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Chaudhary F, Agrawal DK. Ethnic and Racial Disparities in Clinical Manifestations of Atopic Dermatitis. ARCHIVES OF INTERNAL MEDICINE RESEARCH 2024; 7:114-133. [PMID: 38938453 PMCID: PMC11210272 DOI: 10.26502/aimr.0170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
Atopic dermatitis is a heterogenous inflammatory skin illness that may last for long time and affect people of different racial and ethnic backgrounds. The condition primarily appears in infants and young children. There are people living with atopic dermatitis in every country and every ethnic group, although the frequency of the disease varies greatly. Due to the varied clinical presentations that atopic dermatitis can have, it can be challenging to characterize and diagnose the disease, particularly in adults. Nevertheless, there exists a dearth of information pertaining to the various presentations of atopic dermatitis among individuals from diverse racial and cultural groups. This critical review article offers a succinct and comprehensive overview of the current findings on the epidemiology of atopic dermatitis with regards to ethnic and racial disparities. The findings hold potential significance in advancing the development of targeted treatments for personalized medicine approaches and enhancing the quality of life for patients with atopy.
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Affiliation(s)
- Fihr Chaudhary
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona CA 91766
| | - Devendra K Agrawal
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona CA 91766
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2
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Virolainen SJ, Satish L, Biagini JM, Chaib H, Chang WC, Dexheimer PJ, Dixon MR, Dunn K, Fletcher D, Forney C, Granitto M, Hestand MS, Hurd M, Kauffman K, Lawson L, Martin LJ, Peña LD, Phelan KJ, Shook M, Weirauch MT, Khurana Hershey GK, Kottyan LC. Filaggrin loss-of-function variants are associated with atopic dermatitis phenotypes in a diverse, early-life prospective cohort. JCI Insight 2024; 9:e178258. [PMID: 38564302 PMCID: PMC11141906 DOI: 10.1172/jci.insight.178258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/22/2024] [Indexed: 04/04/2024] Open
Abstract
Loss-of-function (LoF) variants in the filaggrin (FLG) gene are the strongest known genetic risk factor for atopic dermatitis (AD), but the impact of these variants on AD outcomes is poorly understood. We comprehensively identified genetic variants through targeted region sequencing of FLG in children participating in the Mechanisms of Progression of Atopic Dermatitis to Asthma in Children cohort. Twenty FLG LoF variants were identified, including 1 novel variant and 9 variants not previously associated with AD. FLG LoF variants were found in the cohort. Among these children, the presence of 1 or more FLG LoF variants was associated with moderate/severe AD compared with those with mild AD. Children with FLG LoF variants had a higher SCORing for Atopic Dermatitis (SCORAD) and higher likelihood of food allergy within the first 2.5 years of life. LoF variants were associated with higher transepidermal water loss (TEWL) in both lesional and nonlesional skin. Collectively, our study identifies established and potentially novel AD-associated FLG LoF variants and associates FLG LoF variants with higher TEWL in lesional and nonlesional skin.
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Affiliation(s)
- Samuel J. Virolainen
- Division of Human Genetics and
- Center for Autoimmune Genomics and Etiology, Cincinnati Children’s Hospital, Cincinnati, Ohio, USA
- Immunology Graduate Program and
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Latha Satish
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Asthma Research, Cincinnati Children’s Hospital, Cincinnati, Ohio, USA
| | - Jocelyn M. Biagini
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Asthma Research, Cincinnati Children’s Hospital, Cincinnati, Ohio, USA
| | - Hassan Chaib
- Division of Human Genetics and
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Wan Chi Chang
- Division of Asthma Research, Cincinnati Children’s Hospital, Cincinnati, Ohio, USA
| | - Phillip J. Dexheimer
- Center for Autoimmune Genomics and Etiology, Cincinnati Children’s Hospital, Cincinnati, Ohio, USA
| | | | - Katelyn Dunn
- Division of Human Genetics and
- Center for Autoimmune Genomics and Etiology, Cincinnati Children’s Hospital, Cincinnati, Ohio, USA
| | | | - Carmy Forney
- Division of Human Genetics and
- Center for Autoimmune Genomics and Etiology, Cincinnati Children’s Hospital, Cincinnati, Ohio, USA
| | - Marissa Granitto
- Division of Human Genetics and
- Center for Autoimmune Genomics and Etiology, Cincinnati Children’s Hospital, Cincinnati, Ohio, USA
| | | | - Makenna Hurd
- Division of Asthma Research, Cincinnati Children’s Hospital, Cincinnati, Ohio, USA
| | - Kenneth Kauffman
- Division of Human Genetics and
- Center for Autoimmune Genomics and Etiology, Cincinnati Children’s Hospital, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Lucinda Lawson
- Division of Human Genetics and
- Center for Autoimmune Genomics and Etiology, Cincinnati Children’s Hospital, Cincinnati, Ohio, USA
| | - Lisa J. Martin
- Division of Human Genetics and
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Loren D.M. Peña
- Division of Human Genetics and
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Kieran J. Phelan
- Division of Asthma Research, Cincinnati Children’s Hospital, Cincinnati, Ohio, USA
- Medical Scientist Training Program, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Molly Shook
- Division of Human Genetics and
- Center for Autoimmune Genomics and Etiology, Cincinnati Children’s Hospital, Cincinnati, Ohio, USA
| | - Matthew T. Weirauch
- Division of Human Genetics and
- Center for Autoimmune Genomics and Etiology, Cincinnati Children’s Hospital, Cincinnati, Ohio, USA
- Immunology Graduate Program and
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Divisions of Developmental Biology and Bioinformatics and Allergy and Immunology, Cincinnati Children’s Hospital, Cincinnati, Ohio, USA
| | - Gurjit K. Khurana Hershey
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Asthma Research, Cincinnati Children’s Hospital, Cincinnati, Ohio, USA
- Medical Scientist Training Program, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Leah C. Kottyan
- Division of Human Genetics and
- Center for Autoimmune Genomics and Etiology, Cincinnati Children’s Hospital, Cincinnati, Ohio, USA
- Immunology Graduate Program and
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Divisions of Developmental Biology and Bioinformatics and Allergy and Immunology, Cincinnati Children’s Hospital, Cincinnati, Ohio, USA
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Mohammad S, Karim MR, Iqbal S, Lee JH, Mathiyalagan R, Kim YJ, Yang DU, Yang DC. Atopic dermatitis: Pathophysiology, microbiota, and metabolome - A comprehensive review. Microbiol Res 2024; 281:127595. [PMID: 38218095 DOI: 10.1016/j.micres.2023.127595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/11/2023] [Accepted: 12/24/2023] [Indexed: 01/15/2024]
Abstract
Atopic dermatitis (AD) is a prevalent inflammatory skin condition that commonly occurs in children. Genetics, environment, and defects in the skin barrier are only a few of the factors that influence how the disease develops. As human microbiota research has advanced, more scientific evidence has shown the critical involvement of the gut and skin bacteria in the pathogenesis of atopic dermatitis. Microbiome dysbiosis, defined by changed diversity and composition, as well as the development of pathobionts, has been identified as a potential cause for recurring episodes of atopic dermatitis. Gut dysbiosis causes "leaky gut syndrome" by disrupting the epithelial lining of the gut, which allows bacteria and other endotoxins to enter the bloodstream and cause inflammation. The same is true for the disruption of cutaneous homeostasis caused by skin dysbiosis, which enables bacteria and other pathogens to reach deeper skin layers or even systemic circulation, resulting in inflammation. Furthermore, it is now recognized that the gut and skin microbiota releases both beneficial and toxic metabolites. Here, this review covers a range of topics related to AD, including its pathophysiology, the microbiota-AD connection, commonly used treatments, and the significance of metabolomics in AD prevention, treatment, and management, recognizing its potential in providing valuable insights into the disease.
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Affiliation(s)
- Shahnawaz Mohammad
- Graduate School of Biotechnology, College of Life Sciences, Kyung Hee University, Yongin-si, Gyeonggi-do 17104, Republic of Korea
| | - Md Rezaul Karim
- Department of Biopharmaceutical Biotechnology, College of Life Sciences, Kyung Hee University, Yongin-si, Gyeonggi-do 17104, Republic of Korea; Department of Biotechnology and Genetic Engineering, Faculty of Biological Sciences, Islamic University, Kushtia 7003, Bangladesh
| | - Safia Iqbal
- Department of Biopharmaceutical Biotechnology, College of Life Sciences, Kyung Hee University, Yongin-si, Gyeonggi-do 17104, Republic of Korea; Department of Microbiology, Varendra Institute of Biosciences, Affiliated by Rajshahi University, Natore, Rajshahi 6400, Bangladesh
| | - Jung Hyeok Lee
- Graduate School of Biotechnology, College of Life Sciences, Kyung Hee University, Yongin-si, Gyeonggi-do 17104, Republic of Korea
| | - Ramya Mathiyalagan
- Graduate School of Biotechnology, College of Life Sciences, Kyung Hee University, Yongin-si, Gyeonggi-do 17104, Republic of Korea; Department of Oriental Medicinal Biotechnology, College of Life Sciences, Kyung Hee University, Yongin-si, Gyeonggi-do 17104, Republic of Korea
| | - Yeon Ju Kim
- Graduate School of Biotechnology, College of Life Sciences, Kyung Hee University, Yongin-si, Gyeonggi-do 17104, Republic of Korea; Department of Oriental Medicinal Biotechnology, College of Life Sciences, Kyung Hee University, Yongin-si, Gyeonggi-do 17104, Republic of Korea
| | - Dong Uk Yang
- Graduate School of Biotechnology, College of Life Sciences, Kyung Hee University, Yongin-si, Gyeonggi-do 17104, Republic of Korea; Department of Oriental Medicinal Biotechnology, College of Life Sciences, Kyung Hee University, Yongin-si, Gyeonggi-do 17104, Republic of Korea.
| | - Deok Chun Yang
- Graduate School of Biotechnology, College of Life Sciences, Kyung Hee University, Yongin-si, Gyeonggi-do 17104, Republic of Korea; Department of Oriental Medicinal Biotechnology, College of Life Sciences, Kyung Hee University, Yongin-si, Gyeonggi-do 17104, Republic of Korea.
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4
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Kim J, Ahn K. Atopic dermatitis endotypes: knowledge for personalized medicine. Curr Opin Allergy Clin Immunol 2022; 22:153-159. [PMID: 35152229 DOI: 10.1097/aci.0000000000000820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Endotypes are clinically relevant phenotypes that can be explained by molecular mechanisms, and are defined to predict the development, progression, prognosis and responses to treatment on the individual level. This review summarizes atopic dermatitis phenotypes, endotypes and their potential application for personalized medicine. RECENT FINDINGS Atopic dermatitis can be classified into several phenotypes according to disease courses that likely have common pathophysiology. The genotype is important to define endotypes, but the value of genotype alone remains somewhat limited in most atopic dermatitis patients. Recent studies have demonstrated that atopic dermatitis phenotypes according to ethnicity or age can be classified into endotypes based on the dominant immunologic markers, that is TH1/TH2/TH17/TH22 cells. Newly developed biologic agents targeting specific cytokines show therapeutic potential in a personalized medicine approach. SUMMARY Cytokine-based endotypes in different age groups or ethnic groups have contributed to expanding our understanding of atopic dermatitis. Recent biologics or small molecules can be used for more personalized treatment of atopic dermatitis. Further research using integrated multiomic analysis is needed to define a more detailed classification of endotypes and provide endotype-driven targeted therapies for personalized medicine.
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Affiliation(s)
- Jihyun Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Kim BE, Kim J, Goleva E, Berdyshev E, Lee J, Vang KA, Lee UH, Han S, Leung S, Hall CF, Kim NR, Bronova I, Lee EJ, Yang HR, Leung DY, Ahn K. Particulate matter causes skin barrier dysfunction. JCI Insight 2021; 6:145185. [PMID: 33497363 PMCID: PMC8021104 DOI: 10.1172/jci.insight.145185] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/21/2021] [Indexed: 11/17/2022] Open
Abstract
The molecular mechanisms that underlie the detrimental effects of particulate matter (PM) on skin barrier function are poorly understood. In this study, the effects of PM2.5 on filaggrin (FLG) and skin barrier function were investigated in vitro and in vivo. The levels of FLG degradation products, including pyrrolidone carboxylic acid, urocanic acid (UCA), and cis/trans-UCA, were significantly decreased in skin tape stripping samples of study subjects when they moved from Denver, an area with low PM2.5, to Seoul, an area with high PM2.5 count. Experimentally, PM2.5 collected in Seoul inhibited FLG, loricrin, keratin-1, desmocollin-1, and corneodesmosin but did not modulate involucrin or claudin-1 in keratinocyte cultures. Moreover, FLG protein expression was inhibited in human skin equivalents and murine skin treated with PM2.5. We demonstrate that this process was mediated by PM2.5-induced TNF-α and was aryl hydrocarbon receptor dependent. PM2.5 exposure compromised skin barrier function, resulting in increased transepidermal water loss, and enhanced the penetration of FITC-dextran in organotypic and mouse skin. PM2.5-induced TNF-α caused FLG deficiency in the skin and subsequently induced skin barrier dysfunction. Compromised skin barrier due to PM2.5 exposure may contribute to the development and the exacerbation of allergic diseases such as atopic dermatitis.
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Affiliation(s)
- Byung Eui Kim
- Department of Pediatrics, National Jewish Health, Denver, Colorado, USA.,Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jihyun Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, South Korea
| | - Elena Goleva
- Department of Pediatrics, National Jewish Health, Denver, Colorado, USA
| | - Evgeny Berdyshev
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
| | - Jinyoung Lee
- Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, South Korea
| | - Kathryn A Vang
- Department of Pediatrics, National Jewish Health, Denver, Colorado, USA
| | - Un Ha Lee
- Department of Dermatology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea
| | - SongYi Han
- Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, South Korea
| | - Susan Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado, USA
| | - Clifton F Hall
- Department of Pediatrics, National Jewish Health, Denver, Colorado, USA
| | - Na-Rae Kim
- Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, South Korea
| | - Irina Bronova
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
| | - Eu Jin Lee
- Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, South Korea
| | - Hye-Ran Yang
- Seoul Metropolitan Government Research Institute of Public Health and Environment, Seoul, South Korea
| | - Donald Ym Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado, USA
| | - Kangmo Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, South Korea
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6
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Dêbiñska A, Danielewicz H, Drabik-Chamerska A, Kalita D, Boznañski A. Chromosome 11q13.5 variant as a risk factor for atopic dermatitis in children. Postepy Dermatol Alergol 2020; 37:103-110. [PMID: 32467693 PMCID: PMC7247065 DOI: 10.5114/ada.2020.93388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 09/19/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Atopic dermatitis is a chronic inflammatory skin disease with a strong genetic basis. Recent GWASs have identified a single nucleotide polymorphism on chromosome 11q13.5 (rs7927894) as novel susceptibility loci of atopic dermatitis. AIM To evaluate the association of this genetic variant with atopic dermatitis and to investigate its possible interaction with filaggrin null mutations in children population. MATERIAL AND METHODS One hundred eighty-eight children less than 2 years old were screened for the variant of allele of rs7927894 on chromosome 11q13.5 and for the 4 most prevalent filaggrin mutations. The variant of allele of rs7927894 and all filaggrin mutations were genotyped by real-time PCR assays with subsequent melting curve analysis using SimpleProbe® probes. RESULTS The allele of rs7927894[T] was associated with a significantly increased risk of atopic dermatitis (OR = 2.21; 95% CI: 1.14-4.28; p = 0.015). Both allergic and non-allergic patient groups had rs7927894[T] allele significantly more frequently than the control group, however, the frequency of alleles did not differ in these two groups. Interestingly, when rs7927894 variant and filaggrin mutations were considered together, the risk of atopic dermatitis was the most increased in the subjects who combined both rs7927894[T] allele and filaggrin mutations (OR = 16.41; p = 0.003). CONCLUSIONS Our results indicate that the rs7927894 variant on chromosome 11q13.5 may play a role in the development of atopic dermatitis, but this effect seems to be independent of allergic sensitization and of the well-established filaggrin risk alleles, but may be modulated by gene-gene interactions.
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Affiliation(s)
- Anna Dêbiñska
- 1 Department and Clinic of Paediatrics, Allergology and Cardiology, Wroclaw Medical University, Wroclaw, Poland
| | - Hanna Danielewicz
- 1 Department and Clinic of Paediatrics, Allergology and Cardiology, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Drabik-Chamerska
- 1 Department and Clinic of Paediatrics, Allergology and Cardiology, Wroclaw Medical University, Wroclaw, Poland
| | - Danuta Kalita
- 1 Department and Clinic of Paediatrics, Allergology and Cardiology, Wroclaw Medical University, Wroclaw, Poland
| | - Andrzej Boznañski
- 1 Department and Clinic of Paediatrics, Allergology and Cardiology, Wroclaw Medical University, Wroclaw, Poland
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Abstract
Atopic dermatitis (AD) is the most common chronic inflammatory skin disease. Genetic predisposition, epidermal barrier disruption, and dysregulation of the immune system are some of the critical components of AD. An impaired skin barrier may be the initial step in the development of the atopic march as well as AD, which leads to further skin inflammation and allergic sensitization. Type 2 cytokines as well as interleukin 17 and interleukin 22 contribute to skin barrier dysfunction and the development of AD. New insights into the pathophysiology of AD have focused on epidermal lipid profiles, neuroimmune interactions, and microbial dysbiosis. Newer therapeutic strategies focus on improving skin barrier function and targeting polarized immune pathways found in AD. Further understanding of AD pathophysiology will allow us to achieve a more precision medicine approach to the prevention and the treatment of AD.
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Affiliation(s)
- Jihyun Kim
- From the Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung Eui Kim
- Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado
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Goleva E, Berdyshev E, Leung DY. Epithelial barrier repair and prevention of allergy. J Clin Invest 2019; 129:1463-1474. [PMID: 30776025 DOI: 10.1172/jci124608] [Citation(s) in RCA: 136] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Allergic diseases have in common a dysfunctional epithelial barrier, which allows the penetration of allergens and microbes, leading to the release of type 2 cytokines that drive allergic inflammation. The accessibility of skin, compared with lung or gastrointestinal tissue, has facilitated detailed investigations into mechanisms underlying epithelial barrier dysfunction in atopic dermatitis (AD). This Review describes the formation of the skin barrier and analyzes the link between altered skin barrier formation and the pathogenesis of AD. The keratinocyte differentiation process is under tight regulation. During epidermal differentiation, keratinocytes sequentially switch gene expression programs, resulting in terminal differentiation and the formation of a mature stratum corneum, which is essential for the skin to prevent allergen or microbial invasion. Abnormalities in keratinocyte differentiation in AD skin result in hyperproliferation of the basal layer of epidermis, inhibition of markers of terminal differentiation, and barrier lipid abnormalities, compromising skin barrier and antimicrobial function. There is also compelling evidence for epithelial dysregulation in asthma, food allergy, eosinophilic esophagitis, and allergic rhinosinusitis. This Review examines current epithelial barrier repair strategies as an approach for allergy prevention or intervention.
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Affiliation(s)
- Elena Goleva
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, and
| | - Evgeny Berdyshev
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, National Jewish Health, Denver, Colorado, USA
| | - Donald Ym Leung
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, and.,Department of Pediatrics, University of Colorado Denver, Aurora, Colorado, USA
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9
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Tsakok T, Woolf R, Smith CH, Weidinger S, Flohr C. Atopic dermatitis: the skin barrier and beyond. Br J Dermatol 2018; 180:464-474. [PMID: 29969827 DOI: 10.1111/bjd.16934] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Atopic dermatitis is the most common chronic inflammatory skin disorder, affecting up to 20% of children and 10% of adults in industrialized countries. This highly debilitating condition poses a considerable burden to both the individual and society at large. The pathophysiology of atopic dermatitis is complex, encompassing both genetic and environmental risk factors. METHODS This is a narrative review based on a systematic literature search. CONCLUSIONS Dysregulation of innate and adaptive immunity plays a key role; however, recent epidemiological, genetic and molecular research has focused interest on skin barrier dysfunction as a common precursor and pathological feature. Current understanding of the aetiology of atopic dermatitis highlights disruption of the epidermal barrier leading to increased permeability of the epidermis, pathological inflammation in the skin, and percutaneous sensitization to allergens. Thus, most novel treatment strategies seek to target specific aspects of the skin barrier or cutaneous inflammation. Several studies have also shown promise in preventing atopic dermatitis, such as the early use of emollients in high-risk infants. This may have broader implications in terms of halting the progression to atopic comorbidities including food allergy, hay fever and asthma.
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Affiliation(s)
- T Tsakok
- St John's Institute of Dermatology, King's College London, London, U.K
| | - R Woolf
- St John's Institute of Dermatology, King's College London, London, U.K
| | - C H Smith
- St John's Institute of Dermatology, King's College London, London, U.K
| | - S Weidinger
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - C Flohr
- St John's Institute of Dermatology, King's College London, London, U.K
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10
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Kim BE, Leung DYM. Significance of Skin Barrier Dysfunction in Atopic Dermatitis. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2018; 10:207-215. [PMID: 29676067 PMCID: PMC5911439 DOI: 10.4168/aair.2018.10.3.207] [Citation(s) in RCA: 201] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/31/2017] [Accepted: 11/08/2017] [Indexed: 12/13/2022]
Abstract
The epidermis contains epithelial cells, immune cells, and microbes which provides a physical and functional barrier to the protection of human skin. It plays critical roles in preventing environmental allergen penetration into the human body and responsing to microbial pathogens. Atopic dermatitis (AD) is the most common, complex chronic inflammatory skin disease. Skin barrier dysfunction is the initial step in the development of AD. Multiple factors, including immune dysregulation, filaggrin mutations, deficiency of antimicrobial peptides, and skin dysbiosis contribute to skin barrier defects. In the initial phase of AD, treatment with moisturizers improves skin barrier function and prevents the development of AD. With the progression of AD, effective topical and systemic therapies are needed to reduce immune pathway activation and general inflammation. Targeted microbiome therapy is also being developed to correct skin dysbiosis associated with AD. Improved identification and characterization of AD phenotypes and endotypes are required to optimize the precision medicine approach to AD.
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Affiliation(s)
- Byung Eui Kim
- Department of Pediatrics, National Jewish Health, Denver, CO, USA
| | - Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, CO, USA.
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11
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Sohn M. Overview and challenges of current genetic research on allergic diseases in Korean children. ALLERGY ASTHMA & RESPIRATORY DISEASE 2018. [DOI: 10.4168/aard.2018.6.s1.s77] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Myunghyun Sohn
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
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12
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Pyun BY. Current research status of pediatric atopic dermatitis in Korea. ALLERGY ASTHMA & RESPIRATORY DISEASE 2018. [DOI: 10.4168/aard.2018.6.s1.s40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Bok Yang Pyun
- Department of Pediatrics, Pediatric Allergy and Respiratory Center, Soonchunhyang University Seoul Hospital, Seoul, Korea
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13
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Kim YM, Kim J, Lee JY, Kim M, Kim H, Jung K, Eo S, Ahn M, Ahn K. Impact of solar ultraviolet radiation on atopic dermatitis symptoms in young children: A longitudinal study. Pediatr Allergy Immunol 2017. [PMID: 28631848 DOI: 10.1111/pai.12746] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There are controversial data about the effects of sun exposure on atopic dermatitis (AD). We evaluated the association between solar ultraviolet radiation (UVR) exposure and AD symptoms in children. METHODS Eighty-two children under 6 years (48 boys and 34 girls) with AD living in Seoul, Korea, were enrolled and followed for 12 months between September 2013 and August 2014. Daily symptoms were recorded to describe the degree of itching, sleep disturbance, erythema, dryness, oozing, and edema. We assessed solar UVR by measuring radiation heat flux over the 290-400 nm wavelength range using thermopiles. A generalized linear mixed model and a generalized additive mixed model were used to evaluate the effects of UVR exposure on AD symptoms after adjusting for age, sex, outdoor temperature, outdoor humidity, and ambient air pollution. RESULTS Symptom records of 12 915 person-days were analyzed. UVR showed a significantly positive relationship with AD symptoms. Over the study period, an increase in UVR by 10 W/cm2 was associated with a 1.46% increase in AD symptoms (95% CI: 0.85-2.07) on the exposure day. An increase in the 6-day average level of UVR of the previous 5 days and the current day by 10 W/cm2 was associated with a 3.58% (95% CI: 2.60-4.56) increase in AD symptoms. UVR exposure significantly increased AD symptoms in autumn, but decreased them in winter. CONCLUSIONS Atopic dermatitis symptoms in children are likely to be affected by exposure to solar UVR with a cumulative effect, and this effect is different according to season.
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Affiliation(s)
- Young-Min Kim
- The Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,The Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea
| | - Jihyun Kim
- The Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,The Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea
| | - Ji Young Lee
- The Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Minji Kim
- The Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyunmi Kim
- The Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea
| | - Kwon Jung
- The Seoul Research Institute of Public Health and Environment, Gwacheon, Korea
| | - Soomi Eo
- The Seoul Research Institute of Public Health and Environment, Gwacheon, Korea
| | - Mijin Ahn
- The Seoul Research Institute of Public Health and Environment, Gwacheon, Korea
| | - Kangmo Ahn
- The Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,The Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea
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14
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Tanjung C, Rzehak P, Mansyur M, Munasir Z, Sudoyo H, Immanuel S, Irawan R, Reischl E, Demmelmair H, Koletzko B, Hadinegoro SR, Sjarif DR. Study protocol to investigate the environmental and genetic aetiology of atopic dermatitis: the Indonesian Prospective Study of Atopic Dermatitis in Infants (ISADI). BMJ Open 2017; 7:e012475. [PMID: 28259851 PMCID: PMC5353254 DOI: 10.1136/bmjopen-2016-012475] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 01/26/2017] [Accepted: 02/08/2017] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Atopic dermatitis (AD) is the most common skin disorder in young children worldwide, with a high impact on morbidity and quality of life. To date, no prospective study has been published on the incidence and potential predictors of AD in South East Asian populations. The Indonesian Prospective Study of Atopic Dermatitis in Infants (ISADI) will address the genetic, metabolic and dietary characteristics of mothers and their offspring, as well as potential determinants of AD within the first year of infant life. METHODS AND ANALYSIS This prospective study will be undertaken in about 400 infants to investigate the direct and indirect effects of filaggrin (FLG) gene mutations, the genetic variants of FADS1, FADS2 and FADS3 and the role of long-chain polyunsaturated fatty acids (LCPUFA) on the development of AD. We will use standardised protocols for subject recruitment, umbilical artery plasma analysis, buccal cell sampling for genotyping, fatty acid analysis, physical exams, 3-day food-intake recall of mothers and children, as well as comprehensive questionnaires on environmental, socioeconomic and AD-related factors, including family history. Monthly monitoring by telephone and physical exams every 3 months will be carried out to assess participants' anthropometry, medical history and incidence of AD diagnosis during the first year of life. Hypotheses-driven analyses of quality-controlled dietary, genetic and metabolic data will be performed with state-of-the-art statistical methods (eg, AD-event history, haplotype, dietary or metabolic factor analysis). Direct and indirect effects of genetics and LCPUFA in buccal cell and cord plasma glycerophospholipids as potential mediators of inflammation on AD development will be evaluated by path analysis. ETHICS AND DISSEMINATION The Permanent Medical Research Ethics Committee in Medicine and Health/Faculty of Medicine Universitas Indonesia/Dr Cipto Mangunkusumo Hospital (No. 47/H2.F1/ETIK/2014) approved the study protocol (extended by the letter no. 148/UN2.F1/ETIK/2015). We aim to disseminate our findings via publication in an international journal with high impact factor.
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Affiliation(s)
- Conny Tanjung
- Postgraduate Program, Faculty of Medicine, Universitas Indonesia,Jakarta, Indonesia
- Pantai Indah Kapuk Hospital, Jakarta, Indonesia
| | - Peter Rzehak
- Division of Metabolic and Nutritional Medicine, Ludwig-Maximilians-Universität München, Dr von Hauner Children's Hospital, University of Munich Medical Centre, Munich, Germany
| | | | - Zakiudin Munasir
- Department of Paediatrics, Faculty of Medicine,Universitas Indonesia, Dr Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
| | - Herawati Sudoyo
- Faculty of Medicine, Sydney University, Sydney,Australia
- Department of Medical Biology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Suzanna Immanuel
- Department of Clinical Pathology, Faculty of Medicine, Universitas Indonesia, Dr Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
| | - Roedi Irawan
- Department of Paediatrics, Faculty of Medicine, Universitas Airlangga, Dr Sutomo General Hospital, Surabaya, Indonesia
| | - Eva Reischl
- Research Unit of Molecular Epidemiology, Institute of Epidemiology II, Helmholtz Zentrum Muenchen, Munich, Germany
| | - Hans Demmelmair
- Division of Metabolic and Nutritional Medicine, Ludwig-Maximilians-Universität München, Dr von Hauner Children's Hospital, University of Munich Medical Centre, Munich, Germany
| | - Berthold Koletzko
- Division of Metabolic and Nutritional Medicine, Ludwig-Maximilians-Universität München, Dr von Hauner Children's Hospital, University of Munich Medical Centre, Munich, Germany
| | - Sri Rezeki Hadinegoro
- Department of Paediatrics, Faculty of Medicine,Universitas Indonesia, Dr Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
| | - Damayanti Rusli Sjarif
- Department of Paediatrics, Faculty of Medicine,Universitas Indonesia, Dr Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
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15
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On HR, Lee SE, Kim SE, Hong WJ, Kim HJ, Nomura T, Suzuki S, Shimizu H, Kim SC. Filaggrin Mutation in Korean Patients with Atopic Dermatitis. Yonsei Med J 2017; 58:395-400. [PMID: 28120571 PMCID: PMC5290020 DOI: 10.3349/ymj.2017.58.2.395] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 09/23/2016] [Accepted: 09/30/2016] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Atopic dermatitis (AD) is a chronic, relapsing eczematous inflammatory skin disease. Mutations in the filaggrin gene (FLG) are major predisposing factors for AD. Ethnic differences exist between Asian and European populations in the frequency and spectrum of FLG mutations. Moreover, a distinct set of FLG mutations has been reported in Asian populations. The aim of this study was to examine the spectrum of FLG mutations in Koreans with AD. We also investigated the association of FLG mutations and clinical features of AD and compared the Korean FLG landscape with that of other East Asian countries. MATERIALS AND METHODS Seventy Korean patients with AD were enrolled in this study. Fourteen FLG mutations previously detected in Korean, Japanese, and Chinese patients were screened by genotyping. RESULTS Four FLG null mutations (3321delA, K4022X, S3296X, and S2889X) were identified in eleven patients (15.7%). The most commonly detected mutations in Korean patients with AD were 3321delA (n=6, 9.1%) and K4022X (n=3, 4.5%). FLG mutations were significantly associated with elevated IgE (≥200 KIU/L and/or MAST-CLA >3+, p=0.005), palmar hyperlinearity (p<0.001), and a family history of allergic disease (p=0.021). CONCLUSION This study expanded our understanding of the landscape of FLG mutations in Koreans and revealed an association between FLG mutations and AD phenotype.
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Affiliation(s)
- Hye Rang On
- Department of Dermatology, Cutaneous Biology Research Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Eun Lee
- Department of Dermatology, Cutaneous Biology Research Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Song Ee Kim
- Department of Dermatology, Cutaneous Biology Research Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Won Jin Hong
- Department of Dermatology, Cutaneous Biology Research Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Jung Kim
- Department of Dermatology, Seoul Medical Center, Seoul, Korea
| | - Toshifumi Nomura
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Shotaro Suzuki
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hiroshi Shimizu
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Soo Chan Kim
- Department of Dermatology, Cutaneous Biology Research Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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16
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Pyun BY. Diagnosis and treatment of atopic dermatitis in children. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2017. [DOI: 10.5124/jkma.2017.60.9.753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Bok Yang Pyun
- Department of Pediatrics, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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17
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Bin L, Leung DYM. Genetic and epigenetic studies of atopic dermatitis. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2016; 12:52. [PMID: 27777593 PMCID: PMC5069938 DOI: 10.1186/s13223-016-0158-5] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 10/04/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is a chronic inflammatory disease caused by the complex interaction of genetic, immune and environmental factors. There have many recent discoveries involving the genetic and epigenetic studies of AD. METHODS A retrospective PubMed search was carried out from June 2009 to June 2016 using the terms "atopic dermatitis", "association", "eczema", "gene", "polymorphism", "mutation", "variant", "genome wide association study", "microarray" "gene profiling", "RNA sequencing", "epigenetics" and "microRNA". A total of 132 publications in English were identified. RESULTS To elucidate the genetic factors for AD pathogenesis, candidate gene association studies, genome-wide association studies (GWAS) and transcriptomic profiling assays have been performed in this period. Epigenetic mechanisms for AD development, including genomic DNA modification and microRNA posttranscriptional regulation, have been explored. To date, candidate gene association studies indicate that filaggrin (FLG) null gene mutations are the most significant known risk factor for AD, and genes in the type 2 T helper lymphocyte (Th2) signaling pathways are the second replicated genetic risk factor for AD. GWAS studies identified 34 risk loci for AD, these loci also suggest that genes in immune responses and epidermal skin barrier functions are associated with AD. Additionally, gene profiling assays demonstrated AD is associated with decreased gene expression of epidermal differentiation complex genes and elevated Th2 and Th17 genes. Hypomethylation of TSLP and FCER1G in AD were reported; and miR-155, which target the immune suppressor CTLA-4, was found to be significantly over-expressed in infiltrating T cells in AD skin lesions. CONCLUSIONS The results suggest that two major biologic pathways are responsible for AD etiology: skin epithelial function and innate/adaptive immune responses. The dysfunctional epidermal barrier and immune responses reciprocally affect each other, and thereby drive development of AD.
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Affiliation(s)
- Lianghua Bin
- The Department of Dermatology, the First Affiliated Hospital, Jinan University, Guangzhou, China
- Biomedical Translational Research Institute, Jinan University, Guangzhou, China
- Department of Pediatrics, National Jewish Health, 1400 Jackson Street, Room K926i, Denver, CO 80206 USA
| | - Donald Y. M. Leung
- Department of Pediatrics, National Jewish Health, 1400 Jackson Street, Room K926i, Denver, CO 80206 USA
- Guangdong Provincial Key Laboratory of Allergy & Clinical Immunology, The State Key Clinical Specialty in Allergy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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18
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Ahn K. The Prevalence of Atopic Dermatitis in Korean Children. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2015; 8:1-2. [PMID: 26540495 PMCID: PMC4695402 DOI: 10.4168/aair.2016.8.1.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 09/30/2015] [Indexed: 11/20/2022]
Affiliation(s)
- Kangmo Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. .,Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea
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19
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Nahm DH. Personalized Immunomodulatory Therapy for Atopic Dermatitis: An Allergist's View. Ann Dermatol 2015; 27:355-63. [PMID: 26273148 PMCID: PMC4530142 DOI: 10.5021/ad.2015.27.4.355] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 05/12/2015] [Indexed: 01/06/2023] Open
Abstract
The current standard medical therapy for atopic dermatitis (AD) mainly focuses on symptomatic relief by controlling skin inflammation with topical corticosteroids and/or topical calcineurin inhibitors. However, the clinical efficacy of pharmacological therapy is often disappointing to both patients and physicians. The terminology of AD contains a historical meaning of eczematous dermatitis caused by hypersensitivity reaction to environmental inhalant or food allergen. Complex interrelationships among genetic abnormalities, environmental triggers, skin barrier defects, and immune dysfunction resulting in a vicious domino-circle seem to be involved in the development and maintenance of AD. In the viewpoint of AD as an allergic disease, complete avoidance of clinically relevant allergen or induction of specific immune tolerance through administrations of allergen (allergen immunotherapy) can provide clinical remission by breaking the vicious domino-circle maintaining a chronic disease state. In recent clinical studies, monoclonal antibodies including the anti-interleukin-4 receptor antibody and anti-B cell antibody induced significant clinical improvements in patients with AD. The detailed characteristics of immune dysfunction are heterogeneous among patients with AD. Therefore, a personalized combination of immunomodulatory therapies to reduce hypersensitivity (allergen immunotherapy) and correct immune dysfunction (monoclonal antibody therapy) could be a reasonable therapeutic approach for patients with AD. Future immunomodulatory therapies for AD should be developed to achieve long-term treatment-free clinical remission by induction of immune tolerance.
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Affiliation(s)
- Dong-Ho Nahm
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
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20
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Park J, Jekarl DW, Kim Y, Kim J, Kim M, Park YM. NovelFLGnull mutations in Korean patients with atopic dermatitis and comparison of the mutational spectra in Asian populations. J Dermatol 2015; 42:867-73. [DOI: 10.1111/1346-8138.12935] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 04/01/2015] [Indexed: 12/24/2022]
Affiliation(s)
- Joonhong Park
- Department of Laboratory Medicine; College of Medicine; The Catholic University of Korea; Seoul Korea
- Catholic Genetic Laboratory Center; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Dong Wook Jekarl
- Department of Laboratory Medicine; College of Medicine; The Catholic University of Korea; Seoul Korea
- Catholic Genetic Laboratory Center; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Yonggoo Kim
- Department of Laboratory Medicine; College of Medicine; The Catholic University of Korea; Seoul Korea
- Catholic Genetic Laboratory Center; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Jiyeon Kim
- Catholic Genetic Laboratory Center; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Myungshin Kim
- Department of Laboratory Medicine; College of Medicine; The Catholic University of Korea; Seoul Korea
- Catholic Genetic Laboratory Center; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Young Min Park
- Department of Dermatology; College of Medicine; The Catholic University of Korea; Seoul Korea
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21
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Pyun BY. Natural history and risk factors of atopic dermatitis in children. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2015; 7:101-5. [PMID: 25729616 PMCID: PMC4341330 DOI: 10.4168/aair.2015.7.2.101] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 04/21/2014] [Indexed: 01/19/2023]
Abstract
Atopic dermatitis (AD) is one of the most common inflammatory allergic diseases with pruritic skin lesions particularly in infancy. It is considered to be the first step of atopic march and has variable disease courses. Many children with AD may resolve their AD symptoms with increasing age and may develop respiratory allergies such as asthma and rhinoconjunctivitis at certain ages. Natural course of AD has been supported by many cross-sectional and longitudinal studies in many countries. In general, atopic dermatitis tends to be more severe and persistent in young children, particularly if they have some risk factors including genetic factors. It appears that approximately 40%-70% of childhood AD will get resolved when they reach the age of 6-7 years. However, it is also observed that over half of the children with AD developed respiratory allergy during late childhood.
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Affiliation(s)
- Bok Yang Pyun
- Pediatric Allergy and Respiratory Center, Department of Pediatrics, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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22
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Wang IJ, Karmaus WJJ. The effect of phthalate exposure and filaggrin gene variants on atopic dermatitis. ENVIRONMENTAL RESEARCH 2015; 136:213-8. [PMID: 25460639 DOI: 10.1016/j.envres.2014.09.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 08/30/2014] [Accepted: 09/16/2014] [Indexed: 05/08/2023]
Abstract
BACKGROUND Phthalate exposure may increase the risk of atopic disorders. However, little is known about the joint effects of phthalate exposure and filaggrin (FLG) gene variants on atopic dermatitis (AD). We want to investigate whether FLG variants are related to a higher urine concentration of phthalates and whether an interaction of FLG and phthalates increases the risk of AD. METHODS We conducted a case-control study comprised of 106 AD children and 347 controls, all of whom were selected from CEAS cohort. Urine phthalate metabolite levels (MEP, MBP, MBzP, and 5OH-MEHP) were measured by UPLC-MS/MS. FLG variants were analyzed by TaqMan assay. At 3 years of age, information about the development of AD and environmental exposures were collected. Logistic regressions were performed to estimate the association of genotypes and phthalate metabolite levels with AD. RESULTS Urine MBP and MBzP levels were higher in children with AD than in controls (p<0.001). Children with the FLG P478S TT genotype had higher urine phthalate metabolite levels as compared with CC carriers, with MBP and MBzP having a statistically significant difference (geometric mean(s.e.) 5.51(3.77) vs. 3.03(3.48), p=0.015 and 0.76(3.01) vs. 0.53(2.56), p=0.018). After stratifying by phthalate metabolite levels, FLG P478S TT genotype was related to a higher odds of AD in children with high MBP levels (aOR=4.74, 95% CI 1.45-15.5) and in children with high MBzP levels (aOR=3.46, 95%CI 1.03-11.58). CONCLUSIONS FLG variants may increase skin permeability leading to higher skin absorption of phthalate and thus confer a higher susceptibility for AD. Or alternatively, the internal burden of phthalates metabolites is increased in children with AD who also have risky variant of the FLG gene.
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Affiliation(s)
- I-Jen Wang
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan; Institute of Environmental and Occupational Health Sciences, College of Medicine, National Yang-Ming University, Taipei, Taiwan; China Medical University, Taichung, Taiwan.
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23
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Yu HS, Kang MJ, Kwon JW, Lee SY, Lee E, Yang SI, Jung YH, Hong K, Kim YJ, Lee SH, Kim HJ, Kim HY, Seo JH, Kim BJ, Kim HB, Hong SJ. Claudin-1 polymorphism modifies the effect of mold exposure on the development of atopic dermatitis and production of IgE. J Allergy Clin Immunol 2014; 135:827-30.e5. [PMID: 25512082 DOI: 10.1016/j.jaci.2014.10.040] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 10/29/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Ho-Sung Yu
- Asan Institute for Life Science, Asan Medical Center, Seoul, Korea
| | - Mi-Jin Kang
- Asan Institute for Life Science, Asan Medical Center, Seoul, Korea
| | - Ji-Won Kwon
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea; Research Center for Standardization of Allergic Diseases, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - So-Yeon Lee
- Research Center for Standardization of Allergic Diseases, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Department of Pediatrics, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Eun Lee
- Research Center for Standardization of Allergic Diseases, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Childhood Asthma Atopy Center, Asan Medical Center, Seoul, Korea
| | - Song-I Yang
- Research Center for Standardization of Allergic Diseases, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Childhood Asthma Atopy Center, Asan Medical Center, Seoul, Korea
| | - Young-Ho Jung
- Research Center for Standardization of Allergic Diseases, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Childhood Asthma Atopy Center, Asan Medical Center, Seoul, Korea
| | | | - Young-Joon Kim
- Asan Institute for Life Science, Asan Medical Center, Seoul, Korea
| | - Seung-Hwa Lee
- Asan Institute for Life Science, Asan Medical Center, Seoul, Korea
| | - Ha-Jung Kim
- Asan Institute for Life Science, Asan Medical Center, Seoul, Korea
| | - Hyung Young Kim
- Research Center for Standardization of Allergic Diseases, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ju-Hee Seo
- Research Center for Standardization of Allergic Diseases, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea
| | - Byoung-Ju Kim
- Research Center for Standardization of Allergic Diseases, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Department of Pediatrics, Inje University, Haeundae Paik Hospital, Gimhae, Korea
| | - Hyo-Bin Kim
- Research Center for Standardization of Allergic Diseases, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Department of Pediatrics, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Soo-Jong Hong
- Research Center for Standardization of Allergic Diseases, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Childhood Asthma Atopy Center, Asan Medical Center, Seoul, Korea.
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