On the occasion of the third Global Allergy Forum Davos, the CK-CARE directors together with a group of internationally leading researchers from the field of allergic skin diseases, compiled an article which concentrates particularly on innovative developments in neurodermatitis and was recently published in the Journal of Allergy & Clinical Immunology. The journal dedicated the cover page of that edition to the subject of neurodermatitis (picture; Werfel et al., 2016: 138: 336-349).
The article tackles the following topics: skin barrier in neurodermatitis, neurodermatitis subgroups, personalised medicine, microbiomes, changes in the immune response, allergen-specific IgE antibodies, mechanisms of itching, allergens and other environmental factors and diagnosis and treatment.
There is a considerable, unmet medical need to define immunological endotypes of neurodermatitis because these have significant repercussions for the forthcoming stratification of the phenotype of neurodermatitis and the resulting, targeted therapies in the development of personalised medicine. Studies on novel biological agents, which have been used in the treatment of neurodermatitis, are also presented in this review. The clinical efficacy of new immunological approaches using biological agents in patients with neurodermatitis is proved by the use of dupilumap (an antibody that blocks recognition of IL-4). A number of studies with other pharmaceuticals that specifically target the immune system players are currently underway. Such approaches might have immunomodulatory and hence positive clinical effects on the general condition of the skin, as well as on the underlying immune discrepancy, which play a role in concurrent diseases. The effect of these immunological treatments on the disturbed microbiome in neurodermatitis patients and in itching might yield other potentially positive knowledge of use for treatment purposes.