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Eczema (young people)

Eczema treatments: immunosuppressant tablets and immunotherapy

Another way to manage allergies is through immunosuppressants tablets and immunotherapy.
 

Dr McPherson talks about immunosuppressant tablets.

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So sometimes, you know- Normally, I find most of my patients, I can- we can control their eczema with topical treatments. But clearly there are, there's a subgroup where that's very difficult, where their disease is very severe, and you have to think about tablets or systemic treatments. And, you know, there's several different options. And we're currently kind of doing some research to find out which one's are the most effective and the most safe. The ones that we use regularly in practice is a tablet called methotrexate. Which is an anti-inflammatory medication which works both for eczema and psoriasis, actually, by reducing the kind of inflammatory state of the skin. It's a folate antagonist. And it's , can be very effective for both these diseases if needed. They do need regular blood tests, because it can have other possible side effects. So it's certainly something we think about carefully before we start. But in some people, you know, that is an option which we have to consider. And particularly in psoriasis sometimes. 

There are other tablets which can be used for eczema. There's one called cyclosporine. Which has been, traditionally was the sort of first line, but at the moment we're trying to see whether cyclosporine or methotrexate, which one is, is best used long term.

And the methotrexate is a safe, safe drug. Relatively safe drug. It's been used around a long, long time. So we're kind of very comfortable with using that one, and that's what most, most people will use first line at the moment. But we're doing some research to work out whether cyclosporine or methotrexate is best for eczema.
Cat recently started taking immunosuppressant tablets. She’s had blood tests and is being “vigilant” for any problems or side effects. She says it has been a bit of an adjustment cutting out drinking alcohol, but likes the fact that she is saving money when she goes out now.
 

Cat has looked online for more information about immunosuppressants.

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Age at interview: 24
Sex: Female
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When they put me on like these immunosuppressants, so you just sort of Google that and sort of like put side effects in or something, and then you just get a whole list of stuff, and you just sort of read through it, see what someone else. So things like, you know, to look out for. Obviously see what like the sort of side effects people have, or things like when to take tablets like well if people have any advice like sort of stuff like that. It probably won't work for you but it's good to sort of see what stuff's out there, or see how long people are sort of on stuff for and things like that so, it is yeah, quite useful.
Immunotherapy
is also known as "allergy shots". This is when the person is given small doses of an allergen over a long period of time. The idea is that the person's body gets used to the allergen and doesn't have such a strong reaction to it. Immunotherapy treatment involves either having injections or taking tablets or drops.

Aadam had immunotherapy to help reduce the impact of allergens like grass pollen on his asthma and eczema. His treatment took four years, had side effects (such as his tongue swelling up) and required “lots of dedication”, but he has seen an improvement. Aadam was pleased to get immunotherapy treatment on the NHS, as it would have been expensive.
 

Aadam had immunotherapy treatment to help ease his grass allergies, which triggered his eczema and asthma.

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Age at interview: 18
Sex: Male
Age at diagnosis: 1
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I am also allergic to grass and dust mites. But for the trees and grass I had something called immunotherapy, which is quite a new sort of treatment that I was fortunately able to get off the NHS, because it does cost a lot. And it’s sort of helped me deal with tree and grass allergies a lot easier, so I don’t I don’t feel breathless easier, because I used to notice when I used to do cross country running that by the end of it I would find it really hard to breathe. So even playing sports in the field, I would find it really hard to breathe. But since the immunotherapy, which took which took four years, which is very long for it took a lot of dedication. Since the immunotherapy I have been a lot better. And hay fever hasn’t been a severe issue of mine anymore, which is good, because I do really enjoy the outdoors. 

Well there were two options. There was the injection option, which would mean coming into hospital and having an injection every two weeks. But me being afraid of needles, [laughs] I obviously didn't go for that option. The alternative was, these sort of mouth drops which I am guessing have like a condensed part of a tree or grass inside [laughs] or the parts that actually were I guess the allergens. So, that involved spraying or putting droplets of the substance in your mouth, once a day. The first time I tried it, I had an allergic reaction. So then, they had to give me a starter pack, which is more or less concentrated, so I was able to sort of get myself used to it a lot quicker. But yeah it was, it was very, it was hard, especially when you would forget. And then, sometimes, the underneath of my tongue where you are supposed to place the droplets and leave them for about two minutes, that part would swell up and go really numb. So, yeah, it was a very long process. It did mean I had to miss like certain amounts at school. 
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