Staphylococcal Exotoxins as Trigger Factors of Atopic Dermatitis

  • K. Breuer
  • T. Werfel
  • A. Kapp

Abstract

S. aureus has been identified as a trigger factor of atopic dermatitis. 30–60% of S. aureus strains are capable to produce exotoxins with superantigenic properties in patients with atopic dermatitis. In order to investigate if these exotoxins exacerbate atopic dermatitis (AD) primarily as superantigens or as ‘conventional’ allergens, we generated exotoxin-reactive T cell lines (TCL) from skin and blood of three patients with atopic dermatitis, who were colonized with toxigenic S. aureus strains. Furthermore we determined the relationship between the severity of skin lesions and the sensitization to staphylococcal enterotoxins A and B in a group of 71 adult patients with atopic dermatitis.

Both super antigen-reactive and exotoxin-specific TCL were generated from skin and blood of the three patients colonized with toxigenic S. aureus strains, which points to the importance of the exotoxins not only as superantigens but also as allergens.

This finding and the recently published fact that patients sensitized to staphylococcal enterotoxin B have a higher disease activity than non-sensitized patients confirm the importance of allergen-specific responses to staphylococcal exotoxins.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Kapp A. Atopic dermatitis—the skin manifestation of atopy. Clin Exp Allergy 199;525:210–219.Google Scholar
  2. 2.
    Werfel T, Kapp A. Environmental and other major provocation factors in atopic dermatitis. Allergy 1998;53:731–739.PubMedCrossRefGoogle Scholar
  3. 3.
    Reekers R, Schmidt P, Kapp A., Werfel T. Evidence of a lymphocyte response to birch pollen related food antigens in atopic dermatitis. J Allergy Clin Immunol 1999;104:466–472.PubMedCrossRefGoogle Scholar
  4. 4.
    Sager N, Feldmann A, Schilling G, Kreitsch P, Neumann C. House dust mite-specific T cells in the skin of subjects with atopic dermatitis: Frequency and lymphokine profile in the allergen patch test. J Allergy Clin Immunol 1992;89:801–810.PubMedCrossRefGoogle Scholar
  5. 5.
    van Reijsen FC, Bruijnzeel-Koomen CA, Kalthoff FS, Maggi E, Romagnani S, Westland JK et al. Skin derived aero allergen-specific T-cell clones of TI12 phenotype in patients with atopic dermatitis. J Allergy Clin Immunol 1992;90:184–193.PubMedCrossRefGoogle Scholar
  6. 6.
    Werfel T, Ahlers G, Schmidt P, Boeker M, Kapp A, Neumann C. Milk-responsive atopic dermatitis is associated with a casein-specific lymphocyte response in adolescent and adult patients. J Allergy Clin Immunol 1997;99:124–133.PubMedGoogle Scholar
  7. 7.
    Mudde GC, von Reijsen FC, Boland GJ, Gast GC, Bruijnzeel PL, Bruijnzeel-Koomen CA. Allergen presentation by epidermal Langerhans cells from patients with atopic dermatitis is mediated by IgE. Immunology 1990;69:335–341.PubMedGoogle Scholar
  8. 8.
    Werfel T, Morita A, Grewe M, Renz H, Wahn U, Krutmann J et al. Allergen-specificity of skininfiltrating T-cells is not restricted to a type 2 cytokine pattern in chronic skin lesions of atopic dermatitis. J Invest Dermatol 1996;107:871–876.PubMedCrossRefGoogle Scholar
  9. 9.
    Aly R. Bacteriology of atopic dermatitis. Acta Dermatol Venereol Stockh 1980;Suppl 92:16–18.Google Scholar
  10. 10.
    Hauser C, Wuethrich B, Matter L, Wilhelm JA, Sonnabend W, Schöpfer K. Staphylococcus aureus skin colonization in atopic dermatitis. Dermatologica 1985;170:35–39.PubMedCrossRefGoogle Scholar
  11. 11.
    Leyden JE, Marples RR, Kligmann AM. Staphylococcus aureus in the lesions of atopic dermatitis. Br J Dermatol 1974;90:525–530.PubMedCrossRefGoogle Scholar
  12. 12.
    Leung DYM, Harbeck R, Bina P, Reiser R, Yang E, Norris DA et al. Presence of IgE antibodies to staphylococcal exotoxins on the skin of patients with atopic dermatitis. J Clin Invest 1993;92:1374–1380.PubMedCrossRefGoogle Scholar
  13. 13.
    Williams REA, Gibson AG, Aitchison TC, Lever R, Mackie RM. Assessment of contact plate sampling technique and subsequent quantitative bacterial studies in atopic dermatitis. Br J Dermatol 1990;123:493–501.PubMedCrossRefGoogle Scholar
  14. 14.
    Akiyama H, Toi Y, Kanzaki H, Tada J, Arata J. Prevalence of producers of enterotoxins and the toxic shock syndrome toxin-i among Staphylococcus aureus strains isolated from atopic dermatitis lesions. Arch Dermatol Res 1996;288:418–420.PubMedCrossRefGoogle Scholar
  15. 15.
    Bunikowski R, Mielke M, Skarabis H, Worm M, Anagnostopoulos I, Kolde G et al. Evidence for a disease-promoting effect of Staphylococcus aureus-derived exotoxins in atopic dermatitis. J Allergy Clin Immunol 2000;105:814–819.PubMedCrossRefGoogle Scholar
  16. 16.
    McFadden JP, Noble WC, Camp RDR. Super antigenic exotoxin-secreting potential of staphylococci isolated from atopic ekzematous skin. Br J Dermatol 2000;128:631–632.CrossRefGoogle Scholar
  17. 17.
    Bunikowski R, Mielke M, Skarabis H, Herz U, Bergmann RL, Wahn U et al. Prevalence and role of serum IgE antibodies to S. aureus-derived superantigens SEA and SEB in children with atopic dermatitis. J Allergy Clin Immunol 1999;103:119–124.PubMedCrossRefGoogle Scholar
  18. 18.
    Marrack P, Kappler J. The staphylococcal exotoxins and their relatives. Science 1990;248:705–711.PubMedCrossRefGoogle Scholar
  19. 19.
    Strange P, Lone S, Lisby S, Nielsen PL, Baadsgaard O. Staphylococcal enterotoxin B applied on intact normal and intact atopic skin induces dermatitis. Arch Dermatol 1996;132:27–33.PubMedCrossRefGoogle Scholar
  20. 20.
    Skov L, Olsen JV, Giorno R, Schlievert PM, Baadsgaard O, Leung DYM. Application of staphylococcal enterotoxin B on normal and atopic skin induces up-regulation of T cells by a super antigen-médiat ed mechanism. J Allergy Clin Immunol 2000;105:820–826.PubMedCrossRefGoogle Scholar
  21. 21.
    Taswell C. Limiting dilution assays for the determination of immunocompetent cell frequencies. J Immunol 1981;126:1614.PubMedGoogle Scholar
  22. 22.
    Strickland I, Hauk PJ, Trumble A, Picker LJ, Leung DY. Evidence for superantigen involvement in skin homing of T cells in atopic dermatitis. J Invest Dermatol 1999;112:249–253.PubMedCrossRefGoogle Scholar
  23. 23.
    Kapp A, Czech W, Krutmann J, Schöpf E. Eosinophil cationic protein in sera of patients with atopic dermatitis. J Am Acad Dermatol 1991;24:555–558.PubMedCrossRefGoogle Scholar
  24. 24.
    Koller DY, Herouy Y, Götz M, Hagel E, Urbanek R, Eichler I. Clinical value of monitoring eosinophil activity in asthma. Arch Dis Child 1995;73:413–417.PubMedCrossRefGoogle Scholar
  25. 25.
    Kapp A. The role of eosinophils in the pathogenesis of atopic dermatitis — eosinophil granule proteins as markers of disease activity. Allergy 1993;48:1–5.PubMedCrossRefGoogle Scholar
  26. 26.
    Kristjansson S, Strannegard IL, Strannegard O, Peterson C, Enander I, Wennegren G. Urinary eosinophil protein X in children with atopic asthma: a useful marker of antiinflammatory treatment. J Allergy Clin Immunol 1996;97(1179):1187.Google Scholar
  27. 27.
    Pucci N, Lombardi E., Novembre E, Farina S, Bernardini R, Rossi E et al. Urinary eosinophil protein X and serum eosinophil cationic protein in infants and children with atopic dermatitis: correlation with disease activity. J Allergy Clin Immunol 2000;105:353–357.PubMedCrossRefGoogle Scholar
  28. 28.
    Nomura I, Tanaka K, Tornita H, Katsunama T, Ohya Y, Ikeda N et al. Evaluation of staphylococcal exotoxin and its specific IgE in childhood atopic dermatitis. J Allergy Clin Immunol 1999;104(441):446.Google Scholar
  29. 29.
    Akdis CA, Akdis M, Simon D, Dibbert B, Weber M, Gratzl S et al. T cells and T cell-derived cytokines as pathogenic factors in the non-allergic form of atopic dermatitis. J Invest Dermatol 1999;113:628–634.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2002

Authors and Affiliations

  • K. Breuer
  • T. Werfel
  • A. Kapp

There are no affiliations available

Personalised recommendations