title: A laboratory test based on determination of cytokine profiles: a promising assay to identify exposition to contact allergens and predict the clinical outcome in occupational allergic contact dermatitis.
abstract: BACKGROUND
  Para-phenylenediamine (PPD) is the main allergen causing adverse reactions to hair dyes and a frequent cause of occupational-related skin sensitization among hairdressers and beauticians. The immunologic mechanism of the disease relies on the production of inflammatory cytokines by allergen-specific T cells, while regulatory T cells are thought to down-modulate the allergic response. This study was aimed at investigating the expression of effector or regulatory cytokines in exposed subjects in order to verify whether different cytokine profiles might predict distinct clinical outcomes. Peripheral blood mononuclear cells (PBMC) from 21 subjects occupationally exposed or not (10) to PPD were kept in short term cultures in the presence of optimized concentrations of NiSO4 × 6H2O or PPD. The production of IFN-γ and IL-10 elicited by antigens were analyzed by the ELISpot assay.
  
  
  RESULTS
  The presence of IFN-γ responses toward PPD was significantly correlated with a positive patch test (P = 0.002) and allergic symptoms, while IL10 responses were invariably found in PPD-exposed but clinically asymptomatic subjects with negative patch testing. We found concordance between the different cytokine profiles and patch test results. No false-positive results were found for the different cytokine profiles induced by PPD, resulting in 100% specificity. The sensitivity of the test was 87.5% (95% CI 65.9-100.0) with an overall test accuracy of 93.3%. Although larger prospective-retrospective studies are necessary to validate the predictive potential of the test, the negative and positive predicted values for PPD in this study were NPV = 87.5% and PPV = 100%, respectively.
  
  
  CONCLUSIONS
  These data indicate that distinct cytokine profiles are associated with different clinical manifestations. The test, which is based on a simple and rapid profiling of cytokine responses by T lymphocytes against allergens, has proven to be a promising laboratory tool, useful for both the identification of previous contact with allergens and the etiologic diagnosis of contact allergies as well as capable of predicting the clinical outcome (development of an allergic or tolerant response).
authors: Clinical Pathology and Microbiology, San Gallicano Dermatology Institute, Via Elio Chianesi 53, Rome, 00144, Italy. bordignon@ifo.it.
authors: Valentina
authors: V
authors: Bordignon
authors: Allergy and Infectious Diseases, San Gallicano Dermatology Institute, Via Elio Chianesi 53, Rome, 00144, Italy. francypalamara@yahoo.it.
authors: Francesca
authors: F
authors: Palamara
authors: Allergy and Infectious Diseases, San Gallicano Dermatology Institute, Via Elio Chianesi 53, Rome, 00144, Italy. giorgia.altomonte@tiscali.it.
authors: Giorgia
authors: G
authors: Altomonte
authors: Epidermiology, Regina Elena Cancer Institute, Via Elio Chianesi 53, Rome, 00144, Italy. sperduti@ifo.it.
authors: Isabella
authors: I
authors: Sperduti
authors: Clinical Pathology and Microbiology, San Gallicano Dermatology Institute, Via Elio Chianesi 53, Rome, 00144, Italy. pietravalle@ifo.it.
authors: Mario
authors: M
authors: Pietravalle
authors: Clinical Dermatology, San Gallicano Dermatology Institute, Via Elio Chianesi 53, Rome, 00144, Italy. Claudia_mat80@yahoo.it.
authors: Claudia
authors: C
authors: Cavallotti
authors: Clinical Pathology and Microbiology, San Gallicano Dermatology Institute, Via Elio Chianesi 53, Rome, 00144, Italy. cordiali-fei@ifo.it.
authors: Paola
authors: P
authors: Cordiali-Fei
authors: Institute of Translational Pharmacology (IFT), National Research Council (CNR), Rome, Italy. mariapia.fuggetta@ift.cnr.it.
authors: Maria Pia
authors: MP
authors: Fuggetta
authors: Allergy and Infectious Diseases, San Gallicano Dermatology Institute, Via Elio Chianesi 53, Rome, 00144, Italy. cristaudo@ifo.it.
authors: Antonio
authors: A
authors: Cristaudo
authors: Clinical Pathology and Microbiology, San Gallicano Dermatology Institute, Via Elio Chianesi 53, Rome, 00144, Italy. ensoli@ifo.it.
authors: Fabrizio
authors: F
authors: Ensoli
mesh_terms: D000328:Adult; D000485:Allergens / Q000276:immunology; D002478:Cells, Cultured; D019411:Clinical Laboratory Techniques / Q000379:methods*; D017449:Dermatitis, Allergic Contact / Q000175:diagnosis* / Q000276:immunology; D009783:Dermatitis, Occupational / Q000175:diagnosis* / Q000276:immunology; D058501:Enzyme-Linked Immunospot Assay; D005260:Female; D006202:Hair Dyes / Q000378:metabolism; D006801:Humans; D007371:Interferon-gamma / Q000378:metabolism; D016753:Interleukin-10 / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009532:Nickel / Q000378:metabolism*; D016273:Occupational Exposure / Q000009:adverse effects; D010655:Phenylenediamines / Q000276:immunology / Q000378:metabolism*; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity; D013601:T-Lymphocytes / Q000276:immunology*; D055815:Young Adult
chemical_list: D000485:Allergens; D006202:Hair Dyes; D010655:Phenylenediamines; D016753:Interleukin-10; D009532:Nickel; D007371:Interferon-gamma; C029728:4-phenylenediamine
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