Autologous Immunoglobulin Therapy in Patients With Severe Recalcitrant Atopic Dermatitis: A Preliminary Report
A 27-year-old male patient with severe AD presented to the out-patient clinic of our university hospital with a complaint of pruritus on March 4, 2010. The patient was diagnosed with AD at the age of 14. He also had a past history of allergic rhinitis and asthma and a family history of atopic dermatitis (grandfather and aunt). On physical examination, severe eczematous skin lesions involving the face, neck, and anterior chest surface area were noted. He had been treated by a topical corticosteroid, oral antihistamine, and intermittent oral corticosteroid at the out-patient dermatology clinics of 2 different university hospitals for 12 years before the initial visit to our hospital. Additionally, he was also treated with oral cyclosporine (100 mg/day) for the last 6 months. However, his clinical condition was not effectively controlled. He had received surgery for cataracts of the right eye at the age 20. The clinical severity score of AD in this patient (SCORAD value) at the initial visit was 45.2. Serum house dust mite-specific IgE assay (ImmunoCAP, Thermo Scientific Inc.) showed a strong positive result (). He was treated with oral cyclosporine (100 mg/day), topical calcineurin inhibitor, and oral anatihistamine for 3 years at our clinic; however, his clinical condition of AD was not effectively controlled.\nOn January 13, 2013 (at age 30), AIGT was started in this patient. The baseline SCORAD value of the patient measured at the day of initiation of AIGT was 60.4 (). The patient reported a subjective improvement in the clinical symptoms of pruritus at 3 weeks after the initiation of AIGT. The SCORAD value decreased to 45.5 at 4 weeks after the initiation of AIGT (24.7% decrease in the SCORAD value compared with the baseline) and 39.3 at 8 weeks after the initiation of AIGT (34.9% decrease in the SCORAD value compared with the baseline) in this patient (). The SCORAD value increased to 59.2 at 12 weeks after the initiation of AIGT in this patient. No side effects were observed during and after AIGT.