Abstract
Atopic dermatitis (AD) is a widespread condition that appears to be increasing in prevalence and severity worldwide, yet the underlying mechanisms are not well understood. Recent research has identified various similarities between AD and autoimmune conditions, as well as indicating that there may be an association between AD and autoimmunity. This systematic review evaluates the association between AD and autoimmunity, as well as between severity of disease in AD and autoimmunity, with an emphasis on the associations with autoantibodies. MEDLINE (1946 to December 2017) and Embase (1974 to December 2017) databases were searched. Further relevant articles were retrieved from reference lists. Only studies measuring direct indicators of autoimmunity, in humans, were included. Qualitative analysis was carried out for all studies. In addition, quantitative analysis was used to evaluate prevalence of IgE autoantibodies and anti-nuclear antibodies (ANAs) in AD patients and control subjects. The Mantel–Haenszel method was used with a random-effects model. 28 studies assessed the occurrence of autoantibodies in AD patients and 16 studies were used to evaluate association between disease severity and autoantibodies. Pooled analysis from 14 studies, involving 986 AD patients and 441 control subjects, showed that IgE autoantibodies were significantly more prevalent in patients with AD (P < 0.00001) than control subjects. Similar analysis was carried out for ANAs, with eight studies that involved 1045 AD patients and 1273 control subjects. ANAs were significantly more prevalent in patients with AD (P = 0.003). This quantitative analysis supported an association between AD and IgE autoantibodies, as well as between AD and ANAs. There was insufficient data to make similar conclusions for other indicators of autoimmunity. The weight of evidence also suggests an association between IgE autoantibodies and disease severity. There was insufficient evidence to make this link for other indicators of autoimmunity.
Highlights
The term Atopic Dermatitis (AD) was first used by Wise and Sulzberger in 1933 [1]
The control groups were comprised predominantly of healthy individuals which makes comparison between, and pooling of, individual studies much easier and more useful. This meant an analysis could be carried out on the combined data, which established an odds ratio of 12.97 and P < 0.00001, indicating that IgE autoantibodies are significantly more likely to be identified in patients with AD compared to the control groups (Fig. 2)
The weight of evidence presented in this review indicates that there is an association between autoreactivity and AD, as well as disease severity in AD, with regard to autoantibodies of IgE class
Summary
The term Atopic Dermatitis (AD) was first used by Wise and Sulzberger in 1933 [1]. The World Allergy Organisation defines eczema ( known as atopic eczema dermatitis syndrome (AEDS) and as AD throughout this review) as ‘an inflammatory, chronically relapsing, non-contagious and extremely pruritic skin disease’ [2].Prevalence of AD worldwide is high, with 7.9% of 6–7 years presenting with the condition in the ISAAC Phase 3 study [3]. The term Atopic Dermatitis (AD) was first used by Wise and Sulzberger in 1933 [1]. The World Allergy Organisation defines eczema ( known as atopic eczema dermatitis syndrome (AEDS) and as AD throughout this review) as ‘an inflammatory, chronically relapsing, non-contagious and extremely pruritic skin disease’ [2]. Prevalence of AD worldwide is high, with 7.9% of 6–7 years presenting with the condition in the ISAAC Phase 3 study [3]. AD appears to be increasing in prevalence globally, with centres reporting increases in self-reported AD and severe AD [3]. There was significant variance in the prevalence of AD between centres, both within and across regions, which has been attributed, in part, to environmental differences [4]. The increasing prevalence and severity of AD makes it essential to understand the underlying mechanisms of the disease, enabling more effective future treatments
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