Atopy Patch Test Research Articles

The diagnostic value of atopy patch test (APT) with regard to late-phase clinical reactions to food in children with atopic dermatitis (AD)

Rationale Non IgE-mediated adverse responses to food tent to involve a T-cell mediated delayed hypersensitivity reaction that can be evaluated by the APT. The aim was to evaluate the diagnostic value of the APT with regard to late-phase reactions observed in double blind, placebo-controlled food challenges (DBPCFCs) with cow's milk, hen's egg, wheat, in children with AD. Methods One hundred and thirteen children [69 males, median age 4.2 years (range 4 months-12.7 years)] suffering from AD and suspected food-related clinical symptoms were investigated with APT and DBPCFCs. Results We found that late-phase clinical reactions to food observed in DBPCFCs were associated with a positive APT; the sensitivity to cow's milk was 64%, to hen's egg 86%, to wheat 100%; the specificity was 86% for milk, 73% for egg and 95% for wheat; positive predictive value was 47% for milk, 22% for egg, 40% for wheat; negative predictive values were 93%, 98% and 100% respectively. Of 229 DBPCFCs, 24 (40%) were assessed as positive for cow's milk, 32 (53%) for hen's egg, 4 (7%) for wheat. Out of 42 patients with APT positive reactions, 20 (53.8%) had positive response to hen's egg, 4 (10.8%) to milk, 4 (10.8%) to wheat, 12 (32.3%) to milk and egg, 2 (5.4%) to milk and wheat. Conclusions Our findings confirm that the APT may be a valuable additional tool in the diagnostic work-up of food allergy in children with AD because of its high specificity and sensibility for late-phase clinical reactions; however DBPCFC must be still considered the diagnostic gold standard test.

Short term exposure to volatile organic compounds enhances atopy patch test reaction

Rationale Exposure to indoor concentrations of NO 2 and formaldehyde was reported to cause disturbance of the epidermal barrier function in healthy volunteers and patients with atopic eczema (AE). No such data are available on VOC which are widely occurring indoor air contaminants. Methods A double-blind crossover study was carried out including 7 patients with AE and positive atopy patch test (APT) to house dust mite (HDM). The subjects were exposed to a mixture of 22 VOC or filtered air as control in an exposure chamber (40 m 3) for 4 h. VOC were added to the chamber air via air supply by a specially adapted micro-dosing system to generate the final TVOC-concentration of 5 mg/m 3 in the chamber air. Directly after the exposure an APT with either HDM or petrolatum as control was applied for 48 h to the upper back and graded according to the guidelines of the European Task Force on Atopic Dermatitis immediately and 24 h after removal of the APT. Results 6 out of the 7 patients showed an enhanced skin reaction to the APT with HDM after VOC exposure compared to the exposure to filtered air alone (p=0.0313; sign-test). Conclusions The results fit to other findings suggesting an impairment of the epidermal barrier function in patients with AE induced by VOC-exposure in concentrations encountered in indoor environments. This observation emphasizes the role of interactions between indoor air pollutants and allergens in atopic skin.

Cutaneous anaphylaxis in mice to Der p 2 independent of IgE and IgG 1

Rationale We have recently shown that immunoglobulin free light chains (IgLC) can elicit immediate hypersensitivity-like responses (Nature Medicine 8, 694, 2002). In this study, we investigated if cutaneous anaphylaxis to a major house dust mite (HDM) antigen could be induced by IgLC. Methods Mice were intradermally sensitized with two Der p 2-specific IgLC to different epitopes. At twenty hours mice received an intravenous challenge with HDM extract or recDer p 2 and changes in ear thickness were monitored. To investigate if anaphylaxis could be inhibited by a specific IgLC antagonist, F991, mice were injected i.p. with 50 microgram F991 at the time of sensitization. Results Intracutaneous injection of 2C5 and A4 followed by intravenous challenge with recDer p or HDM extract resulted in a rapid development of ear swelling reaching a maximum at 10 to 30 min after challenge. At 60 min post challenge, the ear thickness returned to basal levels. The PCA induced by crosslinking of Der p 2-specific Ig light chains could be completely prevented by F991. Conclusions The role of IgE in atopic dermatitis (AD) induced by aeroallergens remains controversial. Total or Ag-specific IgE does not always correlate with clinical symptoms. In several studies a discordance between the results from the atopy patch test or skin prick test and the levels of IgE specific for HDM were reported. We show that Der p 2-specific IgLC can elicit an IgE/IgG 1-independent cutaneous anaphylaxis. Our study suggests that induction of immediate hypersensitivity-like responses via IgLC might be responsible for positive skin reactions in non-atopic or intrinsic AD.

Wheat allergy in a child casting doubt on celiac disease in mother

Clinical case A child, birth weight 3220 g, was normally fed with gluten-containing foods introduced at 1 year and a weight curve on the 85th centile. At 15 months, following feeding refusal, loose stools and failure to thrive (weight 70th centile), a medical evaluation revealed negative prick tests with various foods, a positive wheat patch test, negative markers of celiac disease and eosinophilic infiltration of the duodenal mucosa, suggesting wheat allergy. A wheat elimination diet allowed the child to regain a normal growth curve. Parents clinical history was remarkable by a condition labeled celiac disease in the mother, diagnosed at age 13 months, following a 7 months period of stunting. The duodenal biopsy, performed at that time, is not available but mother evaluation carried out together with her son's investigation indicated the absence of celiac disease: despite a normal diet since age 10 years (negative anti-gliadine and anti-endomysium antibodies and a normal hemoglobin level), whereas a familial atopic background could be assessed by peanut allergy in the mother's twin sister. Conclusions 1) Revaluation of the data suggests that instead of celiac disease, the mother probably exhibited wheat allergy misdiagnosed celiac disease; 2) Wheat atopy patch test could be a useful tool to detect delayed reaction to wheat in the presence of digestive symptoms, diarrhea and failure to thrive, mimicking celiac disease; 3) Wheat allergy might account for some so-called celiac disease without villous atrophy and/or negative serology. Confusion between celiac disease and wheat allergy may be misleading and lead to unnecessary prolonged elimination diets.

Reproducibility of atopy patch tests with Dermatophagoides: a study on 85 patients with atopic dermatitis.

Atopy patch tests (APTs) are considered a useful addition to standard testing procedures for the identification of allergens triggering the appearance of eczema in patients with atopic dermatitis (AD). The aim of the study was to evaluate the reproducibility of APTs with house dust mites by simultaneously patch testing AD patients. 85 subjects affected by AD, 36 males and 48 females, aged from 1 to 52 years, were patch tested with Dermatophagoides mix (D. pteron/D. farinae) 20% pet. In our patients, the percentage of agreement between the frequency of positive and negative responses to Dermatophagoides mix was 96.7%. Reproducibility was highly satisfactory, as evaluated by k-value (0.953). As regards the agreement in the intensity of APT responses to Dermatophagoides mix between the right and left sides, we found that reproducibility was also highly satisfactory (k = 0.851). In conclusion, for Dermatophagoides APTs, the agreement rate was similar to that of standard patch tests, and therefore APTs may be considered sufficiently reproducible to be employed as a diagnostic testing procedure.

Influence of Age on the Outcome of the Atopy Patch Test with Food in Children with Atopic Dermatitis

Influence of Age on the Outcome of the Atopy Patch Test with Food in Children with Atopic Dermatitis

Allergy and irritation: an adverse association in patients with atopic eczema.

The pathomechanism of atopic eczema is complex. Two of the most important exogenous factors for atopic eczema are allergenic and irritant substances. In this study we investigate the combined effect of topical aeroallergens and irritation on the skin of atopic individuals. We performed patch testing with several aeroallergens (atopy patch test) and with an irritant, sodium lauryl sulphate, on clinically unaffected skin of 30 sensitized patients with atopic eczema. Application was conducted alone and as a consecutive application. Healthy volunteers served as controls. Evaluation was made by measurement of transepidermal water loss 2 h after removal of the patches. In atopic patients, we found increased levels of transepidermal water loss induced by the aeroallergens as well as by sodium lauryl sulphate. The most impressive barrier disruption was seen after application of house dust mite, followed by cat dander and grass pollen. However, the consecutive application of aeroallergens and sodium lauryl sulphate led to a highly pronounced increase in transepidermal water loss. Hence, in sensitized atopic subjects the combined effect of aeroallergens and detergents may cause severe skin problems, and this may be relevant in daily practice.

Combined skin prick and patch testing enhances identification of peanut-allergic patients with atopic dermatitis.

Food atopy patch tests (APTs) are considered a useful tool for the diagnosis of food allergy. Hypersensitivity to peanuts has not been investigated by means of APTs so far. APTs and skin prick tests (SPTs) with peanuts were performed in 136 atopic dermatitis (AD) patients. Relevance of positive and negative responses to these tests was assessed by repeated open challenges with peanuts. Nine percent of our AD patients reacted to the challenge. Positive responses to APTs were recorded in 19% of the patients, whereas in 12% positive SPTs were observed. APTs were more frequently positive in subjects with eczematous responses after challenge with respect to those with urticarial reactions. SPT reactivity proved to be higher in patients above 12 years of age, whereas APT positivity was more frequent in children under 6 years. APT sensitivity proved significantly higher than SPT sensitivity, in particular in children under 12 years of age. On the contrary, SPT specificity and positive predictive value were significantly higher with respect to those of APT in the age group of subjects under 6 years of age. Our data suggest that APTs with peanuts may represent a useful integration to standard testing modalities employed for the diagnosis of peanut allergy in AD patients.

Frequency and intensity of responses to mite patch tests are lower in nonatopic subjects with respect to patients with atopic dermatitis.

So far the issue of patch tests with mite allergens in subjects not affected by atopic dermatitis (AD) has been poorly investigated. The aim of this study was to assess the frequency and intensity of responses to atopy patch tests with Dermatophagoides in non-AD subjects, and to compare them to the ones observed in AD patients. Patch tests were performed, employing a mixture of Dermatophagoides pteronyssinus and farinae at two different concentrations (20 and 40% pet.), on 75 non-AD subjects, including 33 patients with allergic rhinitis and 42 healthy volunteers, and on 210 AD patients, as controls. Positive responses to 20% mite patch tests were observed in 17 non-AD subjects (23%) and in 102 AD ones (49%). The former showed a lower intensity of the responses, with a mean score of 1.4 compared with 2.1 in atopics. Although positive responses to mite patch tests are also observable in subjects without AD, their frequency and intensity are significantly lower compared with AD patients.

Atopy patch test reactions show a rapid influx of inflammatory dendritic epidermal cells in patients with extrinsic atopic dermatitis and patients with intrinsic atopic dermatitis

Background: Normal human skin harbors a single epidermal dendritic cell (DC) population, the CD1a +++CD11b − Langerhans cells. In many chronic inflammatory skin diseases, the epidermal DC pool bears a second population, the CD1a +CD11b +++ inflammatory dendritic epidermal cells (IDECs). Immunophenotypic, ultrastructural, and functional aspects of IDECs have been investigated in chronic untreated skin lesions of intrinsic and extrinsic atopic dermatitis (AD), contact dermatitis (CD), and psoriasis, but little is known about freshly induced early skin lesions. Objective: We sought to characterize enumerative and immunophenotypic changes in the epidermal DC pool during the development of eczematous skin lesions. Methods: The atopy patch test with aeroallergens and food-protein allergens and a conventional patch test with standard-series haptens were performed as models for early skin lesions of extrinsic and intrinsic AD and CD, respectively. After 72 hours, epidermal cell suspensions were prepared, analyzed in a standardized flow cytometric technique, and compared with the results obtained from chronic lesions. Results: The migration of IDECs into the epidermis occurs within 72 hours and is thus an early event. It continues in chronic AD, but not in chronic CD, lesions. The specific upregulation of FcϵRI, especially on IDECs, occurs later during formation of extrinsic but not intrinsic AD lesions. LCs were negative for Cd36 in patch test lesions, whereas in chronic skin lesions, LCs expressed Cd36. Conclusion: The DC alteration during skin lesion formation can be subdivided into early and late events, with the influx of IDECs as an early event and the alteration of the DC phenotype as a late event. (J Allergy Clin Immunol 2003;111:869-74.)

Atopy patch test reactions to Malassezia allergens differentiate subgroups of atopic dermatitis patients.

The yeast Malassezia is considered to be one of the factors that can contribute to atopic dermatitis (AD). To investigate the reactivity to Malassezia allergens, measured as specific serum IgE, positive skin prick test and positive atopy patch test (APT), in adult patients with AD. In total, 132 adult patients with AD, 14 with seborrhoeic dermatitis (SD) and 33 healthy controls were investigated for their reactions to M. sympodialis extract and three recombinant Malassezia allergens (rMal s 1, rMal s 5 and rMal s 6). Sixty-seven per cent of the AD patients, but only one of the SD patients and none of the healthy controls, showed a positive reaction to at least one of the Malassezia allergens (extract and/or recombinant allergens) in at least one of the tests. The levels of M. sympodialis-specific IgE in serum correlated with the total serum IgE levels. Elevated serum levels of M. sympodialis-specific IgE were found in 55% and positive APT reactions in 41% of the AD patients with head and neck dermatitis. A relatively high proportion of patients without head and neck dermatitis and patients with low total serum IgE levels had a positive APT for M. sympodialis, despite lower proportions of individuals with M. sympodialis-specific IgE among these groups of patients. These results support that Malassezia can play a role in eliciting and maintaining eczema in patients with AD. The addition of an APT to the test battery used in this study reveals a previously overlooked impact of Malassezia hypersensitivity in certain subgroups of AD patients.

Advances in anaphylaxis and hypersensitivity reactions to foods, drugs, and insect venom

This review highlights some of the research advances in anaphylaxis and hypersensitivity reactions to foods, drugs, and insect venom that were reported primarily in this Journal from 2001 to 2002. Among the topics highlighted: Epinephrine injected intramuscularly into the thigh provides the most efficient absorption profile for adults and children; determination of serum IgE antibody-specific food allergen concentrations and atopy patch tests with foods show promise for enhanced diagnostic accuracy; numerous food allergens are now characterized on the molecular level, allowing for improved diagnostic and treatment modalities; the complex immunologic mechanisms underlying drug hypersensitivity reactions are being elucidated; venom immunotherapy improves quality of life for sufferers, and increased venom immunotherapy doses are useful in recalcitrant cases. (J Allergy Clin Immunol 2003;111:S829-34.)

The atopy patch tests for detection of cow's milk allergy with digestive symptoms

Infants (n = 35) with digestive symptom were investigated for diagnosis of cow's milk allergy (CMA). Milk atopy patch tests (APTs) were positive in 19 of 24 CMA versus 1 of 11 in non-CMA patients (P <.001). This sensitivity (79%) and specificity (91%) suggest that the APT could improve the detection of conditions related to CMA. (J Pediatr 2003;142:203-5)

Atopy patch tests in young adult patients with atopic dermatitis and controls: dose-response relationship, objective reading, reproducibility and clinical interpretation.

The clinical interpretation and reproducibility of atopy patch tests was studied in 23 selected young adult patients with atopic dermatitis and 25 healthy controls using standard inhalant allergens. Non-invasive measurements were used for objective assessment of test reactions and the participants were retested after 6 weeks. Ten of 19 (53%) evaluable patients with atopic dermatitis had at least one positive atopy patch test. However, there was no clear clinical relevance of the atopy patch test results when related to patient history and distribution of dermatitis. Reproducible and dose-dependent results were obtained with Dermatophagoides pteronyssinus, grass and cat with a reproducibility rate of 0.69 to 0.81 in patients and 0.60-0.96 in controls. A unique finding was a significant positive correlation between a positive atopy patch test, allergen dose and increase in transepidermal water loss and erythema, while measurement of capacitance did not distinguish between positive and negative reactions. The results of the present study do not support the routine use of atopy patch tests in the evaluation of adult patients with atopic dermatitis.

An Evaluation of Cockroach Allergies in Atopic Dermatitis

Background: Atopic dermatitis (AD) is primarily influenced by environmental factors including exposure to pollutants and indoor allergens (particularly, house dust mites). Although house dust mite antigens are the most prevalent components of indoor allergens in Korea, cockroaches also can be considered to act as an important allergen. Object: This study was done to evaluate the differences in three different atopic patch test(APT) techniques, and the relationship between APT and skin prick test, total IgE, and specific serum IgE level using cockroach allergen. Methods: We performed patch test in 57 patients with AD and 30 normal controls on clinically lesional and normal appearing skin with German cockroach (GC) allergens (extract, as is) in three different techniques (standard, scratch, DMSO). Reactions were evaluated after 48hours, and compared with the results of skin prick test, total and specific IgE levels. Detailed atopy history and severity scoring were taken. Results: In the GC (whole body) prick test positive group, there was 1263.02 IU/ml of total IgE, and this amount was significantly higher than GC (whole body) prick test negative group who had 549.46 IU/d (p<O.05). The positive reaction rate to whole body of American cockroach (AC) was significantly higher in the patient group than control group (p<O.05 ), but the positive rate to whole body of GC was high, but not significantly high in the patient group (p=0.053). There were significant differences in positive patch test reactions to either Ext or As is between patient group and control group (p<0.05 ). The positive rate to As is was significantly higher than to Ext in either lesional skin or non-lesional skin in patient group (p<0.05). But there were no considerable differences in positive reactions to either Ext or As is between 3 different methods (standard, scratch, DMSO mix) in both lesional and nan-lesional areas (p<0.05). There was no significant relationship between the positive reactions to patch test and prick test to Ext and As is antigen. The APT results showed no significant concordances with skin prick test and RAST for cockroach antigens. Conclusions: APT seems to be a different dimension of atopic skin inflammation and may provide further diagnostic information in addition to a patients history, skin prick test, and RAST results.

Adult-Onset Atopic Dermatitis in a Patch Test Population

Background: Epidemiological studies about atopic dermatitis (AD) almost exclusively relate to childhood disease with little mention of adult-onset disease. In clinical practice, however, patients who have AD and in whom the onset of disease occurs in adult life are sometimes seen. Objective: Because the subjects with a chronic and recalcitrant eczema are frequently patch tested, the aim of this study was to evaluate the prevalence of adult-onset AD in a patch test population and the differences existing between the early- and adult-onset subsets. Methods: This retrospective analysis was performed on 502 adults (458 males, 44 females) affected by eczematous dermatitis, consecutively examined in the Department of Dermatology of the Italian Navy Hospital in Taranto. In this department, all the eczematous subjects are routinely submitted to the following tests: standard series (GIRDCA or SIDAPA with integrative haptens), prick test with environmental aeroallergens and common food allergens and dosage of total serum IgE. If it is required, additional series of patch tests are also applied. Many patients are also submitted to the atopy patch test (APT) with whole bodies of house dust mites at a concentration of 20%. In the AD patients, diagnosed according to the criteria of Hanifin and Rajka, the ages of onset were subdivided into the following categories: infancy (0–3 years); childhood (4–11 years); adolescence (≧12 years). We arbitrarily also used the age of 18 years as the cut-off mark to allocate the patients to the adult-onset group (AOG) and defined as early-onset group (EOG) the cases encompassed in the aforesaid categories (i.e. onset ≤17 years). Results: 8.8% of all eczemas were adult-onset ADs. 28 (5.6% of all eczemas) adult-onset ADs were ‘sole’ ADs, while 22 cases (3.2% of all eczemas) were adult-onset ADs in which a contact sensitization was detected. The mean SCORAD indexes, according to the age-of-onset groups, decreased when the age of onset increased. No statistical difference was detected between the EOG and AOG with regard to true contact sensitization, clinically relevant or non-relevant contact sensitization, prevalence of ‘pure’ AD and ‘mixed’ AD, and outcome of the APT. The hands were the most frequently affected site in the AOG. Conclusion: A small but significant number of patch-test-negative eczematous cases could be adult-onset ADs and, in this instance, the other two allergological tests (i.e. prick tests and dosage of total serum IgE) and an accurate evaluation according to stated clinical criteria should be performed. However, other studies on large series of patients are required to confirm our observation.

Diagnostic accuracy of the atopy patch test and the skin-prick test for the diagnosis of food allergy in young children with atopic eczema/dermatitis syndrome.

To evaluate the diagnostic value of the skin-prick test and the atopy patch test in diagnosing basic food allergy in young children suffering from atopic eczema/dermatitis syndrome. 141 children, the majority under 2 y of age (mean 16 mo) with atopic eczema/dermatitis syndrome were investigated using skin-prick and atopy patch tests for milk, egg, wheat and rye. Open diagnostic elimination challenge was done since this has been reported to be a reliable method in young children. A positive challenge response was found to milk in 63 (45%), egg in 78 (55%), wheat in 61 (43%) and rye in 61 (43%). Sensitivity/specificity of the atopy patch test was 60%/97% for milk, 71%/97% for egg, 90%/94% for wheat and 93%/90% for rye. For the skin-prick test the corresponding figures were 41%/99%, 60%/97%, 13%/98% and 15%/99%. Patch testing was found to be a more sensitive method than the skin-prick test in diagnosing food allergy in children with atopic eczema/dermatitis syndrome, especially in those under 2 y of age. Many children with a negative skin-prick test result have a positive patch test result, especially in the case of cereals. A diagnosis of food allergy should be confirmed by elimination and in the research setting also by challenge.

Diagnostic accuracy of the atopy patch test and the skin‐prick test for the diagnosis of food allergy in young children with atopic eczema/dermatitis syndrome

Aim: To evaluate the diagnostic value of the skin‐prick test and the atopy patch test in diagnosing basic food allergy in young children suffering from atopic eczema/dermatitis syndrome. Methods: 141 children, the majority under 2y of age (mean 16 mo) with atopic eczema/dermatitis syndrome were investigated using skin‐prick and atopy patch tests for milk, egg, wheat and rye. Open diagnostic elimination challenge was done since this has been reported to be a reliable method in young children. Results: A positive challenge response was found to milk in 63 (45%), egg in 78 (55%), wheat in 61 (43%) and rye in 61 (43%). Sensitivity/specificity of the atopy patch test was 60%/97% for milk, 71%/97% for egg, 90%/94% for wheat and 93%/90% for rye. For the skin‐prick test the corresponding figures were 41%/99%, 60%/97%, 13%/98% and 15%/99%. Conclusion: Patch testing was found to be a more sensitive method than the skin‐prick test in diagnosing food allergy in children with atopic eczema/dermatitis syndrome, especially in those under 2 y of age. Many children with a negative skin‐prick test result have a positive patch test result, especially in the case of cereals. A diagnosis of food allergy should be confirmed by elimination and in the research setting also by challenge.

Results of atopy patch tests with house dust mites in adults with 'intrinsic' and'extrinsic' atopic dermatitis.

The most frequently employed diagnostic criteria of atopic dermatitis (AD) can be fulfilled in the absence of elevated total circulating IgE or specific IgE to food allergens or environmental aeroallergens and/or in the absence of personal or familial history of atopy as well. Therefore a distinction between 'extrinsic' or 'allergic' and 'intrinsic' or 'non-allergic' AD has been suggested. Recently, a patch test with environmental aeroallergens, named atopy patch test (APT), has been proposed for use in the study of AD. OBJECTIVE The aim of this study was to investigate the reactivity to APT in patients with 'extrinsic' and 'intrinsic' AD. Two groups of adult male subjects with AD were examined consecutively in our department (Department of Dermatology, Italian Navy Main Hospital, Taranto, Italy) andpatch tested with whole bodies of house dust mites (HDM) at a concentration of 20% in petrolatum (Dermatophagoides pteronyssinus 50%, D. farinae 50%). The groups included: (i) 95 patients affected by the adult clinical form of 'extrinsic' AD; (ii) 12 patients affected by the adult clinical form of 'intrinsic' AD; and (iii) a control group of 49 adult healthy male subjects with a negative anamnesis for eczema and atopy and negative skin prick test to aeroallergens/food allergens and/or normal level of total circulating IgE, also patch tested with the same allergen. The statistical differences were calculated by chi2 test and 95% confidence intervals (CI) were provided. The APT was positive in 47.4% (CI: 37-57%) of'extrinsic'AD, in 66.6% (CI: 41-93%) of'intrinsic' AD and in 12.2% (CI: 3-21%) of healthy subjects. The differences between the two AD subgroups and the control group were statistically significant (P < 0.001). APT positivity is more frequent in both 'extrinsic' and 'intrinsic' AD than in unaffected subjects. Other studies are needed to confirm our data and to explain why the APT is positive in the 'intrinsic' form.

Historische Aspekte der Hausstaubmilbenallergie

Background: Previous reviews on historical aspects of house dust mite allergy do not mention ancient authors. Furthermore, the German speaking literature from the first half of the 20th century is underrepresented. Methods: Therefore, we investigated ancient greek and roman literature as well as german literature from the period 1900 until 1950. Also, reviews listed in Medline were considered. Results: In ancient times, Hippokrates, Galen, Celsus and Pliny the Older mentioned untoward effects of dust on the skin and on the mucous membranes. In the german speaking literature from the first half of the 20th century, there was a discussion whether dust allergens could be a relevant provocation factor of atopic dermatitis. However, the interest into this topic diminished in the following years. But in the 1960s, with the discovery of Dermatophagoides pteronyssinus as major allergenic house dust mite, researchers began again to investigate the indoor environment as triggering factor of asthma. With respect to atopic dermatitis, the first description of the atopy patch test in 1982 renewed the interest in dust mites as pathogenetically relevant factor for the skin manifestation of atopy. Conclusion: Dust is known for hundreds of years as provocation factor of skin and respiratory disease. However, the interest into this topic varied with time.