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Atopie-Patch-Test

Atopisches Ekzem und Allergie

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Zusammenfassung

Die Rolle IgE-vermittelter Allergien beim atopischen Ekzem wird kontrovers beurteilt. Bei einem Teil der Patienten mit atopischem Ekzem konnten durch den Atopie-Patch-Test Aeroallergene wie Hausstaubmilbe, Katzenepithelien oder Pollen als relevante Triggerfaktoren nachgewiesen werden. Der Atopie-Patch-Test (APT) ist ein Epikutantest mit Allergenen, die IgE-vermittelte Reaktionen induzieren mit Evaluation ausgelöster ekzematöser Hautreaktionen. In einer Serie mono- und multizentrischer Studien wurde für den APT eine standardisierte Methode entwickelt und mit anderen diagnostischen Techniken (Pricktest, spezifisches Serum-IgE) bei Patienten mit atopischem Ekzem verglichen. Im Hinblick auf die allergenspezifische Anamnese wurden mit dem APT die Resultate mit der höchsten Spezifität erzielt (allergenabhängig 69–92%), während die Sensitivität für den Pricktest (69–82%) und das spezifische IgE (65–94%) höher lag. Die Charakterisierung einer Patientengruppe mit relevanter IgE-vermittelter Allergie könnte zu zielgerichteter Allergenkarenz und möglicherweise auch zur erfolgreichen spezifischen Immuntherapie im Management des atopischen Ekzems beitragen.

Abstract

The role of IgE-mediated allergic reactions in atopic eczema remains controversial. Using the atopy patch test, aeroallergens such as house dust mites, animal dander or pollen can be identified as relevant trigger factors in a subgroup of patients with atopic eczema. The atopy patch test is an epicutaneous patch test employing allergens known to elicit IgE-mediated reactions and used to evaluate eczematous skin reactions. In a series of single- and multicenter studies, a method was developed, standardized and compared to other diagnostic techniques (specific serum-IgE, skin prick test) in atopic eczema patients. With regard to clinical history, the most specific results were obtained with the atopy patch test (allergen-dependent 69–92%), while sensitivity was higher for skin prick test (69–82%) and specific IgE (65–94%). The characterization of a patient subgroup with relevant IgE-mediated allergy may lead to more efficient avoidance and perhaps even specific immunotherapy strategies in the management of atopic eczema.

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Abb. 1
Abb. 2

Abbreviations

AE:

Atopisches Ekzem

APT:

Atopie-Patch-Test

Literatur

  1. Adinoff A, Tellez P, Clark R (1988) Atopic dermatitis and aeroallergen contact sensitivity. J Allergy Clin Immunol 81:736–742

    CAS  PubMed  Google Scholar 

  2. Andersen KE et al. (1987) The European environmental and contact dermatitis research group: contact dermatitis a review. Contact Dermat 16:55–78

    CAS  Google Scholar 

  3. Barnetson RSTC, MacFarlane HAF, Benton EC (1987) House dust mite allergy and atopic eczema: a case report. Br J Dermatol 116:857–860

    CAS  PubMed  Google Scholar 

  4. Bieber T (1994) FCeRI on human Langerhans cells: a receptor in seach of new functions. Immunol Today 15:52–53

    Article  CAS  PubMed  Google Scholar 

  5. Bieber T, Rieger A, Neuchrist C et al. (1989) Induction of FCeR2/CD23 on human epidermal Langerhans-Cells by human recombinant IL4 and IFN. J Exp Med 170:309–314

    CAS  PubMed  Google Scholar 

  6. Bieber T, de la Salle C, Wollenberg A et al. (1992) Constitutive expression of the high affinity receptor for IgE (FCeR1) on human Langerhans-cells. J Exp Med 175:1285–1290

    CAS  PubMed  Google Scholar 

  7. Bruijnzeel-Koomen C, van Wichen DF, Toonstra J et al. (1986) The presence of IgE molecules on epidermal Langerhans-cells in patients with atopic dermatitis. Arch Dermatol Res 278:199–205

    PubMed  Google Scholar 

  8. Bruijnzeel-Koomen C, van Wichen D, Spry C et al. (1988) Active participation of eosinophils in patch test reactions to inhalant allergens in patients with atopic dermatitis. Br J Dermatol 118:229–238

    PubMed  Google Scholar 

  9. Clark R, Adinoff A (1989) Aeroallergen contact can exacerbate atopic dermatitis: patch test as a diagnostic tool. J Am Acad Dermatol 21:863–869

    CAS  PubMed  Google Scholar 

  10. Darsow U (1998) Etablierte Diagnostikverfahren. In: Ring J (Hrsg) Neurodermitis. Ecomed, Landsberg, S 61–73

  11. Darsow U, Ring J (2000) Airborne and dietary allergens in atopic eczema: a comprehensive review of diagnostic tests. Clin Exp Dermatol 25:544–551

    Article  CAS  PubMed  Google Scholar 

  12. Darsow U, Abeck D, Ring J (1997) Allergie und atopisches Ekzem: Zur Bedeutung des "Atopie-Patch-Tests". Hautarzt 48:528–535

    Article  CAS  PubMed  Google Scholar 

  13. Darsow U, Behrendt H, Ring J (1997) Gramineae pollen as trigger factors of atopic eczema: evaluation of diagnostic measures using the atopy patch test. Br J Dermatol 137:201–207

    CAS  PubMed  Google Scholar 

  14. Darsow U, Vieluf D, Ring J (1995) Atopy patch test with different vehicles and allergen concentrations—an approach to standardization. J Allergy Clin Immunol 95:677–684

    CAS  PubMed  Google Scholar 

  15. Darsow U, Vieluf D, Ring J (1996) The atopy patch test: an increased rate of reactivity in patients who have an air-exposed pattern of atopic eczema. Br J Dermatol 135:182–186

    CAS  PubMed  Google Scholar 

  16. Darsow U, Vieluf D, Berg B et al. (1999) Dose response study of atopy patch test in children with atopic eczema. Pediatr Asthma Allergy Immunol 13:115–122

    Google Scholar 

  17. Darsow U, Vieluf D, Ring J for the APT study group (1999) Evaluating the relevance of aeroallergen sensitization in atopic eczema using the tool "atopy patch test": a randomized, double-blind multicenter study. J Am Acad Dermatol 40:187–193

    CAS  PubMed  Google Scholar 

  18. European Task Force on Atopic Dermatitis (1993) Severity scoring of atopic dermatitis: the SCORAD index. Dermatology 186:23–31

    PubMed  Google Scholar 

  19. Fisher AA (1986) Contact sermatitis, 3rd edn. Lea & Febiger, Philadelphia, pp 686–691

  20. Fukuda H, Imayama S, Okada T (1991) Mite-free room (MFR) for the management of atopic dermatitis. Jpn J Allergol 40:626–632

    CAS  Google Scholar 

  21. Gondo A, Saeki N, Tokuda Y (1986) Challenge reactions in atopic dermatitis after percutaneous entry of mite antigen. Br J Dermatol 115:485–493

    CAS  PubMed  Google Scholar 

  22. Grewe M, Gyufko K, Schöpf E, Krutmann J (1994) Lesional expression of interferon-gamma in atopic eczema. Lancet I:25–26

    Google Scholar 

  23. Hanifin JM (1983) Clinical and basic aspects of atopic dermatitis. Semin Dermatol 2:5

    Google Scholar 

  24. Hanifin JM, Rajka G (1980) Diagnostic features of atopic dermatitis. Acta Derm Venereol (Stockh) 114:146–148

    Google Scholar 

  25. Imayama S, Hashizuma T, Miyahara H et al. (1992) Combination of patch test and IgE for dust mite antigens differentiates 130 patients with atopic dermatitis into four groups. J Am Acad Dermatol 27:531–538

    CAS  PubMed  Google Scholar 

  26. Johansson SGO, Hourihane JO, Bousquet J et al. (2002) A revised nomenclature for allergy. An EAACI position statement from the EAACI nomenclature task force. Allergy 56:813–824

    Article  Google Scholar 

  27. Jones HE, Inouye JC, McGerity JL, Lewis CW (1975) Atopic disease and serum immunoglobulin-E. Br J Dermatol 92:17–25

    CAS  PubMed  Google Scholar 

  28. Kerschenlohr K, Günther S, Darsow U et al. (2003) Clinical and immunological reactivity to aeroallergens in "intrinsic" atopic dermatitis patients. J Allergy Clin Immunol 111:195–197

    PubMed  Google Scholar 

  29. Langeland T, Braathen L, Borch M (1989) Studies of atopic patch tests. Acta Derm Venereol (Stockh) [Suppl] 144:105–109

    Google Scholar 

  30. Lau S, Ehnert B, Cremer B et al. (1995) Häusliche Milbenallergenreduktion bei spezifisch sensibilisierten Patienten mit atopischem Ekzem. Allergo J 4:432–435

    Google Scholar 

  31. Leung DYM, Ghan AK, Schneeberger EE, Geha RS (1983) Characterization of the mononuclear cell infiltrate in atopic dermatitis using mononuclear antibodies. J Allergy Clin Immunol 71:47–56

    CAS  PubMed  Google Scholar 

  32. Leung DYM, Rhodes AR, Geha RS et al. (1993) Atopic dermatitis (atopic eczema). In: Fitzpatrick TB, Eisen AZ, Wolff K et al. (eds) Dermatology in general medicine, 4th edn. McGraw Hill, New York, pp 1543–1563

  33. Maeda K, Yamamoto K, Tanaka Y et al. (1992) House dust mite (HDM) antigen in naturally occurring lesions of atopic dermatitis (AD): The relationship between HDM antigen in the skin and HDM antigen-specific IgE antibody. J Derm Science 3:73–77

    CAS  Google Scholar 

  34. Maurer D, Ebner C, Reininger B et al. (1995) The high affinity IgE receptor mediates IgE-dependent allergen presentation. J Immunol 154:6285–6290

    CAS  PubMed  Google Scholar 

  35. Mitchell E, Chapman M, Pope F et al. (1982) Basophils in allergen-induced patch test sites in atopic dermatitis. Lancet I:127–130

    Google Scholar 

  36. Morren MA, Przybilla B, Bamelis M et al. (1994) Atopic dermatitis: triggering factors. J Am Acad Dermatol 31:467–473

    CAS  PubMed  Google Scholar 

  37. Norris P, Schofield O, Camp R (1988) A study of the role of house dust mite in atopic dermatitis. Br J Dermatol 118:435–440

    CAS  PubMed  Google Scholar 

  38. Ohmen JD, Hanifin JM, Nickoloff BJ et al. (1995) Overexpression of IL-10 in atopic dermatitis. Contrasting cytokine patterns with delayed-type hypersensitivity reactions. J Immunol 154:1956–1963

    CAS  PubMed  Google Scholar 

  39. Platts-Mills T, Mitchell E, Rowntree S et al. (1983) The role of dust mite allergens in atopic dermatitis. Clin Exp Dermatol 8:233–247

    CAS  PubMed  Google Scholar 

  40. Przybilla B, Ring J (1990) Food allergy and atopic eczema. Semin Dermatol 9:220–225

    CAS  PubMed  Google Scholar 

  41. Rajka G (1989) Essential aspects of atopic dermatitis. Springer, Berlin Heidelberg New York Tokyo

  42. Ramb-Lindhauer CH, Feldmann A, Rotte M, Neumann CH (1991) Characterization of grass pollen reactive T-cell lines derived from lesional atopic skin. Arch Dermatol Res 283:71–76

    CAS  PubMed  Google Scholar 

  43. Reitamo S, Visa K, Kähönen K et al. (1986) Eczematous reactions in atopic patients caused by epicutaneous testing with inhalant allergens. Br J Dermatol 114:303–309

    CAS  PubMed  Google Scholar 

  44. Reitamo S, Visa K, Kaehoenen K et al. (1989) Patch test reactions to inhalant allergens in atopic dermatitis. Acta Derm Venereol (Stockh) 144:119–121

    Google Scholar 

  45. Renz H, Jujo K, Bradley K et al. (1992) Enhanced IL-4 production and IL-4 receptor expression in atopic dermatitis and their modulation by interferon-gamma. J Invest Dermatol 99:403–408

    CAS  PubMed  Google Scholar 

  46. Ring J (1991) Atopy: condition, disease, or syndrome? In: Ruzicka T, Ring J, Przybilla B (eds) Handbook of atopic eczema. Springer, Berlin Heidelberg New York Tokyo, pp 3–8

  47. Ring J (1995) Angewandte Allergologie, 2. Aufl. MMV Medizin Verlag, München, 1995

  48. Ring J, Brockow K, Abeck D (1996) The therapeutic concept of "patient management" in atopic eczema. Allergy 51:206–215

    CAS  PubMed  Google Scholar 

  49. Ring J, Kunz B, Bieber T et al. (1989) The "atopy patch test" with aeroallergens in atopic eczema (abstr). J Allergy Clin Immunol 82:195

    Google Scholar 

  50. Ring J, Bieber T, Vieluf D et al. (1991) Atopic eczema, Langerhans cells and allergy. Int Arch Allergy Appl Immunol 94:194–201

    CAS  PubMed  Google Scholar 

  51. Rostenberg A, Sulzberger MD (1937) Some results of patch tests. Arch Dermatol 35:433–454

    CAS  Google Scholar 

  52. Sager N, Feldmann A, Schilling G et al. (1992) 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 89:801–810

    CAS  PubMed  Google Scholar 

  53. Sanda T, Yasue T. Oohashi M, Yasue A (1992) Effectiveness of house dust-mite allergen avoidance with atopic dermatitis. J Allergy Clin Immunol 89:653–657

    CAS  PubMed  Google Scholar 

  54. Schäfer L, Kragballe K (1991) Abnormalities in epidermal lipid metabolism in patients with atopic dermatitis. J Invest Dermatol 96:10–15

    PubMed  Google Scholar 

  55. Seidenari S, Manzini M, Danese P (1992) Patch testing with pollens of Gramineae in patients with atopic dermatitis and mucosal atopy. Contact Dermat 27:125–126

    CAS  Google Scholar 

  56. Seidenari S, Manzini BM, Danese P, Giannetti A (1992) Positive patch tests to whole mite culture and purified mite extracts in patients with atopic dermatitis, asthma and rhinitis. Ann Allergy 69:201–206

    CAS  PubMed  Google Scholar 

  57. Seifert H, Wollemann G, Seifert B, Borelli S (1987) Neurodermitis: Eine Protein-Kontaktdermatitis? Dtsch Derm 35:1204–1214

    Google Scholar 

  58. Skov L, Baadsgaard O (1996) Ultraviolet B-exposed major histocompatibility complex class II positive keratinocytes and antigen-presenting cells demonstrate a differential capacity to activate T cells in the presence of staphylococcal superantigens. Br J Dermatol 134:824–830

    CAS  PubMed  Google Scholar 

  59. Sowden J, Powell R, Allen B (1992) Selective activation of circulating CD4+ lymphocytes in severe adult atopic dermatitis. Br J Dermatol 127:228–232

    CAS  PubMed  Google Scholar 

  60. Tan B, Weald D, Strickland I, Friedman P (1996) Double-blind controlled trial of effect of housedust-mite allergen avoidance on atopic dermatitis. Lancet 347:15–18

    CAS  PubMed  Google Scholar 

  61. Tanaka Y, Anan S, Yoshida H (1990) Immunohistochemical studies in mite antigen-induced patch test sites in atopic dermatitis. J Derm Science 1:361–368

    CAS  Google Scholar 

  62. Tupker R, DeMonchy J, Coenraads P et al. (1996) Induction of atopic dermatitis by inhalation of house dust mite. J Allergy Clin Immunol 97:1064–1070

    CAS  PubMed  Google Scholar 

  63. van Bever HP, Docx M, Stevens WJ (1989) Food and food additives in severe atopic dermatitis. Allergy 44:588–594

    PubMed  Google Scholar 

  64. van Reijsen FC, Bruynzeel-Koomen CAFM, Kalthoff FS et al. (1992) Skin-derived aeroallergen-specific T-cell clones of TH2 phenotype in patiens with atopic dermatitis. J Allergy Clin Immunol 90:184–192

    PubMed  Google Scholar 

  65. van Voorst Vader PC, Lier JG, Woest TE et al. (1991) Patch tests with house dust mite antigens in atopic dermatitis patients: methodological problems. Acta Derm Venereol (Stockh) 71:301–305

    Google Scholar 

  66. Vercelli D, Jabara H, Lauener R, Geha R (1990) IL-4 inhibits the synthesis of INF-gamma and induces the synthesis of IgE in human mixed lymphocyte cultures. J Immunol 144:570–573

    CAS  PubMed  Google Scholar 

  67. Vieluf D, Kunz B, Bieber T et al. (1993) "Atopy Patch Test" with aeroallergens in patients with atopic eczema. Allergo J 2:9–12

    Google Scholar 

  68. Vocks E, Seifert H, Seifert B, Drosner M (1991) Patch test with immediate type allergens in patients with atopic dermatitis. In: Ring J, Przybilla B (eds) New trends in allergy III. Springer, Berlin Heidelberg New York Tokyo, pp 230–233

  69. Wistokat-Wülfing A, Schmidt P, Darsow U et al. (1999) Atopy patch test reactions are associated with T lymphocyte-mediated allergen-specific immune responses in atopic dermatitis. Clin Exp Allergy 29:513–521

    Article  PubMed  Google Scholar 

  70. Wüthrich B (1983) Neurodermitis atopica sive constitutionalis. Ein pathogenetisches Modell aus der Sicht des Allergologen. Akt Dermatol 9:1–7

    Google Scholar 

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Authors and Affiliations

  1. Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, München

    U. Darsow & J. Ring

  2. Klinische Kooperationsgruppe Umweltdermatologie und Allergologie GSF/TUM, Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, TU München, Biedersteiner Straße 29, 80802 , München

    U. Darsow

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Darsow, U., Ring, J. Atopie-Patch-Test. Hautarzt 54, 930–936 (2003). https://doi.org/10.1007/s00105-003-0601-7

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