Application of component-resolved diagnostics in treatment of severe atopic dermatitis: a case report

Atopic dermatitis (AD) is a chronic allergic inflammation of the skin. Precise identification of the causative allergen is an important step in the successful treatment of patients with moderate to severe AD. Common diagnostic methods in allergy assess the presence or absence of allergen-specific sensitization, but none exhibits a complete clinical correlation. Component-resolved diagnostics (CRD) is a new precise method for identifying the culprit allergen. Here, we report the case of a nine-year-old boy with severe AD. He was polysensitized (based on a skin prick test), with a poor response to routine AD therapeutic measures and food elimination diets. He had experienced recurrent flares while under treatment. Skin biopsy confirmed AD. Systemic therapy with cyclosporine (200 mg per day) was initiated and caused significant symptom relief within eight weeks. However, he had a flare when the dose was decreased to 150 mg daily. The causative allergen was diagnosed based on CRD, and he was successfully treated by allergen immunotherapy. CRD can determine the causative allergen in selected polysensitized patients with AD with poor response to treatment. The application of allergen-specific immunotherapy in AD management is controversial, but highly sensitized patients could benefit from it once the diseasecausing allergen is identified.