Allergen-specific immunotherapy in atopic dermatitis

Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by intense pruritus, xerosis and recurrent episodes of exacerbation, significantly impacting patients’ quality of life. The pathogenesis of the disease is complex and involves the interaction between skin barrier dysfunction, genetic predisposition, immune dysregulation and environmental factors. In recent years, interest in allergen-specific immunotherapy (AIT) as a therapeutic strategy for atopic dermatitis has increased significantly, particularly in patients with confirmed sensitization to aeroallergens.AIT represents the only therapeutic intervention capable of modifying the natural course of allergic diseases by inducing immunological tolerance to specific allergens. Although its efficacy is well established in allergic rhinitis and allergic asthma, its role in atopic dermatitis remains controversial. Available clinical studies suggest a significant reduction in disease severity, assessed through clinical scores such as SCORAD or EASI, as well as a decreased need for symptomatic medication in certain subgroups of patients. The immunological mechanisms involved in AIT include the induction of regulatory T cells, reduction of the Th2 immune response, decreased levels of allergen-specific IgE and increased production of blocking IgG4 antibodies. In atopic dermatitis, these changes may contribute to the reduction of cutaneous inflammation and improvement of clinical symptoms. This review article analyzes the current literature on allergen-specific immunotherapy in atopic dermatitis, discussing the underlying immunological mechanisms, clinical efficacy, safety profile and recommendations from international guidelines. Additionally, the limitations of existing studies and future research directions in this field are highlighted.