Atopic Eczema/dermatitis Syndrome Research Articles

Fetal Tobacco Smoke Exposure in the Third Trimester of Pregnancy Is Associated with Atopic Eczema/Dermatitis Syndrome in Infancy.

The manifestation of atopic dermatitis (AD) is initially nonatopic eczema in early infancy; the manifestations subsequently change in age-specific stages. Since allergen-specific T-helper 2 cells appear in the fetus primarily after the third trimester of pregnancy and rapidly mature during the first 6 months of life, different timings of tobacco smoke exposure may have different effects on AD. In this study, we investigated whether the timing of fetal or/and infantile tobacco smoke exposure affects the cumulative incidence of atopic eczema/dermatitis syndrome (AEDS) in infants in Japan. This cross-sectional study enrolled 1,177 parent–infant pairs, in which the infants were >6 months old. Parental allergic history, number of older siblings, physician-diagnosed AEDS and food allergy (FA), and the perinatal fetal and/or infantile tobacco smoke exposure timing after 28 weeks gestation and during the first 6 months of life were assessed using self-completed questionnaires. Fetal tobacco smoke exposure after 28 weeks gestation was significantly associated with higher cumulative incidence of AEDS in exposed infants than in unexposed infants: AEDS in all infants, 41.4% versus 34.0% (Chi-squared, P = 0.020; adjusted odds ratio, 5.21; 95% confidence interval, 1.08–25.15); AEDS in those without parental allergic history, 38.0% versus 26.6% (Chi-squared, P = 0.024). Postnatal infantile tobacco smoke exposure timing was not significantly associated with cumulative incidence of AEDS. No significant associations were observed between any tobacco smoke exposure timings and the cumulative incidence of FA. Fetal tobacco smoke exposure during the third trimester of pregnancy was positively associated with AEDS in infancy and might induce epigenetic changes in the fetal allergen-specific immune responses.

Seasonal variation and monthly patterns of skin symptoms in Korean children with atopic eczema/dermatitis syndrome.

There have been controversies about the seasonality in aggravation of atopic eczema/dermatitis syndrome (AEDS) symptoms, although understanding the seasonal patterns of AEDS symptoms is an important step in preventing exacerbation through proactive management. The aim of this study was to evaluate whether there are seasonal variations or monthly patterns of symptoms in children with AEDS. A total of 590 children with AEDS (median age, 21 months) were enrolled and were followed up for at least 1 year between August 2012 and March 2015. Daily symptom scores that described the extent of itching, sleep disturbance, erythema, dryness, oozing, and edema were recorded on a scale of 0 to 4. The baseline score for each patient was defined as the 20th percentile of each individual's total score. The symptom score difference of each patient was expressed relative to the baseline level. The seasonal or monthly variation in symptom score differences was analyzed through generalized estimating equation analysis. Based on the AEDS symptom records from 87,879 person-days, the mean symptom score difference from baseline in patients with AEDS increased significantly in spring, autumn, and winter relative to the reference season (summer): by 0.62 (95% confidence interval [CI], 0.44-0.81) in spring, by 0.45 (95% CI, 0.24-0.67) in winter, and by 0.18 (95% CI, 0.02-0.36) in autumn. The mean symptom score difference from baseline increased significantly in January, February, March, April, May, June, October, November, and December relative to the reference month of August. Skin symptoms in children with AEDS were worse in spring, winter, and autumn than in summer. In terms of monthly patterns, the skin symptoms were the worst in April.

Serum interleukin 17, interleukin 23, and interleukin 10 values in children with atopic eczema/dermatitis syndrome (AEDS): association with clinical severity and phenotype.

To date cytokines profile in AEDS is poorly described in children. We evaluated the interleukin (IL)-17, IL-23, and IL-10 levels in atopic eczema/dermatitis syndrome (AEDS) children and healthy controls, in atopic AEDS (aAEDS) and nonatopic (naAEDS) subtypes and their relationship with disease severity. A total of 181 children with aAEDS and 93 healthy children were evaluated. According to the skin-prick test (SPT) for allergens and serum total IgE, all patients were subdivided in two groups: 104 aAEDS and 77 naAEDS. In all patients, serum IL-17, IL-23, and IL-10 levels were detected. Serum IL-17 and IL-23 levels were significantly higher, and serum IL-10 levels were significantly lower in AEDS children than healthy group (p < 0.001). Moreover, serum IL-17 and IL-23 levels were significantly higher in aAEDS than in naAEDS subtypes (p < 0.001). Differently, serum IL-10 levels resulted similar in both subtypes. There was a correlation between Score Atopic Dermatitis (SCORAD) index and both IL-17 and IL-23 and an inverse correlation between SCORAD index and IL-10 in aAEDS and naAEDS types. Serum IL-17 and IL-23 values were positively related to total IgE levels (p < 0.0001) in aAEDS. Further increase of IL-17 and IL-23 levels was detected in aAEDS subjects with atopic diseases such as asthma and rhinitis than children with only allergic sensitization. Our study confirms the role of IL-17, IL-23, and IL-10 and their relationship with the severity of AEDS. We firstly found a correlation between high IL-17/IL-23 axis levels and different phenotypes of AEDS in children, suggesting its role as marker of "atopic march" and disease severity.

PD26 ‐ Acute allergic reactions in children following a cow's milk exclusion diet for intolerance symptoms such as gastro‐oesophageal reflux

Clear guidelines have been published by ESPGHAN [1] and RCPCH [2] concerning the diagnostic approach and management of Cow’s milk protein allergy (CMPA) in infants and children. Immune reactions may be IgE mediated, non IgE mediated or mixed and present either with acute allergic reactions or delayed manifesting as eczema “flare ups”, or often non-specific gastrointestinal manifestations such as Gastro-oesophageal Reflux (GORD). We have observed 5 infants (over 18 months) where there has been emergence of IgE mediated allergic symptoms on reintroduction of cow’s milk following an exclusion diet for intolerance symptoms such as GORD. All infants had been sensitized to cow’s milk, and had been able to tolerate it without immediate hypersensitivity prior to the exclusion diet. Not all had allergy testing prior to challenge. This has not been described in the literature following exclusion for GORD, but there have been reports of acute allergic reaction following exclusion diet in the management of severe eczema. Flinterman el al. [3] describe a study where children who had been previously sensitized to cow’s milk had this excluded as part of management of Atopic Eczema Dermatitis Syndrome. On re-introduction of CMP often after several years, the children all had acute allergic reactions. This occurred following accidental exposure and during formal food challenge. The children had been able to tolerate CMP without acute reaction prior to exclusion. This finding has led us to consider changing our practice. We will now perform allergy testing of all children (SPT +/-RAST) who have been following an exclusion diet for intolerance symptoms before proceeding to formal milk challenge. This is because of the chance of developing acute allergic reactions. Parents should be counselled of this risk.

Seroprevalence of IgG anti-Toxocara canis antibodies and anti-Fasciola sp. antibodies in patients with urticaria.

Chronic urticaria (CU) is defined by recurrent episodes occurring at least twice a week for 6 weeks and generally characterized by the rapid appearance of wheals and/or angioedema and may be associated with parasitic infections. We aimed to investigate the seroprevalance of Toxocara canis and Fasciola species in patients with CU. We included 55 patients (in age 16-55) with urticaria admitted in study. As a control group we recruited 30 healthy volunteers they had no history of urticaria, rhinitis, asthma, atopic eczema/dermatitis syndrome (AEDS), or other relevant diseases. IgG antibodies to Toxocara canis and Fasciola species were investigated by ELISA method. In a total of 55 patients (mean age: 31.85 ± 8.92), 8 patients (14.5%) were positive for IgG antibodies to Toxocara canis. Among seropositive patients (mean age: 38.62 ± 12.46) 6 patients were female. No patient was positive for Fasciola by ELISA. Six of Toxocara canis seropositive cases were frequently visited or lived in rural areas and had contact with pets. Patients with urticaria, should be tested for Toxocara canis and treated with anthelminthic drugs in endemics areas for toxocariasis.

Different Timings of Prenatal or Postnatal Tobacco Smoke Exposure have Different Effects on The Development of Atopic Eczema/Dermatitis Syndrome (AEDS) during Infancy

Tobacco smoke is an important environmental factor for allergic diseases. Prenatal tobacco smoke exposure affects both fetal lung and immune function with increased subsequent risk of asthma and respiratory infection in infancy. About the skin, tobacco smoke increases the prevalence of wrinkling, skin cancer, psoriasis and systemic lupus erythematosus. The influence of tobacco smoke for the development of atopic eczema/dermatitis syndrome (AEDS) is controversial and when is the critical period unclear.

570 Atopy Patch Test to Aeroallergens Extracts is Useful In Allergic Diseases Diagnosis When Skin Prick Test is Negative

BackgroundThe atopic diseases are generally diagnosed by performing skin prick tests (SPTs) to different aeroallergens. However, when this study results negative, it is possible to perform atopy patch test (APT). This technique has been introduced to evaluate sensitization to aeroallergens in patients with atopic eczema dermatitis syndrome. Nevertheless, its role in other allergic diseases has not been proved. Objective: Evaluate aeroallergens response using skin prick test (SPT) and atopy patch test (APT) in patients with allergic diseases.MethodsRetrospective cohort study of individuals who performed SPT and APT as part of allergic diseases study. The study subjects were patch and skin prick tested to house dust mite (Dermatophagoides), trees, grass and fungi mix, cat and dog dander, among others. The tests were performed at the respiratory allergic disease center of Santa Maria Clinic in Santiago, Chile, between January 2010 and April 2011.ResultsFifty-five patients were included, 18 (33%) males and 37 (67%) females, median age 6 years (range from 3 months to 62 years), with the following diagnosis: atopic dermatitis syndrome (60%), allergic rhinitis (58%), contact allergic dermatitis (16%), asthma (9%), recurrent bronchial obstructive syndrome (7%), allergic rhinoconjuctivitis (4%), chronic cough (4%), recurrent acute otitis media (2%) and recurrent laryngitis (2%). They underwent usual SPTs and APTs with multiple aeroallergens extracts. Of the 55 patients, 22 showed a positive SPT and 32 a positive APT; in 14 (25%) both, SPT and APT were positive. In 8 (15%) the SPT was positive and APT negative, while in 18 (33%) the SPT was negative, but the APT positive. Fifteen (27%) were negative to both tests.ConclusionsOur results show that APT might be a useful diagnosis test in patients with allergic diseases and that its routine use can improve their diagnosis.

Reply

lettersReply Hossein Moravej Hossein Moravej Department of Pediatric, Nemazee Hospital, Shiraz, Iran Search for more papers by this author Email the corresponding author at [email protected] Published Online::1 Dec 2011https://doi.org/10.5144/0256-4947.2011.662SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionI read the letter from Dr. Mahmood Al-Mendalawi and his suggestion about the use of the atopy patch test (APT) rather than skin prick test (SPT) in infantile colic. SPT is a painful method for infants, but certainly it is simpler and less troublesome than dietary changes in infants.In our study, we found that the elimination of cow's milk from mother's diet in exclusively breast-fed infants had no effect on the symptoms of colic in infants with a negative SPT. We did not conclude that performing this test as a routine test for all cases of infantile colic. As mentioned in the article, more studies are needed to determine which patients will benefit from these tests.The atopy patch test is a good test, especially for diagnosis of late-phase clinical reactions, but the SPT is especially useful for diagnosis of immediate-type reactions.1,2 Although in multiple studies, the APT has been introduced as an acceptable method for diagnosis of food allergy, its sensitivity and specificity has been variable.3,4 As Dr. Al-Mendalawi mentioned, the predictive value of APT in infantile colic needs extensive comparative studies.ARTICLE REFERENCES:1. In: Cudowska B, Kaczmarski M. "Atopy patch test in the diagnosis of food allergy in children with atopic eczema dermatitis syndrome" . Rocz Akad Med Bialymst. 2005; 50:261-7. Google Scholar2. In: Chung BY, Kim HO, Park CW, Lee CH. "Diagnostic Usefulness of the Serum-Specific IgE, the Skin Prick Test and the Atopy Patch Test Compared with That of the Oral Food Challenge Test" . Ann Dermatol. 2010; 22:404-411. Google Scholar3. In: Lipozencic J, Wolf R. "The diagnostic value of atopy patch testing and prick testing in atopic dermatitis: facts and controversies" . lin Dermatol. 2010; 28:38-44. Google Scholar4. In: Wainstein BK, Kashef S, Ziegler M, Jelley D, Ziegler JB. "Frequency and significance of immediate contact reactions to peanut in peanut-sensitive children" . Clin Exp Allergy. 2007; 37:839-45. Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 31, Issue 6Nov–Dec 2011 Metrics History Published online1 December 2011 InformationCopyright © 2011, Annals of Saudi MedicineThis is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.PDF download

The atopy patch test: is it time to redefine its significance?

The atopy patch test (APT) was recently defined as an important tool in the diagnosis of atopic eczema/dermatitis syndrome (AEDS). Recent data showed that the APT may be positive also in patients with rhinitis or asthma. We examined the mechanisms that could underlie such findings. To locate relevant articles pertaining to the use of APT, MEDLINE databases from 1989 (when the APT was first introduced) to the present were searched. Articles concerning the results of APT in patients with AEDS and with rhinitis or asthma attributable to sensitization to inhalant allergens were examined. Recent data show that APT to dust mites is frequently positive, and it may be the only positive test, not only in subjects with AEDS but also in subjects with only respiratory symptoms (rhinitis, asthma) and a history of AEDS. Instead, positive skin prick tests and in vitro immunoglobulin (Ig) E tests prevail in patients with a negative history for AEDS. Based on the pathophysiology of AEDS, in which the mechanisms of delayed hypersensitivity are predominant, the APT seems to have a greater significance than skin prick tests or in vitro IgE tests in patients with current or past history of AEDS. That different sensitization mechanisms underlie these different clinical expressions seems conceivable. In particular, if mite allergens enter the skin in the presence of a filaggrin-dependent skin barrier dysfunction, the sensitization mechanism seems to be ultimately revealed by a positive APT.

Is Prediction of the Allergic March Possible on the Basis of Nasal Cytology?

The term allergic march has been used to describe natural evolution of the atopic disease in children, accompanied by the change in organ manifestation with time. The aim of the study was to analyze the role of the cellular components of the nasal cytology as a tool for prediction of atopic diseases and clinical symptoms preceding allergic march. In a retrospective manner out of a group of 1620 children, 146 symptomatic children (60 girls and 86 boys) meeting inclusion criteria (age below 4 years at first visit, symptoms suggesting allergy, nasal cytology performed at the beginning of observation, observation of at least 4 years) were included in analysis. Mean age of children at time of enrollment was 27 months (SD 10 months). After 4 years allergic rhinitis (AR) was diagnosed in 85 children (58.2%), atopic eczema/dermatitis syndrome (AEDS) in 51 (34.9%) and asthma in 48 (32.9%). Nonallergic etiology was identified in 36 patients (22.5%). All patients with asthma suffered from AR. Significant differences between groups were found in number of eosinophils (p < 0.001), neutrophils (p < 0.001), and lymphocytes (p = 0.028) in cytological examination of nasal mucosa. In children with AR (alone or combined with other comorbidities) nasal eosinophilia was higher than in children with AEDS (18% v. 3%; p = 0.004) or non-allergic disease (18% v. 4%; p < 0.001). Nasal eosinophilia of at least 8% was predictive for development of AR (sensitivity 80%, specificity 95%). In children below 4 years nasal eosinophilia >or= 8% was predictive for AR development. Allergic march was observed in children with AEDS or/and gastrointestinal allergy symptoms present at the beginning of observation. Nasal eosinophilia in small children might be predictive for the risk of allergic march.

Effect of Lactobacillus sakei supplementation in children with atopic eczema–dermatitis syndrome

Probiotics have been suggested to be useful in children with atopic eczema-dermatitis syndrome (AEDS). To assess the clinical effect of Lactobacillus sakei supplementation in children with AEDS. In a double-blind, placebo-controlled trial, children aged 2 to 10 years with AEDS with a minimum SCORing of Atopic Dermatitis (SCORAD) score of 25 were randomized to receive either daily L sakei KCTC 10755BP or daily placebo supplementation for 12 weeks. Changes in SCORAD scores and serum chemokine levels from baseline were evaluated. Eighty-eight children were enrolled, and 45 were allocated to probiotic treatment. Seventy-five children completed the study, with 4 dropouts in the probiotic group and 9 in the placebo group. At week 12, SCORAD total scores adjusted by pretreatment values were lower after probiotic treatment than after placebo treatment (P = .01). There was a 31% (13.1-point) improvement in mean disease activity with probiotic use compared with a 13% (5.2-point) improvement with placebo use (P = .008). Significant differences in favor of probiotic treatment were also observed in proportions of patients achieving improvement of at least 30% and 50%. Compared with placebo, probiotic administration was associated with lower pretreatment-adjusted serum levels of CCL17 and CCL27 (P =.03 for both), which were significantly correlated with SCORAD total score (r = 0.59 and 0.63, respectively; P < .001). Supplementation of L sakei in children with AEDS was associated with a substantial clinical improvement and a significant decrease in chemokine levels, reflecting the severity of AEDS.

Relationship between the atopy patch test and clinical expression of the disease in children with atopic eczema/dermatitis syndrome and respiratory symptoms

The atopy patch test (APT) may be the only positive skin test result in patients with either atopic eczema/ dermatitis syndrome (AEDS) or respiratory abnormalities with or without AEDS. To investigate the possible significance of APT to dust mite by comparing the positive result to this test with that of the skin prick test (SPT) in patients with different characteristics. A total of 297 individuals (178 boys and 119 girls) aged 5 to 221 months (mean [SD] age, 64.5 [42.1] months; median age, 58 months) were included in this study. Participants were divided into 4 groups: current AEDS, current AEDS and respiratory symptoms, past AEDS and respiratory symptoms, and respiratory symptoms with neither current nor past AEDS (control group). All the patients underwent SPT and APT using house dust mite extract. In the study groups, the rate of positivity was significantly higher for APT, whereas in the control group, there were significantly more positive results to SPT (P < .001 for both). Multivariate analysis showed that there was a high probability of a positive APT result in patients with AEDS (odds ratio [OR], 17.4), with AEDS and respiratory disease (OR, 21.9), and with past AEDS and respiratory disease (OR, 22.8). These patients with AEDS showed 2 different patterns of allergic response to allergens, one IgE mediated (as evaluated by positive SPT results) and the other cell mediated (as evaluated by positive APT results). The former seems to follow the so-called atopic march model, and the latter persists even after the disappearance of AEDS and is likely to be implicated in the pathogenesis of respiratory allergy.

Evaluation of an in vitro Mast Cell Degranulation Test in the Context of Food Allergy to Wheat

Background: Antigenic profiles obtained by ELISA with IgE from patients with wheat food allergy (WFA) established that major allergens are albumins/globulins (AG) for children suffering from atopic eczema/dermatitis syndrome (AEDS), ω5-gliadins for adults suffering from wheat-dependent exercise-induced anaphylaxis (WDEIA), anaphylaxis or urticaria and low-molecular-weight (LMW) glutenin subunits for patients with anaphylaxis. We aimed to characterize a new mast cell transfectant for its ability to degranulate with wheat proteins and patient sera and compare these results to those obtained by ELISA. Methods: Thirty sera from patients with WFA were tested: 14 with AEDS (group 1) and 16 with WDEIA, anaphylaxis or urticaria (group 2). An IgE Fc receptor (FcΕRI) humanized rat RBL-2H3 line was established by transfection with cDNAs encoding α-, β- and γ-subunits for the human IgE receptor. Results: A humanized RBL clone was selected for its capacity to express mRNA α-, β- and γ-subunits of FcΕRI, to bind allergen-specific human IgE and to degranulate. In group 1, sera induced enhanced degranulation with AG extract, but rarely reacted with gliadins and glutenins. In group 2, half of the sera showed degranulation with LMW glutenins whereas the AG fraction and lipid transfer proteins were rarely positive. ω5-Gliadins did not appear as a major allergen in degranulation assays, although functional allergen-specific IgE was measurable in appreciable amounts. Conclusion: Our data demonstrate that in wheat food allergen evaluation, correlation exists between mast cell degranulation and IgE measurements, depending on the type of allergen. Therefore, the biological activity of some allergen types may also be affected by other parameters.

Therapeutic indications to amino acid-based formula in infants with atopic eczema dermatitis syndrome

Therapeutic indications to amino acid-based formula in infants with atopic eczema dermatitis syndrome

The analysis of the severity of sensitization to extensively hydrolyzed cow's milk formula in infants with atopic eczema dermatitis syndrome

The analysis of the severity of sensitization to extensively hydrolyzed cow's milk formula in infants with atopic eczema dermatitis syndrome

IgE values and T-lymphocyte subsets in children with atopic eczema/dermatitis syndrome

High levels of IgE and IgE-mediated reactions represent a typical finding in patients with atopic eczema/dermatitis syndrome (AEDS). However, 10-30% of patients usually do not show any increase of total blood IgE levels and any detectable specific IgE sensitization. We performed this study to evaluate the difference of T-lymphocyte subsets in AEDS patients with high or normal IgE values. We enrolled 21 children with AEDS who were at least two years of age (8 boys and 13 girls, aged 2-13 years) and 20 children as control cases with the same age and sex. These patients were classified as IgE-associated AEDS or not IgE-associated AEDS syndrome according to their IgE levels. We used monoclonal antibodies against CD3 (T cells), CD4 (T-helper cells), CD8 (T-cytotoxic cells), CD 19 (B cells), CD56 and CD16 (natural killer cells), CD3/HLA-DR (activated T cells), CD45Ra in CD4 (naive lymphocytes), CD25 (interleukin-2 receptor), CD57 in CD3 (suppressor/cytotoxic), and CD5 in CD20 (Becton Dickinson, Mountain View, CA). The severity of atopic dermatitis (AD) was determined according to the Scoring Atopic Dermatitis (SCORAD) index. Moreover, we checked the levels of peripheral blood eosinophils and of total and specific IgE for a panel of inhalant and food allergens. We found that the CD8+ level was significantly lower and the CD4/CD8 ratio was significantly higher than in healthy cases. Moreover, patients with not IgE associated AEDS (aAD) showed CD4+ levels significantly higher than IgE aAD patients and healthy controls. We found no difference of the SCORAD index in the two groups but there was an inverse relationship between this index and CD4/CD8 ratio. We did not find any correlation between IgE levels and the SCORAD index between eosinophils and SCORAD index or between age and IgE values. A decrease of CD8+ circulating T cells and an increase of the CD4/CD8 ratio are peculiar findings in AEDS patients with either high or normal IgE values.

Vascular pattern of the palms ? a clinical feature of atopic skin diathesis

Atopic skin diathesis is a clinical term to describe skin atopics with previous, present or future atopic eczema/dermatitis syndrome (AEDS). In clinical practice, an unequivocal assessment of atopic skin diathesis in non-eczematous patients may be difficult. The majority of the known clinical features included in diagnostic scores are characteristic, but not specific markers of atopy. Especially, the vasoreactivity of atopic skin is disturbed. This is manifested by white dermographism, an irregular vascular response to thermal stimuli, and paradoxic skin reactions to histamine, cholinergic agents, and nicotinates. The aims of our study were to investigate the clinical morphology of palmar vascular reactions in skin atopic and non-atopic individuals, and to determine whether this abnormal vascular reaction is more pronounced in skin atopic individuals. Forty persons, 20 of them skin atopics, assessed by the Erlangen Atopy Score and an elevated serum IgE level (>150 U/ml), were included in a prospective single-centre study. Standardized digital photographs of the palms were presented in a blinded manner to five dermatologists in random order by means of the computerized imaging analysis system KS400 3.0. Evaluation of the original rgb (red, green, blue) color images and modified gray-level images showed that a pronounced reticular pattern of erythema of the palms was significantly (P < 0.0001) more common in skin atopics (72% and 69.6%, respectively). The gross vascular pattern of the palm might be an additional diagnostic feature of atopy, and further studies are needed to establish its exact prevalence.

Circulating Levels of Urokinase-Type Plasminogen Activator (uPA) and its Soluble Receptor (suPAR) in Patients with Atopic Eczema/Dermatitis Syndrome

Accumulating evidence has indicated that different immune and inflammatory processes may be accompanied by up-regulation of the uPA/uPAR system. Moreover, it has been suggested that the fibrinolytic system participates actively in immune-mediated skin disorders, including atopic eczema/dermatitis syndrome (AEDS). To study a possible role of such uPA/uPAR system in AEDS, we investigated circulating levels of uPA and suPAR in patients at different clinical stages of AEDS. Levels of u-PA and suPAR were measured by enzyme-linked immunoassay in plasma from 13 patients (five females and eight males; median age 27 years) with moderate AEDS, eight patients (three females and five males; median age 25.5 years) with severe AEDS, and 18 age- and sex-matched healthy subjects. Plasma levels of uPA and suPAR in AEDS patients did not differ significantly when compared with those in healthy subjects. Moreover, we failed to observe any significant differences in levels of these components between patients with moderate and severe AEDS and the controls. It seems that plasma levels of uPA and suPAR are similar in patients at the different stages of AEDS and the healthy subjects. Moreover, these data suggest that the release of uPA and its soluble receptor into the bloodstream is not increased in the course of complex immune-mediated processes associated with AEDS.

Induction of atopic eczema/dermatitis syndrome-like skin lesions by repeated topical application of a crude extract of Dermatophagoides pteronyssinus in NC/Nga mice

Mite antigen has been considered to play important roles in the development of atopic eczema/dermatitis syndrome (AEDS). In the present study, we attempted to induce an AEDS-like skin lesion in mice using Dermatophagoides pteronyssinus crude extract (DPE) as an antigen and performed pathophysiological evaluations. Ears of mice were tape-stripped and DPE was painted 3 times a week. Eczematous skin lesion and ear swelling were apparent in NC/Nga mice treated with DPE after 2 weeks, whereas neither skin lesion nor ear swelling were observed in BALB/c mice even after 30 days. Histological evaluation demonstrated that edema, epidermal hyperplasia and the accumulation of inflammatory cells were apparent in the ears of DPE-treated NC/Nga mice. In contrast to skin lesion and ear swelling, total serum IgE levels were increased in both NC/Nga and BALB/c mice. Treatment with DPE also increased auricular lymph node weight in both NC/Nga mice and BALB/c mice. To further characterize, we analyzed cytokine mRNA expression in ears and lymph nodes of DPE-treated NC/Nga mice. Increased expression of IL-4 and TNF-α mRNA was observed in both ears and lymph nodes of NC/Nga mice treated with DPE. Additionally, there was no change in the responsiveness of BALB/c mice to DPE treatment by adaptive transfer of serum from DPE-treated NC/Nga mice to BALB/c mice. Taken together, our results indicate that eczematous skin lesion and ear swelling caused by repeated application of DPE in NC/Nga mice has a Th2-dominant background and that inflammation is involved in this process. The animal model of AEDS established in this report may be used to investigate the pathogenesis of AEDS and evaluate the potential therapeutic agents for AEDS.

Diagnosis and treatment of atopic dermatitis in children and adults: European Academy of Allergology and Clinical Immunology/American Academy of Allergy, Asthma and Immunology/PRACTALL Consensus Report

There are remarkable differences in the diagnostic and therapeutic management of atopic dermatitis practiced by dermatologists and pediatricians in different countries. Therefore, the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma and Immunology nominated expert teams who were given the task of finding a consensus to serve as a guideline for clinical practice in Europe as well as in North America. The consensus report is part of the PRACTALL initiative, which is endorsed by both academies.