Sublingual immunotherapy for severe pediatric atopic dermatitis.

Abstract

Atopic dermatitis (AD) is a chronic inflammatory skin disease with a complex pathogenesis. Current therapy involves a stepped approach, starting with barrier repair strategies and escalating to topical and systemic antiinflammatory therapy. Owing to the limitations of conventional interventions, several new targeted treatments have emerged for the treatment of severe AD. Allergen immunotherapy (AIT) using house dust mite (HDM) extracts is an established treatment for allergic rhinitis and asthma; however, its role in sensitized AD remains unclear. We report a 6-year-old Omani boy with severe AD refractory to conventional therapy who achieved marked clinical improvement with sublingual HDM immunotherapy (SLIT). Within two months of treatment, his Scoring Atopic Dermatitis (SCORAD) index decreased from 72.65 (severe) to 22.2 (mild). Concurrently, the Children’s Dermatology Life Quality Index (CDLQI) improved from 20 (extremely large effect on quality of life) at baseline to 7. At two-year follow-up, sustained disease control was observed with a SCORAD score of 26 and a CDLQI score of 3, indicating minimal impact on quality of life. This case highlights the potential of SLIT as an adjunctive therapy for severe AD in pediatric patients, consistent with recent reports suggesting its disease-modifying effects.