Atopic eczema and allergy |
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Authors: | Johannes Ring Prof Dr Med Dr phil Ulf Darsow PD Dr Med Heidrun Behrendt Prof Dr Med |
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Institution: | (1) Division of Environmental Dermatology and Allergy GSF TUM, Department of Dermatology and Allergy Biederstein, Technical University Munich, Biedersteiner Str. 29, 80802 München, Germany |
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Abstract: | Although the pathomechanisms of respiratory atopy are well established, the role of IgE-mediated hypersensitivity in the elicitation
and maintenance of eczematous skin lesions in atopic eczema (AE) is still controversial. There is, however, evidence for exogenous
elicitation of AE by contact with aero- or food allergens (house dust mite, cat, and so forth). Recent investigations show
that epidermal Langerhans’ cells bind IgE via different receptors, especially the high-affinity receptor (FcεRI), which is
significantly more strongly expressed in lesional skin of AE compared with other inflammatory skin diseases including allergic
contact dermatitis. The clinical relevance of IgE-mediated sensitization in AE has been evaluated by the so-called atopy patch
test (APT). The APT shows a much higher specificity compared with the skin prick test and radioallergosorbent test. However,
allergic reactions do not play a decisive role in every case of AE. Other factors, such as nonspecific skin irritability or
psychosomatic interactions, have to be considered. The concept of “extrinsic” versus “intrinsic” types of AE seems attractive.
The concept of AE starting with TH2 inflammation, becoming TH1 inflammation in chronicity, and finally progressing to an autoimmune disease with IgE antibodies against autologous epidermal
proteins is very attractive. Based on new knowledge, new methods in diagnosis, treatment, and prevention will develop, including
more effective avoidance strategies, more potent anti-inflammatory treatment (eg, immunomodulation or topical immunophyllins), and new ultraviolet modalities. The new findings have given rise to a possible
new classification of eczema/dermatitis. The concept of “patient management,” including all aspects from avoidance to therapy,
has gained acceptance. |
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