Allergic hyperreactivity to microbial components: A trigger factor of “intrinsic” atopic dermatitis?

To the Editor: Atopic dermatitis is a common, chronic, relapsing inflammatory skin disease characterized by typically distributed eczematous skin lesions and intense pruritus

Natalija Novak

2006

Scholarcy highlights

  • To the Editor: Atopic dermatitis is a common, chronic, relapsing inflammatory skin disease characterized by typically distributed eczematous skin lesions and intense pruritus
  • In the so-called non–IgE-mediated/nonallergic or intrinsic form, which has been reported to represent 10% to 30% of all patients with AD, patients have normal total serum IgE levels and no allergen-specific IgE against aeroallergens or food allergens, they exhibit the same clinical phenotype. These exotoxins can act as classical allergens and induce the production of functional relevant specific IgE antibodies, which trigger mediator release from sensitized basophils after IgE antibodies have been cross-linked with the appropriate antigen
  • Because skin colonization with microbial components is a common feature of both patients with high and low serum IgE levels, it was the aim of our study to determine the prevalence of circulating IgE antibodies with specificity to microbial products in the intrinsic subgroup of patients with AD
  • In the extrinsic form of AD, in 85% of the patients, allergen-specific IgE against aeroallergens or food allergens in combination with allergen-specific IgE against microbial components was detectable, whereas no allergen-specific IgE against microbial components was detectable in the control group, in which the serum IgE level was 11.4 ± 5.4 kU/L
  • At present, the presence and relevance of these allergen-specific antibodies in the skin of patients with AD has not been proved sufficiently. If this were the case, the clinical effect of IgE antibodies to microbial antigens might derive from their capability to promote the itch-scratch cycle in these patients, which later contributes the release of mast cell–derived mediator, leading to intense pruritus and the typical skin lesions of AD
  • We conclude that the determination of allergen-specific IgE levels against microbial components in the peripheral blood is important to classify a subgroup of patients with Atopic dermatitis in which the immune response might be predominated by a solely allergic hyperreactivity to microbial components

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