Systemic rxn 56 children Ages 5 -16 yrs 1 month observ SCORAD classified HDM +spt, RAST SLIT (28) 26 SLIT Placebo (28) 14 mild-mod AD 22 Placebo 6 dropouts: 1 moved 3 noncompliant 2 lost to f/u © 2008 Allergychoices, Inc. All Rights Reserved. 18 month f/u SCORAD 12 severe AD VAS Med Rescue 18 month f/u

n Pajno, Caminiti et al: SLIT in mite-sensitized children with AD: A randomized, double-blind, placebo controlled study. JACI 120: 164 -170, 2007. Maintenance 5 drops 3 x/wk For 18 mos (24/26 pts) 15 day buildup #drops 1 drop = 50 ul 5 1 2 3 4 100 RAST U/ml 1 2 3 4 5 1000 RAST u/ml © 2008 Allergychoices, Inc. All Rights Reserved. 1 2 3 4 5 10, 000 RAST u/ml

n Pajno, Caminiti et al: SLIT in mite-sensitized children with AD: A randomized, double-blind, placebo controlled study. JACI 120: 164 -170, 2007. Caculations for monthly Der p 1 & Der f 1 dosing: 5 drops 3 x/wk = 15 drops/wk x 4 weeks = 60 drops/month 1 drop = 50 u. L 60 drops = 3000 ul = 3 ml/month High concentration vial = 4. 3 ug/ml Der p 1, 3. 5 ug/ml Der fl 1 month = 3 x 4. 3 ug/ml Der p 1 = 12. 9 ug Der p 1/month 1 month = 3 ml x 3. 5 ug/ml Der f 1 = 10. 5 ug Der f 1/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: 164 -170, 2007 Clinical Efficacy: Parameter Measurements SCORAD Improv VAS improv Rescue Med improv All AD P=. 0025* NS P=. 03* Mild/Mod AD P<. 0005* P=. 002* P=. 01* Severe AD NS NS NS © 2008 Allergychoices, Inc. All Rights Reserved.

n Pajno, Caminiti et al: SLIT in mite-sensitized children with AD: A randomized, double-blind, placebo controlled study. JACI 120: 164 -170, 2007. Adverse Events Side Effect SLIT Placebo Fatigue 6 1 Headache 1 - Local ENT swelling during buildup phase 4 - (2 patients dropped out of Rx group due to Generalized itching and skin flareup on SLIT) © 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: 164 -170, 2007. “…We conclude that SLIT with a standardized mite extract can be considered effective in children with mildmoderate Allergic AD, whereas the benefit was inconsistent in the severe form…” © 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: 164 -170, 2007 n Question: Were the results biased against improvement because of: Infrequent use (3 x/wk SLIT) n Total load effect: n n 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: 164 -170, 2007 n Questions for the future… n SLIT for AD in adult patients? n SLIT for AD with other inhalant allergens? n SLIT for AD with food allergens? n SLIT for AD with inhalant and food allergens? n SLIT for other skin diseases? : n n urticaria from inhalants and/or foods? Contact dermatitis? © 2008 Allergychoices, Inc. All Rights Reserved.