Léčiva

Celková terapie

Antihistamines

• Sedative properties
• Short-term adjuvant to topical treatment during relapses associated with severe pruritus
• Nonsedating antihistamines
• Only very modest value in atopic eczema [4]
• There are no large controlled studies to date [4]

Cetirizine

• Zyrtec
• Several months theraphy may be helpful
• May have disease-modifying effects in adults and children [3]

Fexofenadine

• Allegra

Diphenhydramine

• Benadryl etc.
• Ospalost [2]

Další protisvědivé medikamenty

Hydroxyzine

• Certain degree of relief from itching [9]
• Not effective without other treatments [9]

Diphenhydramine hydrochloride

• Certain degree of relief from itching [9]
• Not effective without other treatments [9]

Ketotifen

• calcium channel blocker
• May be effective [9]

Oil of evening primrose

• Was believed to be effective
• In a randomized controlled study
• no benefit in children [9]
• Little improvement in adults [9]

Neúspěšná terapeutické pokusy

• Everolimus [9]
• Rapamycin-derived macrolide [9]
• Combination therapy with either prednisone or cyclosporine A was not effective [9]
• Thymopentin [9]
• Gamma interferon [9]
• Chinese herbs [9]

Kortikoidy

Interferon

• Sometimes used in adults if other treatment doesn't work [1]

Cyclosporin A - (CyA)

• Inhibits calcineurin-dependent pathways
• Reduced levels of proinflammatory cytokines
• IL-2
• IFN-gamma [4]
• Effective treatment for adult and childhood AD
• Relapse after discontinuation of therapy is often observed [4]
• Posttreatment disease severity often does not return to baseline levels [4]
• Renal toxicity
• Limited to patients with severe refractory disease
• Blood pressure and laboratory parameters must be monitored closely
• Short- or long-term therapy
• High-dose (3–5 mg/kg/d)
• Low-dose (2.5 mg/kg/d)
• Aim for the lowest effective dose
• Shortest treatment period
• Vaccinations might not be effective during immunosuppression

Azathioprine

• Affecting purine nucleotide synthesis and metabolism
• Efficient for many dermatologic conditions [4]
• As monotherapy in nonlicensed indications, including AD [4]
• Accumulating evidence for its efficacy in severe recalcitrant AD [4]
• Number of side effects
• Myelosuppression
• Hepatotoxicity
• Gastrointestinal disturbances
• Increased susceptibility for infections
• Possible development of skin cancer [4]
• Metabolized by the thiopurine methyltransferase
• Deficiency of this enzyme should be excluded before starting oral immunosuppression with azathioprine [4]
• Recommended dosage of azathioprine for dermatologic indications
• 1 to 3 mg/kg daily
• Determined based on thiopurine methyltransferase levels
• Regular blood tests must be performed [4]
• Onset of action is usually slow
• Benefit might not be apparent until 2 to 3 months after starting treatment [4]

Methotrexate - MTX

Mycophenolate mofetil

Immunotherapy

• Hyposensitization is not an established instrument for the treatment of AD [4]
• Case reports suggest clinical benefit from allergen-specific desensitization in AD [4]
• Double-blinded controlled trials have failed to show consistent efficacy [4]
• Allergen-specific immunotherapy of house dust mite preparations in patients with AD sensitized to house dustmite allergens for 1 year [4]
• Dose-dependent effect on disease symptoms [4]

Zkoumané možnosti terapie AD

Rituximab

• B-cell antibody, shows promise [3]
• Has severe side effects [3]
• Not effective in every case [3]

Omalizumab

• Monoclonal antibody that blocks IgE function
• Case reports suggest that it may be an effective
• got the indication in Europe for the treatment of chronic spontaneous urticaria after escapement to antihistamines [12]
• Randomized, placebo-controlled trial did not demonstrate improvement in the clinical course [9]

Dupilumab

• Monoclonal antibody that blocks the IL-4 receptor
• Randomized, double-blind, placebo-controlled trials have demonstrated marked and rapid improvement in AD disease activity
• Drug remains to be FDA-approved for AD [9]

Corynebacterium bovis

• Induced robust T helper 2 cell responses in mice skin
• Langerhans cells were required for eliciting immune responses against S. aureus inoculation [13]
• Possible target for future therapeutics in eczematous dermatitis [13]

Oficiální prohlášení

• Insufficient evidence exists to recommend:
• Probiotics
• Leukotriene inhibitors
• Essential fatty acids
• Traditional Chinese medicines
• Allergen immunotherapy
• May be useful in a small number of individuals with proven sensitisation to inhalant allergens [3]

Estrogeny

• Mohou ovlivnit aktivitu delta-6-desaturázy
• Některé studie naznačují, že estrogeny mohou zvýšit expresi a aktivitu delta-6-desaturázy
• Vedlo ke zvýšené konverzi omega-3 mastných kyselin