Phenotype of atopic dermatitis subjects with a history of eczema herpeticum - 20/08/11
, Mark Boguniewicz, MD b, Tissa Hata, MD c, Lynda C. Schneider, MD d, Jon Hanifin, MD e, Rich Gallo, MD, PhD c, Amy S. Paller, MD h, Susi Lieff, PhD f, Jamie Reese, BS f, Daniel Zaccaro, MS f, Henry Milgrom, MD b, Kathleen C. Barnes, PhD g, Donald Y.M. Leung, MD, PhD b
Reprint requests: Lisa A. Beck, MD, University of Rochester, Department of Dermatology, 601 Elmwood Ave, Box 697, Rochester, NY 14642.Abstract |
Background |
A subset of subjects with atopic dermatitis (AD) are susceptible to serious infections with herpes simplex virus, called eczema herpeticum, or vaccina virus, called eczema vaccinatum.
Objective |
This National Institute of Allergy and Infectious Diseases–funded multicenter study was performed to establish a database of clinical information and biologic samples on subjects with AD with and without a history of eczema herpeticum (ADEH+ and ADEH− subjects, respectively) and healthy control subjects. Careful phenotyping of AD subsets might suggest mechanisms responsible for disseminated viral infections and help identify at-risk individuals.
Methods |
We analyzed the data from 901 subjects (ADEH+ subjects, n = 134; ADEH− subjects, n = 419; healthy control subjects, n = 348) enrolled between May 11, 2006, and September 16, 2008, at 7 US medical centers.
Results |
ADEH+ subjects had more severe disease based on scoring systems (Eczema Area and Severity Index and Rajka-Langeland score), body surface area affected, and biomarkers (circulating eosinophil counts and serum IgE, thymus and activation-regulated chemokine, and cutaneous T cell–attracting chemokine) than ADEH− subjects (P < .001). ADEH+ subjects were also more likely to have a history of food allergy (69% vs 40%, P < .001) or asthma (64% vs 44%, P < .001) and were more commonly sensitized to many common allergens (P < .001). Cutaneous infections with Staphylococcus aureus or molluscum contagiosum virus were more common in ADEH+ subjects (78% and 8%, respectively) than in ADEH− subjects (29% and 2%, respectively; P < .001).
Conclusion |
Subjects with AD in whom eczema herpeticum develops have more severe TH2-polarized disease with greater allergen sensitization and more commonly have a history of food allergy, asthma, or both. They are also much more likely to experience cutaneous infections with S aureus or molluscum contagiosum.
Le texte complet de cet article est disponible en PDF.Key words : Atopic dermatitis, herpes simplex virus, eczema herpeticum, eczema vaccinatum, biomarkers, Staphylococcus aureus
Abbreviations used : AD, ADEH+, ADEH−, ADVN, ASC, CBC, CSC, CTACK (CCL27), CTL, DACI, DAIT, EASI, EH, EV, HSV, IP-10 (CXCL11), IV, JHAAC, NIAID, SDCC, SEA, SEB, TARC (CCL17), TSST-1
Plan
| Supported by National Institutes of Health/National Institute of Allergy and Infectious Diseases Atopic Dermatitis and Vaccinia Network contract N01 AI40029 and NO1 AI40033. Partial funding also provided by Mary Beryl Patch Turnbull Scholar Program. |
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| Disclosure of potential conflict of interest: L. A. Beck owns stock in Wyeth; receives grant support from the National Institutes of Health/National Institute of Allergy and Infectious Diseases, Centocor, and the National Institutes of Health/Clinical and Transitional Science Institute/University of Rochester Medical Center; is a consultant for Glycomimetics, Anacor, and Magen; and is on the scientific advisory board for the National Eczema Association. M. Boguniewicz received grant support from Novartis, serves as a consultant for Graceway and Unilever; and is a member of and speaker at the annual meeting of the American College of Allergy, Asthma & Immunology. L. C. Schneider received grant support from Novartis and the National Institutes of Health/National Institute of Allergy and Infectious Diseases Atopic Dermatitis Vaccinia Network. A. S. Paller received grant support from the National Institutes of Health. S. Lieff is employed by Rho, Inc. J. Reese is employed by Rho, Inc. D. Zaccaro is employed by Rho, Inc. D. Y. M. Leung received grant support from the National Institutes of Health/National Institute of Allergy and Infectious Diseases. |
Vol 124 - N° 2
P. 260 - août 2009 Retour au numéro
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