The significance of component-resolved allergy diagnostics in atopic dermatitis patients when prescribing allergen-specific immunotherapy

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The paper presents clinical cases of patients with severe atopic dermatitis with polyvalent sensitization in an adult patient and in a pediatric patient. Standard topical and systemic therapy proved to be an insufficiently effective strategy in these patients. Both patients underwent component-resolved allergy diagnostics, which made it possible to identify the causally significant components of allergens, sensitization to which affects the course of atopic dermatitis. On the basis of the survey, indications for allergen-specific immunotherapy with causally significant allergens were determined. The treatment made it possible to achieve non-drug remission not only of atopic dermatitis but also of concomitant respiratory allergic diseases.

The cases demonstrate the efficacy and safety of allergen-specific immunotherapy in patients with proven sensitization to causally significant allergens based on component allergy diagnostics.

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About the authors

Olga G. Elisyutina

National Research Center ― Institute of Immunology; Peoples’ Friendship University of Russia

Author for correspondence.
ORCID iD: 0000-0002-4609-2591
SPIN-code: 9567-1894

MD, Dr. Sci. (Med.)

Russian Federation, Moscow; Moscow

Elena S. Fedenko

National Research Center ― Institute of Immunology

ORCID iD: 0000-0003-3358-5087
SPIN-code: 5012-7242

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow

Eugeniy V. Smolnikov

National Research Center ― Institute of Immunology; Peoples’ Friendship University of Russia

ORCID iD: 0000-0003-1302-4178
SPIN-code: 4874-8100
Russian Federation, Moscow; Moscow

Alla O. Litovkina

National Research Center ― Institute of Immunology; Peoples’ Friendship University of Russia

ORCID iD: 0000-0002-5021-9276
SPIN-code: 2337-7930
Russian Federation, Moscow; Moscow

Olga V. Shtyrbul

National Research Center ― Institute of Immunology

ORCID iD: 0000-0001-8254-9715
SPIN-code: 4146-1788

MD, Cand. Sci. (Med.)

Russian Federation, Moscow


  1. Khaitov RM. Immunology. 3rd edition, revised and updated. Moscow: GEOTAR-Media; 2018. 496 p. (In Russ).
  2. Federal clinical guidelines for the management of patients with atopic dermatitis. Moscow: Russian Society of Dermatovenerologists and Cosmetologists, Russian Association of Allergologists and Clinical Immunologists, Union of Pediatricians of Russia, National Alliance of Dermatovenerologists and Cosmetologists; 2021. Available from: Accessed: 12.11.2022.
  3. Wollenberg A, Christen-Zäch S, Taieb A, et al. European task force on atopic Dermatitis/EADV eczema task force. ETFAD/EADV eczema task force 2020 position paper on diagnosis and treatment of atopic dermatitis in adults and children. J Eur Acad Dermatol Venereol. 2020;34(12):2717–2744. doi: 10.1111/jdv.16892
  4. Ständer S. Atopic dermatitis. N Engl J Med. 2021;384(12): 1136–1143. doi: 10.1056/NEJMra2023911
  5. Li H, Zhang Z, Zhang H, et al. Update on the Pathogenesis and therapy of atopic dermatitis. Clin Rev Allergy Immunol. 2021; 61(3):324–338. doi: 10.1007/s12016-021-08880-3
  6. Sabat R, Wolk K, Loyal L, et al. T cell pathology in skin inflammation. Semin Immunopathol. 2019;41(3):359–377. doi: 10.1007/s00281-019-00742-7
  7. Yang L, Fu J, Zhou Y. Research progress in atopic march. Front Immunol. 2020;(11):1907. doi: 10.3389/fimmu.2020.01907
  8. Paller AS, Spergel JM, Mina-Osorio P, Irvine AD. The atopic march and atopic multimorbidity: Many trajectories, many pathways. J Allergy Clin Immunol. 2019;143(1):46–55. doi: 10.1016/j.jaci.2018.11.006
  9. Roduit C, Frei R, Depner M, et al. Phenotypes of atopic dermatitis depending on the timing of onset and progression in childhood. JAMA Pediatr. 2017;171(7):655–662. doi: 10.1001/jamapediatrics.2017.0556
  10. Weidinger S, Novak N. Atopic dermatitis. Lancet. 2016;387(10023): 1109–1122. doi: 10.1016/S0140-6736(15)00149-X
  11. David Boothe W, Tarbox JA, Tarbox MB. Atopic dermatitis: pathophysiology. Adv Exp Med Biol. 2017;(1027):21–37. doi: 10.1007/978-3-319-64804-0_3
  12. Anto JM, Bousquet J, Akdis M, et al. Mechanisms of the development of allergy (MeDALL): Introducing novel concepts in allergy phenotypes. J Allergy Clin Immunol. 2017;139(2):388–399. doi: 10.1016/j.jaci.2016.12.940
  13. Matricardi PM, Kleine-Tebbe J, Hoffmann HJ, et al. EAACI molecular allergology user’s guide. Pediatr Allergy Immunol. 2016; 27(Suppl 23):1–250. doi: 10.1111/pai.12563
  14. Alvaro-Lozano M, Akdis CA, Akdis M, et al. EAACI allergen immunotherapy user’s guide. Pediatr Allergy Immunol. 2020; 31(Suppl 25):1–101. doi: 10.1111/pai.13189
  15. Seegräber M, Srour J, Walter A, et al. Dupilumab for treatment of atopic dermatitis. Expert Rev Clin Pharmacol. 2018;11(5):467–474. doi: 10.1080/17512433.2018.1449642
  16. Nezamololama N, Fieldhouse K, Metzger K, Gooderham M. Emerging systemic JAK inhibitors in the treatment of atopic dermatitis: A review of abrocitinib, baricitinib, and upadacitinib. Drugs Context. 2020;9:2020-8-5. doi: 10.7573/dic.2020-8-5
  17. Ferreira S, Guttman-Yassky E, Torres T. Selective JAK1 inhibitors for the treatment of atopic dermatitis: Focus on upadacitinib and abrocitinib. Am J Clin Dermatol. 2020;21(6):783–798. doi: 10.1007/s40257-020-00548-6
  18. Simpson EL, Bieber T, Guttman-Yassky E, et al.; SOLO 1 and SOLO 2 Investigators. Two phase 3 trials of dupilumab versus placebo in atopic dermatitis. N Engl J Med. 2016;375(24):2335–2348. doi: 10.1056/NEJMoa1610020
  19. Traidl S, Freimooser S, Werfel T. Janus kinase inhibitors for the therapy of atopic dermatitis. Allergol Select. 2021;(5):293–304. doi: 10.5414/ALX02272E
  20. Traidl S, Roesner L, Zeitvogel J, Werfel T. Eczema herpeticum in atopic dermatitis. Allergy. 2021;76(10):3017–3027. doi: 10.1111/all.14853
  21. Silverberg JI, Thyssen JP, Fahrbach K, et al. Comparative efficacy and safety of systemic therapies used in moderate-to-severe atopic dermatitis: A systematic literature review and network meta-analysis. J Eur Acad Dermatol Venereol. 2021;35(9):1797–1810. doi: 10.1111/jdv.17351
  22. Paller A, Jaworski JC, Simpson EL, et al. Major comorbidities of atopic dermatitis: beyond allergic disorders. Am J Clin Dermatol. 2018;19(6):821–838. doi: 10.1007/s40257-018-0383-4
  23. Traidl S, Werfel T. [Allergen immunotherapy for atopic dermatitis]. Hautarzt. 2021;72(12):1103–1112. (In German). doi: 10.1007/s00105-021-04909-y
  24. Lee J, Park CO, Lee KH. Specific immunotherapy in atopic dermatitis. Allergy Asthma Immunol Res. 2015;7(3):221–229. doi: 10.4168/aair.2015.7.3.221
  25. Głobińska A, Boonpiyathad T, Satitsuksanoa P, et al. Mechanisms of allergen-specific immunotherapy: Diverse mechanisms of immune tolerance to allergens. Ann Allergy Asthma Immunol. 2018; 121(3):306–312. doi: 10.1016/j.anai.2018.06.026
  26. Halken S, Larenas-Linnemann D, Roberts G, et al. EAACI guidelines on allergen immunotherapy: Prevention of allergy. Pediatr Allergy Immunol. 2017;28(8):728–745. doi: 10.1111/pai.12807
  27. Gushchin IS, Kurbacheva OM. Allergen-specific immunotherapy. Allergology immunology. 2001;2(2):73. (In Russ).
  28. Novak N. Allergen specific immunotherapy for atopic dermatitis. Curr Opin Allergy Clin Immunol. 2007;7(6):542–546. doi: 10.1097/ACI.0b013e3282f1d66c
  29. Zhong H, Deng X, Song Z, et al. Immunological changes after ASIT in AD allergen-specific immunotherapy and their potential correlation with clinical response in patients with atopic dermatitis patients sensitized to house dust mite. J Eur Acad Dermatol Venereol. 2015;29(7):1318–1324. doi: 10.1111/jdv.12813
  30. Hajdu K, Kapitány A, Dajnoki Z, et al. Improvement of clinical and immunological parameters after allergen-specific immunotherapy in atopic dermatitis. J Eur Acad Dermatol Venereol. 2021;35(6): 1357–1361. doi: 10.1111/jdv.17018
  31. Kiatiwat P, Mitthamsiri W, Boonpiyathad T, et al. Successful treatment of atopic dermatitis with house dust mite sublingual immunotherapy tablets. Asian Pac J Allergy Immunol. 2021. doi: 10.12932/AP-231120-1004
  32. Fedenko E, Elisyutina O, Shtyrbul O, et al. Microarray-based IgE serology improves management of severe atopic dermatitis in two children. Pediatr Allergy Immunol. 2016;27(6):645–649. doi: 10.1111/pai.12572
  33. Pellefigues C. IgE autoreactivity in atopic dermatitis: Paving the road for autoimmune diseases? Antibodies (Basel). 2020;9(3):47. doi: 10.3390/antib9030047
  34. Breiteneder H, Peng YQ, Agache I, et al. Biomarkers for diagnosis and prediction of therapy responses in allergic diseases and asthma. Allergy. 2020;75(12):3039–3068. doi: 10.1111/all.14582
  35. Wollenberg A, Kinberger M, Arents B, et al. European guideline (EuroGuiDerm) on atopic eczema: Part I ― systemic therapy. J Eur Acad Dermatol Venereol. 2022;36(9):1409–1431. doi: 10.1111/jdv.18345

Supplementary files

Supplementary Files
1. Fig. 1. The back skin of the patient V. before treatment: severe infiltration, hyperemia, papular rashes with scales, linear excoriations, crusts. Index SCORAD 82.6 points.

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2. Fig. 2. The back skin of the patient V. after treatment: the severity degree of infiltration, hyperemia, papular rashes with scales decreased. Linear excoriations and crusts regressed. Index SCORAD 28 points.

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3. Fig. 3. The hand skin of the patient P. before treatment: erythematous areas, papular rashes with scales, severe lichenification, excoriations and superficial fissures covered by crusts. Index SCORAD 76.5 points.

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4. Fig. 4. The hand skin of the patient P. after 4 weeks of treatment: the severity degree of erythema and lichenification, the amount of papular rashes with scales decreased. Excoriations and superficial fissures regressed. Index SCORAD 49.9 points.

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5. Fig. 5. The hand skin of the patient P. on follow-up visit: rare papules, post-inflammatory areas of hypopigmentation, mild lichenification.

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