title: Evaluation of the staphylococcal exotoxins and their specific IgE in childhood atopic dermatitis.
abstract: BACKGROUND
  Superantigenic exotoxins produced by Staphylococcus aureus and their specific IgE antibodies are thought to be important precipitating factors of atopic dermatitis (AD), but there are few reports evaluating these 2 factors at the same time.
  
  
  OBJECTIVE
  We examined whether the presence of the exotoxins sampled from the skin of patients with AD and the levels of anti-exotoxin IgE antibodies in their sera correlated with their severity of AD.
  
  
  METHODS
  Patients with mild-to-severe AD, 1 to 22 years of age, were evaluated by using Leicester's scoring system. Specific IgE antibodies against these exotoxins were determined by using ELISA. S aureus was isolated from 3 different areas of the skin. We examined whether the exotoxin (staphylococcal enterotoxin [SE]A, SEB, SEC, SED, and toxic shock syndrome toxin-1) could be detected.
  
  
  RESULTS
  The levels of SEB-specific IgE were correlated with the severity of AD. Five of 6 patients having very high SEB-specific IgE antibody titers were under 6 years of age, and SEB was most frequently isolated (41%). There was no difference in severity between patients with or without exotoxin-producing S aureus. The severity of 9 patients who had both exotoxin-producing S aureus on the skin and specific IgE antibody against the same exotoxin in sera was significantly higher than that of the other patients.
  
  
  CONCLUSIONS
  Anti-SEB IgE titers correlate well with the severity of AD. The presence of exotoxin-producing S aureus may precipitate AD through its specific IgE antibody.
authors.affiliation: Department of Allergy, National Children's Hospital, Setagayaku, Tokyo, Japan.
authors.forename: I
authors.initials: I
authors.lastname: Nomura
authors.forename: K
authors.initials: K
authors.lastname: Tanaka
authors.forename: H
authors.initials: H
authors.lastname: Tomita
authors.forename: T
authors.initials: T
authors.lastname: Katsunuma
authors.forename: Y
authors.initials: Y
authors.lastname: Ohya
authors.forename: N
authors.initials: N
authors.lastname: Ikeda
authors.forename: T
authors.initials: T
authors.lastname: Takeda
authors.forename: H
authors.initials: H
authors.lastname: Saito
authors.forename: A
authors.initials: A
authors.lastname: Akasawa
mesh_terms: D000293:Adolescent; D000328:Adult; D000918:Antibody Specificity; D002648:Child; D002675:Child, Preschool; D003876:Dermatitis, Atopic / Q000276:immunology*; D005083:Exfoliatins / Q000032:analysis* / Q000276:immunology*; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood / Q000276:immunology; D007223:Infant; D008297:Male; D012720:Severity of Illness Index; D012867:Skin / Q000276:immunology / Q000382:microbiology; D013211:Staphylococcus aureus / Q000302:isolation & purification
chemical_list: D005083:Exfoliatins; D007073:Immunoglobulin E