Serum Immunoglobulin E Concentrations and Radioallergosorbent Tests in Children with Atopic Dermatitis

Abstract

ExtractSerum IgE concentrations and the presence of allergen-specific IgE were determined in a series of 23 children with atopic dermatitis. In this group 83% had significantly elevated serum levels of IgE, 91% had coexistent respiratory allergy, 70% had radioallergosorbent test (RAST) evidence of pollen hypersensitivity, and 43% gave a history and demonstrated a RAST score consistent with milk or egg hypersensitivity. In patients with eczema a significant proportion of the elevated serum IgE appears to be antigen specific. SpeculationThe mechanisms involved in the pathogenesis of atopic dermatitis remain unknown. Elevated serum IgE and the presence of antigen specific IgE suggest a causal relationship of atopic eczema with immediate hypersensitivity. Alternatively, the disease process may ,have a marked stimulatory effect on the specific IgE response. The precise nature of this association remains to be determined.Atopic dermatitis or eczema has been defined as an allergic dermatosis which is characterized by erythema, intense itching, and vesiculation (3). Although the pathogenesis is unknown, the strong association of atopic dermatitis, asthma, hay fever, and family history of atopic disease suggests that immunologic mechanisms are frequently involved. Elevated serum IgE levels have been reported frequently in atopic dermatitis, (1,(6)(7)(8)10) and the concentration of IgE appears to be correlated with the severity of the dermatitis (6, 7). Further, Hoffman et al. (5,6) have recently demonstrated specific IgE to a wide variety of antigen in patients with eczema.The present study was undertaken to evaluate serum IgE levels in a selected group of pediatric patients seen in an allergy clinic to determine the presence or absence of allergen-specific IgE and to examine the relation of atopic dermatitis to inhalant and food allergies. SUBJECTS AND METHODS PATIENT POPULATIONThe patient population consisted of 23 children ranging in age from I to 15 years with varying degrees of symptomatic atopic dermatitis seen at the Georgetown University Allergy-lmmunology-Respiratory Disease (AIR) Clinic (Table 1). There were 10 males and 13 females in the study group. In order to examine the relationships of age and IgE, the patients were divided into four age categories: 9 were 1-4 years of age, 4 were 5-8 years of age, 6 were 9-12 years of age, and 4 were 13-15 years of age. CLASSIFICATION OF DISEASEAtopic dermatitis was classified as mild, moderate, or severe according to the extent of the eruption at the time serum samples were obtained. 'Dermatitis of limited distribution with few or no active lesions was classified as "mild." Dermatitis limited to the face, neck, or flexor surfaces of the extremities with limited erythema and vesidulation was "moderate." Extensive involvement of the trunk and extensor surfaces, severe lichenification, extensive erythema, and vesiculation or any of these in combination were classified as "severe."For the purpose of this study, allergic rhinitis or asthma was designated as present (+) or a...

IgE and IgG4 Levels in Children with Atopic Dermatitis

“…The results of the total and specific IgE determinations in children with AD confirm our previous studies [29][30][31][32][33] and recent ob servations [2,5] that serum IgE levels in AD are correlated with disease severity and co existing RA. Thus serum IgE determination is of little value -with the exception of in fants and young children [10,11] -in dis criminating this skin condition from other eczematous or inflammatory skin diseases or in the prognosis of their evolution.…”

“…29], The aetiology of this distressing condition is ob scure, but genetic, environmental and psy chological factors, together with pharmaco logical and immunological disturbances, both of the humoral and the cellular im mune response, are implicated in its patho genesis [18,29]. During recent years, the at tention was focused on the hyperproduction of IgE [5,28,[30][31][32][33] and on the deficiency in a small subpopulation of T cells, notably suppressor cells, with immunoregulatory functions [4,9,21,26], Evidence has also been produced that the IgG4 subclass of IgG antibodies, previously described as 'short term anaphylactic IgG antibodies' [16,17] plays a role in the production of allergic asthma or in eliciting adverse reactions to foodstuffs [1,3,6,13]. However, here are on ly few reports concerning the behaviour of IgG4 in AD [7,8,22], While these studies were carried out on adults or a mixture of adults and children, or children with con comitant respiratory diseases, we have con fined this study to children only and evalu ated the relationships between the serum IgE and IgG4 levels and the severity of the dis ease and the coexistence of respiratory aller gy (RA), taking into consideration the agedependent distribution of both, the IgE and IgG4 values [12,14,23,27],…”

Cow's Milk Allergy

“…In another series of 28 children with AD, a close correlation was noted between a positive history and RAST to CM (14). The total concentration of IgE was often elevated in AD (14) and in AD with CMA (86).…”