slit and atopic dermatitis george f. kroker, md ©2008 allergychoices, inc. all rights reserved

SLIT and Atopic Dermatitis

George F. Kroker, MD

©2008 Allergychoices, Inc. All Rights Reserved.

SLIT and Atopic Dermatitis

SLIT has been poorly studied in pediatric AD Results mixed:

2 open-controlled studies with improvement 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 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.

SLIT and Atopic Dermatitis

©2007 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.

©2008 Allergychoices, Inc. All Rights Reserved.

Study Design

56 childrenAges 5-16 yrs1 month observ

SCORAD classifiedHDM +spt, RAST

SLIT (28)

Placebo (28)

2 dropouts:Systemic rxn

6 dropouts: 1 moved 3 noncompliant 2 lost to f/u

26 SLIT

22 Placebo

14 mild-mod AD

12 severe AD

18 month f/u

18 month f/u SCORADVASMed Rescue

Pajno, Caminiti et al: SLIT in mite-sensitized children with AD: A randomized, double-blind, placebo controlled study. JACI 120: 164-170, 2007.

©2008 Allergychoices, Inc. All Rights Reserved.

100 RAST U/ml

#drops1 drop = 50ul

12

34

5

1000 RAST u/ml 10,000 RAST u/ml

12

34

5

12

34

5

15 day buildup

Maintenance5 drops 3x/wkFor 18 mos(24/26 pts)

Pajno, Caminiti et al: SLIT in mite-sensitized children with AD: A randomized, double-blind, placebo controlled study. JACI 120: 164-170, 2007.

©2008 Allergychoices, Inc. All Rights Reserved.

Caculations for monthly Der p1 & Der f1 dosing:

5 drops 3x/wk = 15 drops/wk x 4 weeks = 60 drops/month

1 drop = 50 uL60 drops = 3000 ul = 3 ml/month

High concentration vial = 4.3ug/ml Der p1, 3.5 ug/ml Der fl

1 month = 3x 4.3 ug/ml Der p1 = 12.9 ug Der p1/month1 month = 3ml x 3.5 ug/ml Der f1 = 10.5 ug Der f1/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.

©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.

©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.

©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.

©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.

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.

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

Pajno, Caminiti et al: SLIT in mite-sensitized children with AD: A randomized, double-blind, placebo controlled study. JACI 120: 164-170, 2007.

©2008 Allergychoices, Inc. All Rights Reserved.

Side Effect SLIT Placebo

Fatigue 6 1

Headache 1 -

Local ENT swelling during buildup phase

4 -

Adverse Events

(2 patients dropped out of Rx group due to Generalized itching and skin flareup on SLIT)

Pajno, Caminiti et al: SLIT in mite-sensitized children with AD: A randomized, double-blind, placebo controlled study. JACI 120: 164-170, 2007.

©2008 Allergychoices, Inc. All Rights Reserved.

“…We conclude that SLIT with a standardized mite extract can be considered effective in children with mild-moderate Allergic AD, whereas the benefit was inconsistent in the severe form…”

Question: Were the results biased against improvement because of: Infrequent use (3x/wk SLIT) Total load effect:

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

Questions for the future… SLIT for AD in adult patients? SLIT for AD with other inhalant allergens? SLIT for AD with food allergens? SLIT for AD with inhalant and food allergens? SLIT for other skin diseases?:

urticaria from inhalants and/or foods? Contact dermatitis?

©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