Atopic Dermatitis

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Jan Hed, Clin Immunologist, MD, PhD
Karolinska Institutet,  IMPI, Div of Clin Immunology
Huddinge University Hospital, Sweden
 
(for review see ref. 1- 2)
 
The statements below are based on conclusions from selected publications. Their intention is to highlight recent research and information that could be beneficial in allergy in vitro testing. They can include seemingly contradictory statements due to differences in selecting patient populations as well as in the study design.
  • Atopic dermatitis (AD) is the first manifestation in the Allergy March (3) with a peak onset normally before 3 months of age (4).
     
  • Life prevalence of AD is about 20% (5), where 60% of patients had their onset during the first year of life and 85% before 5 years (4).
     
  • AD is a late phase reaction (cellular reaction), in contrast to urticaria, which is an early phase reaction (vascular reaction).
     
  • AD patients show a hyperreactivity in the skin to cholinergic agents analogous to bronchial hyperreactivity in asthma.
     
  • A high prevalence of asthma, ranging from 30 to 76% has been described in children with AD (6,7) and been related to the severity of AD (8,9).
     
  • Bronchial hyperreactivity is also seen in some AD patients without symptoms of asthma (10).
     
  • About 40% of AD patients showed clearing of disease after 20 years of age (for review see 1) and only those serious or moderate cases still had symptoms (8). 
     
  • Total serum-IgE is increased in about 80% of AD patients and is sometimes above 10,000 kU/l.
     
  • Approximately 85% of patients with AD are sensitized to food and inhalant allergens (11,12).
     
  • Studies have demonstrated that food allergens can exacerbate skin rashes in AD (13,14).
     
  • Approximately one third of children with refractory, moderate-severe AD have IgE-mediated clinical reactivity to food proteins (15).
  • In highly atopic children, 80% were positive in food challenge tests with reactions from the skin being found in 74% of the patients (16).
     
  • Egg, milk, peanut, soy, fish, tree-nuts and wheat accounted for most (99%) of positive food challenge tests in one study (17), and egg, milk, peanut, and soy accounted for 87% positives in another study (18).
     
  • High concentration of specific IgE to food allergens can be used as a predictive marker for positive food challenge test and thereby for clinical symptoms (18, 19).
     
  • Clinical studies suggest that inhalation or contact with aeroallergens may play a role in the exacerbation of AD (for review see 2).
     
  • Some studies show a significant improvement of skin lesions after control of exposure to house-dust mite (20, 21). Another shows that direct contact can exacerbate the skin lesion (22). 

References:

    1. Bruijnzeel-Koomen CAFM, Madde GC, Kapp A. Atopic dermatitis. In: Kay AB, editor. Allergy and Allergic Diseases. Blakwell Science 1997:1573-85.
    2. Leung DYM. Atopic dermatitis: the skin as a window into the pathogenesis of chronic allergic diseases. J Allergy Clin Immunol 1995;96:302-18.
    3. Businco L, Falconieri P, Di Rienzo A, Bruno G. From atopic dermatitis to asthma. Pediatr Pulmonol 1997;suppl 16:19-20.
    4. Rajka G. Essential aspects of atopic dermatitis. Springer, Berlin, Heidelberg, New York. 1989.
    5. Kay J, Gawkrodger DJ, Mortimer MJ, Jaron AG. The prevalence of childhood atopic eczema via general general population. J Am Acad Dermatol 1994;30:35-9
    6. Businco L, Ziruolo MG, Ferrara M, Benincori N, Muraro A, Campietro PG. Natural history of atopic dermatitis in childhood: an updated review and personal experience of a five-year follow-up. Allergy 1989;44 suppl 9:70-8.
    7. Salob SP, Altherton DJ. Prevalence of respiratory symptoms in children with atopic dermatitis attending pediatric dermatology clinics. Pediatrics 1993;91:8-12.
    8. Queille-Roussel C, Raynaud F, Saurat JH. A prospective computerized study of 500 cases of atopic dermatitis in childhood. Acta Derm Venereol Suppl (Stockh) 1985;114:87-92.
    9. Rystedt I. Prognostic factors in atopic dermatitis. Acta Derm Venereol 1985;65:206-13.
    10. Fabrizi G, Corbo GM, Ferrante E, Macciocchi B, Angelis V, Romano A, et al. The relationship between allergy, clinical symptoms and bronchial responsiveness in atopic dermatitis. Acta Derm Venereol Suppl (Stockh) 1992;176:68-73.
    11. Hoffman DR, Yamamoto FY, Geller B, Haddad Z. Specific IgE antibodies in atopic eczema. J Allergy Clin Immunol 1975;55:256-67.
    12. Sampson HA, Albergo R. Comparison of results of prick skin test, RAST, and double- blind placebo-controlled food challenges in children with atopic dermatitis. J Allergy Clin Immunol 1984;74:26-33.
    13. Bock SA, Lee WY, Remigio LK, May CD. Studies of hypersensitivity reactions to foods in infants and children. J Allergy Clin Immunol 1978;62:327-34.
    14. Jones SM, Sampson HA. The role of allergens in atopic dermatitis. Clin Rev Allergy1993;11:471-90.
    15. Eigenmann PA, Sicherer SH, Borkowski TA, Cohen BA, Sampson HA. Prevalence of IgE-mediated food allergy among children with atopic dermatitis. Pediatrics 1998;101:E8.
    16. Sampson HA. Food sensitivity and the pathogenesis of atopic dermatitis. JRS Med 1997;90 suppl 30:2-8.
    17. Burks AW, James JM, Hiegel A, Wilson G, Wheeler JG, Jones SM, Zuerlein N. Atopic dermatitis and food hypersensitivity reactions. J Pediatr 1998;132-6.
    18. Sampson HA, Ho DG. Relationship between food-specific IgE concentrations and risk of positive food challenges in children and adolescents. J Allergy Clin Immunol 1997;100:444-51.
    19. Daul CB, Morgan JE, Hughes J, Lehrer SB. Provocation-challenge studies in shrimp- sensitive individuals. J Allergy Clin Immunol 1988;81:1180-6.
    20. Sanda T, Yasue T, Oohashi, Yasue A. Effectiveness of house-dust mite allergen avoidance through clean room therapy in patients with atopic dermatitis. J Allergy Clin Immunol 1992;89:653-7.
    21. Adinoff AD, Tellex P, Clark RA. Atopic dermatitis and aeroallergen contact sensitivity. J Allergy Clin Immunol 1988;81:736-42.
    22. Seidenari S, Manzini BM, Danese P, Giannetti A. Positive patch tests to whole mite culture and purified mite extracts in patients with atopic dermatitis, asthma and rhinitis. Ann Allergy 1992;69:201-6.