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Giornale Italiano di Dermatologia e Venereologia 2006 December;141(6):513-9

Copyright © 2006 EDIZIONI MINERVA MEDICA

language: English

Atopy Patch Test with house dust mites and atopic dermatitis: an update

Ingordo V. 1, Iannazzone S. S. 2, Cusano F. 2, Nino M. 3

1 Department of Dermatology Military Hospital Center G. Venticinque, Taranto, Italy 2 Department of Dermatology G. Rummo Hospital, Benevento,Italy 3 Unit of Clinical, Allergologic and Venereologic Dermatology Department of Systematic Pathology Federico II University, Naples, Italy


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It has been hypothesized that allergens usually responsible of atopic manifestations of respiratory type, which are the house dust mites (HDM), can act as triggers of the aggravation of the atopic dermatitis (AD) through the cutaneous direct contact. Many studies, carried out in the last 20 years using the patch test with HDM, suggest that the eczema can be elicited in the skin of a subgroup of patients with AD through an immuno-mediated mechanism. This patch test, that is also carried out with other airborne-allergens, has been called Atopy Patch Test (APT). In the present paper the main methodological problems of APT with HDM and the rates of positivity in the AD subjects, reported by the literature are examined. The evidences showing that an immunopathologic mechanism is involved in the outcome of APT are also reviewed. According to the available studies, the allergen, after the penetration in the skin, would stimulate a lymphocytic reaction via IgE-bearing Langerhans cells. In a premature phase the inflammatory infiltration is composed mostly by Th-2 lymphocytes, secreting IL-4 and IL-5. In a later phase a switch towards an infiltration composed mostly by producers of IFN-γ Th-1 lymphocytes has been observed. It has been proposed that APT can be used, in a subgroup of patients with AD, as a provocation test, analogous to bronchial or nasal provocation tests for asthma and rhinitis, and it has been supposed that the positivity of the test would have predictive significance for clinical worsening of AD after the allergen exposure. The papers supporting this hypothesis are reviewed. Finally, the problem of APT-positivities observed in some non-eczematous patients with respiratory or constitutional atopy and in some nonatopic subjects is considered and the possible explications of this results are examined.

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