Keeping dogs indoor aggravates infantile atopic dermatitis]

We had a two-month-old girl with severe dermatitis since birth. Her serum RAST to HD, Df and Dp were 1.06, 0.03 and 0.01 Ua/ml respectively. A Yorkshire terrier were kept at her mother's parents' home where the patient had lived for a month since birth. Her eczema, which became markedly aggravated whenever she visited there, improved after the elimination of the dog. We investigated the relationship between keeping dogs and infantile atopic dermatitis. We studied 368 patients under the age of two years (211 boys and 157 girls). Skin symptoms were graded globally mild, moderate or severe. Total serum IgE and specific antibody titer to dog dander were measured. We asked them whether they kept dogs and specifically, where they kept dogs, outdoor, indoor, in their own house, or in their grandparents' house. 197 patients had no contact with dogs, 90 patients kept dogs outdoor and 81 patients did indoor. The positive rate of RAST (> or = 0.7 Ua/ml) to dog dander was 6.1%, 17.8% and 46.9% respectively in these three groups. There were strong statistical differences between three groups. On the other hand, among the 81 patients who kept indoor, the RAST positive rates were almost same regarding where the dogs were kept, in their own house or their grandparents' house. Interestingly this difference happens only with patients under the age of 3 months. Patients older than 4 months showed no significant differences in the positive RAST rates, whether they kept dogs indoor or outdoor. This suggests the sensitization occurs before the age of 3 months. Speaking of symptoms, patients who kept dogs indoor showed significantly more severe symptoms than patients who had no contact with dogs and patients who kept dogs outdoor. There was no significant difference between the symptoms of patients who had no contact with dogs and those of patients who kept dogs outdoor. This implies the patient's symptom will improve only by moving the dog out of the house.     

Clinical features of atopic dermatitis and a family history of atopy

In 365 children and 213 adults the characteristics of atopic dermatitis isolated by Hanifin and Rajka were analysed in relation to a family history of allergy. A positive history in both parents and/or their families was associated with higher IgE titres, earlier appearance of skin changes, more frequent occurrence of urticaria, allergic respiratory diseases, cheilitis, and, in women, nipple eczema. These changes were less frequent and the IgE titre was lower in patients with one atopic parent, and even less frequent (or lower IgE titre) in patients with no family history of atopic disease, although the latter difference was sometimes slight.     

Positive atopy patch test reactions to Pityrosporumorbiculare in atopic dermatitis patients

BACKGROUND: Pityrosporum orbiculare, although a part of our normal cutaneous microflora, can cause skin infections and induce specific immunoglobulin (Ig) E antibodies in atopic dermatitis patients. P. orbiculare is therefore considered to be one of the trigger factors for atopic dermatitis. OBJECTIVE: To investigate if P. orbiculare can induce an eczematous reaction in atopic dermatitis patients, seborrhoeic dermatitis patients and healthy controls. METHODS: Fifteen atopic dermatitis patients, eight seborrhoeic dermatitis patients and eight healthy controls were patch tested with extract of P. orbiculare on non-lesional, tape-stripped skin of the back. NaCl was used as a negative control. The patch tests were evaluated after 24, 48 and 72 h. Skin biopsies were taken from P. orbiculare patch test sites at 24 h and 72 h, from NaCl patch test sites at 72 h, from non-lesional skin and, in the atopic dermatitis patients, also from lesional skin. The skin biopsies were investigated with immunohistochemical techniques. P. orbiculare-specific IgE in serum was analysed with RAST. RESULTS: Specific IgE to P. orbiculare was found in serum from 13/15 atopic dermatitis patients and in eight of them a positive patch test reaction to P. orbiculare was observed, with a maximal reaction at 48 h. Significantly higher serum levels of P. orbiculare-specific IgE were detected in patch test-positive compared with patch test-negative atopic dermatitis patients (P < 0. 01). The seborrhoeic dermatitis patients and healthy controls were RAST and patch test-negative for P. orbiculare. In the patch test-positive atopic dermatitis patients an infiltration of CD4+ T cells and eosinophils was observed at the P. orbiculare patch test sites together with an upregulation of ICAM-1 and HLA-DR expression. CONCLUSIONS: P. orbiculare can induce an eczematous reaction in sensitized atopic dermatitis patients and may be an important trigger factor in these patients. The P. orbiculare patch test can be of diagnostic value in this subgroup of atopic dermatitis patients.     

Prenatal prediction of infant atopy by maternal but not paternal total IgE levels

BACKGROUND: The atopic history of parents has long been used to predict infant atopy. However, bias from questionnaires of allergic history are also frequently suspected, because a large number of vasomotor rhinitis, intrinsic asthma, and seborrheic dermatitis cases are probably misinterpreted to be atopic diseases. OBJECTIVE: We attempted to identify a risk factor other than parental atopic history to predict elevated infant IgE levels and infant atopy. METHODS: A total of 655 core families were prenatally recruited, and finally 545 families completed the study for the prospective analysis of infant atopy at 6 months of age. Atopic history and blood samples of parents were collected in the third trimester during pregnancy. Cord blood (CB) was collected immediately after birth. Infant blood samples and history of infant eczema were collected in the 6-month physical checkup clinic. Blood total IgE and specific IgE levels were determined by use of the Pharmacia CAP system. RESULTS: In univariate analysis, maternal, but not paternal, atopic history correlated with elevated CB IgE levels and the occurrence of infant eczema. Elevated maternal, but not paternal, total IgE levels (>150 KU/L) significantly correlated with increases of CB IgE levels (median, 0.54 vs 0.17 KU/L, P <.001), infant IgE levels (log-transformed mean values, 1.32 +/- 0.51 vs 1.13 +/- 0.51 KU/L, P <.001), and infant eczema (P =.008). Multivariate logistical regression analysis, however, showed that only maternal total IgE levels correlated with CB and infant IgE levels and the development of infant eczema. CONCLUSIONS: The maternal, but not paternal, total IgE level correlates with elevated infant IgE levels and infant atopy. This provides a high specificity (83%) and a sensitivity of 34% for prediction of infant atopy. This suggests that maternal factors, placental factors, or both have an impact on perinatal allergic sensitization.     

Treatment of infantile atopic dermatitis with a strict elimination diet

Of twenty-one infants with atopic dermatitis, twenty were treated with a strict elimination diet for a period of up to 6 weeks. Seven infants healed and twelve improved. The infants who healed were less than 6 months old and had had a short duration of dermatitis. For one infant the skin condition was unchanged. Another infant was breast-fed throughout the period with dermatitis. Blood eosinophilia and/or elevated serum IgE commonly found on admission decreased significantly (P< 0.01) during the diet period. On challenge with cows’ milk, twelve infants were considered as intolerant. At the age of 2 years the dermatitis had cleared in all but four children. Of these four children, two were still cows’ milk intolerant. Another two infants were also cows’ milk intolerant, but without dermatitis.     

The role of atopy patch tests in the diagnosis of allergy in atopic dermatitis

PURPOSE OF REVIEW: Recent literature on the atopy patch test, published since 2004, is reviewed to evaluate whether the pathomechanism of the test has become more evident and whether previous studies require standardization. RECENT FINDINGS: There is evidence accumulating that a smaller subset of patients with atopic dermatitis show only atopy patch test positivity while specific IgE to the same allergen remains negative. It is possible that local IgE-mediated reactions occur in the skin. New data bring us a step forward in understanding the role of the atopy patch test in diagnosis of allergy in atopic dermatitis but no comprehensive studies were published during the period reviewed. SUMMARY: Despite recent advances in determining the value and indication for use of the atopy patch test in atopic dermatitis, more objective studies are needed. The atopy patch test may be useful in understanding the mechanisms of atopic allergy, and in defining the clinical relevance of the airborne allergens in eliciting dermatitis. Regarding food allergy, the atopy patch test still requires standardization. To date, methodology differs in all published papers; even the gold standard, the challenge test itself, is not appropriately standardized, which makes the interpretation of results less reliable.     

The severity of atopic dermatitis and the relation to the level of total IgE,onset of atopic dermatitis and family history about atopy

The aim of this study is the evaluation, if the level of total IgE, onset of atopic dermatitis (AD) and the family history are in the significant dependence to the severity of AD. The statistical evaluation of the dependence between the severity of AD and the the level of total IgE, family history and onset of AD was performed. 296 patients were examined. The level of total IgE above 200 IU/ml is recorded in 93 % of patients suffering from severe form and the positive data about atopy in family history are recorded in 66 % of patients with severe form of AD. The significant dependence was recorded between the severity of AD and parameters such as the level of total IgE, and family history about atopy. No dependence was recorded between the severity of AD and the onset of AD.     

Urinary eosinophil protein X in children with atopic dermatitis: relation to atopy and disease activity

BACKGROUND: Parameters of eosinophil inflammation have been suggested as markers of disease activity in atopic dermatitis (AD), but the value of urinary eosinophil protein X (U-EPX) in children with AD, as well as the influence of allergic sensitization, is not known. METHODS: We measured U-EPX in 59 atopic and 29 nonatopic children with mild (n = 32), moderate (n = 34), and severe (n = 22) AD, as well as in 64 controls. RESULTS: U-EPX was increased in children with AD (110; 67-164 microg/mmol creatinine, median; quartiles) compared to controls (62; 41-95, P<0.001). Children with mild (97; 63-164, P < 0.01), moderate (108; 67-157, P < 0.01), and severe disease (152; 99-202, P < 0.001) had levels of U-EPX higher than controls. U-EPX was significantly higher in children with severe AD than in mild and moderate disease (P < 0.05 for both). Children with AD and a positive skin prick test (120; 81-176) had higher levels of U-EPX than children with a negative skin prick test (87; 56-155, P<0.05). CONCLUSIONS: U-EPX is significantly increased in children with AD and may reflect disease activity. U-EPX may also reflect differences in eosinophil activation between those sensitized and those not sensitized to common allergens.     

Early life risk factors for atopic dermatitis in Ethiopian children

BACKGROUND: Atopic dermatitis (AD) has increased in prevalence in many countries in recent decades, but the risk factors for AD in developing countries are unknown. Helminthic parasites may play a role in protecting against allergic disease, but few studies have investigated the association of AD with parasitic infection. OBJECTIVE: To establish the independent effects of parasitic infection and other early life factors on the risk of AD in Ethiopia. METHODS: We conducted a cross-sectional survey and nested case-control study of children age 1 to 5 years in Jimma and surrounding rural areas in southwest Ethiopia. Cases were defined according to the International Study of Asthma and Allergies in Childhood criteria for AD and confirmed by clinical examination. Information on lifestyle and other potential risk factors was collected by parental questionnaire, and stool samples were analyzed for parasites. RESULTS: Complete data were obtained on 306 AD cases defined by International Study of Asthma and Allergies in Childhood criteria (prevalence, 4.4%) and 426 controls. There was no reduction in the risk of AD in relation to intestinal parasite infection; in fact, AD was increased in subjects with Trichuris (1.61; 95% CI, 1.14-2.26). The risk of AD was also unrelated to family size, crowding in the home, or breast-feeding, but was related to previously unrecognized factors including malaria and access to piped drinking water. Similar findings were apparent in cases and controls confirmed by clinical examination. CONCLUSION: Neither intestinal parasite infection nor other proposed risk factors for AD appear to be related to the presence of the condition in young children in Ethiopia, suggesting that other factors may be more important in this population.