Abstract
Atopic dermatitis (AD) is a common skin disease affecting 20% of the population beginning usually before one year of age. It is associated with the emergence of allergen-specific IgE, but also with autoreactive IgE, whose function remain elusive. This review discusses current knowledge relevant to the mechanisms, which leads to the secretion of autoreactive IgE and to the potential function of these antibodies in AD. Multiple autoantigens have been described to elicit an IgE-dependent response in this context. This IgE autoimmunity starts in infancy and is associated with disease severity. Furthermore, the overall prevalence of autoreactive IgE to multiple auto-antigens is high in AD patients. IgE-antigen complexes can promote a facilitated antigen presentation, a skewing of the adaptive response toward type 2 immunity, and a chronic skin barrier dysfunction and inflammation in patients or AD models. In AD, skin barrier defects and the atopic immune environment facilitate allergen sensitization and the development of other IgE-mediated allergic diseases in a process called the atopic march. AD is also associated epidemiologically with several autoimmune diseases showing autoreactive IgE secretion. Thus, a potential outcome of IgE autoreactivity in AD could be the development of further autoimmune diseases.
Highlights
Atopic Dermatitis: A Multifactorial PathogenesisAtopic dermatitis (AD) is a chronic relapsing systemic skin disorder characterized by an intense pruritus and the development of eczematous lesions to particular sites
Atopic dermatitis (AD) is a common skin disease affecting 20% of the population beginning usually before one year of age
The most recent study looking for the prevalence of Anti-nuclear antibodies (ANA) in children by immunofluorescence showed that ANA were detectable at a younger age in AD than in healthy controls [49]
Summary
Atopic dermatitis (AD) is a chronic relapsing systemic skin disorder characterized by an intense pruritus and the development of eczematous lesions to particular sites. It usually begins before one year of age, and fades after childhood in ~80–90% of the cases. The adult form of the disease is more severe, and associated with a high morbidity. It is the most common skin condition showing up to 20% lifetime prevalence in some countries [1,2].
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