title: Exacerbation of atopic dermatitis on grass pollen exposure in an environmental challenge chamber.
abstract: BACKGROUND
  It has frequently been speculated that pruritus and skin lesions develop after topical exposure to aeroallergens in sensitized patients with atopic dermatitis (AD).
  
  
  OBJECTIVE
  We sought to study cutaneous reactions to grass pollen in adult patients with AD with accompanying clear IgE sensitization to grass allergen in an environmental challenge chamber using a monocenter, double-blind, placebo-controlled study design.
  
  
  METHODS
  Subjects were challenged on 2 consecutive days with either 4000 pollen grains/m(3) of Dactylis glomerata pollen or clean air. The severity of AD was assessed at each study visit up to 5 days after challenge by (objective) scoring of AD (SCORAD). Additionally, air-exposed and non-air-exposed skin areas were each scored using local SCORAD scoring and investigator global assessments. Levels of a series of serum cytokines and chemokines were determined by using a Luminex-based immunoassay. The primary end point of the study was the change in objective SCORAD scores between prechallenge and postchallenge values.
  
  
  RESULTS
  Exposure to grass pollen induced a significant worsening of AD. A pronounced eczema flare-up of air-exposed rather than covered skin areas occurred. In grass pollen-exposed subjects a significantly higher increase in CCL17, CCL22, and IL-4 serum levels was observed.
  
  
  CONCLUSIONS
  This study demonstrates that controlled exposure to airborne allergens of patients with a so-called extrinsic IgE-mediated form of AD induced a worsening of cutaneous symptoms.
authors.affiliation: Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Werfel
authors.affiliation: Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany. Electronic address: heratizadeh.annice@mh-hannover.de.
authors.forename: Annice
authors.initials: A
authors.lastname: Heratizadeh
authors.affiliation: Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany.
authors.forename: Margarete
authors.initials: M
authors.lastname: Niebuhr
authors.affiliation: Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kapp
authors.affiliation: Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany.
authors.forename: Lennart Matthias
authors.initials: LM
authors.lastname: Roesner
authors.affiliation: Institute for Biostatistics, Hannover Medical School, Hannover, Germany.
authors.forename: Annika
authors.initials: A
authors.lastname: Karch
authors.affiliation: Novartis Pharma AG, Basel, Switzerland.
authors.forename: Veit J
authors.initials: VJ
authors.lastname: Erpenbeck
authors.affiliation: Novartis Pharma AG, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Lösche
authors.affiliation: Novartis Pharma AG, Basel, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Jung
authors.affiliation: Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Research (BREATH), Member of the German Center for Lung Research, Hannover, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Krug
authors.affiliation: Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Badorrek
authors.affiliation: Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Research (BREATH), Member of the German Center for Lung Research, Hannover, Germany.
authors.forename: Jens M
authors.initials: JM
authors.lastname: Hohlfeld
mesh_terms: D000328:Adult; D000485:Allergens / Q000009:adverse effects / Q000276:immunology; D001273:Atmosphere Exposure Chambers / Q000009:adverse effects; D054414:Chemokine CCL17 / Q000097:blood; D054422:Chemokine CCL22 / Q000097:blood; D031745:Dactylis; D003876:Dermatitis, Atopic / Q000276:immunology*; D018450:Disease Progression; D004485:Eczema / Q000276:immunology*; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D015847:Interleukin-4 / Q000097:blood; D008297:Male; D011058:Pollen / Q000276:immunology; D011537:Pruritus / Q000276:immunology*; D055815:Young Adult
chemical_list: D000485:Allergens; D054414:Chemokine CCL17; D054422:Chemokine CCL22; D015847:Interleukin-4; D007073:Immunoglobulin E
keywords: Atopic dermatitis; environmental challenge chamber; exposure; grass pollen; inhalant allergen