Characteristics of extrinsic vs. intrinsic atopic dermatitis in infancy: correlations with laboratory variables

BACKGROUND: Atopic dermatitis (AD) has been divided into the extrinsic type (ADe) and the intrinsic type (ADi) according to the serum IgE levels and the presence or absence of allergen-specific IgE. Although previous studies have demonstrated differences in the various immunological parameters, the characteristics of AD in infancy have rarely been reported. OBJECTIVES: Our study was performed to analyse the correlations between the laboratory parameters of infantile ADe and ADi. METHODS: We recruited 237 infants with AD and checked the SCORAD index, the number of peripheral blood eosinophils, the serum eosinophil cationic protein (ECP) levels, the total serum IgE levels and the specific serum IgE levels in all the patients. We also checked the serum interleukin (IL)-4 and IL-5 levels in 20 patients with ADe and in 20 with ADi. RESULTS: This study showed many peculiar characteristics of infantile AD. In infancy, ADi was more prevalent than ADe. The eosinophil count, the ECP level and the SCORAD in ADi were lower than in ADe. Furthermore, a group of patients without characteristics of ADi or ADe could be identified. We tentatively classify this group as indeterminate type (ADind) and propose it as a separate entity. The clinical severity was well correlated with the eosinophil count and the serum ECP levels in ADe and ADi. Therefore these two parameters could be used as clinical severity markers in infancy. Infants are more allergic to food, and the variety of specific allergenic responses was connected with clinical severity. A higher eosinophil count, a higher ECP level and a higher detection rate of IL-5 in the peripheral blood of infants with ADe means that eosinophils have a more prominent role in ADe than in ADi. CONCLUSIONS: Infantile AD has many distinctive features in its laboratory variables as compared with AD in other age groups. Clinicians should recognize these facts when they deal with infants with AD, and further studies are warranted on the natural course of infantile AD.     

Eosinophil cationic protein in atopic dermatitis: changes of serum levels by the anti-allergic agent ketotifen *

Background Eosinophil cationic protein (ECP) is a highly basic protein (pI over 11) with molecular weight ranging from 18.5 to 22 kDa, and is released upon eosinophil activation. ECP is stored in the eosinophil granules and has potent bactericidal, helminthotoxic, cytotoxic and neurotoxic effects. ECP levels in scrum and other body fluids are often elevated in allergic diseases and other inflammatory conditions and their measurement may give information regarding eosinophil involvement in a pathological process. Material and Methods We evaluated the scrum levels of eosinophil cationic protein (ECP), assayed using an ECP radioimmunoassay kit, and the effect of an anti-allergic agent, ketotifen, which has a potent anti-eosinophil activity, in atopic dermatitis (AD) patients. Serum ECP levels in AD patients correlated with the severity of AD as determined in clinical evaluations. Results In patients with severe and moderate AD, serum ECP levels were significantly higher (31.04 ± 3.35 μg/1, n= 32) than in non-atopic controls (4.92 ± 1.06 μg/1, n= 16) (P < 0.001). However, no significant correlation was observed between serum ECP and IgE levels, or between serum ECP levels and peripheral eosinophil count. After a 4-weck administration of ketotifen (1 mg; twice a day), in AD patients with serum ECP levels more than 20 μg/I (n= 14), serum ECP levels decreased significantly (from 44.17 ± 4.53 to 18.46 ± 3.35 μg/1, P < 0.05). Conclusion The results suggest that serum ECP levels are a useful indicator of AD activity and of the effect of anti-allergic agents on eosinophil involvement in AD.     

Serum Levels of Eosinophil Cationic Protein Reflect the State of In vitro Degranulation of Blood Hypodense Eosinophils in Atopic Dermatitis

In patients with atopic dermatitis (AD), serum levels of eosinophil cationic protein (ECP) have been shown to be a good reflector of disease severity. To elucidate what serum levels of ECP actually reflect, ECP levels in serum and plasma and cytological aspects of blood eosinophils were examined in AD patients (n=27) and compared to healthy subjects (n=12). Significantly elevated levels of serum ECP were noted in AD patients, while plasma ECP were uniformly recorded at nadir levels in both AD patients and normal subjects. In addition to blood eosinophilia, AD patients had significantly increased numbers of hypodense eosinophils (HEo) with morphological characteristics consistent with an activated state. Serum ECP levels strongly correlated with HEo numbers rather than with total eosinophil counts. These results indicate that elevated levels of serum ECP may be a consequence of in vitro degranulation of “activated” HEo, not of ECP supplementation from lesional skin. In addition, the dynamic correlations of eosinophil-associated parameters (total eosinophil counts, HEo numbers, and serum ECP levels) with AD severity suggest that inflammatory events in lesional skin may be involved in causing not only eosinophilopoiesis in bone marrow, but also development of HEo in the periphery, whose degree in turn may be mirrored in the levels of serum ECP in vitro.     

Serum eosinophil cationic protein in children with atopic dermatitis

BACKGROUND: Eosinophil cationic protein (ECP) is a cytotoxic agent secreted by activated eosinophils during allergic and inflammatory processes. The aim of the study was to determine the ECP level, absolute and relative eosinophil count and IgE antibodies in children with atopic dermatitis (AD) compared with those of nonatopic children, and to assess the correlation of these laboratory parameters with the clinical severity of AD. METHODS: This prospective study comprised 70 children. There were 49 children with AD aged 3-36 months, and the control group comprised 21 children with a negative personal and family history for atopic diseases. Detailed history, serum ECP levels (UniCAP FEIA), relative and absolute eosinophil counts and total serum IgE antibodies were determined in both groups. In the children with AD, skin involvement was measured by the SCORAD index. RESULTS: The calculated SCORAD index was between 16 and 83. IgE antibodies, relative and absolute eosinophil counts showed a significantly wider range of values and a statistically higher median (P < 0.001) in the patients with AD compared with the control group. These laboratory parameters did not correlate with the severity of AD. The serum ECP median level, in the children with AD, was 16.2 microg/L (range 3.01-65.30) compared with 5.92 microg/L (range 2.76-21.90) in the control group. Correlation of the total SCORAD index and the serum ECP levels was negative, weak (r = -0.065) and statistically not significant (P > 0.05). The same was found for the correlation of serum ECP and intensity of skin changes (r = -0.095) and serum ECP and subjective symptoms (r = -0.045). The correlation was positive, but weak and statistically not significant for the serum ECP and extent of the skin lesions (r = 0.079, P > 0.05). CONCLUSION: Elevated levels of ECP, relative and absolute eosinophil counts, as well as IgE antibodies were determined in the patients with AD. As these laboratory findings did not correlate with the severity of AD, they can be considered only as additional methods in the evaluation of patients with AD.     

Correlation of eosinophils, eosinophil cationic protein and soluble interleukin-2 receptor with the clinical activity of atopic dermatitis.

To evaluate the correlation with the clinical activity of atopic dermatitis (AD) we investigated prospectively cellular and serological parameters such as eosinophils, eosinophil cationic protein (ECP), soluble IL-2 receptor (sIL-2R), soluble CD23 (sCD23) and lactate dehydrogenase (LDH) in peripheral blood of 37 AD patients on admission to and discharge from the Department of Dermatology at the University Hospital in Zurich. On admission the actual clinical skin condition as measured by the skin intensity score (SIS) was significantly correlated with eosinophils (p less than 0.005), ECP (p less than 0.05) and sIL-2R (p less than 0.001). During the observation period a significant improvement in the clinical status as measured by the SIS was observed in all AD patients (p less than 0.001). A significant decrease in sIL-2R (p less than 0.005), which was most pronounced in the group of AD patients receiving systemic steroids, together with a decrease in eosinophils and ECP but not in sCD23 and LDH could be demonstrated between admission and discharge. In addition, a slight but significant increase in peripheral blood lymphocytes (p less than 0.005) and monocytes (p less than 0.01) was noted. Comparing the 'extrinsic' (n = 32) and the 'intrinsic' (n = 5) types of AD no significant differences with regard to the above mentioned parameters were found. Our data indicate that cellular and serological parameters such as eosinophils, ECP and sIL-2R reflect the clinical activity of AD and may therefore give further insights into the pathogenesis of this disease.     

Specific IgE and skin tests to house dust and storage mites and eosinophil cationic protein in scabies

Background In addition to the infestation with scabies mites also allergic IgE mediated mechanisms play a role in the pathogenesis of scabies. Aim The aim of this study was to answer the question whether specific IgE mediated reactions to house dust and storage mites can be found and whether eosinophils are involved in the pathogenesis of scabies. Material 44 scabies patients (12 children. 32 adults) were classified according to the extent of skin involvement as mild, moderate and severe. Age- and sex-matched healthy controls and patients with atopic dermatitis were studied for comparative purposes. Methods Total and specific IgE to Dermatophagoides pteronyssinus, D. farinae, Acartis siro and Pityrosporon ovale were tested by CAP-FEIA (Pharmacia. Sweden) before and 6 weeks after treatment and prick tests were performed with the same allergens. The number of eosinophils in the peripheral blood and tissue specimens was counted and the eosinophil cationic protein (ECP) was determined by CAP-FEIA in serum before and 6 weeks after therapy. Results The total IgE was increased in 86% of patients. It was correlated with the extent of skin involvement (p < 0.05) and was significantly less increased 6 weeks after treatment (p < 0.115). Specific IgE to house dust and storage mites was increased up to 48% in the CAP-EEIA and up to 61% in the prick test, all together significantly higher than in controls and in comparable frequencies with atopic dermatitis. Pityrosporon ovate IgE was within normal ranges. Die ECP levels were increased in 89% of patients and correlated only in mild versus moderate or severe extent of the disease. 6 weeks after treatment, however, they were significantly less increased (p < 1.01). In addition. ECP levels were correlated with the IgE levels in scabies (C = 0.88). The number of eosinophils in the peripheral blood was increased in 64% of cases and in tissue specimens in 84% of cases studied. In principle, the extent of skin lesions was milder and the frequencies of specific IgE in the CAP- and prick test as well as the levels of total IgE (p < 0.01) and ECP (only in the tendency) were lower in children than in adults. Discussion The frequencies in the total and specific IgE to house dust and storage mites are comparable with those in atopic dermatitis. The question remains open, whether this is due to cross reactivity with scabies mites or whether this suggests an enhanced susceptibility to generalized scabies eruption. The increase in the ECP and its correlation to IgE, its decline after treatment (p < 0.05) and the occurrence of eosinophils in the peripheral blood and in inflammatory infiltrates of the skin suggest the involvement of eosinophils in the pathogenesis of scabies as an ectoparasitic IgE mediated disease.     

Serum eosinophil derived neurotoxin may reflect more strongly disease severity in childhood atopic dermatitis than eosinophil cationic protein

Serum levels of eosinophil cationic protein (ECP) have been shown to be a good parameter of the disease severity of patients with atopic dermatitis (AD). However, the relationship between the disease severity and the eosinophil derived neurotoxin (EDN) has not been established in AD patients. The purpose of this study is to examine serum ECP and EDN levels in relation to the disease severity in AD children. Serum ECP and EDN levels were assessed in relation to the skin scores in 34 AD children (18 boys and 16 girls; age 0.6 to 7years: mean+/-S.D. 2.2+/-1.9) and six non-atopic control children (three boys and three girls; age 1 to 3years: mean+/-S.D. 1.7+/-0.9). Serum ECP and EDN levels of the patients with AD were significantly increased compared with the non-atopic controls. Serum EDN levels of the patients were also related to the disease severity. The skin scores were more significantly correlated with serum EDN levels than ECP levels. We concluded that serum EDN may reflect more strongly disease severity as eosinophilic activation in AD children than serum ECP.     

Selected eosinophil proteins as markers of inflammation in atopic dermatitis patients

Atopic dermatitis (AD) is an inflammatory skin disease characterized by chronic and recurrent course, beginning primarily in early childhood. The etiopathogenesis of AD has not yet been fully understood, although various types of inflammatory cells including eosinophils may be involved in its pathomechanism. The basic aim of the study was to evaluate the usefulness of selected eosinophil proteins in serum and urine of AD patients, as markers of disease severity. The study also aimed to analyze correlations between the level of examined proteins and parameters such as skin prick test (SPT) results, serum concentration of total IgE, and coexistence of symptoms of other atopic diseases. The study included 30 AD patients and two control groups: 30 patients suffering from chronic urticaria and 30 healthy individuals. The mean level of eosinophil proteins measured in serum and urine of AD patients was higher than that in controls, although a significant difference was only recorded for serum and urine level of eosinophil protein X (EPX). Patients with very severe/severe AD presented higher levels of eosinophil proteins than patients presenting with mild/moderate AD, although no significant difference was found between these two groups. AD patients with positive SPT results and detectable specific IgE in serum, and with coexisting symptoms of other atopic diseases presented with higher mean levels of serum and urine eosinophil proteins than AD cases with negative SPT results and without any symptoms of other atopic diseases. In children suffering from AD, serum eosinophil cationic protein level, EPX level and urine EPX level were higher than those in healthy children, however, without statistical significance. Study results suggested a significant role of eosinophils in the etiopathogenesis of AD. Serum and urine levels of selected eosinophil proteins may serve as an important part of diagnostic approach to AD patients, especially in differentiation of allergic and non-allergic forms of AD. The results are also promising for the usefulness of selected eosinophil proteins in the diagnosis of AD in children, however, thorough analysis on a larger group of patients is needed.     

Serum eosinophil cationic protein (ECP) is a sensitive measure for disease activity in atopic dermatitis

Atopic dermatitis (AD) is characterized by alterations in cellular and humoral immunity including elevated serum levels of IgE, IL-2 receptor (IL-2R) and eosinophil cationic protein (ECP). In order to evaluate the relevance of these serum parameters as indicators of disease activity, the concentrations of IgE, IL-2R and ECP were measured in serum samples of patients with an acute exacerbation of AD (n = 19) on admission to hospital and every 6 days up to discharge, and compared with those from normal non-atopic controls (n = 15). The severity of the disease in the AD patients was examined using an established clinical scoring system. On admission, AD patients showed significantly elevated serum levels of IgE, IL-2R and ECP compared with normal controls (P less than or equal to 0.0001). Clinical improvement was associated with a decrease of both the clinical score (P less than or equal to 0.001) and serum ECP levels (P less than or equal to 0.005). No significant changes in serum IgE and serum IL-2R were observed. In addition, there was a significant correlation between serum ECP and the clinical score (R = 0.67, P less than or equal to 0.001). These data indicate that serum ECP may be a helpful tool for monitoring disease activity in AD.     

Soluble E-selectin and eosinophil cationic protein are distinct serum markers that differentially represent clinical features of atopic dermatitis

The serum levels of eosinophil cationic protein (ECP), soluble E-selectin (sE-selectin), soluble CD14 (sCD14) and interleukin (IL)-4 are known to be elevated in patients with atopic dermatitis (AD). However, little is known of the mutual relationship between these factors. To elucidate the clinical and mutual relevance of these markers, we examined the serum levels of ECP, sE-selectin, sCD14 and IL-4 as compared with eruption scores, itch scores, total IgE and numbers of peripheral eosinophils in patients with AD (n = 43), non-atopic eczema (n = 24) and urticaria (n = 13) and in normal individuals (n = 45). In 27 patients with AD the levels of these markers were compared before and after treatment. Levels of ECP were elevated only in the patients with AD, whereas the sE-selectin levels were higher not only in AD but also in non-atopic eczema in a severity-dependent manner. The levels of both markers significantly diminished after treatment. Significant correlations existed between ECP levels and numbers of eosinophils, sE-selectin levels and itch scores, and sE-selectin levels and IgE levels. No significant changes were observed in the sCD14 and IL-4 levels. Taken together, sE-selectin and ECP are good but distinct serum markers that reflect different clinical features of AD.     

Significance of interleukin-16, macrophage-derived chemokine, eosinophil cationic protein and soluble E-selectin in reflecting disease activity of atopic dermatitis--from laboratory parameters to clinical scores

BACKGROUND: The search for the ideal clinical score reflecting atopic dermatitis (AD) severity has developed in parallel with unveiling key events in disease pathogenesis and finding laboratory parameters for monitoring disease activity. A major difficulty in assessing the relevance of reported serum markers of AD severity is the use of nonvalidated referent tools, which compromises comparison of results across studies. OBJECTIVES: The aim of our study was to compare the significance of serum levels of interleukin (IL)-16, macrophage-derived chemokine (MDC), soluble E-selectin (sE-selectin) and eosinophil cationic protein (ECP) in reflecting AD severity and identify the most relevant parameter for monitoring the course of disease. Serum levels were tested against the same referent severity score in the same time frame and group of patients. METHODS: The Severity Scoring of Atopic Dermatitis (SCORAD) index was used for assessment of disease severity in 21 adult patients in acute stage of AD and after complete resolution of clinical findings. Serum levels of IL-16, MDC, ECP and sE-selectin were measured at the same time points in 18 patients and compared with healthy nonatopic controls. The correlation between SCORAD and each laboratory parameter was tested for significance and compared. RESULTS: Serum levels of IL-16, MDC, ECP and sE-selectin were significantly higher in patients in acute stage of AD compared with controls and decreased significantly after treatment, in parallel with clinical improvement. All monitored parameters reflected disease severity assessed by the clinical score. We found the highest significance level of correlation with SCORAD for IL-16 (r = 0.68, P =0.0019), followed by ECP (r = 0.65, P = 0.0032) and MDC (r = 0.55, P =0.0326). There was significant correlation between serum levels of IL-16 and MDC (r = 0.53, P = 0.0443) and ECP and sE-selectin (r = 0.48, P = 0.0427). CONCLUSIONS: The study established a significant correlation between serum levels of IL-16 and SCORAD in adult AD patients. We report a significant correlation between IL-16 and MDC, both T-helper 2 activation markers. Our data suggested that IL-16 reflects most convincingly disease severity and may be used as a marker in clinical studies preferentially in combination with a clinical activity score.     

大疱性类天疱疮患者血清及疱液嗜酸性粒细胞阳离子蛋白水平检测

【摘要】 目的 探讨血清及疱液嗜酸性粒细胞阳离子蛋白（ECP）水平与大疱性类天疱疮（BP）的关系。方法 选择2012年1月至2019年10月在北京协和医院皮肤科就诊的初发BP患者40例、健康人40例进行血清ECP检测；选择同一时期就诊的33例初发BP患者、41例非免疫性疱病患者进行疱液ECP检测。用酶联免疫吸附实验检测血清和疱液ECP含量，同时对1例BP和1例接触性皮炎患者皮损部位病理切片进行ECP免疫组化染色。符合正态分布的两组间数据比较采用t检验或t′检验，计数资料的比较采用χ2检验。采用Pearson相关系数分析BP患者血清ECP与外周血嗜酸性粒细胞之间的关系。结果 BP组血清ECP含量为（116.9 ± 19.3） ng/L，健康对照组为（93.3 ± 15.9） ng/L，差异有统计学意义（t = 5.96，P＜0.001）。BP组疱液ECP含量为（665.8 ± 189.0） ng/L，非免疫性疱病组为（547.5 ± 240.6） ng/L，差异有统计学意义（t = 2.31，P = 0.02）。免疫组化结果显示，BP患者ECP阳性细胞胞质棕黄色颗粒明显多于接触性皮炎患者。BP患者血清ECP与外周血嗜酸性粒细胞比例之间无统计学相关性（r = -0.15，P = 0.35）。结论 BP患者血液、疱液ECP水平明显升高，且疱液ECP水平远远高于血清ECP水平，提示ECP可能参与BP的发病过程。     

CD35 expression on peripheral blood granulocytes of patients with atopic dermatitis

We examined CD35 expression on granulocytes from 45 patients with atopic dermatitis (AD) (male, 21, female, 24) and 25 age and sex-matched controls (male, 15; female, 10). There was no significant difference in the peripheral blood neutrophil count between AD patients and controls, whereas the eosinophil count in AD patients was significantly higher than that of controls. The percentages of CD35 positive eosinophils and neutrophils were determined by using two-color flow cytometric analysis. As regards eosinophils, we found CD35 expression from AD patients to be lower than that of controls (P < 0.05), but there was no correlation between the CD35 expression and disease severity. In contrast, the CD35 expression on neutrophils from AD patients was much lower than that of controls (P < 0.005). Furthermore, CD35 expression on neutrophils of severe AD group was significantly higher than that of the mild AD group (P < 0.05). This suggests that the CD35 expression of neutrophils but not eosinophils reflects disease severity in AD patients and the CD35 expression on neutrophils in AD patients may associate with susceptibility to bacterial infection.     

特应性皮炎患者血浆中P物质的测定及其临床意义

目的 探讨特应性皮炎患者血清中P物质水平及其临床意义.方法 用放射免疫法测定35例特应性皮炎患者血浆中P物质浓度,观察P物质与疾病严重程度积分及嗜酸粒细胞数的关系.结果 特应性皮炎患者血浆中P物质浓度明显高于正常人对照P<0.01),且疾病的EASI评分和Rajka严重度积分与P物质浓度呈显著正相关,r分别为0.95和0.86,P均<0.01.特应性皮炎患者外周血嗜酸粒细胞数明显高于正常人对照(P<0.01),并且与疾病的严重度呈正相关(与EASI评分r=0.42,P=0.011,与Rajka严重度积分r=0.42,P=0.013):特应性皮炎患者血浆中P物质浓度与外周血嗜酸粒细胞数呈正相关(r=0.43,P=0.009).结论 P物质对判断特应性皮炎活动性可能有一定价值;P物质可能与嗜酸粒细胞共同参与特应性皮炎发病.     

Eosinophil cationic protein in sera of patients with atopic dermatitis

Patients with atopic dermatitis frequently show elevated blood eosinophil counts, and eosinophil-derived major basic protein has been demonstrated in the eczematous skin from patients with atopic dermatitis. To evaluate further the role of eosinophils in the pathogenesis of atopic dermatitis, the concentration of eosinophil cationic protein was measured in serum samples of 42 patients with moderate to severe disease. The results were compared with those obtained in 32 patients with psoriasis with (n = 9) or without (n = 23) a history of inhalant allergy, 12 patients with a history of pseudoallergic reactions to acetylsalicylic acid, 14 patients with a history of inhalant allergy, and 31 nonatopic healthy control subjects. Eosinophil cationic protein levels were significantly increased in the serum of patients with atopic dermatitis (p less than or equal to 0.005) and patients with a history of pseudoallergic reactions to acetylsalicylic acid (p less than or equal to 0.01). There was no significant difference between eosinophil cationic protein levels in patients with psoriasis or a history of inhalant allergy and in control subjects. Moreover, eosinophil cationic protein levels did not differ significantly in psoriasis patients with or without inhalant allergy. These studies support the concept of an active participation of eosinophils in atopic dermatitis and point to a possible role for eosinophils in pseudoallergy.     

40例成人发病型特应性皮炎患者外周血嗜酸性粒细胞和血清总IgE的检测

 目的: 探讨外周血嗜酸性粒细胞（EOS）和血清总IgE与成人发病型特应性皮炎（AD）的关系。方法：选取首次发病年龄>18岁的40例AD患者作为病例组,30例健康成年体检者作为对照组,检测两组外周血EOS和血清总IgE水平,比较性别、年龄、外周血EOS和血清总IgE水平在病例组和对照组以及不同疾病严重程度、伴／不伴呼吸道过敏、伴／不伴户尘螨阳性的病例组间分布情况。结果： 病例组EOS和血清总IgE水平均明显高于对照组(t分别为2.80、3.88,均P<0.05)。性别在重度与轻度、重度与中度间分布均有明显差异(  X² 分别为12.29、10.89, 均P<0.05);EOS在中度、重度组的分布均高于轻度组(t分别为2.23、2.53,均P<0.05)。血清过敏原检测户尘螨阳性的患者血清总IgE水平高于阴性患者(t＝2.32,P＝0.03)。结论：外周血EOS和血清总IgE水平与成人发病型特应性皮炎的发生和发展有一定的相关性。     

Serum levels of vasoactive intestinal peptide are elevated in patients with atopic dermatitis

Vasoactive intestinal peptide (VIP) has been suggested to play some roles in atopic dermatitis. Tissue of VIP levels has been reported to increase in chronic lichenified lesions of atopic dermatitis (AD). To analyze whether serum levels of VIP in AD patients are elevated compared with normal controls and correlated with the disease severity, we measured serum levels of VIP using enzyme-linked immunosorbent assay in 53 patients with AD and 21 healthy individuals. The results showed that serum levels of VIP in AD patients (345.8+/-71.5 microg/ml) were significantly higher than those in healthy individuals (307.1+/-42.6 microg/ml). However, a correlation was not found between serum VIP levels and disease severity, other markers including serum LDH levels, total serum IgE levels, and peripheral blood eosinophil counts in patients with AD. This indicates that VIP levels in AD patients were elevated not only in the skin but also in the serum, suggesting that increased serum VIP levels in the patients with AD might be involved in its pathogenesis.     

Wells' syndrome (eosinophilic cellulitis): correlation between clinical activity, eosinophil levels, eosinophil cation protein and interleukin-5

Wells' syndrome (WS) (eosinophilic cellulitis) is characterized by the presence of oedematous skin lesions associated with eosinophilia of the tissues. It has recently been observed that in patients with this disease, increased eosinophil cation protein (ECP) and interleukin (IL) -5 can be detected in peripheral blood, with T lymphocytes that have mRNA for this lymphokine. We present a patient with WS in whom we found a close correlation between clinical activity, eosinophils in blood and bone marrow, and ECP and IL-5 levels in peripheral blood and tissues. We underline the major part played by IL-5 in this disease.     

Chemotactic responsiveness of eosinophils isolated from patients with inflammatory skin diseases

We determined the chemotactic responsiveness of peripheral eosinophilic granulocytes (eosinophils) isolated from patients with inflammatory dermatoses and healthy volunteers. Ten patients with atopic dermatitis, five patients with drug reactions, ten patients with psoriasis, and fourteen healthy volunteers were studied. Well characterized chemotaxins, the complement split product C5a, leukotriene B4 (LTB4), platelet activating factor (PAF), and N-formyl-methionyl-leucyl-phenylalanine (FMLP), were used as chemoattractants. Eosinophils from healthy volunteers showed strong migratory responses towards C5a and PAF but responded poorly to LTB4 and FMLP. When patients were grouped by disease severity, eosinophil chemotactic responses to PAF were significantly enhanced in severely affected patients (p less than 0.05); this was not true with C5a, LTB4 or FMLP. This enhanced eosinophil chemotaxis to PAF was not related to a specific disease. No correlation between eosinophil chemotactic activity and peripheral blood eosinophil count was observed. The increased responsiveness of circulating eosinophils towards PAF may be related to altered receptor expression during cutaneous inflammation.     

Eosinophilic cationic protein (ECP) in skin disorders.

Eosinophil cationic protein (ECP) is exclusively secreted only by the eosinophilic leukocyte. In this study the ECP concentration in the serum was measured in patients (n = 155) with various skin disorders and compared with the number of circulating eosinophils. The presence of activated eosinophils in the skin was also studied immunohistochemically using the monoclonal antibody EG-2, which recognizes both the eosinophil protein X (EPX/EDN) and ECP. EG-2 distinctly revealed these proteins in the eosinophils and their granules. Non-activated eosinophils were studied with the monoclonal antibody EG-1. In most cases this did not disclose any more eosinophils and often it was located more diffusely and not seldom on collagen fibers. Elevated serum ECP but normal numbers of circulating eosinophils were found in half of the patients with progressive plaque psoriasis and long-standing daily chronic urticaria. In patients with prurigo nodularis, papular erythematous eruptions, vasculitis, purpura and toxic drug reactions, Wells' syndrome, porphyria cutanea tarda and persistent light reaction the serum ECP was increased, although in some cases the number of circulating eosinophils was normal. In these disorders an increased number of activated eosinophils was found in the skin. Both serum ECP and the number of activated eosinophils normalized when the patients' condition improved. In atopic dermatitis the serum ECP and the number of activated eosinophils in the skin were increased only during exacerbation of the disease. High serum levels of ECP and activated eosinophils in the skin are frequent findings in many skin disorders in spite of often normal blood eosinophil counts.(ABSTRACT TRUNCATED AT 250 WORDS)