Traditional and popular treatments aimed at calming the often intense pruritus that accompanies atopic dermatitis might not be optimal therapeutic options, according to a review published August 2019 in the Journal of Allergy and Clinical Immunology.
“Classically, it was widely believed that treatment of atopic dermatitis with anti-inflammatory agents was the only manner in which itch could be alleviated. In other words, inflammation in the skin was inextricably linked to itch. This article highlights new and emerging pathways in atopic dermatitis-associated itch, such that itch can be selectively and potently targeted with newer therapeutics. These include existing therapies like dupilumab, or emerging therapies like [interleukin-] IL-13 and IL-31 antagonists as well as [Janus kinase] JAK inhibitors,” says review author Brian S. Kim, MD, MTR, associate professor dermatology and co-director, Center for the Study of Itch, at Washington University School of Medicine, in St. Louis.
Researchers have traditionally thought itch mechanisms revolved around the canonical IgE-mast-cell-histamine axis, yet therapies focused on blocking the histaminergic itch pathway have been in large part ineffective against atopic dermatitis associated itch, the authors write.
Today, there’s new emphasis on targeting nonhistaminergic itch pathways.
Atopic dermatitis patients exhibit systemic immune dysregulation and increased serum IgE levels. Like other atopic disorders, such as asthma and food allergy, atopic dermatitis is associated with increased expression of epithelial cell-derived cytokines, as well as enhanced adaptive TH2 cell and innate basophil, eosinophil, mast cell and group 2 innate lymphoid cell responses, the authors write.
Dr. Kim has served as a consultant for AbbVie, Cara Therapeutics, Concert Pharmaceuticals, Incyte, Menlo Therapeutics, and Pfizer; has served on advisory boards for Celgene, Kiniksa Pharmaceuticals, Menlo Therapeutics, Regeneron Pharmaceuticals, Sanofi, and Theravance Biopharma; and is founder, chief scientific officer and stockholder of Nuogen Pharma.