The dynamics of the manifestations of atopic dermatitis in severe persistent uncontrolled asthma children with omalizumab therapy

Background

in children with severe persistent uncontrolled asthma atopic dermatitis (AD) is often characterized by persistent continually relapsing.

According to the approach ICON for children > 6 y o with severe uncontrolled asthma as an additional treatment from 3-4 step of therapy omalizumab (Omab) is recommended for use of. We report on the experience of the use of Omab in children with asthma and AD.

Methods

Medical files of 64 children treated with Omab were analysed: 36% of patients have had a concomitant diagnosis of AD, 39.1% of them suffered of severe AD (SCORAD >60-70) at baseline.

All of the following data were recorded, at baseline and after 6, 12 and 24 mo of Omab therapy: values of SCORAD, duration of periods of remission and periods of exacerbation of AD, quality of life (on a scale CDLQI and ACQ), requirement to use of topical steroids and maintenance asthma therapy, PFTs values, symptom scores and control level (GINA, ACT).

Results

the characteristics of children with uncontrolled severe asthma and persistent AD were: mean age of the beginning of Omab therapy – 11.8 y, 60% girls, mean SCORAD index 72 points, quality of life (questionnaire CDLQI – mean 15,2), the requirement of topical steroids was high (mean 6.2 g/day of therapy), the duration of periods of remission were extremely short and periods of exacerbation of AD were more than 280 days/y. Initial maintenance asthma therapy was ICS (mean daily dose: 750µg fluticasone) with LABA, asthma symptom control questionnaires (mean ACT: 7.5, mean ACQ 23), mean FEV1 76%, mean PFT 69.7%.

After prolonged Omab therapy following indices significantly improved: mean SCORAD 28, 17 and 10 points (after 6, 12 and 24 mo accordingly), mean CDLQI 9, 4, and 2.1; the use of topical steroids 2.9, 1.6 and 0.7 g/d, periods of AD remission were extended, asthma control (mean ACT: 19, mean ACQ 12), mean FEV1 96%.

The effectiveness of treatment was directly correlated with the duration of therapy.

Conclusions

Omab therapy not only improves asthma control, it allows to reduce of the manifestations and rate of exacerbations of severe AD and has shown steroid saving effect.