Vitamin D in atopic dermatitis,chronic urticaria and allergic contact dermatitis

Vitamin D influences allergen-induced pathways in the innate and adaptive immune system, and its potential immunomodulatory role in allergic skin disorders has been explored. This comprehensive review article provides an overview of the role of vitamin D in three common dermatologic conditions: atopic dermatitis (AD), chronic urticaria, and allergic contact dermatitis (ACD). Whereas the literature regarding vitamin D and AD has resulted in mixed findings, several studies have described an inverse relationship between vitamin D levels and AD severity, and improvement in AD with vitamin D supplementation. Similarly, several studies report an inverse relationship between vitamin D levels and severity of chronic urticaria. Although current research in humans remains limited, an increased likelihood of ACD has been demonstrated in vitamin D-deficient mice. Additional well-designed clinical trials will be necessary to determine whether vitamin D supplementation should be recommended for prevention or adjuvant treatment of these common dermatologic conditions.     

Evaluation of allergy to soy in patients with atopic dermatitis older than 14 years of age

Atopic dermatitis is associated with food allergies. The aim of this study is to evaluate soy allergy in patients suffering from atopic dermatitis. Altogether 228 persons were included; specific IgE, skin prick tests, atopy patch tests, challenge tests with soy and history of soy allergy were evaluated. Soy allergy was confirmed in eight patients (3.5%, in four patients with worsening of atopic dermatitis, in four patients with oral allergy syndrome), sensitisation to soy was found in another 47 patients (20%) with no clinical manifestation after soy ingestion. Dependence was confirmed statistically between soy allergy and pollen allergy and soy sensitivity and pollen allergy. About 20% of patients suffering from atopic dermatitis are sensitised to soy. Clinical symptoms of soy allergy occur only in 3.5% of patients suffering from atopic dermatitis.     

Immediate contact allergy from hydrolyzed wheat in a cosmetic cream

Immediate contact allergy to cosmetics seems to be rare, since only a few case reports on it have been published. We report on a case of IgE-mediated allergic contact urticaria caused by hydrolyzed wheat in a body cream.     

Atopic sensitization and atopic dermatitis in Estonian and Swedish infants

BACKGROUND: Early life events seem to have a major impact on the development of tolerance or sensitization. OBJECTIVE: The aim of the study was to compare the prevalence of sensitization and atopic dermatitis (AD) during the first 2 years of life in Estonia and in Sweden. METHODS: Two groups comprising 110 Estonian and 123 Swedish infants were followed from birth up to 2 years of age. Data about symptoms of allergy, infections and use of antibiotics were obtained by questionnaires. Clinical examinations, skin prick tests (SPTs) with food and inhalant allergens, and blood sampling for IgE analyses were carried out at 3, 6, 12 and 24 months. RESULTS: The cumulative incidence of AD and positive SPTs were lower in the Estonian than the Swedish infants (14% vs. 24%; P = 0.06 and 13% vs. 24%; P = 0.03), while circulating IgE antibodies were more common (39% vs. 27%; P = 0.06) and often present without any clinical significance in Estonian children. Estonian infants had respiratory illnesses more often and they had received antibiotics more frequently. Use of antibiotics increased the risk for positive SPT in the Estonian (odds ratio = 1.7, 95% confidence interval = 1.1-2.5), but not in the Swedish infants. This may be explained by the use of broad-spectrum antibiotics in Estonia, while in Sweden mostly penicillin was prescribed. CONCLUSIONS: The prevalence of AD and positive SPTs was lower in the Estonian than the Swedish infants, while circulating IgE antibodies were more common and often present without any clinical significance. These differences cannot simply be explained by infections, or use of broad-spectrum antibiotics in the two countries, although more the natural lifestyle in Estonia may be contributing factor.     

Biologicals targeting type 2 immunity: Lessons learned from asthma,chronic urticaria and atopic dermatitis

During the last decades, progression of research has led to great achievements for treatment and therapy of several disabling disorders, particularly in the field of chronic inflammatory diseases. The increased knowledge of the molecular mechanisms operating in such diseases has represented the first step in this process, and the discovery of molecules able to interfere with the natural history of the diseases, has been the second. This review is focused on the effects of biologics on type 2 diseases such as asthma, chronic urticaria and atopic dermatitis, both biologics just approved for clinical application and also those that are currently undergoing clinical trials. We will also discuss aspects and emphasize clinical trials and recently published studies, as well as research that is currently in the progress, which will be highly relevant for basic immunologists. Likewise, we will cover aspects that are pertinent for clinical immunologists and highlight translational studies that are evaluating novel biologicals in animal models.     

Absence of specific IgE antibodies in allergic contact sensitivity to formaldehyde

Immunologic reactions are customarily divided into two broad categories, cell-mediated and antibody-mediated. An interplay between these two pathogenetic principles is indicated by reactions such as cutaneous basophil hypersensitivity, late-phase reaction, and cutaneous lesions indistinguishable from regular allergic contact dermatitis lesions after sensitization with IgE antibodies against certain haptens. In the present study, 23 patients with a history of a positive epicutaneous test to formaldehyde participated. On retest, 15 showed a positive reaction. Eight patients were Phadiatop® positive, indicating an atopic diathesis, and eight had a history of or ongoing atopic dermatitis. On RAST test®, only two, nonatopic patients had specific IgE antibodies to formaldehyde. In the cellular infiltrates of biopsies from epicutaneous test sites, cells reactive with monoclonal antibodies against IgE were found in positive and negative formalin tests, both in atopies and nonatopics, as well as in control biopsies from nonlesional skin. Double immunofluorescence staining experiments showed that IgE occurred on Langerhans' cells. The proportion of IgE-positive cells correlated to the level of serum IgE, but not to atopy. These cells were also found both in the epidermis and in the dermis in nonatopic patients. ICAM-1 occurred on keratinocytes in all patient groups. This study does not support the hypothesis that specific IgE antibodies are active in the pathogenesis of contact sensitivity to formaldehyde either in atopic or in nonatopic patients.     

Immediate hypersensitivity to Malassezia furfur and Candida albicans mannans in vivo and in vitro

BACKGROUND: Elevated and correlative Malassezia furfur (M. furfur) and Candida albicans (C. albicans) mannan-specific IgE have been demonstrated in atopic eczema dermatitis syndrome (AEDS) of the head, neck and shoulder (HNS) region of the skin. The significance of these antibodies in vivo has not been demonstrated. METHODS: Sixty-five AEDS patients with HNS distribution were included. Serum total IgE (S-IgE) and yeast antigen-specific (Cetavlon-purified mannan and whole extract antigens of M. furfur and C. albicans) IgE were measured and skin prick tests (SPT) were performed with the yeast antigens. RESULTS: Mannan-specific IgE and SPT were positive in 51 and 48% of patients with M. furfur and in 42 and 22% with C. albicans, respectively. Whole extract-specific IgE and SPT were positive in 85 and 95% of patients with M. furfur and in 91 and 57% with C. albicans, respectively. The highest correlation between specific IgE and SPT was seen with M. furfur mannan (r = 0.60; P < 0.0001). Both M. furfur mannan-specific IgE (r = 0.76; P < 0.0001) and SPT (r = 0.44; P = 0.0005) correlated with S-IgE. CONCLUSIONS: Mannan-induced immediate hypersensitivity in vivo was demonstrated in SPT. The significant correlation between M. furfur mannan-specific IgE and SPT suggests that mannan is an important allergen in yeast hypersensitive AEDS in vivo.     

Skin prick tests and specific IgE in adults from three different areas of Sweden

The aims of this part of the European Respiratory Health Survey were to estimate the prevalence of atopic sensitization to inhalant allergens among adults in three different areas of Sweden and to investigate the association between sensitization and certain risk factors. Randomly selected subjects aged 20–46 years from Göteborg, Uppsala, and Västerbotten were investigated with the skin prick test (SPT), analyses for specific IgE antibodies in serum (specific IgE) and total serum immunoglobulin E (total IgE), and a questionnaire. SPT was performed in 1572 subjects and analyses of specific IgE in 1470. One or more positive SPT were found in 35.6% and one or more positive specific IgE in 31.7% - approximately the same values in all three areas. Birch, grass, cat, and dog were the most frequent sensitizing agents and occurred at similar prevalences, i.e., around 15%, in all areas. The SPT to mite was positive in 14.1% in Göteborg, 7.4% in Uppsala, and 7.9% in Västerbotten. A positive SPT to pellitory of the wall ( Parietaria ), not described previously in Sweden, was found in 3.4% in Göteborg. Living in Göteborg was independently associated with a higher risk of a positive SPT to mite and Parietaria. Heredity, male sex, and low age were independently associated with atopy. Birth in the Scandinavian countries was independently associated with sensitization to cat, whereas birth in other countries was associated with sensitization to mite. The overall prevalence of atopy was similar in the three Swedish areas, but the sensitizing allergens varied. There is an indication that sensitization is increasing in the population, as low age was associated with sensitization. Sensitization to cat, but not to mite, appears to be particularly important in persons born in the Scandinavian countries.     

Occupational contact urticaria from diglycidyl ether of bisphenol A epoxy resin

BACKGROUND: Epoxy resin (ER) is a common cause of occupational allergic contact dermatitis (ACD), but contact urticaria from ER is very rare. METHODS AND RESULTS: A plastic-product worker first developed ACD from diglycidyl ether of bisphenol A (DGEBA) epoxy resin, and subsequent exposure resulted half a year later in contact urticaria: first with edema of the lips and eyelids, and later an urticarial reaction on the upper chest, with strong swelling of the eyelids and tightness of the throat. The diagnosis was based on a positive skin prick test to his "own" ER compound, a positive prick test reaction to DGEBA, and a positive skin provocation test with the ER compound and DGEBA. The contact urticaria test reaction was strongly aggravated when the allergen was wiped off with an alcohol solution, apparently because the solution enhanced the penetration of the allergen. CONCLUSIONS: Our case is of interest, first, because contact urticaria from ER is very rare, and second, because this is the second report in which a strongly intensified contact urticaria reaction was provoked by an alcohol solution. We suggest that if the contact urticaria provocation test with low-molecular-weight chemicals is negative, a contact urticaria provocation test with alcohol (CUPTA) should be performed.     

Increased plasma eotaxin in atopic dermatitis and acute urticaria in infants and children

BACKGROUND: The previously reported eotaxin overexpression in the lesional skin of atopic dermatitis (AD) led us to the assumption that circulating levels of eotaxin may be elevated too. We sought to investigate the plasma expression of eotaxin in children with skin allergy in relation to clinical activity and type of lesions. METHODS: Plasma eotaxin was assayed in 78 infants and children, of whom 16 had AD, 19 had acute urticaria (AU), and 43 were healthy matched subjects. Seven children in the group of AU were resampled for plasma eotaxin after clinical remission. RESULTS: The plasma eotaxin levels in AD (median=158 pg/ml, mean [SD]=168 [61] pg/ml) were significantly higher than the control values (median=60 pg/ml, mean [SD]=59.5 [18.5] pg/ml). Not only did patients with AU demonstrate elevated plasma eotaxin levels (median=126 pg/ml, mean [SD]=124 [33] pg/ml), but also a significant decline occurred on follow-up. The coexistence of angioedema with AU did not cause any further increase in plasma eotaxin expression. Plasma eotaxin levels were significantly higher in AD than in AU, probably reflecting the chronic nature of eczematous AD lesions. The plasma eotaxin levels did not correlate with serum total IgE, peripheral blood absolute eosinophil count, or age of the patients. However, there was a positive correlation between age and plasma eotaxin in the control group. CONCLUSION: Our findings imply that circulating levels of eotaxin increase in AD and during flares of AU, probably to serve in the recruitment and activation of eosinophils. It may also represent a biomarker of lesional activity.     

Evaluation of food allergy to wheat,cow milk,egg, soy and peanuts in patients suffering from atopic dermatitis

Few large studies concerning the importance of food allergy in adolescents and adult patients with atopic dermatitis exist. The evaluation of food allergy to egg white and yolk, peanuts, soy, cow milk and wheat in patients suffering from atopic dermatitis. Two hundred forty patients (70 men, 170 women) were examined. Complete dermatological and allergological examination was performed in all patients, including specific IgE, skin prick test and atopy patch test. The challenge test was performed according to the results of examinations with suspected foods. The food allergy to peanuts was confirmed in 20% of patients, to egg in 6%, to soy in 3.3%, to wheat in 2.5% and to milk in 0.8% – altogether in 65 patients (27.5%). The positive results in examinations without clinical symptoms of food allergy were recorded in another 78 patients (32.5%). The diagnostic work-up should comprise not only the laboratory methods, but also the diagnostic hypoallergenic diet and the challenge test.     

Skin prick test reactions to brewer's yeast (Saccharomyces cerevisiae) in adult atopic dermatitis patients

The sensitizing capacity of brewer's yeast ( Saccharomyces cerevisiae ) was studied with the skin prick test method in 449 subjects, including 226 atopic dermatitis (AD) patients, 50 patients with allergic rhinitis (AR) and/or asthma (A), and 173 nonatopic controls. A positive SPT reaction (≥++) was seen in 94% of patients with severe AD, in 76% with moderate AD, and in 25% with mild AD or no history of AD. Patients with AR and/or A and nonatopic controls displayed a positive reaction in only 8 and 2% of cases, respectively. There was also a parallel skin prick test reactivity with other yeasts including Pityrosporum ovale and Candida albicans , suggesting cross-reactivity. Parallel skin reactivity was observed also with molds and animal dander but not with pollen or house-dust mite. A significant correlation was also found between total serum IgE level and skin prick test (SPT) results with S. cerevisiae .     

Type-IV sensitization profile of individuals with atopic eczema: results from the Information Network of Departments of Dermatology (IVDK) and the German Contact Dermatitis Research Group (DKG)

The role of atopic eczema (AE) as risk factor for the development of allergic contact dermatitis is discussed controversially, as well as its influence on patch test results due to increased irritability. In this study, we analysed the pattern of positive patch test results to most frequent contact allergens in patients with AE (n = 9020) and age matched nonatopic (n = 15,263) individuals. The pattern and the frequencies of the observed sensitizations did not differ greatly from nonatopic individuals. Bufexamac is an exception: in AE patients sensitization is observed three times more often. For the other substances tested only minor differences were detected. Moreover, the frequencies of single, double or polyvalent sensitizations were nearly identical between the two groups. The analysis of the anatomical sites of dermatitis shows differences between the groups: in AE patients, the face (7.2%) and hand dermatitis (6.6%) was more common, and leg dermatitis (4.0%) less common. Analysis of occupation, suspected allergen source, and accompanying factors revealed no major differences between the both groups. CONCLUSION: The chronic and long-term exposure to external drugs and emollients presumably carries a risk for sensitization against specific contact allergens in AE patients. However, the sensitization of contact allergens differs surprisingly little between patients with or without AE.     

Atopy patch test in examination of food allergy in patients suffering from atopic dermatitis

Aim: The evaluation of the importance of atopy patch tests in patients suffering from food allergy to egg’s white and yolk, peanuts, soy, cow’s milk and wheat. Methods: 240 patients were examined. Complete dermatological and allergological examination was performed in all patients including specific IgE, skin prick test, atopy patch test and the challenges tests. Results: The specificity of atopy patch tests is for soy 96%, for egg 95%, for wheat 95%, for peanuts 99% and for milk 99%. The sensitivity of atopy patch tests is for soy 62%, for egg 35.7%, for wheat 16.7%, for peanuts 20.8% and for milk 50%. Conclusion: The specificity of atopy patch tests may be considered good; regarding the sensitivity, the high percentage of false negative results should make us believe that these tests are not conclusive.