title: Severe atopic dermatitis is associated with sensitization to staphylococcal enterotoxin B (SEB).
abstract: BACKGROUND
  Staphylococcus aureus has been identified as a possible trigger factor in atopic dermatitis (AD). Some 30-60% of S. aureus strains isolated from patients with AD are able to produce exotoxins with superantigenic properties, mostly staphylococcal enterotoxins A, B, C, and D (SEA-D) and toxic shock syndrome toxin-1 (TSST-1). Recently, it was demonstrated that the presence of IgE antibodies to SEA and SEB is correlated with the severity of skin lesions in children with AD. To determine the relevance of staphylococcal enterotoxins in adult patients with AD, we investigated the relationship between the severity of skin lesions and sensitization to SEA and SEB.
  
  
  METHODS
  Clinical severity was determined by the SCORAD index. Circulating IgE antibodies to SEA and SEB, serum eosinophil cationic protein (ECP) levels, and urine eosinophil protein X (EPX) levels were measured.
  
  
  RESULTS
  The skin condition was significantly worse in patients sensitized to SEB than in unsensitized patients. Serum ECP and urine EPX levels were found to be significantly higher in SEB-sensitized patients, confirming the higher degree of cutaneous inflammation.
  
  
  CONCLUSIONS
  Our results demonstrate a relationship between severity of skin lesions and sensitization to SEB in adult patients with AD, but a relationship between disease activity and sensitization to SEA could not be shown.
authors.affiliation: Department of Dermatology and Allergology, Hannover Medical University, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Breuer
authors.forename: M
authors.initials: M
authors.lastname: Wittmann
authors.forename: B
authors.initials: B
authors.lastname: Bösche
authors.forename: A
authors.initials: A
authors.lastname: Kapp
authors.forename: T
authors.initials: T
authors.lastname: Werfel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000485:Allergens / Q000276:immunology; D001798:Blood Proteins / Q000032:analysis / Q000652:urine; D003876:Dermatitis, Atopic / Q000097:blood / Q000276:immunology* / Q000652:urine; D004768:Enterotoxins / Q000276:immunology*; D047091:Eosinophil Granule Proteins; D047208:Eosinophil-Derived Neurotoxin; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000032:analysis; D008297:Male; D012260:Ribonucleases / Q000652:urine; D012720:Severity of Illness Index
chemical_list: D000485:Allergens; D001798:Blood Proteins; D004768:Enterotoxins; D047091:Eosinophil Granule Proteins; C026066:enterotoxin A, Staphylococcal; D007073:Immunoglobulin E; C031818:enterotoxin B, staphylococcal; D047208:Eosinophil-Derived Neurotoxin; D012260:Ribonucleases