More Evidence that Treating Allergies Is Important to Treatment Refractory Alopecia Areatea

Allergen Immunotherapy is Increasingly Part of Alopecia Areata Treatment

I enjoyed reading a recent report in the Journal of Dermatology regarding house dust mite allergies.

The case was that of a 38-year-old man with alopecia areata and atopic dermatitis who presented to clinic with severe symptoms of both diseases. Despite using oral methylprednisolone (8 mg/day) and cyclosporine (100 mg/day) for 3 months, he has lost over 90% of his hair and his atopic dermatitis was rated as severe.

Total serum immunoglobulin E (IgE) levels were 4454 kU/L (normal <100 kU/L) and the specific IgE levels for dust mites were high

Treatment began with subcutaneous allergen immunotherapy against dust mites along with oral cyclosporine (100 mg/day). Topical tacrolimus was also applied to eczematous areas on body. Antihistamines were used, as necessary, to reduce itching.

Hair loss was almost completely improved 1 year after the start of allergen immunotherapy, and the skin lesions of atopic dermatitis also dramatically improved.

Conclusions and Comments

All in all, this is another nice report of how a comprehensive treatment plan for alopecia areata must address environmental triggers where possible. This patient had great results with immunotherapy. Treating alopecia areata is never about using template “one size fits all” treatments. It’s about understanding the patient’s comorbidities and addressing these comorbidities where appropriate. We must consider allergen immunotherapy in patients with alopecia areata who have severe allergies.

REFERENCE*

Kwon IJ et al. Allergen-specific immunotherapy improves alopecia totalis in a severe atopic dermatitis patient. J Dermatol. 2023 Oct;50(10):1353-1356. doi: 10.1111/1346-8138.16841. Epub 2023 May 29.