Deleuran M, Ellingsen A R, Paludan K, Schou C, Thestrup-Pedersen K
Department of Dermatology, Marselisborg Hospital, Aarhus University Hospital, Denmark.
Acta Derm Venereol. 1998 Jul;78(4):241-3. doi: 10.1080/000155598441783.
Atopic dermatitis has many similarities with allergic contact dermatitis. Previous studies have revealed delayed-type allergic reactions indicating specific cell-mediated immune reactions in subgroups of patients. It has recently been recognized that purified house dust mite major allergens, Der p1 and Der p2 from Dermatophagoides pteronyssinus, exhibit a proteolytic enzyme activity similar to papain and maybe serine proteases (e.g. trypsin), respectively. This opens the possibility that house dust mites apart from an allergic epitope could elicit irritant reactions in atopic skin. We examined cutaneous reactivity to the purified proteins of house dust mite antigens, Der p1 and Der p2, in 36 consecutive patients with atopic dermatitis. We also patch-tested with trypsin and papain, in order to see if these proteolytic enzymes could induce irritant reactions. Twelve patients had type 1 allergy to Der p1 and two of these had type IV reactivity to D. pteronyssinus extract. Positive reactions were observed in another four patients, but they had also irritant reactions to papain and trypsin, indicating that the enzymatic activity may have elicited the reactions. The cutaneous reactivity was not linked to total serum IgE, but the patients with specific allergic patch tests had type I reactions to D. pteronyssinus extract. Our observations indicate that allergic patch tests towards Der p1 and p2 are rare and that irritant reactions from D. pteronyssinus proteolytic activity may be a more common phenomenon when patch-testing atopic dermatitis patients with house dust mite antigen extract.
特应性皮炎与过敏性接触性皮炎有许多相似之处。以往的研究揭示了迟发型过敏反应，表明在部分患者亚组中存在特定的细胞介导免疫反应。最近人们认识到，来自粉尘螨的纯化主要变应原Der p1和Der p2，分别表现出与木瓜蛋白酶相似的蛋白水解酶活性，可能分别是丝氨酸蛋白酶（如胰蛋白酶）。这使得除了过敏表位外，屋尘螨还可能在特应性皮肤中引发刺激性反应成为可能。我们检测了36例连续性特应性皮炎患者对屋尘螨抗原纯化蛋白Der p1和Der p2的皮肤反应性。我们还用胰蛋白酶和木瓜蛋白酶进行了斑贴试验，以观察这些蛋白水解酶是否能诱导刺激性反应。12例患者对Der p1有1型过敏，其中2例对粉尘螨提取物有IV型反应。另外4例患者观察到阳性反应，但他们对木瓜蛋白酶和胰蛋白酶也有刺激性反应，表明酶活性可能引发了这些反应。皮肤反应性与血清总IgE无关，但特异性过敏斑贴试验阳性的患者对粉尘螨提取物有I型反应。我们的观察结果表明，针对Der p1和p2的过敏斑贴试验很少见，在用屋尘螨抗原提取物对特应性皮炎患者进行斑贴试验时，粉尘螨蛋白水解活性引起的刺激性反应可能是更常见的现象。
