Tanaka M, Aiba S, Matsumura N, Aoyama H, Tabata N, Sekita Y, Tagami H
Department of Dermatology, Tohoku University School of Medicine, Sendai, Japan.
Arch Dermatol. 1994 Nov;130(11):1393-401.
Atopic dermatitis (AD) is a chronic eczematous skin disease that develops in a patient with atopic diathesis, which is characterized by an increased liability to produce IgE antibodies for environmental allergens mostly derived from other living organisms. Experimentally, eczematous skin lesions cannot be induced by immediate IgE-mediated reactions alone. They are produced by cell-mediated allergic contact reactions, and recently contact sensitivity to various environmental allergens has been demonstrated in patients with AD. However, the pathologic role of IgE-mediated skin hypersensitivity or that of delayed-type hypersensitivity to various environmental allergens in AD is not fully evaluated. They have been studied separately and against only specific allergens. Thus, we performed a combined testing procedure consisting of radioallergosorbent test, prick, and scarification patch tests for eight environmental allergens in 97 Japanese adult patients with AD; 48 of them had a history of atopic respiratory diseases (ARD), whereas the remaining 49 had no history of ARD (pure AD).
Patients with AD, particularly those with ARD (AD+ARD), showed a higher incidence of positive radioallergosorbent test and prick test results as well as patch test results against multiple environmental allergens than healthy age-matched control subjects. Among them, we found a significantly high positive correlation between radioallergosorbent test scores and patch test reactions to two allergens, Japanese cedar, and Dermatophagoides farinae allergens in patients with AD. However, the patients with AD displayed a significantly lower incidence of positive patch test reactions to Candida albicans allergen than the healthy control subjects. Patients with AD with negative C albicans patch tests tended to have higher levels of total serum IgE including anti-C albicans IgE antibody. We found negative correlations between total serum IgE levels including specific antibodies and patch test reactions to C albicans allergen.
Except for the dissociated reactivities to C albicans allergen consisting of decreased contact sensitivity and heightened IgE response, generally both IgE-mediated skin hypersensitivity and delayed-type hypersensitivity to various environmental allergens are pronounced in patients with AD. The combined use of these in vivo and in vitro tests is useful to estimate the immunological state of patients with AD.
特应性皮炎（AD）是一种慢性湿疹性皮肤病，发生于具有特应性素质的患者，其特征是对主要源自其他生物体的环境过敏原产生IgE抗体的倾向增加。在实验中，单纯的即刻IgE介导反应不能诱发湿疹性皮肤损害。它们是由细胞介导的过敏性接触反应产生的，最近在AD患者中已证实对各种环境过敏原存在接触性敏感。然而，IgE介导的皮肤超敏反应或对AD中各种环境过敏原的迟发型超敏反应的病理作用尚未得到充分评估。它们一直是分别针对特定过敏原进行研究的。因此，我们对97名日本成年AD患者进行了针对8种环境过敏原的放射性变应原吸附试验、点刺试验和划痕斑贴试验的联合检测程序；其中48人有特应性呼吸道疾病（ARD）病史，其余49人无ARD病史（单纯AD）。
AD患者，尤其是那些患有ARD（AD+ARD）的患者，与年龄匹配的健康对照受试者相比，放射性变应原吸附试验、点刺试验结果以及针对多种环境过敏原的斑贴试验结果的阳性发生率更高。其中，我们发现AD患者的放射性变应原吸附试验评分与针对两种过敏原（日本雪松和粉尘螨过敏原）的斑贴试验反应之间存在显著的高度正相关。然而，AD患者对白假丝酵母菌过敏原的斑贴试验阳性反应发生率明显低于健康对照受试者。白假丝酵母菌斑贴试验阴性的AD患者血清总IgE水平，包括抗白假丝酵母菌IgE抗体水平往往较高。我们发现包括特异性抗体在内的血清总IgE水平与对白假丝酵母菌过敏原的斑贴试验反应之间存在负相关。
除了对白假丝酵母菌过敏原的分离反应，即接触敏感性降低和IgE反应增强外，一般来说，AD患者中IgE介导的皮肤超敏反应和对各种环境过敏原的迟发型超敏反应都很明显。这些体内和体外试验的联合应用有助于评估AD患者的免疫状态。
