BACKGROUNDAtopic dermatitis (AD) is an inflammatory skin disease characterized by chronic recurrent dermatitis with profound itching. Most patients have personal and/or family history of atopic diseases. Several criteria have been proposed for the diagnosis of AD. Although the clinical features of childhood AD have been widely studied, there has been less large-scale study on adult/adolescent AD. The aim of this study was to investigate the clinical features of adult/adolescent patients with chronic symmetrical eczema/AD and to propose Chinese diagnostic criteria for adult/adolescent AD.

METHODSA hospital-based study was performed. Forty-two dermatological centers participated in this study. Adult and adolescent patients (12 years and over) with chronic symmetrical eczema or AD were included in this study. Questionnaires were completed by both patients and investigators. The valid questionnaires were analyzed using EpiData 3.1 and SPSS 17.0 software.

RESULTSA total of 2662 valid questionnaires were collected (1369 male and 1293 female). Of all 2662 patients, 2062 (77.5%) patients had the disease after 12 years old, while only 600 (22.5%) patients had the disease before 12 years old, suggesting late-onset eczema/AD is common. Two thousand one hundred and thirty-nine (80.4%) patients had the disease for more than 6 months. One thousand one hundred and forty-four (43.0%) patients had a personal and/or family history of atopic diseases. One thousand five hundred and forty-eight (58.2%) patients had an elevated total serum IgE and/or eosinophilia and/or positive allergen-specific IgE. Based on these clinical and laboratory features, we proposed Chinese criteria for adult/adolescent AD. Of all 2662 patients, 60.3% were satisfied with our criteria, while only 48.2% satisfied with Hanifin Rajka criteria and 32.7% satisfied with Williams criteria, suggesting a good sensitivity of our criteria in adult/adolescent AD patients.

CONCLUSIONLate-onset of eczema or AD is common. The clinical manifestations of AD are heterogeneous. We have proposed Chinese diagnostic criteria for adolescent and adult AD, which are simple and sensitive for diagnosis of adult/adolescent AD.

Adolescent ; Adult ; Dermatitis, Atopic ; diagnosis ; immunology ; Eczema ; diagnosis ; Female ; Humans ; Immunoglobulin E ; blood ; Male ; Middle Aged ; Retrospective Studies ; Surveys and Questionnaires

BACKGROUND/AIMS: Chronic urticaria (CU) is defined as itchy wheals lasting 6 weeks or more. As the aged population increases worldwide, it is essential to identify the specific features of this disease in the elderly population. METHODS: We investigated the prevalence and clinical features of CU in elderly patients. Medical records of 837 CU patients from the outpatient Allergy Clinic of Ajou University Hospital, Korea were analyzed retrospectively. Patients with chronic spontaneous urticaria according to the EAACI/GA2LEN/EDF/WAO guidelines were included. Patients older than 60 years were defined as elderly. RESULTS: Of the 837 patients, 37 (4.5%) were elderly. In elderly versus nonelderly CU patients, the prevalence of atopic dermatitis (AD) was significantly higher (37.8% vs. 21.7%, respectively; p = 0.022), while that of aspirin intolerance was lower (18.9% vs. 43.6%, respectively; p = 0.003) in terms of comorbid conditions. The prevalences of serum specific immunoglobulin E antibodies to staphylococcal enterotoxin A and staphylococcal enterotoxin B were considerably higher in elderly CU patients with AD than in those without AD (37.5% vs. 0%, respectively). CONCLUSIONS: Elderly patients with CU had a higher prevalence of AD. Therefore, there is a need to recognize the existence of AD in elderly CU patients.
Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Aging ; Antibodies, Bacterial/blood ; Biological Markers/blood ; Child ; Chronic Disease ; Comorbidity ; Dermatitis, Atopic/diagnosis/epidemiology ; Enterotoxins/immunology ; Female ; Hospitals, University ; Humans ; Immunoglobulin E/blood ; Male ; Middle Aged ; Outpatient Clinics, Hospital ; Prevalence ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Urticaria/blood/*diagnosis/*epidemiology/immunology ; Young Adult

OBJECTIVETo investigate the influence of maternal atopy on cord blood effector T cells and to identify these biologic markers as predictors of atopic dermatitis (AD).

METHODSSeventy mother-infant pairs were recruited in this prospective birth cohort study. Suspected factors for allergy, including maternal allergic history, total serum IgE, and maternal age at birth, were collected. Mother peripheral blood samples and cord blood were obtained and assayed for the percentage of interferon-γ (IFN-γ) and interleukin 4 (IL-4) producing T cells(Th1 and Th2 respectively) using flow cytometry. Their offspring at the age of 2 years old were evaluated by their dermatologist whether they had AD. Statistical analysis was performed using multiple logistic regression models and receiver-operating characteristic curve was employed to predict atopic dermatitis.

RESULTSTwenty-one allergic and 49 nonallergic mothers were recruited in this study. During the first two years of life, 15.7% children (n = 11) developed a physician-diagnosed AD (all children were the only child in the family). In group with maternal allergic rhinitis, a significantly increased percentage of Th2 was observed in peripheral blood of mother (7.10[1.18;16.1]% vs. 0.37[0.25;0.72]%, U = 10.0, P < 0.05) and cord blood of newborns (1.02[0.57;1.34]% vs. 0.21[0.15;0.42]%, U = 127.5, P < 0.05), respectively. Maternal atopic history did not affect the percentage of Th1 cells in cord blood (0.69[0.40;1.12]% vs.0.50[0.31;0.66]%, U = 361.0, P > 0.05). Children with reduced Th1/Th2 ratio in cord blood had a higher risk to develop AD (OR = 1.72, P = 0.001) . The model including Th1/Th2, maternal allergy, maternal age at birth and maternal total IgE showed high ability to discriminate children with and without AD. AUC was 0.907 (95% CI: 0.804-1.011, P < 0.001).

CONCLUSIONSElevated IL-4⁺CD4⁺ T cells in cord blood were of relevance with maternal allergic history. Imbalance between Th1 cell and Th2 cell at birth are associated with maternal allergy and promoted subsequent AD development.

Adult ; Child, Preschool ; Dermatitis, Atopic ; immunology ; Female ; Fetal Blood ; cytology ; Flow Cytometry ; Humans ; Immunoglobulin E ; blood ; Infant ; Infant, Newborn ; Mothers ; Prospective Studies ; Rhinitis, Allergic ; blood ; immunology ; Th1 Cells ; cytology ; Th1-Th2 Balance ; Th2 Cells ; cytology

We attempted to investigate the correlation between the severity of atopic dermatitis (AD) in children and the indoor level of house dust mite (HDM) allergens. Ninety-five patients (31.1 +/- 19.5 months of age) with AD were enrolled in this study, and serum specific IgE against Dermatophagoides pteronyssinus and D. farinae was measured. The severity of AD was assessed using the visual analogue scale on the same day of house dust collection. Living rooms and mattresses where the child usually slept were vacuumed for 2 minutes and concentrations of Der f 1 were measured by enzyme-linked immunosorbent assay. The skin symptoms were more severe in patients with Der f 1 concentrations in living room > 2 microg/g dust than < or = 2 microg/g dust (P = 0.018). This difference was noted in AD patients without sensitization to HDM (P = 0.004), but not in patients with sensitization. There was no difference in symptom severity according to Der f 1 concentrations in mattresses (P = 0.062). The severity of skin symptoms is associated with indoor concentrations of HDM in children with AD, and it is likely to act as nonspecific irritants as well as allergens in AD skin lesions.
Adolescent ; Animals ; Antigens, Dermatophagoides/*analysis ; Beds/parasitology ; Child ; Child, Preschool ; Dermatitis, Atopic/*diagnosis/pathology ; Dermatophagoides farinae/immunology ; Dermatophagoides pteronyssinus/immunology ; *Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Immunoglobulin E/blood ; Infant ; Male ; Severity of Illness Index

Cow's milk is one of the most common food allergens in children with atopic dermatitis (AD). This study was conducted to describe the natural course of cow's milk allergy in children with AD, and to identify factors predictive of outcome. To accomplish this, we reviewed the medical records of 115 children who were diagnosed with AD and cow's milk allergy before 24 months of age to evaluate their clinical characteristics and prognostic factors. During a follow-up period of 24 to114 months, the median age for tolerance to cow's milk was found to be 67 months. Multivariate analysis using the Cox proportional hazard model revealed that the peak cow's milk-specific IgE level within 24 months after birth was the most important factor for prediction of the outcome of cow's milk allergy. In conclusion, half of the children younger than 24 months of age with AD and cow's milk allergy could tolerate cow's milk at 67 months of age. The peak cow's milk-specific IgE level within the first 24 months of birth is useful to predict the prognosis of cow's milk allergy in children with AD.
Animals ; Cattle ; Child ; Child, Preschool ; Dermatitis, Atopic/complications/*diagnosis ; Female ; Follow-Up Studies ; Humans ; Immune Tolerance ; Immunoglobulin E/blood ; Infant ; Male ; Milk/immunology ; Milk Hypersensitivity/complications/*diagnosis ; Odds Ratio ; Prognosis ; Time Factors

IgE-dependent activation of mast cells and basophils through the high-affinity IgE receptor (FcepsilonRI) is involved in the pathogenesis of allergen-induced immune responsiveness in atopic diseases like atopic dermatitis (AD). We sought to determine FcepsilonRI gene polymorphisms are associated with AD in Korean patients, and analyzed the relevance of FcepsilonRI gene polymorphisms and serum IgE levels. We conducted a case-control association analysis (175 patients and 56 controls) of Korean subjects. Genotyping was performed using the TaqMan fluorogenic 5' nuclease assay, and serum levels of IgE were measured using a fluorescence enzyme immunoassay. We found that there were no significant relationships between FcepsilonRI and AD, although there were trends towards an association between the 66T>C (rs2251746) polymorphism and total serum IgE levels in the Korean AD patients. In conclusion, while the 66T>C (rs2251746) of the FcepsilonRIalpha polymorphism may be linked to AD and higher serum IgE levels, polymorphisms in the FcepsilonRIbeta gene did not confer susceptibility to AD in our patient sample.
Adolescent ; Alleles ; Asian Continental Ancestry Group/*genetics ; Case-Control Studies ; Child ; Child, Preschool ; Dermatitis, Atopic/*genetics/immunology ; Female ; Genetic Predisposition to Disease ; Genotype ; Humans ; Immunoglobulin E/*blood ; Male ; *Polymorphism, Single Nucleotide ; Promoter Regions, Genetic ; Receptors, IgE/*genetics ; Republic of Korea

BACKGROUND: Atopic dermatitis (AD) is a chronic inflammation of the skin that often appears in early childhood. The manifestation is related to the tendency towards T helper 2 cytokine immune responses (interleukin (IL)-4, IL-5). Genetic factors are suggested to play important roles in AD, and it can be transmitted to newborns, increasing their risk of developing allergies. OBJECTIVE: To determine the association between cord-blood cytokine levels (IL-5, interferon (IFN) γ), cord-blood total immunoglobulin E (IgE) level, perinatal environmental exposure, and the risks of allergy as well as the development of AD in the first 6 months of life. METHODS: A 6-month cohort study with a nested case-control within was conducted on newborns in Jakarta from December 2008 until May 2009. After the umbilical cord blood samples were taken and stored, subjects were followed up monthly until 6 months old. The occurrence of AD and lifestyle or environmental exposures were recorded. The allergic risk was determined using a modified pediatric allergy immunology work groups scoring system based on allergic history (allergic rhinitis, asthma, AD) in the family. The levels of IL-5 and IFN-γ were measured using ELISA and total IgE by CAP system FEIA. Multivariate analysis was used to evaluate risk factors. RESULTS: This study was conducted on 226 subjects. The incidence of AD was 16.4%; of those, 59% had low risk allergy, 38.5% moderate, and 2% high risk. AD mostly occurred at the age of 1 month (57%). Cord blood samples were examined in 37 subjects with AD and 51 without AD; of those, 25% showed high levels of total IgE (>1.2 IU/µL), and 51% showed normally-distributed high absorbance IL-5 values (≥0.0715, absolute value was undetected). The increased level of IL-5 was directly proportional to IgE. High absorbance IFN-γ values (≥0.0795, absolute value = 18.681 pg/µL) were observed in 52% of subjects. CONCLUSION: The associations between the risk of allergy in the family, cord-blood total IgE, IL-5, IFN levels, and some perinatal environmental exposure with AD in the first 6 months of life have not been established.
Allergy and Immunology ; Asthma ; Case-Control Studies ; Cohort Studies ; Dermatitis, Atopic ; Environmental Exposure ; Enzyme-Linked Immunosorbent Assay ; Fetal Blood ; Humans ; Hypersensitivity ; Immunoglobulin E ; Immunoglobulins ; Incidence ; Infant, Newborn ; Inflammation ; Interferons ; Interleukin-5 ; Life Style ; Multivariate Analysis ; Rhinitis ; Risk Factors ; Skin

Historically, German chamomile (GC) oil has been used for treatment of skin disorders. BALB/c mice were sensitized twice a week with 100 microL of 1% 2,4-dinitrochlorobenzene (DNCB) and challenged twice the following week with 100 microliter of 0.2% DNCB for atopic dermatitis induction. Thereafter, 3% GC oil was applied daily (70 microliter, 6 times week) on the dorsal skin for 4 weeks. Saline or jojoba oil was used for the control mice. Blood was collected after second DNCB challenge, and at 2 and 4 weeks after initiating oil application. Serum IgE levels were significantly lowered in the GC oil application group at the end of the 4-week application period. The GC oil application for 4 weeks resulted in reduction in serum IgG1 level compared with that after 2-week application. The GC oil application group showed a significantly lower serum histamine level than the control group 2 weeks after oil application. Scratching frequency of the GC oil application group was significantly lower than either control groups. This study is to demonstrate GC oil's immunoregulatory potential for alleviating atopic dermatitis through influencing of Th2 cell activation.
Animals ; Behavior, Animal/drug effects ; Chamomile/*immunology ; Dermatitis, Atopic/drug therapy/*immunology ; Disease Models, Animal ; Histamine/blood ; Immunoglobulin E/blood ; Immunoglobulin G/blood ; Interleukin-4/analysis ; Male ; Matricaria/*immunology ; Mice ; Mice, Inbred BALB C ; Phytotherapy/*methods ; Specific Pathogen-Free Organisms ; Th2 Cells/*immunology

OBJECTIVETo assess the preventive effects of different dietary regimens on development of eczema and food allergy in infants at high-risk for allergy.

METHODSForty-six infants whose parents were atopic and umbilical cord IgE > 0.35 kU/L were enrolled in the study. The infants were randomly assigned at birth to one of 2 dietary regimen protocols: those in intervention group (23 cases) were breast fed till more than 4 months of age, then followed by feeding with partially hydrolyzed formula (pHF), combined solid foods avoidance until 4-month of age, egg, fish, shrimp avoidance until 12-month of age. The other 23 cases in non-intervention group were breast fed for less than 4 months, or bottle fed with cow's milk-based formula, egg yolk was introduced at 4-month of age, and egg white at 6-month of age, besides, no any other dietary avoidance was applied. All the infants were followed-up for 18 months. The primary end point was the presence of atopic eczema. Food allergy was detected by fresh food prick-to-prick tests or in vitro sIgE or Fx5E.

RESULTSAt 6 months, 12 months and 18 months, the incidence of eczema in intervention group was 4.3% (1/23), 8.7% (2/23), and 17.4% (4/23), respectively, which was significantly reduced as compared to that of the non-intervention group, which was 26.1% (6/23), 34.8% (8/23), and 39.1% (9/23), respectively. Food allergy was found in 13.0% (3/23) of intervention group and 34.8% (9/23) of non-intervention group by skin prick tests or sIgE. Egg white was the most common offending food.

CONCLUSIONEarly life dietary interventions which included breastfeeding, delayed solid food introducing, pHF feeding, and high risk food avoidance could reduce the risk of atopic eczema and food allergy development, and was probably an effective primary intervention method for infants at high risk for atopy.

Breast Feeding ; Dermatitis, Atopic ; diet therapy ; epidemiology ; etiology ; prevention & control ; Female ; Fetal Blood ; immunology ; Follow-Up Studies ; Food Hypersensitivity ; complications ; diet therapy ; epidemiology ; Humans ; Immunoglobulin E ; blood ; Infant ; Infant Formula ; methods ; Infant, Newborn ; Male ; Mothers ; Prevalence ; Risk Factors ; Time Factors ; Treatment Outcome

Atopic dermatitis (AD) is a chronic, relapsing, inflammatory skin disease. Children with AD tend to have a higher prevalence of food allergies. This study investigated the clinical significance of food sensitization in AD patients. A total of 266 AD patients participated in this study. The prevalence of food sensitization and clinically relevant sensitization were compared in the subjects according to their age and AD severity. Sera from all patients were analyzed for food-specific IgE levels using the Pharmacia CAP System FEIA. The serum specific IgE levels for egg, milk, peanut and soybean were measured. Patients were regarded as sensitized to the food if their food-specific IgE levels were above 0.35 kUA/L. Also the food-specific IgE levels, the so-called diagnostic decision point, which is recommended as the clinically relevant level, for clinical food allergy, as suggested by Sampson et al, was used as an alternative method. From the measurement of food-specific IgE antibodies of the four foods, egg was the most highly sensitized and the main causative allergenic food in children with AD. The positive rates of specific IgE to the four major food allergens, and the prevalences of clinically relevant food sensitization, were higher for all foods tested in the group less than 1 year of age, and were significantly higher in moderate to severe AD compared to mild AD in infants and young children. In summary, presence of food specific IgE is prevalent in infants and young children with AD, and clinically relevant food sensitization is important in Korean infants and children with moderate to severe AD.
Child, Preschool ; Dermatitis, Atopic/*immunology ; Egg Hypersensitivity/epidemiology ; Female ; Food Hypersensitivity/diagnosis/*epidemiology ; Humans ; Immunoglobulin E/blood ; Infant ; Male ; Milk Hypersensitivity/epidemiology ; Peanut Hypersensitivity/epidemiology ; Soybeans/immunology