Debunking the Myth of Wool Allergy: Reviewing the Evidence for Immune and Non-immune Cutaneous Reactions

Zallmann, Michaela; Smith, Pete; Tang, Mimi L.K.; Spelman, Lynda; Cahill, Jennifer; Wortmann, G; Katelaris, Constance H.; Allen, Katrina J.; Su, John

doi:10.2340/00015555-2655

Cited by 14 publications

(6 citation statements)

References 54 publications

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“…This study has demonstrated that wearing fine-diameter Merino wool garments may actually improve signs and symptoms in patients with mild to moderate atopic dermatitis. This is in contrast to the opinion of some patients and professionals 15 who feel that wool clothing is necessarily scratchy and exacerbates irritation in individuals with sensitive skin. The Merino wool fiber used in the clothing for this study was all of fine diameter, which has been demonstrated to be comfortable to wear.…”

Section: Discussioncontrasting

confidence: 80%

Effects of Merino Wool on Atopic Dermatitis Using Clinical, Quality of Life, and Physiological Outcome Measures

Fowler¹,

Fowler²,

Lorenz³

2019

Dermatitis

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Background Wool clothing may be perceived as a poor choice for use by individuals with sensitive skin or atopic dermatitis. Objectives The aims of the study were to evaluate the effect on atopic dermatitis of wearing fine Merino wool clothing versus standard clothing and to assess the effect of Merino wool clothing on quality of life in children and adults with atopic dermatitis 5 years and older. Methods Subjects with mild to moderate atopic dermatitis were assessed in a crossover fashion after wearing Merino wool clothing for 6 weeks and standard clothing for 6 weeks, for Eczema Area and Severity Index, Dermatology Life Quality Index, static Investigator's Global Assessment, and skin hydration. Results While wearing Merino wool clothing, compared with standard clothing, statistically significant improvements were seen in mean Eczema Area and Severity Index scores, Dermatology Life Quality Index scores, and static Investigator's Global Assessment scores. No significant difference was seen with skin hydration. Wearing Merino wool clothing did not produce any negative cutaneous effects compared with wearing standard clothing. Conclusions Merino wool clothing compared with standard clothing provided improvements in severity of atopic dermatitis as well as quality of life in atopic patients.

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Section: Discussioncontrasting

confidence: 80%

Effects of Merino Wool on Atopic Dermatitis Using Clinical, Quality of Life, and Physiological Outcome Measures

Fowler¹,

Fowler²,

Lorenz³

2019

Dermatitis

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“…Physical contact with textile fibers such as wool or cotton swabs from the seemingly normal skin area neighboring the itchy skin often evokes itching sensation 15 . Because alloknesis could be intolerable under pathological itch conditions, it could be a presenting problem for patients with chronic itch, including atopic dermatitis, dry skin itch, and urticaria 3 , 16 – 20 . One plausible mechanism is the excitation of the spinal interneurons, which receive input from low threshold mechanoreceptors (LTMRs) 11 , 13 , 21 .…”

Section: Introductionmentioning

confidence: 99%

A spinal neural circuitry for converting touch to itch sensation

et al. 2020

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Touch and itch sensations are crucial for evoking defensive and emotional responses, and light tactile touch may induce unpleasant itch sensations (mechanical itch or alloknesis). The neural substrate for touch-to-itch conversion in the spinal cord remains elusive. We report that spinal interneurons expressing Tachykinin 2-Cre (Tac2Cre) receive direct Aβ low threshold mechanoreceptor (LTMR) input and form monosynaptic connections with GRPR neurons. Ablation or inhibition markedly reduces mechanical but not acute chemical itch nor noxious touch information. Chemogenetic inhibition of Tac2Cre neurons also displays pronounced deficit in chronic dry skin itch, a type of chemical itch in mice. Consistently, ablation of gastrin-releasing peptide receptor (GRPR) neurons, which are essential for transmitting chemical itch, also abolishes mechanical itch. Together, these results suggest that innocuous touch and chemical itch information converge on GRPR neurons and thus map an exquisite spinal circuitry hard-wired for converting innocuous touch to irritating itch.

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“…31 Prolonged contact of the pre-sensitized AD skin with cysteine proteases can lead to the release of alarmins and in consequence may promote Th2-type response and sensitization. 32,33 The sensitization of cowhage-activated mechanosensitive polymodal C-fibres in non-lesional skin of AD might also explain wool intolerance phenomenon, 34,35 which is one of the minor criteria of AD. 36 Our findings advocate investigation and development of therapeutic interventions aimed at diminishing of proteases and PARs interaction, such as previously proposed topical use of protease inhibitors in AD.…”

Section: Discussionmentioning

confidence: 99%

Clinically uninvolved but not healthy—The skin of patients with atopic dermatitis is primed for itch and inflammation

Moon,

Stasikowska‐Kanicka,

Wągrowska‐Danilewicz

et al. 2023

Acad Dermatol Venereol

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BackgroundAtopic dermatitis (AD) is a highly prevalent inflammatory skin disorder characterized by episodic exacerbations and remissions. Why the clinically healthy skin of AD patients becomes rapidly inflamed and very pruritic is poorly understood.ObjectiveTo investigate cowhage‐ and histamine‐induced itch and skin expression levels of their target receptors in lesional and non‐lesional skin of AD, compared to the skin of patients with psoriasis, chronic spontaneous urticaria (CSU) and healthy subjects.MethodsPatients with AD, psoriasis and chronic spontaneous urticaria (CSU) as well as healthy control subjects (HC) (n = 20 each) were assessed for differences in itch parameters, neurogenic flare reaction and local blood flow responses to skin provocations with cowhage and histamine. Skin biopsies from 10 AD, 10 psoriasis,11 CSU and 12 HC were obtained to assess expression of protease‐activated receptors 2 and 4 (PAR‐2, PAR‐4), histamine H1 and H4 receptors (H1R, H4R), and mast cells.ResultsProvocation of non‐lesional skin of AD patients with cowhage resulted in prolonged itch (p = 0.020), which was not observed in psoriasis and CSU. Significantly prolonged and more intense cowhage‐ and histamine‐induced itch (for duration, peak and overall intensity) was also observed in lesional AD skin. Diminished neurogenic flare reaction and blood flow after histamine provocation were shown in AD and psoriasis patients. Non‐lesional AD skin along with lesional AD and psoriasis skin showed an increased expression of PAR‐2 and PAR‐4, H1R and H4R. Mast cell number was higher in lesional AD and psoriasis skin (p = 0.006 and p = 0.006, respectively).ConclusionThe non‐lesional skin of AD patients markedly differs from healthy skin in cowhage‐induced itch responses and the expression of receptors for proteases and histamine. Proactive therapeutic interventions that downregulate these receptors may prevent episodic exacerbation in AD.

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Debunking the Myth of Wool Allergy: Reviewing the Evidence for Immune and Non-immune Cutaneous Reactions

Cited by 14 publications

References 54 publications

Effects of Merino Wool on Atopic Dermatitis Using Clinical, Quality of Life, and Physiological Outcome Measures

Effects of Merino Wool on Atopic Dermatitis Using Clinical, Quality of Life, and Physiological Outcome Measures

A spinal neural circuitry for converting touch to itch sensation

Clinically uninvolved but not healthy—The skin of patients with atopic dermatitis is primed for itch and inflammation

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