Eczema (i.e., atopic dermatitis) is a genetically determined condition which causes long term inflammation of the skin which may result in itching, thickening, redness, and occasionally ulcerations of the skin. A similar appearance can sometimes be seen in other chronic skin conditions.
Eczema or atopic dermatitis affects an estimated 7% of the population with varying degrees of severity. It often begins in early childhood and may wax and wane throughout a lifetime. The severity can vary from mild dryness and/or excessive creasing of the skin to a severe debilitating illness presenting with painful sores and/or skin infections. The intractable itching often does not respond to medications and may lead to loss of sleep, inability to focus on work and/or school, and/or emotional problems.
Unfortunately there is no known cure for the condition yet. The flare-ups of this disorder are typically treated with topical and/or oral corticosteroid medications, which usually offer only short-term relief. The numerous topical corticosteroids available vary in potency and should be prescribed based on the severity of the eczema as well as the location of the eczema on the body. The side effects of the corticosteroid medications can also be worrisome, so it is important to use them sparingly and to avoid excessive use. A few new non-steroidal topical medications and injectable biological medications have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of atopic dermatitis. It is important to note that the response rates to these medications are highly variable. There are also side effects one should be aware of regarding the biological medications in particular.
Allergy shots (i.e., allergen immunotherapy, allergy injections, allergy desensitization, allergy hyposensitization) is a systematic treatment option which helps the immune system to develop tolerance to the offending allergens that cause allergy symptoms. As a result, individuals have less or even no allergy symptoms when subsequently exposed to these allergens. This method has been practiced for over 100 years in the United States and is highly effective in reducing the symptoms and lessening the need for medications for patients with respiratory and eye allergies such as hay fever (i.e., allergic rhinitis), asthma, and allergic conjunctivitis.
Despite the fact that allergy immunotherapy is so efficacious in allergies of the respiratory tract and eyes, allergy immunotherapy has not been studied extensively in patients with eczema. A case-study, however, presented at a recent annual scientific meeting of the American College of Asthma, Asthma & Immunology, offers hope.
In this case-study, a 48 year-old man who had suffered from severe eczema involving a large part of his body since his childhood was observed. He had tried many therapies for years including both mild and high-strength topical corticosteroid creams, other topical anti-inflammatory creams, and topical moisturizer creams without adequate relief.
Since he also had respiratory allergy-related symptoms, his doctors tested him for environmental allergies and diagnosed him with sensitivity to dust mites, molds, animal dander, trees, grasses, and weeds. In fact allergic rhinitis, asthma and eczema constitute the “atopic triad” and share a similar genetic predisposition.
Because his allergies could all be treated with allergy shots, his doctors thought that treating his allergies may also be beneficial for his eczema. After one year of allergy shots, he reported significant improvement of his eczema symptoms. Once he reached a maintenance dose on his allergy shots, he no longer needed high dose corticosteroid treatment for his eczema.
There is a need for more extensive controlled studies investigating the benefits of allergy shots for individuals with moderate to severe eczema. If further studies substantiate the data observed in this patient, allergy shots have the potential to benefit thousands of people with severe recalcitrant eczema.
The board certified allergists at Black & Kletz Allergy see patients of all ages and have over 50 years of experience in the field of allergy, asthma, and immunology. In addition to allergic rhinitis, allergic conjunctivitis, and asthma, skin disorders such as eczema, contact dermatitis, poison ivy, poison oak, poison sumac, hives (i.e., urticaria), generalized itching (i.e., pruritus) are common skin ailments that we routinely diagnose and treat. Black & Kletz Allergy has 3 offices in the Washington, DC, Northern Virginia, and Maryland metropolitan area. Our offices are located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA and all locations have on-site parking. The Washington, DC and McLean, VA offices are Metro accessible and we offer a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line. To make an appointment, please call us or alternatively, you can click Request an Appointment and we will respond to your request within 24 hours by the next business day. The allergists at Black & Kletz Allergy are happy to answer any questions or concerns you may have about any allergic, asthmatic, or immunologic concern.