IgE modulation and disease severity in atopic dermatitis treated with methotrexate

초록

Atopic dermatitis (AD) is a chronic inflammatory skin disorder characterized by Th2-skewed responses. Methotrexate (MTX) is a cost-effective systemic therapy for moderate-to-severe AD, yet there is limited quantitative data regarding its impact on immunologic biomarkers. This study aimed to evaluate changes in serum immunoglobulin E (IgE) and allergen-specific IgE following MTX therapy and their association with clinical response. A retrospective analysis was conducted on 28 patients with moderate-to-severe AD treated with oral MTX. Serum levels of total IgE, Dermatophagoides farinae (D1), Dermatophagoides pteronyssinus (D2), and Malassezia (M227) were measured before and after MTX treatment. Clinical severity was assessed using the Eczema Area and Severity Index (EASI). Paired t-tests or Wilcoxon signed-rank tests were used for statistical analyses. Following MTX therapy, significant reductions were observed in total IgE and D1-specific IgE levels (p = 0.0107 and p = 0.0075, respectively), reflecting the immunosuppressive effects of MTX. D2 and M227-specific IgE levels also decreased, but the reductions were not statistically significant (p = 0.3235 and p = 0.2072). EASI scores improved significantly following treatment. However, no significant linear correlation was found between changes in IgE biomarkers and EASI score reduction. MTX therapy in AD patients led to significant decreases in total IgE and D1-specific IgE, highlighting its immunomodulatory effect. While clinical improvement was evident, the absence of a direct correlation between biomarker changes and EASI reduction suggests a complex therapeutic mechanism. These findings support the potential utility of IgE-based biomarkers in monitoring treatment response, warranting further prospective studies to validate their role in precision management of AD.