What Are Cytokine Therapies?

Atopic dermatitis (AD), also known as atopic eczema, is a chronic relapsing inflammatory skin disease. The exact cause of AD is unknown, although there appear to be multiple factors concerning the pathogenesis of AD including genetic predisposition, dysfunction in the skin barrier, environmental factors, and altered immune function.1,2 Researchers have determined that atopic dermatitis it is a disease of the immune system and therefore have identified cytokines as a key component of the disease.

What are cytokines?

Cytokines are signaling molecules that assist in cell to cell communication in the body’s immune response. They assist by stimulating cells to move towards the sites where inflammation, trauma or infection is occurring.3 In conditions like AD, the immune response is abnormally over-activated, causing a chronic inflammatory state. In AD, the T-helper cell 2 (Th2), a subset of T-cells, are drawn to the skin in large numbers by cytokines (chemical messengers) like interleukin-25 (IL-25), interleukin-33 (IL-33), and thymic stromal lymphopoietin (TSLP). The abundance of these cytokines calls the Th2 cells to the skin, causing the characteristic presentation of inflammation of skin seen in AD.3

Examples of cytokine therapies

Interferon gamma

Interferon gamma (IFN-G) is a cytokine (chemical messenger) that plays a role in the immune system response. In clinical trials, IFN-G has been moderately and variably effective for severe AD, and it may be considered as an alternative treatment for severe AD that does not respond to other therapies.The brand name is Actimmune® (Interferon gamma-1b). Actimmune binds to gamma receptors, which enhances the action of macrophages (a type of white blood cell that digests cellular debris), natural killer cells (another type of white blood cell that kill infected or cancerous cells in the body), as well as other processes of the immune response.2,6Actimmune has been studied in clinical trials on patients with AD and has shown effectiveness in treating symptoms including redness, rash, and damaged skin barrier.3 Common side effects experienced by patients taking Actimmune include fever, headache, rash, chills, redness or tenderness at the injection site, fatigue, and diarrhea.4,5 Prior to treatment with Actimmune, patients must receive a clinical and laboratory work-up including blood and urine tests. Actimmune is an injection that is given subcutaneously (under the skin). The dosage is dependent on the individual’s body surface area and is usually administered three times weekly. There is no optimal recommended dose of Actimmune for the treatment of AD.4,6

Intravenous (IV) immunoglobulins

Immunoglobulins are a type of protein that function as antibodies, attaching to and aiding in the destruction of foreign substances. Because of their potential to affect the immune response, IV immunoglobulins have been used for the treatment of severe autoimmune and inflammatory skin conditions like severe AD. The use of IV immunoglobulins is controversial in AD, as some patients have no or little improvement. The brand name is BayGam® (immune globulin).4

Omalizumab

Omalizumab is a monoclonal antibody, a type of protein that is made to attach to a particular substance. Omalizumab targets immunoglobulin E (IgE), the antibody produced by the immune system that begins the process of an allergic reaction. Omalizumab is marketed as Xolair® (omalizumab) for the treatment of moderate to severe asthma and chronic idiopathic urticaria. A significant improvement in skin symptoms has been reported in patients who have both AD and asthma and who are treated with Xolair. The U.S. Food and Drug Administration (FDA) has not approved Xolair for the treatment of AD. However, it may be effective for those with severe AD who also have asthma. Common side effects experienced by patients taking Xolair include pain in the arms and legs, dizziness, fatigue, skin rash, bone fractures, headache, fever, nausea, vomiting, and discomfort in the ears. Severe side effects may occur with Xolair, including severe allergic reactions, inflammation of the blood vessels, fever, muscle aches, rash, heart and circulation problems, an increased risk of parasitic infection, and an increased risk of cancer.3,7

Emily Downward | June 2017
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