Abstract
Although the pathophysiological role of house-dust mite (HDM) in atopic dermatitis (AD) remains controversial, reduction of exposure to HDM in the bed and bedroom has been shown to benefit AD patients. It is 16 years since Mitchell and colleagues 1 Mitchell EB Crow J Chapman MD Jouhal SS Pope FM Platts-Mills TA Basophils in allergen-induced patch test sites in atopic dermatitis.. Lancet. 1982; i: 127-130 Summary Scopus (370) Google Scholar established that application of the HDM antigen P1 (now Der p 1) to the skin of AD patients, as a patch test, induced a local delayed-type hypersensitivity response. Such atopy patch-test reactions to aeroallergens, particularly HDM, occur even on uninvolved skin, in one-third to two-thirds of children and adults with AD, predominantly in those with high specific IgE concentrations. 2 Langeveld-Wildschut EG van Marion AM Thepen T Mudde GC Bruijnzeel PL Bruijnzeel-Koomen CA Evaluation of variables influencing the outcome of the atopy patch test.. J Allergy Clin Immunol. 1995; 96: 66-73 Summary Full Text Full Text PDF PubMed Scopus (91) Google Scholar Biopsy studies reveal HDM allergens, associated with antigen-presenting cells, in the epidermis and dermis in AD but not in normal volunteers. 3 Maeda K Yamamoto K Tanaka Y Anan S Yoshida H House dust mite (HDM) antigen in naturally occurring lesions of atopic dermatitis (AD): the relationship between HDM antigen in the skin and HDM antigen-specific IgE antibody.. J Dermatol Sci. 1992; 3: 73-77 Summary Full Text PDF PubMed Scopus (48) Google Scholar Specific IgE antibodies are thought to mediate this binding and such IgE-enhanced antigen presentation has been shown to require 100–1000-fold less antigen to induce lymphocyte proliferation. 4 van der Heijden FL van Neerven RJ Kapsenberg ML Relationship between facilitated allergen presentation and the presence of allergen-specific IgE in serum atopic patients.. Clin Exp Immunol. 1995; 99: 289-293 Crossref PubMed Google Scholar Unfortunately the Der p 1 content of allergen preparations used in atopy patch tests has not often been documented, but reactions have been reported 1 Mitchell EB Crow J Chapman MD Jouhal SS Pope FM Platts-Mills TA Basophils in allergen-induced patch test sites in atopic dermatitis.. Lancet. 1982; i: 127-130 Summary Scopus (370) Google Scholar at 12·5 ng/cm 2 Langeveld-Wildschut EG van Marion AM Thepen T Mudde GC Bruijnzeel PL Bruijnzeel-Koomen CA Evaluation of variables influencing the outcome of the atopy patch test.. J Allergy Clin Immunol. 1995; 96: 66-73 Summary Full Text Full Text PDF PubMed Scopus (91) Google Scholar . The mean Der p 1 found in young children's beds in Wellington is 4·9 ng/cm 2 Langeveld-Wildschut EG van Marion AM Thepen T Mudde GC Bruijnzeel PL Bruijnzeel-Koomen CA Evaluation of variables influencing the outcome of the atopy patch test.. J Allergy Clin Immunol. 1995; 96: 66-73 Summary Full Text Full Text PDF PubMed Scopus (91) Google Scholar (range 0·01–281·2 ng/cm 2 Langeveld-Wildschut EG van Marion AM Thepen T Mudde GC Bruijnzeel PL Bruijnzeel-Koomen CA Evaluation of variables influencing the outcome of the atopy patch test.. J Allergy Clin Immunol. 1995; 96: 66-73 Summary Full Text Full Text PDF PubMed Scopus (91) Google Scholar ) of mattress surface (unpublished data). We questioned whether there might be sufficient Der p 1 on the skin surface to potentially continue to stimulate a hypersensitivity response after rising from bed.
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