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To the Editor: It is paramount to consider the pathophysiology of infantile atopic dermatitis (AD), which heralds the atopic march, to manage subsequent allergic diseases. Cytokines such as IL-33 are involved in inducing Th2/Th1 imbalance [1]. The serum IL-33 level increases in adult patients with AD [2]. However, it remains unknown whether the serum IL-33 level increases in infantile AD specifically.
The study involved 10 infants with AD diagnosed based on the guidelines of the American Academy of Dermatology [3]. Laboratory investigations covered peripheral eosinophil count, thymus and activation-regulated chemokine (TARC), non-specific IgE, house-dust mite (HDM)-specific IgE antibody, and egg white (EW) -specific antibody levels. The serum IL-33 level was determined using an enzyme-linked immunosorbent assay (IL-33; R&D Systems, Minneapolis, MN, US).
The median age at the time of diagnosis was 4 (range, 1–9) mo. The median peripheral eosinophil count was 493/µL (0–6300/µL), median TARC was 5299 (2455–18170) pg/mL, and median total non-specific IgE was 24.4 (1.5–8675) IU/mL. HDM and EW sensitizations were observed in one and seven patients, respectively. The serum IL-33 level (1.32–2.49 pg/mL) was not elevated in any patient.
Here, the serum IL-33 level was not elevated in any patient. However, the TARC level was elevated in all patients. Accordingly, we considered that the serum IL-33 level may not be elevated in early-onset infantile AD. IL-33 may only have substantial local skin effects in early-onset infantile AD. Barrier dysfunction and necrosis of epidermal cells due to aggressive excoriation or recurrent scratching over a long duration may be required to increase the serum IL-33 level. Tamagawa-Mineoka et al. reported higher levels of IL-33 in patients with AD who exhibit numerous excoriations [2]. Infants cannot scratch more strongly than school-age children and adults. Furthermore, the pathophysiology of infantile AD may completely differ from that of adult AD.
References
Cayrol C, Duval A, Schmitt P, et al. Environmental allergens induce allergic inflammation through proteolytic maturation of IL-33. Nat Immunol. 2018;19:375–85.
Tamagawa-Mineoka R, Okuzawa Y, Masuda K, Katoh N. Increased serum levels of interleukin 33 in patients with atopic dermatitis. J Am Acad Dermatol. 2014;70:882–8.
Eichenfield LF, Tom WL, Chamlin SL, et al. Guidelines of care for the management of atopic dermatitis: Section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014;70:338–51.
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Fujita, Y., Yoshihara, S. Serum Level of Interleukin-33 in Infantile Atopic Dermatitis. Indian J Pediatr 91, 515 (2024). https://doi.org/10.1007/s12098-023-04906-0
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DOI: https://doi.org/10.1007/s12098-023-04906-0