Molecular aspects of allergens in atopic dermatitis

Abstract

Purpose of reviewMolecular allergology uses pure, mainly recombinant and structurally defined allergen molecules and allergen-derived epitopes to study mechanisms of IgE-associated allergy, to diagnose, and even predict the development of allergic manifestations and to treat and prevent IgE-associated allergies. Atopic dermatitis, a chronic inflammatory skin disease is almost always associated with IgE sensitization to allergens. However, also non-IgE-mediated pathomechanisms seem to be operative in atopic dermatitis and it is often difficult to identify the disease-causing allergens. Here we review recent work showing the usefulness of molecular allergology to study mechanisms of atopic dermatitis, for diagnosis and eventually for treatment and prevention of atopic dermatitis.Recent findingsIgE sensitization to airborne, food-derived, microbial allergens, and autoallergens has been found to be associated with atopic dermatitis. Using defined allergen molecules and non-IgE-reactive allergen derivatives, evidence could be provided for the existence of IgE- and non-IgE-mediated mechanisms of inflammation in atopic dermatitis. Furthermore, effects of epicutaneous allergen administration on systemic allergen-specific immune responses have been studied. Multi-allergen tests containing micro-arrayed allergen molecules have been shown to be useful for the identification of culprit allergens in atopic dermatitis and may improve the management of atopic dermatitis by allergen-specific immunotherapy, allergen avoidance, and IgE-targeting therapies in a personalized medicine approach.SummaryMolecular allergology allows for dissection of the pathomechanisms of atopic dermatitis, provides new forms of allergy diagnosis for identification of disease-causing allergens, and opens the door to new forms of management by allergen-specific and T cells-targeting or IgE-targeting interventions in a personalized medicine approach.

Position Statement on Atopic Dermatitis in Sub‐Saharan Africa: current status and roadmap

“…During the discussion of the clinical aspects of AD, the common use of rubbing with abrasive ‘washing nets’ to exfoliate and smoothen the skin was described and may explain some cases of severe lichenification and possibly hyperpigmentation. There was an expressed need for more in‐depth studies of the AD phenotype in black skin in African populations, the expectations of the African populations, and allergy testing to identify local relevant allergens, differentiate AD from contact dermatitis or to diagnose additional contact dermatitis in AD patients …”

“…There was an expressed need for more in-depth studies of the AD phenotype in black skin in African populations, 18,19 the expectations of the African populations, and allergy testing to identify local relevant allergens, differentiate AD from contact dermatitis or to diagnose additional contact dermatitis in AD patients. 20…”

Immune mediators and therapies for pruritus in atopic dermatitis and psoriasis

“…23 After allergens penetrate the impaired skin barrier, they bind to Langerhans cells and activate Th2 cells to release inflammatory cytokines mainly IL-4 and IL-13. 23 After allergens penetrate the impaired skin barrier, they bind to Langerhans cells and activate Th2 cells to release inflammatory cytokines mainly IL-4 and IL-13.…”

“…The precise allergens in most patients with AD are not known, but AD in some patients is associated with house dust mite and fungal allergens. 23 After allergens penetrate the impaired skin barrier, they bind to Langerhans cells and activate Th2 cells to release inflammatory cytokines mainly IL-4 and IL-13. These cytokines stimulate IgE production and reduce production of antimicrobial peptides, which may facilitate microbial infections such as S. aureus.…”

Aplicações práticas de uma plataforma multiplex para detecção de IgE específica por componentes alergênicos em doenças alérgicas

“…A hipersensibilidade mediada por células parece ter papel mais importante na patogênese da EEo do que a IgE 23 . Sendo assim, o valor dos testes in vivo e in vitro para identificar alérgenos alimentares relevantes na EoE são limitados, o que faz com que a dieta de eliminação, seguida de reintrodução do alimento, com biópsias esofágicas de controle, sejam a maneira mais adequada para avaliar a melhora/piora da inflamação local relacionada a diferentes alimentos 24 . Portanto, a identificação da etiologia por meio de dieta de eliminação de alimentos requer múltiplas endoscopias, o que pode afetar sobremaneira a qualidade de vida dos pacientes.…”