Isolation of alpha-toxin-producing Staphylococcus aureus from the skin of highly sensitized adult patients with severe atopic dermatitis.
BACKGROUND
Staphylococcus aureus (S. aureus) is a well-known trigger factor of atopic dermatitis (AD). Besides staphylococcal superantigens, alpha-toxin may influence cutaneous inflammation via induction of T-cell proliferation and cytokine secretion.


OBJECTIVE
To investigate the association between sensitization to inhalant allergens and skin colonization with alpha-toxin-producing S. aureus in AD.


METHODS
We investigated 127 patients with AD, aged 14-65 years, who were on standard anti-inflammatory and antiseptic treatment before investigation. We evaluated skin colonization, medical history, severity of AD and sensitization to inhalant allergens.


RESULTS
Forty-eight of 127 patients were colonized with S. aureus, suffered from more severe AD, had asthma more often and showed higher sensitization levels to inhalant allergens. Thirty of 48 patients with S. aureus skin-colonizing strains produced alpha-toxin and had higher total IgE and specific IgE to birch pollen and timothy grass pollen.


CONCLUSIONS
Under topical treatment with antiseptic and anti-inflammatory agents the colonization of lesional skin with S. aureus was clearly lower than commonly found in untreated patients with AD. Colonization with S. aureus was associated with a higher severity of AD, higher degree of sensitization, and a higher frequency of asthma. The proportion of patients whose skin was colonized with alpha-toxin-producing S. aureus was higher than expected from a former study. Cutaneous colonization with alpha-toxin-producing S. aureus was associated with a higher sensitization level to birch pollen allergen in AD. This may point to a higher susceptibility of patients with higher T-helper 2 polarization towards alpha-toxin-producing S. aureus.
Department of Immunodermatology and Allergy Research, Hannover Medical School, Ricklinger Str. 5, 30449 Hannover, Germany. wichmann.katja@mh-hannover.de
K
K
Wichmann
W
W
Uter
J
J
Weiss
K
K
Breuer
A
A
Heratizadeh
U
U
Mai
T
T
Werfel
D000293:Adolescent; D000328:Adult; D000368:Aged; D000485:Allergens / Q000276:immunology; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001427:Bacterial Toxins / Q000378:metabolism*; D003876:Dermatitis, Atopic / Q000188:drug therapy / Q000276:immunology / Q000382:microbiology*; D005260:Female; D006460:Hemolysin Proteins / Q000378:metabolism*; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D008213:Lymphocyte Activation / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012867:Skin / Q000382:microbiology; D013207:Staphylococcal Skin Infections / Q000188:drug therapy / Q000276:immunology / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000302:isolation & purification* / Q000378:metabolism; D055815:Young Adult
D000485:Allergens; D000893:Anti-Inflammatory Agents; D001427:Bacterial Toxins; D006460:Hemolysin Proteins; C021091:staphylococcal alpha-toxin; D007073:Immunoglobulin E