Autologous Immunoglobulin Therapy in Patients With Severe Recalcitrant Atopic Dermatitis: A Preliminary Report
A 33-year-old male patient with severe AD presented to the out-patient clinic of our university hospital with complaints of severe pruritus on July 20, 2010. The patient was diagnosed with AD shortly after birth. He also had asthma, allergic rhinitis, and allergic conjunctivitis. He had a family history of allergic rhinitis (elder brother). He was diagnosed with iatrogenic Cushing syndrome at age 11 on the basis of a moon face, obesity, and history of long-term oral corticosteroid treatment at the dermatology clinic of another university hospital. He was treated with a topical corticosteroid and oral antihistamine in the out-patient clinic of another university hospital for 22 years from the age of 11; however, the clinical condition of the patient was not effectively controlled by treatment. He had also received phototherapy (ultra-violet ray therapy) at the age of 22 for 31 months but discontinued due to concerns over the development of side effects from long-term phototherapy. He had received surgery for cataract and glaucoma. On physical examination, eczematous skin lesions on the whole body surface area were noted. The clinical severity score of AD in this patient (SCORAD value) at the initial visit was 60.4. Serum house dust mite-specific IgE assay (ImmunoCAP, Thermo Scientific Inc.) showed a strong positive result (). After the initial visit to our hospital, he was treated with oral cyclosporine (200 mg/day) for 1 year and then with a combination of oral cyclosporine (100 mg/day) and oral methotrexate (12.5 mg/week) for an additional 1 year in the out-patient clinic of our hospital. However, his clinical symptom of AD had not been effectively controlled.\nOn February 19, 2013 (at age 36), AIGT was started in this patient. The baseline SCORAD value of the patient measured at the day of initiation of AIGT was 60.7 (). The patient reported a subjective improvement in clinical symptoms of pruritus from 1 week after the initiation of AIGT and he reported a 100% improvement in the quality of sleep scores (scores from 10 to 0) at 3 weeks after the initiation of AIGT injection. The SCORAD value decreased to 43.1 at 4 weeks after the initiation of AIGT (29.0% decrease in SCORAD value compared with the baseline) and 28.2 at 8 weeks after the initiation of the AIGT (53.5% decrease in the SCORAD value compared with the baseline) in this patient (). The SCORAD value further decreased to 25.7 at 12 weeks after the initiation of AIGT (57.7% decrease in the SCORAD value compared with the baseline) in this patient. No side effects were observed during and after AIGT.