title: Staphylococcus aureus-derived enterotoxins enhance house dust mite-induced patch test reactions in atopic dermatitis.
abstract: BACKGROUND
  Up to 65% of Staphylococcus aureus strains isolated from the skin of patients with atopic dermatitis (AD) produce exotoxins with superantigenic properties that may also act as allergens leading to an induction of exotoxin-specific IgE antibodies. Staphylococcal enterotoxin B (SEB) applied epicutaneously in a concentration of 10 micro g/cm(2), i.e. 200 micro g/ml, under occlusion induces cutaneous inflammation in patients with AD and healthy individuals.
  
  
  METHODS
  We performed patch tests in 32 adult patients with AD using different concentrations (i.e. 2-200 micro g/ml) of SEA, SEB and house dust mite (HDM) extract (500 micro g/ml). Furthermore, the respective enterotoxins and HDM extract were applied simultaneously to the same patch test site. Specific IgE levels to SEA, SEB and HDM were measured with the CAP FEIA.
  
  
  RESULTS
  The rates of patch test reactions to SEA and SEB increased with rising enterotoxin concentrations. There were no differences in the rates of patch test reactions to SEA and SEB between patients sensitized to the corresponding enterotoxin and non-IgE-sensitized patients. The number of patch test reactions to the mixture of enterotoxin and HDM extract was higher than the number of patch test reactions to either the enterotoxins or HDM extract. We identified 11 patients with AD who reacted neither to the enterotoxins nor to HDM extract, but who showed patch test reactions to the mixture. These reactions were not predicted by the presence of enterotoxin- or HDM-specific IgE.
  
  
  CONCLUSIONS
  Colonization with exotoxin-producing S. aureus may influence the outcome of patch tests in patients with AD.
authors.affiliation: Department of Dermatology and Allergology, Hannover Medical School, Hannover, Germany. langer.katja@mh-hannover.de
authors.forename: Katja
authors.initials: K
authors.lastname: Langer
authors.forename: Kristine
authors.initials: K
authors.lastname: Breuer
authors.forename: Alexander
authors.initials: A
authors.lastname: Kapp
authors.forename: Thomas
authors.initials: T
authors.lastname: Werfel
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D003876:Dermatitis, Atopic / Q000276:immunology*; D004768:Enterotoxins / Q000276:immunology*; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010328:Patch Tests; D039981:Pyroglyphidae / Q000276:immunology*; D013211:Staphylococcus aureus
chemical_list: D004768:Enterotoxins; D007073:Immunoglobulin E