title: Clinical Signs, Staphylococcus and Atopic Eczema-Related Seromarkers.
abstract: Childhood eczema or atopic dermatitis (AD) is a distressing disease associated with pruritus, sleep disturbance, impaired quality of life andStaphylococcus aureusisolation. The pathophysiology of AD is complex and various seromarkers of immunity are involved. We investigated if anti-staphylococcal enterotoxin IgE (anti-SE), selected seromarkers of T regulatory (Treg), T helper (Th) and antigen-presenting cells (APC) are associated with clinical signs of disease severity and quality of life. Disease severity was assessed with the Scoring Atopic Dermatitis (SCORAD) index, and quality of life with the Children's Dermatology Life Quality Index (CDLQI) in AD patients ≤18 years old. Concentrations of anti-staphylococcusenterotoxin A and B immunoglobulin E (anti-SEA and anti-SEB), selected Treg/Th/APC chemokines, skin hydration and transepidermal water loss (TEWL) were measured in these patients. Forty patients with AD [median (interquartile range) age of 13.1 (7.9) years) were recruited. Backward stepwise linear regression (controlling for age, personal allergic rhinitis and asthma, and other blood markers) showed the serum anti-SEB level was positively associated withS. aureusandS. epidermidisisolations, objective SCORAD, clinical signs and CDLQI. TNF-α (a Th1 cytokine) was positively associated with objective SCORAD (B = 4.935,p= 0.010), TGF-β (a Treg cytokine) negatively with disease extent (B = -0.015,p= 0.001), IL-18 (an APC cytokine) positively with disease extent (B = 0.438,p= 0.001) and with TEWL (B = 0.040,p= 0.010), and IL-23 (an APC cytokine) negatively with disease extent (B = -2.812,p= 0.006) and positively with pruritus (B = 0.387,p= 0.007).
  
  
  CONCLUSIONS
  Blood levels of anti-SEB, Th1, Treg and APC cytokines are correlated with various clinical signs of AD. AD is a systemic immunologic disease involvingStaphylococcus aureus, cellular, humoral, cytokine and chemokine pathophysiology.
authors.affiliation: Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China. ehon@hotmail.com.
authors.forename: Kam Lun
authors.initials: KL
authors.lastname: Hon
authors.affiliation: Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China. kathytsang78@link.cuhk.edu.hk.
authors.forename: Kathy Yin Ching
authors.initials: KY
authors.lastname: Tsang
authors.affiliation: Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China. jsckung@gmail.com.
authors.forename: Jeng Sum C
authors.initials: JS
authors.lastname: Kung
authors.affiliation: Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China. tfleung@cuhk.edu.hk.
authors.forename: Ting Fan
authors.initials: TF
authors.lastname: Leung
authors.affiliation: State Key Laboratory of Quality Research in Chinese Medicine, Macau Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Taipa, Macau, China. wklam@must.edu.mo.
authors.forename: Christopher W K
authors.initials: CW
authors.lastname: Lam
authors.affiliation: Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China. ck-wong@cuhk.edu.hk.|Institute of Chinese Medicine and State Key Laboratory of Phytochemistry and Plant Resources in West China, The Chinese University of Hong Kong, Hong Kong, China. ck-wong@cuhk.edu.hk.
authors.forename: Chun Kwok
authors.initials: CK
authors.lastname: Wong
mesh_terms: D000293:Adolescent; D000938:Antigen-Presenting Cells / Q000276:immunology; D015415:Biomarkers / Q000097:blood; D018925:Chemokines / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003876:Dermatitis, Atopic / Q000097:blood / Q000175:diagnosis*; D004768:Enterotoxins / Q000097:blood; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood*; D008297:Male; D011537:Pruritus / Q000097:blood / Q000175:diagnosis*; D011788:Quality of Life; D012867:Skin / Q000382:microbiology; D013211:Staphylococcus aureus; D050378:T-Lymphocytes, Regulatory / Q000276:immunology; D018417:Th1 Cells / Q000276:immunology; D016212:Transforming Growth Factor beta / Q000097:blood; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D015415:Biomarkers; D018925:Chemokines; D004768:Enterotoxins; D016212:Transforming Growth Factor beta; D014409:Tumor Necrosis Factor-alpha; C026066:enterotoxin A, Staphylococcal; D007073:Immunoglobulin E; C031818:enterotoxin B, staphylococcal
keywords: CDLQI; IgE; SCORAD; T helper and Treg lymphocytes; anti-staphylococcal enterotoxin IgE; antigen presenting cell; atopic dermatitis; eosinophil