Autologous Immunoglobulin Therapy in Patients With Severe Recalcitrant Atopic Dermatitis: A Preliminary Report
A 21-year-old male patient with severe AD visited the emergency room of our university hospital with complaints of intractable pruritus and difficulty in sleep due to pruritus on August 30, 2010. The patient was diagnosed with AD at 5 months of age and reported a progressive worsening of his eczema over the past 5 years before the initial visit to our hospital. He had also allergic rhinitis; however, there was a no family history of allergic diseases. 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 81.5. Serum house dust mite-specific IgE assay (ImmunoCAP, Thermo Scientific Inc.) showed a strong positive result (). After admission, he was treated with a topical corticosteroid, systemic corticosteroid, and oral cyclosporine (200 mg/day). During the admission, he received subcutaneous allergen immunotherapy with house dust mite extract with ultra-rush schedule as previously reported. He was discharged from the hospital with clinical improvement. After discharge, he was treated with topical corticosteroid, topical calcineurin inhibitor, emollients, oral antihistamine, and oral cyclosporine (200 mg/day) as well as a monthly maintenance dose of subcutaneous allergen immunotherapy at the out-patient clinic of our university hospital. However, his clinical condition was not completely controlled even after treatment. At 11 months after the initial admission to our hospital, the patient was hospitalized again due to a severe acute exacerbation of AD with secondary bacterial skin infection. After admission, the acute flare-up was treated by a systemic corticosteroid with oral antibiotics. After discharge, he was again treated with oral cyclosporine (125 mg/day) and a monthly maintenance dose of subcutaneous allergen immunotherapy; however, these treatments did not effectively control AD symptoms and only the intermittent use of oral corticosteroids were effective for the control of acute exacerbations of AD.\nOn November 1, 2012 (at age 23), AIGT was started in this patient. The baseline SCORAD value of the patient measured at the day of initiation of AIGT was 88.0 (). The clinical severity of AD did not significantly improve in the patient during the first 4 weeks after the initiation of AIGT; however, the clinical condition started to improve 5 weeks after the initiation of AIGT. The SCORAD value was 55.0 at 8 weeks after the initiation of AIGT (37.5% decrease in the SCORAD value compared with the baseline value) (). Moreover, his AD symptoms progressively improved every 4 weeks during the follow-up for 24 weeks after the initiation of AIGT (). At 24 weeks after the initiation of AIGT, the SCORAD value was measured at 24.7 in the patient (a 71.9% decrease in SCORAD value compared with the baseline value). This clinical condition at 24 weeks after the initiation of AIGT was the best condition during the clinical observation of this patient during the follow-up over 3 years after the initial visit to our hospital. No side effects were observed during and after AIGT.