Efficacy of oral amphotericin B for refractory atopic dermatitis with specific IgE to Candida albicans and food allergens in sera

Abstract

The efficacy of oral amphotericin B (ApB) was studied in 125 cases of refractory atopic dermatitis (AD). Indications for ApB therapy were positive CAP-RAST (Pharmacia & Upjohn Co. Ltd)-class to Candida albicans and several food allergens and a high intake of sweets or alcoholic beverages together with recalcitrant symptoms of AD, such as facial erythema and eruptions refractory to topical steroids. Good or excellent results were obtained in 56.8% of 125 cases. Assessment of improvement in the 125 subjects was statistically compared with that in 55 controls who were not treated with ApB. There were no significant differences in the background between the two study groups. Cases treated with oral ApB showed significantly greater improvement (P <0.01) than did the controls, who were not treated with ApB, over 3 and 6 month periods. Treatment with ApB helped patients to discontinue or to reduce the frequency of topical steroid use or to change from high-dose steroids to lower-dose steroids. Treatment of patients with oral ApB resulted in improvements in laboratory data, including CAP-RAST to C. albicans and several food allergens. Good results were associated with restricting the intake of food allergens. A poor response was recognized in patients with a significantly high titer of CAP-RAST levels to Dermatophagoides farinae. Controlling environmental allergens and limiting exposure to food allergens was necessary to achieve success with ApB treatment.

Keywords

• amphotericin B
• antifungal therapy
• atopic dermatitis
• Candida albicans
• food allergy