Clinical and immunologic variables in skin of patients with atopic eczema and either positive or negative atopy patch test reactions.
BACKGROUND
Epicutaneous application of aeroallergens induces a positive atopy patch test (APT) response in about 50% of patients with atopic eczema (AE) and sensitization for these allergens.


OBJECTIVE
To elucidate the mechanisms determining the outcome of the APT, the following questions were addressed. Are there differences in clinical features between patients with AE who have positive versus negative APT responses? Is a macroscopically negative APT response also histologically negative, and if so, are there differences in clinically noninvolved skin between the two groups regarding (1) the sensitivity toward an irritant, (2) the composition of cellular infiltrate, (3) the presence of aeroallergen-specific T cells, and (4) the number of IgE(+) cells?


METHODS
Punch biopsy specimens from both house dust mite patch tested and the clinically noninvolved skin of patients with AE who have positive APT responses (n = 10) and negative APT responses (n = 10) and those from the normal skin of atopic individuals without AE (n = 10) and nonatopic volunteers (n = 10) were analyzed by using immunohistochemistry with mAbs against eosinophil cationic protein, IgE, the high-affinity receptor for IgE, and CD3 and CD25 mAbs. Furthermore, T-cell lines were propagated from noninvolved skin of all patient and control groups. The T-cell lines were tested for house dust mite specificity.


RESULTS
Negative APT sites were immunohistochemically similar to clinically noninvolved AE skin. There were no significant differences between patients with AE who had positive and negative APT results regarding either clinical features, the composition of cellular infiltrate, or the presence of allergen-specific T cells in clinically noninvolved skin. However, differences were observed regarding the presence of IgE on epidermal CD1a(+) cells.


CONCLUSIONS
Our results indicate that a positive APT reaction requires the presence of epidermal IgE(+) CD1a(+) cells in clinically noninvolved skin, but that also other, as yet unknown, discriminatory factors are involved.
Langeveld-Wildschut
E G
EG
Department of Dermatology/Allergology, University Medical Center Utrecht, the Netherlands.
Bruijnzeel
P L
PL
Mudde
G C
GC
Versluis
C
C
Van Ieperen-Van Dijk
A G
AG
Bihari
I C
IC
Knol
E F
EF
Thepen
T
T
Bruijnzeel-Koomen
C A
CA
van Reijsen
F C
FC
D000818:Animals; D017252:CD3 Complex / Q000032:analysis; D003876:Dermatitis, Atopic / Q000097:blood / Q000276:immunology*; D004391:Dust / Q000009:adverse effects; D000939:Epitopes; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000175:diagnosis*; D007073:Immunoglobulin E / Q000097:blood / Q000276:immunology; D007509:Irritants / Q000494:pharmacology; D018655:Lymphocyte Count; D008925:Mites / Q000276:immunology; D010328:Patch Tests; D017455:Receptors, IgE / Q000032:analysis; D015375:Receptors, Interleukin-2 / Q000032:analysis; D012867:Skin / Q000187:drug effects / Q000276:immunology*; D013601:T-Lymphocytes / Q000276:immunology
D017252:CD3 Complex; D004391:Dust; D000939:Epitopes; D007509:Irritants; D017455:Receptors, IgE; D015375:Receptors, Interleukin-2; D007073:Immunoglobulin E