特应性皮炎（AD）前沿文献精读特辑（J Allergy Clin Immunol Pract）

BACKGROUND: Elevated IgE levels are common in atopic dermatitis (AD). Although their role in AD pathogenesis is unclear, elevated IgE levels may be associated with disease exacerbation. OBJECTIVE: To investigate the association of total IgE and/or disease severity with flares and dupilumab's impact on IgE levels and flares in patients with AD. METHODS: Patients >18 years enrolled in LIBERTY AD CHRONOS (NCT02260986) received dupilumab 300 mg every 2 weeks or placebo + topical corticosteroids (TCS), for 52 weeks. Flares were defined as disease worsening requiring treatment escalation. Flare probability was evaluated by baseline IgE levels and disease severity (measured by the Eczema Area and Severity Index). IgE level ratio change over 52 weeks was also evaluated. RESULTS: Patients with higher baseline IgE treated only with TCS had a significantly higher flare probability (odds ratio [OR; 95%CI]: 1.59 [1.18-2.13], P=.002). There was no association between baseline AD severity and flares (OR [95%CI]: 1.02 [1.0-1.04], P=.058). This association between total baseline IgE and flares was significantly higher in severe (OR [95%CI]: 1.95 [1.33-2.85], P=.0006) vs moderate AD (OR [95%CI]: 1.02 [0.61-1.71], P=.95). In dupilumab-treated patients, IgE levels were significantly reduced, with no associations between total baseline IgE levels (OR [95%CI]: 0.92 [0.51-1.65], P=.78), baseline AD severity (OR [95%CI]: 0.98 [0.94-1.03], P=.42), and flares at week 52. CONCLUSION: Total IgE levels were associated with an increased risk of flares in adults with moderate-to-severe AD, which were not explained by disease severity alone. Dupilumab reduces IgE levels in patients with AD, which is associated with a reduced flare probability.

Shared decision-making (SDM) between patients and healthcare professionals is a patient-centered approach that integrates clinical evidence with patient values and preferences to arrive at healthcare decisions. The major components of shared decision making include seeking the patient's participation and forming a partnership, helping the patient explore and compare treatment options, learning about the patient and their preferences, creating choice awareness, and jointly making and evaluating management decisions. Goals of treatment for chronic spontaneous urticaria (CSU) and atopic dermatitis (AD) are to decrease inflammation in the skin for AD and raised welts/angioedema for CSU, reduce itching and scratching, restore the skin barrier, minimize sleep disturbance, and improve health-related quality of life (HRQoL). Given the growing number of therapeutic options for patients with AD and CSU, shared decision-making has become increasingly important for selecting the best treatment option for each patient and family, in consideration of their unique values, preferences, risk-benefit analysis and outcome priorities, including the impact of treatment on health-related HRQOL. Here, we provide an overview of SDM and HRQoL in patients with chronic spontaneous, chronic inducible urticaria and atopic dermatitis.