Atopic dermatitis is often the first symptom of allergic disease, commonly affecting young children, typically before 5 years of age. Atopic dermatitis is triggered by allergies to foods and environmental allergens (such as pollen, molds, pet dander and dust mites) in 85 percent of affected people. In many children with atopic dermatitis, allergic rhinitis will begin to develop at school age, and some of these children will develop asthma by adolescence. This progression of allergic disease is called the "atopic march". There has been some success at stopping the atopic march through the use of medications and immunotherapy (allergy shots).
Various treatments are available for these different allergic diseases, including avoidance of allergic triggers, medications, as well as the use of immunotherapy. Immunotherapy, including allergy shots and allergy drops, are the only allergy treatments that actually change the underlying problem of allergies, and are the only possible cure. For many years, immunotherapy has been used for the treatment of allergic rhinitis, allergic conjunctivitis, and allergic asthma. More recently, various studies suggest that immunotherapy may also be useful for the treatment of atopic dermatitis.
Allergy Shots for Atopic Dermatitis
Various studies have been conducted in recent years to examine the possibility that allergy shots may actually be helpful for the treatment of atopic dermatitis. A number of these studies revealed that allergy shots are helpful in reducing the amount of atopic dermatitis symptoms (as measured by SCORAD -- a tool useful in assigning a numerical value based on the amount of skin involved, from 1 to 100) as well as reducing the amount of topical steroids required to control symptoms. Allergy shots were most effective at treating people with more severe atopic dermatitis, with SCORAD values greater than 40, as well as for people with dust mite allergies as a trigger for their atopic dermatitis.
Allergy Drops for Atopic Dermatitis
Allergy drops, or sublingual immunotherapy, involve taking what a person is allergic to and placing it under the tongue. The result is very much the same as traditional allergy shots -- reduction in the amount of allergy symptoms, reduction in the amount of allergy medication required, and the potential for allergy symptoms to be cured. Allergy drops, while used in Europe for decades, are considered investigational in the United States at present, and are therefore only offered by a few allergists. Similar to allergy shots, allergy drops have been used for the treatment of allergic rhinitis, allergic conjunctivitis, and allergic asthma -- but traditionally not used for atopic dermatitis.
A few studies have examined the benefit of allergy drops for the treatment of atopic dermatitis, all in people with dust mite allergy. A study published in 2007 found that allergy drops containing dust mite was effective for the treatment of mild to moderate atopic dermatitis (with a SCORAD between 8 and 40). In this group, there was a decrease in atopic dermatitis symptoms and a decrease in the amount of medication required to treat atopic dermatitis symptoms. Allergy drops were not helpful for the treatment of severe atopic dermatitis (SCORAD greater than 40) caused by dust mite allergy.
Safety of Immunotherapy for Atopic Dermatitis
Allergy shots are generally a safe and effective treatment for various allergic conditions; because of the possibility of anaphylaxis, however, people receiving immunotherapy should be monitored in a physician’s office for 30 minutes. Allergy drops, on the other hand, are traditionally given at home, given the extremely low risk for this method of immunotherapy to cause severe anaphylaxis.
For many years, allergists were concerned about the possibility of allergy shots actually making atopic dermatitis worse. This is because chronic atopic dermatitis shares immunologic features with autoimmune diseases (such as lupus and rheumatoid arthritis), which may worsen with allergy shots. While most studies show that immunotherapy is safe and effective for atopic dermatitis, up to 20 percent of people had worsening of their atopic dermatitis symptoms with allergy shots or drops.
By Daniel More, MD
Updated July 03, 2012