IgE-independent pathophysiology of severe atopic dermatitis demonstrated in an IgE-deficient patient

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Background: About 20% of patients with clinical diagnosis of atopic dermatitis (AD) have no IgE-sensitization to food- or aeroallergen-specific IgE, in contrast to archetypal AD patients, who show clinically relevant IgE-sensitization. The pathophysiology of these two forms of AD has been studied, although to what extent they share common mechanisms remains unclear. There is still a debate on possible pathogenic roles of IgE in such apparently non-IgE associated AD patients, because several reports note that they react to skin microbial allergens that are not routinely measured in clinical practice, but may contribute to the pathogenesis. We report an adult case of severe AD with total absence of IgE.