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PubMed1995

Adrenal function following topical steroid treatment in children with atopic dermatitis.

Adrenal suppression is a potential complication of topical corticosteroid treatment in atopic dermatitis. We used a low-dose adrenocorticotrophic hormone (ACTH) test (500 ng/1.73 m2) to detect subtle changes in adrenal glucocorticoid function in 14 prepubertal children with moderate or severe atopic dermatitis affecting 16-90% (median 58%) of the body surface area. All had received regular treatment with mild potency BNF (British National Formulary) classification topical corticosteroid ointments (hydrocortisone 48.7-223.2 mg/m2 body surface area/day; median 134.2) for 3-10 years (median 6.5 years). Nine children had also intermittently used moderate potency preparations. However, none had been treated with corticosteroids by any other route in the preceding 6 months. Fourteen prepubertal children with constitutional short stature, without atopic disease, served as controls. The basal, peak, increment and area-under-curve in plasma cortisol concentrations in children with atopic dermatitis were not significantly different from controls, indicating normal adrenal sensitivity to low-dose ACTH. However, the peak in plasma cortisol occurred earlier in children with atopic dermatitis (median 17.5 min) than in controls (median 25 min) (P = 0.02). In addition, there was a significant inverse relationship between time to peak and extent of atopic dermatitis (rs = -0.52; P < 0.05), but not topical steroid treatment dose or score in children with atopic dermatitis. These findings indicate accelerated adrenal responsiveness to ACTH in children with atopic dermatitis, which is independent of treatment. Mild to moderately potent topical corticosteroid ointments in these doses did not suppress adrenal glucocorticoid function in this sample of children with atopic dermatitis.

Administration, Topical↗

PubMed1995

Blood eosinophils, eosinophil-derived proteins, and leukotriene C4 generation in relation to bronchial hyperreactivity in children with atopic dermatitis.

To assess the relation among eosinophil-related variables in the peripheral blood, bronchial hyperreactivity, and the presence of atopic dermatitis in children aged 5-14 years, we studied 11 patients with atopic dermatitis alone, six with asthma and atopic dermatitis, 12 with asthma alone, and 12 healthy controls. Eosinophil counts, levels of eosinophil cationic protein, and the capacity of eosinophils to generate leukotriene (LT) C4, as well as bronchial hyperreactivity and a severity score for atopic dermatitis, were determined. Eosinophil variables were significantly higher in both patient groups with atopic dermatitis than in normal controls. In particular, ionophore A 23187 LTC4 generation was higher in patients with atopic dermatitis alone (median 82, range 25-273 ng/10(6) cells) and patients with combined asthma and atopic dermatitis (median 68, range 32-583 ng/10(6) cells) than in normal controls (median 9, range 1-67 ng/10(6) cells). However, there was no difference between the group of atopic dermatitis patients with asthma and without asthma. We conclude that eosinophil variables in the peripheral blood are mainly influenced by the presence of atopic dermatitis, and not the presence and the severity of asthma in patients with both asthma and atopic dermatitis.

Adolescent↗

PubMed1993

CD23/Fc epsilon R11 expression in contact sensitivity reactions: a comparison between aeroallergen patch test reactions in atopic dermatitis and the nickel patch test reaction in non-atopic individuals.

The immunopathology of patch test reactions to aeroallergens in patients with atopic dermatitis (AD) has been compared to that of contact sensitivity reactions to nickel in non-atopic individuals. Both reactions were found to exhibit equivalent erythema and induration on gross examination at 48 h. Four millimetre punch biopsies were obtained at 48 h frozen, and cryostat sections stained with a panel of MoAbs. The distribution of macrophages, dermal dendritic cells, Langerhans cells, T lymphocytes and the expression of CD23 antigen was recorded. Increased numbers of dermal dendritic cells, macrophages, T lymphocytes and Langerhans cells were found in the dermal infiltrates of both the nickel patch test reactions and the aeroallergen patch test reactions compared with their respective controls. There were no significant differences between atopic patch test reaction and nickel patch test reaction samples in the tissue distribution of these cell types. There was a significant increase in CD23 expression on Langerhans cells and dermal dendritic cells in the atopic patch test reactions, whereas an increase was only observed on dendritic cells in nickel patch test reactions. No significant difference in CD23 expression was observed in the control skin samples taken from patients with AD, nickel-sensitive patients and normal controls. This study supports the hypothesis that the aeroallergen patch test reaction in atopic dermatitis is a delayed hypersensitivity reaction, yet is distinct from the contact sensitivity reaction to nickel in terms of raised expression of CD23.

Adult↗

PubMed2001

[Atopic dermatitis in Tunisia: epidemiological and clinical aspects].

INTRODUCTION: The prevalence of atopic dermatitis is usually high in western countries, varying from 18 p. 100 to 20 p. 100. Recent studies suggest an increasing of this frequency. The aim of our study is to determine the epidemiological and clinical characteristics of atopic dermatitis in Tunisia through the analysis of a retrospective cohort. PATIENTS AND METHODS: We retrospectively studied all the medical reports of atopic dermatitis registrated in the department of dermatology during a 7 years period (1992-1998). We analysed epidemiological and clinical features of every medical report. We used diagnosis criteria of Hanifin and Rajka. RESULTS: Four hundred fifty-one cases of atopic dermatitis have been diagnosed (54 adults and 397 infants). Relative frequency of new cases of atopic dermatitis compared to new diagnosis was 0.37 p. 100 in 1992 and 0.72 p. 100 in 1998. Mean age was 3.2 years. A personal history of atopy was observed for 15.2 p. 100 of patients and a family history of atopy for 35.9 p. 100. A few numbers of complications were observed. Bacterial infections interested 15.3 p. 100 of cases. Hospitalisation was needed for 4 patients (0.88 p. 100). Class III and IV topical corticosteroids were usually used (84.8 p. 100). Potent corticosteroids (class I) were required for only 3.2 p. 100 of cases. CONCLUSIONS: We notice a low frequency of atopic dermatitis in this study and a predominance of mild forms of the disease. Other studies are needed to confirm these results and to determine the prevalence of atopic dermatitis in Tunisia.

Adolescent↗

PubMed1977

T and B lymphocytes in contact and atopic dermatitis.

Twenty patients with contact dermatitis, eighteen with atopic dermatitis, two with mixed dermatitis, and 20 controls were examined for the number of T and B lymphocytes, and serum concentrations of IgD and IgE. Significantly higher counts of B lymphocytes bearing IgE and high serum IgE values were found in the atopic group. No other significant differences were found. In particular, we found a normal frequency of IgD bearing lymphocytes in contact dermatitis, and normal T lymphocyte counts in both groups of patients.

Adolescent↗

PubMedDate not supplied

Predictability of early onset atopic dermatitis by cord blood IgE and parental history.

Cord blood IgE and atopic family history have been used as predictors of atopic disease in infants for more than 20 years. In recent years, the value of cord blood IgE in predicting the development of atopic dermatitis has been questioned, while family history of atopy has consistently been regarded as a useful predictor for atopic dermatitis. A birth cohort was followed-up to 6 months of age to record the development of atopic dermatitis and to study its association with cord blood IgE levels and parental history of atopy. The cumulative incidence of atopic dermatitis over the 1st, 3rd and 6th months of life amounted to 5.0%, 8.2% and 14.0%, respectively. When the cutoff value for cord blood IgE was set at 0.5 kU/L, there was a significant association between elevated cord blood IgE level and atopic dermatitis at 1, 3 and 6 months of age; when the cutoff value was set at 0.9 kU/L, the association was only found at 3 months of age. There was a significant association with atopic history of the mother. The effect of maternal atopic history on atopic dermatitis seen only at 1 month was lost by 3 months of age. There was no correlation between paternal history and atopic dermatitis. In our study, the predictive capacity of maternal history and cord blood IgE was not high enough to recommend them as screening factors.

Dermatitis, Atopic↗

PubMed2001

Intravenous immune globulin effects on serum-soluble CD5 levels in atopic dermatitis.

BACKGROUND: Intravenous immune globulin (IVIG) therapy has been tried in the treatment of atopic dermatitis. Recently, the presence of serum-soluble CD5 (ssCD5) in atopic dermatitis was reported. OBJECTIVE: IVIG effects on ssCD5 levels in atopic dermatitis were examined and the correlation of ssCD5 level changes with clinical and laboratory parameters were investigated. METHODS: IVIG therapy was tried on 40 atopic dermatitis and 17 recurrent spontaneous abortion patients. Five atopic dermatitis patients received normal saline as a placebo control group. The clinical and laboratory parameters were evaluated on day 0, 1, 7 and 21 after administering the IVIG therapy. RESULTS: With IVIG therapy, in atopic dermatitis, the ssCD5 level was 5.5 +/- 6.2 ng/mL before infusion (day 0), 15.2 +/- 12.1 ng/mL on day 1, 13.8 +/- 14.1 ng/mL on day 7, and 3.9 +/- 4.1 ng/mL on day 21. The clinical severity score was 350.5 +/- 120.3 on day 0, 420.4 +/- 174.8 on day 1, 250.0 +/- 121.2 on day 7, and 115.5 +/- 53.9 on day 21. White blood cell (WBC) counts and serum IgE levels showed a gradual decrease with IVIG infusions. Blood eosinophil fractions were 5.3 +/- 2.8% on day 0, 8.6 +/- 5.2% on day 1, 7.3 +/- 3.7% on day 7, and 6.8 +/- 4.0% on day 21. Changes in the total eosinophil count were insignificantly parallel with those of blood eosinophil fractions CONCLUSION: In atopic dermatitis, IVIG therapy increased the ssCD5 levels. Further studies concerning the exact role of ssCD5 are needed.

CD5 Antigens↗

PubMed1999

Intravenous immune globulin (i.v.IG) therapy in steroid-resistant atopic dermatitis.

Many trials have been done on steroid-resistant atopic dermatitis. Recently, intravenous immune globulin (i.v.IG) was reported to be effective in the treatment of steroid-dependent atopic dermatitis. The aim of this study was to clarify whether i.v.IG therapy is effective in steroid-resistant atopic dermatitis. Forty-one steroid-resistant atopic dermatitis patients were tested in this study. Patients who weighed less than 30 kg were administered 500 mg/kg of i.v.IG. Patients who weighed 30 kg or more were administered 15 g of i.v.IG. Patient evaluations and laboratory tests with peripheral bloods such as eosinophil percentages and serum IgE levels were performed at days 0, 1, 7, and 21. In the present study, patients who responded to i.v.IG therapy were classified as Group A. Twelve patients who showed transient effects with lower clinical significance were classified as Group B (29.3%). Remaining 12 patients (29.3%) in Group C showed no improvement at all. Serum IgE levels and blood eosinophil percentages were markedly decreased in Group A. I.v.IG therapy may be recommended in the treatment of atopic dermatitis with extremely high serum IgE levels.

Adolescent↗

PubMed2001

Intracellular 3',5'-adenosine cyclic monophosphate level regulates house dust mite-induced interleukin-13 production by T cells from mite-sensitive patients with atopic dermatitis.

We studied the relationship between cAMP and house dust mite-induced cytokine production in T cells from mite-sensitive patients with atopic dermatitis. T cells from atopic dermatitis patients secreted high level of interleukin-13 (mean 851.1 pg per ml) when cultured with autologous monocytes pulsed with Dermatophagoides pteronyssinus extract. Dermato- phagoides pteronyssinus-induced interleukin-13 secretion was not detected in normal subjects. Adenylate cyclase inhibitor MDL 12,330A and cyclic nucleotide phosphodiesterase type 4 inhibitor rolipram blocked Dermatophagoides pteronyssinus-induced interleukin-13 secretion in atopic dermatitis T cells. In atopic dermatitis T cells, cAMP level rose at 5 min after Dermatophagoides pteronyssinus stimulus then decreased to the basal level at 1 h. MDL 12,330A blocked the Dermatophagoides pteronyssinus-induced cAMP elevation while rolipram blocked its reversal. In atopic dermatitis T cells, adenylate cyclase activity increased at 5 min after Dermatophagoides pteronyssinus stimulus, followed by the increase of cyclic nucleotide phosphodiesterase activity at 15 min. In atopic dermatitis T cells, phospholipase C inhibitor ET-18-OCH3 blocked Dermatophagoides pteronyssinus-induced activation of adenylate cyclase, while rolipram, protein kinase A inhibitor H-89, and MDL 12,330A blocked the activation of cyclic nucleotide phosphodiesterase. These results suggest that Dermatophagoides pteronyssinus may first increase cAMP in atopic dermatitis T cells by activating adenylate cyclase via phospholipase C, and next decrease cAMP by activating cyclic nucleotide phosphodiesterase 4 via protein kinase A, which may be activated by adenylate cyclase-generated cAMP signal. These events are required for interleukin-13 response Dermatophagoides pteronyssinus.

3',5'-Cyclic-AMP Phosphodiesterases↗

PubMed2002

Susceptibility loci for atopic dermatitis on chromosomes 3, 13, 15, 17 and 18 in a Swedish population.

Atopic dermatitis is a hereditary, pruritic, inflammatory and chronic skin disease that typically presents in early childhood and may continue or recur later. The etiology of atopic dermatitis is unknown, but several lines of evidence indicate that it is a multifactorial disorder caused by the combined influence of genetic and environmental factors, even though the relative contributions of genes and environment are not known. To identify important loci that contribute to the development of atopic dermatitis, we conducted a genome-wide linkage analysis with 367 microsatellite markers, using a non-parametric affected relative-pair method in 109 pedigrees. Three qualitative phenotypes and one semi-quantitative phenotype were studied. For the phenotype atopic dermatitis, linkage to chromosome region 3p24-22 was found. For another phenotype, atopic dermatitis combined with raised allergen-specific IgE levels, a suggestive linkage was found to chromosome region 18q21. For the semi-quantitative phenotype severity score of atopic dermatitis, suggestive linkage was found to chromosome regions 3q14, 13q14, 15q14-15 and 17q21. Identifying chromosome regions linked to susceptibility genes for atopic dermatitis provides a platform from which the search for atopic dermatitis genes can proceed.

Chromosome Mapping↗

PubMed1999

Itch and atopic dermatitis: an overview.

Itching is the hallmark of atopic dermatitis, and a vicious itch-scratch circle is easily established. Itching and scratching are important factors in the maintenance of symptoms and can have a significant impact on the sufferer's quality of life. The pathophysiology of itch in atopic dermatitis is still not understood. Unlike in urticaria, histamine is not considered to be a major pruritogen in atopic dermatitis. In fact, the peripheral pruritogens and their cellular origin(s) still remain to be identified in this disease. Various treatments are used to relieve the skin inflammation, itching, and scratching in patients with atopic dermatitis, but no specific antipruritic therapy is available. However, several nonspecific therapies can effectively break the vicious itch-scratch circle. The use of topical corticosteroids and emollients and the elimination of individual trigger factors are still first-line measures.

Anti-Inflammatory Agents↗

PubMed2005

Gastrointestinal disorders in children with atopic dermatitis.

UNLABELLED: The aims of this study were to analyze the peculiarities of allergies to food; to determine gastrointestinal disorders, endoscopic signs of mucosal damage and histological lesions of the mucosa and to establish their relation to the extent of atopic dermatitis and its degree of severity. MATERIAL AND METHODS: A total of 164 children (86 boys and 78 girls) suffering only from atopic dermatitis were examined. Atopic dermatitis was diagnosed using standard diagnostic criteria; extent of disease (the Basic Clinical Scoring System (BCSS)) and the severity (Scoring Atopic Dermatitis (SCORAD) index), total serum IgE levels were determined; skin prick and patch tests with the main food allergens were performed. Using questionnaire gastrointestinal disorders with the symptoms of atopic dermatitis were ascertained. In children with atopic dermatitis suffering from chronic dyspepsia esophagealgastroduodenoscopy was performed and biopsy samples from the antrum of the stomach and duodenum were taken. RESULTS: The age of patients ranged from 6 months to 18 years. According to extent of atopic dermatitis and degree of severity localized, mild atopic dermatitis prevailed. Analysis of the changes in total Ig E levels showed different degree of sensitization of the children examined. Considering the type of allergic reaction, immediate-type allergic reactions dominated only in 11.6% of children with atopic dermatitis, whereas delayed-type allergic reactions manifested in 44.5% of children. No food allergy was present in one-fifth of children with atopic dermatitis. One hundred four (63.4%) children complained of gastrointestinal disorders. Of these 104 patients, 17 children (mean age 6.9 years) who underwent esophagealgastroduodenoscopy with biopsy had no pathology; however, histological examination of mucosa revealed eosinophilic infiltration in the gastric antrum and duodenum in three children. CONCLUSIONS: The most common gastrointestinal disorders are: abdominal pain vomiting, diarrhea, abdominal distention, and constipation. The incidence of gastrointestinal disorders does not depend on the extent and severity of atopic dermatitis. Gastrointestinal disorders manifest independent of the type of allergic reactions inducing atopic dermatitis. The most common food allergens, such as soy, milk, peanuts, corn, carrots, rye, wheat, white of the egg, cod, and chicken were determined by skin patch test. According to our data, no pathology was found in children with atopic dermatitis during endoscopic examination. Our data showed that allergic-like changes in gastric and duodenal mucosa were present only in older (7-10-year-old) children.

Adolescent↗

PubMed2005

Atopy patch testing with aeroallergens in patients with atopic dermatitis and controls in Singapore.

The role of allergy in atopic dermatitis is controversial. The atopy patch test (APT) has been used to investigate the association between atopic dermatitis and aeroallergen allergy. To determine the proportion of patients with atopic dermatitis with positive patch tests to common local aeroallergens and to compare this to controls with and without respiratory atopy, we performed APT, skin-prick tests (SPT) and IgE radioallergosorbent tests (RAST) on 73 patients with atopic dermatitis and on 38 nonatopic controls (13 with and 25 without respiratory atopy). The allergens used were house dust mite, cat dander, Bermuda grass and German cockroach. Only the APT for house dust mite showed a significant difference between the two groups. APT for house dust mite correlated with the RAST test, while APT for cat fur correlated with the SPT. The APT may be useful to evaluate aeroallergens in atopic dermatitis, but further work is needed to make it more reliable.

Adolescent↗

PubMed1979

Beta adrenergic receptor binding on polymorphonuclear leukocytes in atopic dermatitis.

It has been postulated that the patient with atopic dermatitis has defective beta adrenergic receptor function. However, a more generalized defect is suggested by the observation that cyclic AMP generation is diminished in these patients following stimulation with both isoproterenol and PGE1. To determine the nature of this abnormality, we measured beta adrenergic receptor binding directly on polymorphonuclear leukocyte membranes using the radiolabeled beta adrenergic antagonist (-) [3H]dihydroalprenolol (DHA). DHA binding was studied in 6 mild and 9 moderate-to-severe atopic dermatitis patients, and 8 normal controls using a subsaturating concentration of DHA (0.5 nM) to estimate receptor affinity and a saturating concentration of DHA (30 mM) to determine the total number of receptors per cell. No significant differences (p greater than .05) were found in the total number of receptors per PMN between the control population (805 +/- 95) and the mild atopic dermatitis patients (745 +/- 91) or the moderate to severe group (621 +/- 79). In addition, no significant differences in receptor affinity were found among any of the 3 study groups. These findings suggest that beta receptor binding in atopic dermatitis is normal. Reduced cyclic AMP generation in atopic dermatitis PMN leukocytes would appear to be due to a defect distal to the beta adrenergic receptor itself.

Adult↗

PubMed2001

The frequency of common skin conditions in preschool-age children in Australia: atopic dermatitis.

OBJECTIVE: To determine the prevalence and severity of atopic dermatitis in a stratified cross-section of preschool-age children examined throughout Victoria, Australia. DESIGN: A cross-sectional skin survey using a selected cluster sample of the various centers throughout Victoria. SETTING: The study population included Victorian children attending child-care centers, preschools, and Maternal and Child Health Centres, with the reference population being Australian children aged 5 years and younger. PARTICIPANTS: Of 1634 potential participants, 1116 children (68.3%) were examined. INTERVENTION: A dermatologist performed a total skin examination, including head and neck, limbs, and trunk, on all children. The diaper area was examined in children younger than 12 months. MAIN OUTCOME MEASURE: All parents were administered a questionnaire to elicit demographic information, history of skin conditions, and family history of skin problems or related diseases. The examiner recorded the presence, site, and severity of atopic dermatitis for calculation of age- and sex-specific prevalence rates. RESULTS: The age- and sex-adjusted point prevalence was 30.8% (95% confidence interval [CI], 28.0%-33.5%). Most children (63.7%) were classified as having minimal or mild disease. Only 5.8% of children with atopic dermatitis did not have face or flexural involvement. Of the 237 children with atopic dermatitis and information available, 209 used 1 or more products to treat their condition. CONCLUSIONS: Atopic dermatitis is common, decreasing in prevalence after the first 3 years of life. Most children have mild disease requiring little if any treatment, and much could be prevented with simple measures. Educational programs directed at those caring for preschool-age children that provide information on simple preventive measures, where practical, and sources of advice for treatment, if necessary, could substantially reduce the morbidity of this condition in predisposed children.

Child Day Care Centers↗

PubMed2005

Psychophysiological reactivity under mental stress in atopic dermatitis.

BACKGROUND: An association of mental stress with atopic dermatitis is widely accepted. However, no long-term evaluation of psychophysiological reactivity over the course of disease has yet been performed. OBJECTIVE: We examined whether atopic dermatitis patients have an increased psychophysiological reactivity compared to healthy controls and in between acute and disease-free phases, and whether they differ in psychological state and trait variables. METHODS: Fifteen patients with atopic dermatitis underwent a stress test during acute exacerbation and after symptom improvement and were compared to matched controls. RESULTS: Psychophysiological responses to stress were not stronger in the patient group than in the controls. Nevertheless, the patients had a higher heart rate and lower vagal activity throughout the resting and stress phases at both examination times. The patients showed significantly higher anxiety, depression and emotional excitability, and self-ratings of inactivity clearly distinguished acute phases from remission. CONCLUSION: There is an increased vegetative excitability level in patients with atopic dermatitis, which cannot be attributed solely to increased disease activity.

Adolescent↗

PubMed1997

Bronchial and cutaneous responses in atopic dermatitis patients after allergen inhalation challenge.

BACKGROUND: Atopic dermatitis (AD) is often associated with allergic asthma (AA). Inhalation of allergens influences the activity of AA but the effect on the skin in AD is unclear. OBJECTIVES: We evaluated the degree of bronchial hyperresponsiveness to methacholine in eight AD patients with AA (AD+) and eight AD patients without AA (AD-) and studied bronchial and cutaneous responses after allergen inhalation challenge. METHODS: All patients were treated in hospital for their eczema with tar ointment (pix liquida) and orally administered antihistamines (mean hospital stay 37 days). After clearing of the skin lesions allergen inhalation challenge was performed. Cutaneous responses were studied by measuring the 'Costa' score before and 24 h after allergen inhalation challenge. RESULTS: The median value of the provocative concentration of methacholine causing a 20% fall (PC20 Mch) in forced expiratory volume in 1 second (FEV1) was significantly higher in the AD- group compared to the AD+ group with median values of 10.70 and 0.60 mg/mL, respectively. These values did not change significantly in both groups during hospital stay. After challenge all AD+ patients showed early and late asthmatic responses whereas only four AD patients showed early asthmatic responses (mean values of the maximal fall in FEV1 during the EAR 37%/16% and in PEF during the LAR 27%/4% for AD+ and AD-patients, respectively). The 'Costa' score increased in both groups (mean score before 19.1/24.4 and after challenge 26.8/26.9 for AD+ and AD- patients, respectively). The increase in the AD+ group was significantly higher compared with the AD- group (P=0.016). CONCLUSION: We conclude that allergen inhalation challenge causes a flare up of the skin lesions in atopic dermatitis patients. This was more prominent in atopic dermatitis patients who already suffered from an IgE-mediated allergic inflammation in the lung.

Adolescent↗

PubMed1995

On the definition and epidemiology of atopic dermatitis.

Hospital-derived criteria for atopic dermatitis may need to be refined before being applied to epidemiologic studies. Atopic dermatitis is a common and miserable condition, and environmental factors are probably at least as important as genetic factors in determining disease expression. These findings put us one step nearer to our dream of disease prevention.

Dermatitis, Atopic↗