title: Phenotype of atopic dermatitis subjects with a history of eczema herpeticum.
abstract: BACKGROUND
  A subset of subjects with atopic dermatitis (AD) are susceptible to serious infections with herpes simplex virus, called eczema herpeticum, or vaccina virus, called eczema vaccinatum.
  
  
  OBJECTIVE
  This National Institute of Allergy and Infectious Diseases-funded multicenter study was performed to establish a database of clinical information and biologic samples on subjects with AD with and without a history of eczema herpeticum (ADEH(+) and ADEH(-) subjects, respectively) and healthy control subjects. Careful phenotyping of AD subsets might suggest mechanisms responsible for disseminated viral infections and help identify at-risk individuals.
  
  
  METHODS
  We analyzed the data from 901 subjects (ADEH(+) subjects, n = 134; ADEH(-) subjects, n = 419; healthy control subjects, n = 348) enrolled between May 11, 2006, and September 16, 2008, at 7 US medical centers.
  
  
  RESULTS
  ADEH(+) subjects had more severe disease based on scoring systems (Eczema Area and Severity Index and Rajka-Langeland score), body surface area affected, and biomarkers (circulating eosinophil counts and serum IgE, thymus and activation-regulated chemokine, and cutaneous T cell-attracting chemokine) than ADEH(-) subjects (P < .001). ADEH(+) subjects were also more likely to have a history of food allergy (69% vs 40%, P < .001) or asthma (64% vs 44%, P < .001) and were more commonly sensitized to many common allergens (P < .001). Cutaneous infections with Staphylococcus aureus or molluscum contagiosum virus were more common in ADEH(+) subjects (78% and 8%, respectively) than in ADEH(-) subjects (29% and 2%, respectively; P < .001).
  
  
  CONCLUSIONS
  Subjects with AD in whom eczema herpeticum develops have more severe T(H)2-polarized disease with greater allergen sensitization and more commonly have a history of food allergy, asthma, or both. They are also much more likely to experience cutaneous infections with S. aureus or molluscum contagiosum.
authors.affiliation: Department of Dermatology, University of Rochester Medical Center, Rochester, NY 14642, USA. Lisa_Beck@URMC.ROCHESTER.EDU
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Beck
authors.forename: Mark
authors.initials: M
authors.lastname: Boguniewicz
authors.forename: Tissa
authors.initials: T
authors.lastname: Hata
authors.forename: Lynda C
authors.initials: LC
authors.lastname: Schneider
authors.forename: Jon
authors.initials: J
authors.lastname: Hanifin
authors.forename: Rich
authors.initials: R
authors.lastname: Gallo
authors.forename: Amy S
authors.initials: AS
authors.lastname: Paller
authors.forename: Susi
authors.initials: S
authors.lastname: Lieff
authors.forename: Jamie
authors.initials: J
authors.lastname: Reese
authors.forename: Daniel
authors.initials: D
authors.lastname: Zaccaro
authors.forename: Henry
authors.initials: H
authors.lastname: Milgrom
authors.forename: Kathleen C
authors.initials: KC
authors.lastname: Barnes
authors.forename: Donald Y M
authors.initials: DY
authors.lastname: Leung
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000485:Allergens / Q000276:immunology; D000914:Antibodies, Viral / Q000097:blood; D054414:Chemokine CCL17 / Q000378:metabolism; D054425:Chemokine CCL27 / Q000378:metabolism; D054357:Chemokine CXCL10 / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D003876:Dermatitis, Atopic / Q000150:complications / Q000276:immunology* / Q000821:virology*; D005260:Female; D018259:Herpesvirus 1, Human; D018258:Herpesvirus 2, Human; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007223:Infant; D016899:Interferon-beta / Q000378:metabolism; D007617:Kaposi Varicelliform Eruption / Q000209:etiology / Q000276:immunology* / Q000821:virology*; D008297:Male; D008875:Middle Aged; D018418:Th2 Cells / Q000276:immunology*; D055815:Young Adult
chemical_list: D000485:Allergens; D000914:Antibodies, Viral; C106230:CCL17 protein, human; C492276:CCL27 protein, human; C114753:CXCL10 protein, human; D054414:Chemokine CCL17; D054425:Chemokine CCL27; D054357:Chemokine CXCL10; D007073:Immunoglobulin E; D016899:Interferon-beta