Specific immunotherapy in the treatment of atopic dermatitis: a systematic review using the GRADE system

Controversy exists regarding the potential role of specific immunotherapy (SIT) as a therapeutic intervention for patients with atopic dermatitis (AD) and aeroallergen sensitivity.

To critically appraise the evidence supporting the use of SIT for patients with AD and aeroallergen sensitivity.

A literature search was performed using the terms immunotherapy plus atopic dermatitis and immunotherapy plus eczema. The same terms were used to search PubMed, Ovid, and Scopus. The limits were humans, English, and randomized controlled trial. Articles that were not in English or were observational in nature were excluded. These double-blinded randomized controlled trials were analyzed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

Seven articles fulfilled the inclusion characteristics; 1 involved sublingual SIT. All studies reported improvement in clinical symptoms of AD; however, studies differed in which type of patient (ie, with mild vs severe AD) benefited most from immunotherapy. Serious methodologic shortcomings were noted, including, but not limited to, many enrolled patients not completing participation; small study; and incomplete descriptions of randomization, blinding, allocation concealment, and/or data analysis not by intention to treat.

In a systematic review using the GRADE system, the strength of recommendation is weak for use of SIT in patients with AD. High-quality evidence from methodologically sound double-blinded randomized controlled trials is needed to support administration of SIT for patients with AD.