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BACTERIA SKIN
COLONIZATION AND INFECTIONS IN PATIENTS WITH ECZEMA
CHAPTER ONE
1.1 Background of the study
Relationship
between Skin Bacterial Colonization and the Occurrence of Allergen-specific and
Non-Allergen-specific Antibodies in Sera of Children with Atopic
Eczema/Dermatitis
Syndrome
In
this study we investigated skin bacterial colonization,
allergen-specific
IgE and antiphospholipid/antinuclear antibodies in 72 children with atopic
eczema/dermatitis syndrome (age 2 – 17 years). Bacteria were found on the skin
in 41 cases and serological allergen-specific IgE positivity in 37. The
different forms of antibodies appeared in the ratio 21/72 (33 antibodies in 21
children).
1.2 Statement of the problem
The
occurrence of antiphospholipid antibodies was significantly higher in the
patients than in the controls. There were significantly more allergens in the
group with bacterial colonization than in the group without colonization.
The
SCORAD index showed a significant positive association with the skin
colonization. We conclude that there are significant relationships between the
occurrence
of
Staphylococcus aureus colonization and the levels of inhalant allergen-specific
IgE in children with atopic eczema/dermatitis syndrome, and between the
occurrence of antiphospholipid IgM positivity and atopic eczema dermatitis
syndrome. Key words: antiphospholipid antibody;
inhalant allergens; bacterial colonization; Staphylococcus
aureus. (Accepted June 26,
2003.)
Atopic
eczema/dermatitis syndrome (AEDS) (1) is a chronic cutaneous inflammatory
disease that nearly always begins in childhood and follows a remitting/ flaring
course that continues throughout life (2 – 4). An
eczematous,
severely pruritic disease, AEDS may be
exacerbated
by several triggering factors, e.g. allergens,
irritants,
seasonal/climate changes and psychic stress.
The
disease often moderates with age, but patients
suffer
from a life-long skin sensitivity to irritants.
Atopy
predisposes patients to various occupational skin
diseases.
Most, but not all, individuals with AEDS have
a
personal or family history of allergic rhinitis or
asthma
(5), along with increased serum IgE antibodies
against
inhalant or food allergens (extrinsic type) (6, 7),
or
against epithelial antigens (8, 9). The role of IgE
remains
obscure, however. The skin bacterial colonization
(as a
base of superantigens) and the exogenous
allergens
play an important role in the progression of
the
clinical status. Antinuclear (ANA) antibodies have
also
been observed in an animal model of atopic
dermatitis
(10). In addition, the impaired skin barrier,
sweating
function (11) and ion content (12) can
contribute
to the pathogenesis of AEDS, including
IgE-mediated
hypersensitivity against sweat antigen
(13) or
epithelial antigens (9). For a better understanding
of the
antibody pattern in AEDS (14), we
compared
the occurrence of allergen-specific IgE and
antiphospholipid
(APL) antibodies, including anticardiolipin
(ACL),
and anti-b2-glucoprotein I (Ab2GPI),
as
well as ANA antibodies in 72 children with AEDS
from
the aspect of bacterial colonization.
1.3 Patients and methods
Seventy-two
children (34 boys, 38 girls; mean age 8 years,
range
2 – 17) with atopic eczema/dermatitis syndrome were
included
in the study; all were suffering from serious or
medium
– severe forms of the disease. The average SCORAD
index
(15) was 48.3 (range 24 – 90). The control group
comprised
22 healthy children (10 boys, 12 girls; mean age
8.6
years, range 1.5 – 14). A tampon was used to take samples
from
the affected skin for microbiological examination, and
the
bacteria were isolated on blood agar medium. The number
of
bacteria was determined using a semiquantitative method.
The
detection of ANA antibodies was carried out by indirect
immunofluorescence
on HEp2 cells. ELISA assays were used
for
measuring anticardiolipin and anti-b2-glycoprotein
I (16).
Serum
total IgE was detected by laser nephelometry. The
allergen-specific
IgE was determined by an immunoblot assay
(INTEX
Basel). Statistical analysis was performed using
Fisher’s
exact test and unpaired t-test
and the odds ratio was
calculated.
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