Interleukin-18 is associated with increased severity of atopic dermatitis in children.

Atopic dermatitis (AD) is a chronic relapsing skin disease characterized by reduced interferon (IFN) gamma production with concurrent up-regulation of interleukin (IL)-4. Recently, it was reported that IL-18, formerly called IFN gamma-inducing factor, induces the production of T helper (Th)2-related cytokines without help from IL-12. This study was performed to evaluate the contribution of IL-18 in the pathogenesis of AD. Significantly higher serum IL-18 concentrations were found in patients with severe AD than in healthy subjects. Under staphylococcal enterotoxin B stimulation, IL-18 secretion was increased in peripheral blood mononuclear cells from patients with AD. There were significant differences in the concentrations of IL-10, IL-12, and soluble Fas ligand between AD patients and normal controls. In conclusion, increased serum IL-18 concentrations may be involved in the pathogenesis of AD.     

Two cases of atopic dermatitis associated with autoimmune abnormalities

SIR, The relationship between allergic disorders [such as atopicdermatitis (AD), asthma, allergic rhinitis and conjunctivitis]and systemic lupus erythematosus (SLE) and/or mixed connectivetissue disease (MCTD) is still unclear and controversial [1–4].Certain reports have indicated a high incidence of these allergicdiseases in SLE patients, but other reports have denied this[1–3]. The prevalence of AD in the children of motherswith SLE is known to be higher than in normal controls [4].There has been no clear evidence of a higher serum concentrationof immunoglobulin (Ig) E in SLE/MCTD patients     

Assessment of IL-31 levels and disease severity in children with atopic dermatitis

Introduction and objectives

Atopic dermatitis is a chronic, relapsing, highly pruritic, inflammatory skin disease characterized by typical localization with increasing prevalence of 10–20% in children. Pruritus is one of the major diagnostic criteria of atopic dermatitis and also the main complaint altering quality-of-life of affected patients, inducing and aggravating inflammation. Although pruritus is the absolute symptom of AD, the etiology has not been fully explained yet and current antihistamine therapies are ineffective.The aim of the study was to assess the correlation between IL-31 level and disease severity in patients with atopic dermatitis through Severity SCORing of Atopic Dermatitis (SCORAD) index and the degree of itching assessed subjectively.

Interleukin-21 is upregulated in hepatitis B-related acute-on-chronic liver failure and associated with severity of liver disease

Summary. The immune mechanism(s) that lead to hepatitis B‐related acute‐on‐chronic liver failure (HB‐ACLF) are poorly understood. Interleukin‐21 is a newly discovered cytokine that is involved in autoimmune and inflammatory diseases. Its potential role in HB‐ACLF remains unknown. The serum levels of 12 immune cytokines measured by cytometric bead arrays and the frequency of IL‐21‐secreting CD4⁺ T cells in peripheral blood mononuclear cells (PBMC) measured by intracellular cytokine staining were compared in moderate chronic hepatitis B (M‐CHB, n = 20), severe chronic hepatitis B (S‐CHB, n = 20), HB‐ACLF (n = 39) and healthy controls (n = 10). PBMC from M‐CHB patients or healthy subjects were stimulated with rhIL‐21 in vitro, and cytokines in supernatants were measured by FlowCytomix. The frequencies of IL‐21‐secreting CD4⁺ T cells were higher in HB‐ACLF (both P < 0.001) and S‐CHB (P = 0.002 and 0.001) as compared to M‐CHB patients and controls. Serum IL‐21 levels were highest (P < 0.001) in HB‐ACLF and positively associated with high MELD score (P = 0.001) and mortality (P = 0.038). Recovery from HB‐ACLF was associated with reduced serum IL‐21 levels (P = 0.003) and lower CD4⁺IL‐21⁺ T‐cell frequency (P = 0.006). The secretions of IL‐1β (P < 0.001), IL‐6 (P < 0.001), IL‐10 (P < 0.001), IFN‐γ (P = 0.001) and TNF‐α (P = 0.042) from PBMC were significantly increased with rhIL‐21 stimulation. In summary, IL‐21 has a causal role in the development of severe liver inflammation, which is upregulated in HB‐ACLF and associated with severity of liver disease.     

Relationship between skin prick and atopic patch test reactivity to aeroallergens and disease severity in children with atopic dermatitis

BackgroundThe immunological mechanism in aetiology of atopic dermatitis (AD) shows significant differences from other allergic diseases. Allergen inhalation exacerbates AD lesions and AD patients’ complaints decrease in house dust mite (HDM) low level environments, which reveals the importance of inhalant allergens.ObjectiveWe evaluated the skin prick test (SPT) and atopy patch test (APT) positivity rates with aeroallergens and studied the effect of test results, and aimed to determine the value of allergic test reactivity on the clinical characteristics of children with AD.MethodsForty-five children aged 2–15 years with AD were included to study between May 2006 and May 2007 in GATA Haydarpasa Teaching Hospital, Allergy Department. The reactivity to inhalant allergens using SPT and APT was evaluated. The severity of AD, which was assessed with SCORAD, was compared with aeroallergen hypersensitivity.ResultsThe highest positivity of APT was seen against HDM (48.9%). HDM SPT positivity and subjective symptoms score were statistically correlated (P < 0.05). Patients with strong SPT positivity to HDM had a higher total SCORAD score (P < 0.05). Although there was no statistical correlation between HDM APT and SCORAD parameters, APT positive patients had generally higher SCORAD parameters. The statistical significance was only shown between the extent of the disease and strong APT positive reactions to Dermatophagoides pteronyssinus.ConclusionHDM allergens play an important role in determining the clinical severity of AD and strong APT positivity could be more meaningful clinically.     

Management of atopic dermatitis

The treatment of atopic dermatitis is symptomatic and adapted to the disease activity. Dermocorticoids (for acute phases) et emollients (mostly away from acute phases) are the most important drug classes. Other treatments will also be addressed in this review.     

Laboratory and severity evaluation of pediatric atopic dermatitis and moisturizer response in different phenotypes

Introduction and objectives

Atopic dermatitis (AD) is an eczematous skin disease. Our aim was to evaluate the clinical and laboratory findings of children with AD and identify the higher responsive group to moisturizers.

Exposure to dogs but not cats is associated to a decrease in the prevalence in atopic dermatitis amongst school-children

Introduction

The association regarding the exposure to pets, especially cats and dogs, and the prevalence of allergic diseases is inconsistent.

Contact sensitization in children with atopic dermatitis

Background

Atopic dermatitis is a common illness in childhood. Children with atopic dermatitis are prone to develop cutaneous sensitization due to skin barrier dysfunction.

Prevalence and associated factors of allergic rhinitis and atopic dermatitis in children

Allergic disorders are the chronic diseases of greatest pediatric morbidity, affecting over 25 % of the pediatric population. Indeed, this situation has been referred to as an "allergic epidemic". In comparison with asthma, atopic dermatitis and allergic rhinitis have been less extensively investigated, although this does not mean that they should be regarded as minor disorders but rather as alterations that affect the quality of life of the patients and their families, which generate considerable direct and indirect costs. Despite an important research effort, the reason for this allergic epidemic is not well known. These are multifactor disorders without a single causal agent, in which the most important component is the genetic predisposition of the patient (atopy), modulated by environmental factors, exposure to allergens, infections and irritants, among others. A confounding element is the fact that the concept of allergic diseases encompasses phenotypes of rhinitis, atopic dermatitis or asthma in which no IgE-mediated atopic mechanism is demonstrated, and which can manifest in a way similar to true allergic phenotypes. Differentiation between the two is difficult to establish on the basis of self-administered questionnaires alone, in the absence of a precise etiological diagnosis. The present article reviews the numerous factors suggested to be responsible for the increase in allergic diseases recorded in the last few decades, and for the differences in prevalence observed among centres. For most of these factors the results published in the literature are contradictory, in some cases due to a lack of control of the associated interacting or confounding factors. Consensus exists for only some of these causal factors, such as the established parallelism between the increase in allergic diseases and the reduction in infectious processes on one hand, and the increase in particles generated by diesel fuel combustion on the other. In addition, the implicated factors could act differently (and in some cases even antagonically) upon atopy and on the different disease phenotypes, thereby complicating the study of these interactions even further.     

Fluoropyrimidine-induced intestinal mucosal injury is associated with the severity of chemotherapy-related diarrhea

Background and aim: Although the fluoropyrimidines are effective chemotherapeutic agents for malignant gastrointestinal tumors, they sometimes cause enteritis with diarrhea. Severe treatment-related diarrhea may result in chemotherapy discontinuation. We investigated the relationship between diarrhea severity and fluoropyrimidine-induced small intestinal mucosal injury.

Methods: We performed small bowel capsule endoscopy in patients undergoing chemotherapy including fluoropyrimidine for a malignant tumor between May 2017 and June 2018 and analyzed the relationship between the endoscopic findings and diarrhea severity. We also performed a cross-sectional analysis of patient factors and routes of chemotherapy to identify risk factors of fluoropyrimidine-induced small intestinal injury.

Results: Small bowel capsule endoscopy was successfully completed in 16 eligible patients. The diarrhea grade (per the Common Terminology Criteria for Adverse Events, version 4.0) was significantly correlated with the percentage of patients with a small intestinal mucosal break (grade 0, 16.7%; grade 1, 57.1%; grade 2, 100%; p?=?.016, Cochran-Armitage trend test). Compared to patients receiving intravenous therapy, those receiving an orally administered fluoropyrimidine had a significantly greater number of small intestinal mucosal breaks (median number of breaks [range]; intravenous 5-fluorouracil, 0 [0–13]; oral fluoropyrimidine, 6.5 [1–20]; p?=?.0162, Mann–Whitney U test).

Conclusions: Many patients with diarrhea caused by chemotherapy including fluoropyrimidine had small intestinal mucosal breaks. Additionally, small intestinal mucosal breaks were more severe in patients receiving a regimen of oral treatment than in those receiving a regimen of intravenous therapy. These outcomes have important implications for investigations of new strategies for preventing anti-cancer drug-induced diarrhea.