Evaluation of the relationship between IgE level and skin superinfection in children with atopic dermatitis

Elevated serum total IgE is associated with eczema exacerbation in children hospitalized for atopic dermatitis

BACKGROUND/OBJECTIVES

Atopic dermatitis (AD) can be a debilitating skin condition, often leading to hospitalization due to severe AD exacerbations or infectious complications. As both AD exacerbations and infectious complications can present similarly, it can be difficult to distinguish the two conditions. Thus, we aimed to evaluate if there is any difference in serum IgE levels in children with AD who were hospitalized for AD exacerbation and for AD-associated infectious complications.

METHODS

A retrospective chart review was performed on hospitalized children with AD exacerbations and AD-associated infectious complications over a 17-year span. Data including length of stay, primary diagnosis, systemic antibiotics, laboratory, and bacterial culture results were collected. Serum total immunoglobulin E (IgE) levels were adjusted by age. Age, length of stay, total IgE levels, and age-adjusted IgE levels were compared using t-test. Logistic regression was used for age-adjusted IgE levels.

RESULTS

The mean serum total IgE level in subjects with AD exacerbation was 9603 ± 15,873 kU/L, which was significantly higher than that of subjects with infectious complications at 3167 ± 5486 kU/L (p = .029). Logistic regression revealed that subjects with an age-adjusted IgE of >4 had more than 3-fold odds of having AD exacerbation than infectious complications.

CONCLUSIONS

Our results suggest that total IgE levels are higher in children who were hospitalized for AD exacerbation than those with AD-associated infectious complications.

Case Report: Relevance of an Accurate Diagnosis and Monitoring of Infective Dermatitis Associated With Human T-Lymphotropic Virus Type 1 in Childhood

Human T-lymphotropic virus type 1 (HTLV-1) is a neglected retrovirus distributed worldwide and the ethiological agent of several pathologies, such as adult T-cell leukemia/lymphoma (ATLL), a chronic myelopathy known as HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) and infective dermatitis associated with HTLV-1 (IDH). HTLV-1 presents tropism for CD4⁺ T cells and induces deregulation of the cytokine profile. IDH is a severe, chronic superinfected eczema generally associated with Staphylococcus aureus and/or Streptococcus beta haemolyticus infection that responds partially to antibiotic therapy but prompt recurrence develops upon treatment withdrawal. IDH could be a risk factor for progression toward both HAM/TSP and ATLL and, similarly to other diseases associated with HTLV-1, it is sub-diagnosed particularly in non-endemic areas. Here, we present a case of IDH in a young boy living in Buenos Aires with symptoms since 2010, at the age of 5. HTLV-1 infection was suspected and confirmed in 2016. The patient exhibited chronic dermatosis with exudative eruption involving mainly the scalp, retroauricular regions, neck and abdomen. Clinical evaluations, routine laboratory tests, full blood count, and HTLV-1 diagnosis for this case are included.

New insights in the pathogenesis of atopic dermatitis

Atopic dermatitis (AD) is characterized by skin barrier defects and increased interleukin (IL)-4/IL-13 expression. Recent evidence also suggests the involvement of innate immunity including Toll-like receptors, IL-33, IL-25, and innate lymphoid cells in the pathogenesis of AD. This article reviews these innate immune components and how they may become an integral part of prognostic factors and therapeutic targets in the treatment of AD.

Atopic dermatitis: a practice parameter update 2012

This parameter was developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma and Immunology. The AAAAI and the ACAAI have jointly accepted responsibility for establishing "Atopic dermatitis: a practice parameter update 2012." This is a complete and comprehensive document at the current time. The medical environment is a changing environment, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the Joint Task Force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma & Immunology. These parameters are not designed for use by pharmaceutical companies in drug promotion. Published practice parameters of the Joint Task Force on Practice Parameters for Allergy & Immunology are available online at http://www.jcaai.org.

Association between atopic dermatitis and obesity in adulthood

BACKGROUND

Obesity in early childhood is associated with increased risk for and severity of atopic dermatitis (AD). Objective To determine whether obesity in adulthood is associated with risk of AD.

METHODS

This was a retrospective case-control study of 2090 adults using questionnaire, height and weight, and skin-prick testing between January 1994 and December 2003.

RESULTS

Obesity in adults was associated with increased AD [multinomial logistic regression: adjusted odds ratio (aOR) 1·43, 95% confidence interval (CI) 1·08-1·89; P=0·01], but not nonatopic dermatitis (aOR 0·59, 95% CI 0·21-1·68; P=0·32). Obesity was also associated with increased atopic asthma (aOR 1·98, 95% CI 1·47-2·66, P<0·0001), but not associated with nonatopic asthma (P=0·20), atopic or nonatopic rhinoconjunctivitis (P=0·08 and 0·31, respectively), food allergies (P=0·67 and 0·35, respectively) or atopy (P=0·40). The association between obesity and AD remained significant even when controlling for history of asthma, rhinoconjunctivitis and food allergies (aOR 1·40, 95% CI 1·05-1·86; P=0·02) or in subset analyses of subjects with AD alone (aOR 1·96, 95% CI 1·02-3·75; P=0·04) and with comorbid asthma, rhinoconjunctivitis and/or food allergies (aOR 1·40, 95% CI 1·03-1·91; P=0·03).

CONCLUSION

Obesity in adulthood is associated with AD. Further studies are warranted to determine if weight loss may prevent or mitigate AD in adults.