Urinary leukotriene E4 correlates with severity of atopic dermatitis in children

Abstract

Leukotriene E4 (LTE(4)) is elevated in adults with atopic dermatitis (AD). We evaluated whether urinary LTE(4) as a noninvasive marker correlates with clinical indices of disease activity in children with AD. AD patients aged 18 years or younger were eligible for inclusion in the study. Disease severity over the preceding 3 days was evaluated by the SCORing Atopic Dermatitis (SCORAD) index. Severity of AD over the past 12 months was evaluated by the Nottingham Eczema Severity Score (NESS) in Chinese. Urinary LTE(4) concentration was measured by competitive enzyme immunoassay. One hundred and twenty-six children with AD (82 boys and 44 girls) and 45 controls were recruited. The mean +/- SD urinary log-transformed LTE(4) concentration in AD patients and controls was 2.94 +/- 0.32 and 2.62 +/- 0.20 pg/mg creatinine, respectively (P < 0.0001). SCORAD significantly correlated with NESS (r = 0.681, P < 0.0001). There were significant correlations between urinary LTE(4) concentration and overall SCORAD score (r = 0.270, P = 0.002) and its extent (r = 0.185, P = 0.038) and intensity components (r = 0.247, P = 0.005), but not with NESS. When compared with mild AD, urinary LTE(4) concentrations were higher in patients with moderate-to-severe disease (P = 0.049). Urinary LTE(4) measurement is noninvasive and may be useful in supplementing the SCORAD for following longitudinal changes in AD severity in children. However, the practical value of this assay in a clinical setting remains to be determined.

Brief case series: Montelukast, at doses recommended for asthma treatment, reduces disease severity and increases soluble CD14 in children with atopic dermatitis

“…Four boys and three girls, with a median (range) age of 12 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16) years, participated in the study. Their median (range) SCORAD scores before and after treatment were 34.7 (16.5-54.8) and 17.0 (6.9-36.9) (Figure 1; pv0.05).…”

“…The elevated urinary concentration of LTE 4 , a stable metabolite of LTC 4 and LTD 4 , and being a useful index of whole-body cysteinyl LT production in vivo [11], have been reported in patients with AD [12][13][14]. In a recent study of 126 children with AD [15], we also found significant correlations between the urinary LTE 4 concentration and overall SCORAD score (r50.270, p50.002), its extent (r50.185, p50.038) and intensity components (r50.247, p50.005). These evidences supported a potential role for increased LT production in the pathogenesis of AD.…”

“…She argued that an improvement in the extent of eczema may have become evident if the treatment period had been longer and, therefore, the extent of the disease may not be a sensitive marker of improvement for patients with extensive moderate-to-severe AD. Measurement of subjective symptoms was also notoriously unreliable [15,21,22], especially with our small sample size.…”

CDLQI, Scorad and Ness: Are they Correlated?

“…This was a self-administered questionnaire and the validated Chinese version was provided [14]. In the modified Chinese version, the surface diagram is enlarged for enhanced clarity and patients are requested to put a 'tick' in boxes of body-parts currently affected with eczema [11,14,15]. The total NESS score further categorized AD severity into three groups: mild, moderate or severity.…”

Are age‐specific high serum IgE levels associated with worse symptomatology in children with atopic dermatitis?

“…It measures the extent, intensity, pruritus, and sleep loss related to AD over the preceding 3 days 3,4 . The severity of AD has also been found to be associated with the levels of various chemokines 5–7 . These chemokine markers have been extensively studied in both adults and children.…”