Omalizumab therapy in atopic dermatitis: depletion of IgE does not improve the clinical course - a randomized, placebo-controlled and double blind pilot study
Omalizumab therapy in atopic dermatitis: depletion of IgE does not improve the clinical course - a randomized, placebo-controlled and double blind pilot study
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DOI：
10.1111/j.1610-0387.2010.07497.x
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发表时间：
2010-12-01
影响因子：
3.6
通讯作者：
Stingl, Georg
中科院分区：
文献类型：
--
作者：
Heil, Peter Maximilian;Maurer, Dieter;Stingl, Georg
背景：我们对特应性皮炎中免疫球蛋白E致病作用的了解还不完全。我们询问阻断游离IgE是否会改变疾病的进程。患者和方法：我们给20例特应性皮炎患者皮下注射人源化抗IgE单抗或安慰剂16周，并检测免疫学和临床疾病参数。结果：奥马珠单抗(I)降低血清游离IgE，(II)降低不同外周血单个核细胞表面IgE和Fc epsilon RI的表达，(Iii)降低Fc epsilon RI与IgE的饱和度，(IV)增加Fc epsilon RI的数量，(V)降低皮肤中Fc epsilon+RI细胞的数量。这些结果的体内相关性通过在滴定皮肤试验中产生I型超敏反应所需的阈值变应原浓度的增加而得到证明。在没有显著改变临床疾病参数的情况下，奥马珠单抗治疗导致单个患者的特应性斑贴试验结果的改善，即对皮肤表面性变应原挑战的湿疹反应。结论：对即刻和延迟型皮肤试验的干扰可能意味着，如果存在奥马珠单抗治疗的话，将在急性形式的疾病而不是慢性形式的疾病的患者中看到疗效。
Background: Our understanding of the pathogenic role of IgE in atopic dermatitis is incomplete. We asked whether blocking free IgE would alter the course of the disease.Patients and Methods: We administered either omalizumab, a humanized monoclonal mouse antibody against IgE, or placebo subcutaneously for 16 weeks to 20 atopic dermatitis patients and measured immunological and clinical disease parameters.Results: Omalizumab (I) reduced free serum IgE, (II) lowered surface IgE and Fc epsilon RI expression on different peripheral blood mononuclear cells, (III) reduced the saturation of Fc epsilon RI with IgE, (IV) increased the number of free Fc epsilon RI and (V) lowered the number of IgE+, but not of Fc epsilon RI+ cells in skin. The in vivo relevance of these results is evidenced by the increase in the threshold allergen concentration required to give a type I hypersensitivity reaction in the titrated skin test. While not significantly altering the clinical disease parameters, omalizumab treatment led to an improvement of the atopy patch test results in single patients, i.e. an eczematous reaction upon epicutaneous allergen challenge.Conclusions: The interference with immediate and delayed type skin tests may imply that a therapeutic benefit of omalizumab treatment, if present at all, would be seen in patients with acute rather than chronic forms of the disease.