Evaluation of Allergen-Specific IgE Antibodies by MAST in Atopic Dermatitis

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Elfreda Robbins
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1 ** * * ** Evaluation of Allergen-Specific IgE Antibodies by MAST in Atopic Dermatitis Yuh-Ru Huang** Hamm-Ming Sheu* Background: Increased serum total IgE and specific IgE antibody to ingested or inhaled antigens are one of the main immunological abnormalities in atopic dermatitis (AD). Dietary factors and a variety of inhalants have been implicated in exacerbation of AD. Purpose: The purpose of the present work is to elucidate the prevalence of inhalant, food, fungal and plant allergens in patients with AD in southern Taiwan. Methods: We collected serum samples from 507 patients with AD who were treated at National Cheng Kung University Hospital. In this study, 35 allergen-specific immunoglobulin (IgE) antibodies were evaluated by Multiple-antigen simultaneous test (MAST). Total IgE antibodies in serum samples form subjects were measured by the N Latex IgE mono assay. Results: The results reveal the positive rates of the allergens detected by the MAST system are 60.2% for Dermatophagoides farinae, 59% for Dermatophagoides pteronyssinus, 44.2% for house dust, 34.7% for cockroach, and 21.3% for milk. The IgE antibody level is low in infantile group and high in adolescent / young adult group. The younger children start with allergy to food allergens. Egg white and milk are the most common sensitizers. Allergy to inhalant and fungal allergens is rare in the first two years, and gradually increases at adolescent / young adult age. Allergy to plant allergens increases with age. Conclusion: The results indicate that mite and foods are the major sensitizing allergens in Taiwan. The prevalence of allergens in various age groups of AD in Taiwan is similar to those in western countries. (Dermatol Sinica 22 : 1-14, 2004) Key words: Atopic dermatitis, IgE, Multiple-antigen simultaneous test, Mite, Food allergens IgE IgE 507 From the Department of Dermatology, National Cheng-Kung University Hospital* and Tainan Municipal Hospital** Accepted for publication: July 15, 2003 Reprint requests: Hamm-Ming Sheu, M.D., Department of Dermatology, National Cheng-Kung University Hospital, 138 Sheng-Li Road, Tainan, Taiwan, R.O.C. TEL: ext FAX:

2 Multiple-antigen simultaneous test (MAST) 35 IgE IgE N Latex IgE mono assay 60.2% 44.2% 34.7% 21.3% IgE 2 ( 22 : 1-14, 2004) (atopic dermatitis, AD) 1 AD 3 %~5% 10%~12% 2 AD AD 1, 3 IgE IgE AD (Multiple-antigen simultaneous test, MAST) IgE RAST (Radioallergosorbent test) IgE 4 AD Fig. 1 Age distribution of 507 patients. Dermatol Sinica, March

3 AD AD AD (Fig. 1) 1994 : 1., 2., 3. (Table I) 5 a 2 35 b c d Fig AD ( Pure AD) 268 (AD with atopic respiratory disease, AD with ARD) AD IgE IgE IgE MAST (Hitachi chemical Diagnostics Inc., Japan) 35 IgE MAST IgE IgE IgE 35 IgE 6 MAST class 4, 3, 2, 1, 1 / 0 0 MAST class4 IgE 242 luminescence units (LUS) class LUS class LUS class LUS class1 / LUS class LUS MAST class4, 3, 2, 1, 1 / 0 IgE IgE unpaired Student's test P P < 0.05 IgE N Latex IgE mono assay (Dade Table I a b ( ) 3. ( ) Dermatol Sinica, March 2004

4 Behring Inc Germany) IU/ml a 35 IgE 507 AD 69.4% IgE 30.6% (155/507) 35 IgE (0-11 LUS, MAST class 0) ( inhalant allergens, aeroallergens) ( house dust) (Mite, Dermatophagoides farinae, Df) (Mite, Dermatophagoides pteronyssinus,dp) ( cockroach) ( feather) ( dog dander) ( cat dander) 2. ( fungal allergens) ( Candida) ( Asper- Fig. 2 Positive ratio and severity score of allergen-specific IgE antibodies detected by MAST of all patients, n=507. Dermatophagoides farinae (Df) shows the highest positive ratio (60.2%) with higher severity score. The positive rates of other main inhalant allergens are 59% for Dermatophagoides pteronyssinus (Dp), 44.2% for house dust, 34.7% for cockroach. The severity scores are high, too. The most common food allergen is milk (21.3%) with lower severity score. The positive reaction rates for other allergens are low with lower severity score. Dermatol Sinica, March

5 gillus) (Cladosporium) ( Penicillium) (Alternaria) 3. (plant allergens) (Ragweed mix) (Grass mix) ( Pine mix) (Willow) (Eucalyptus) (berry mix) (Bermuda mix) 4. (food allergens) (corn) (wheat) (veg- 5 Dermatol Sinica, March 2004

6 Fig. 3 Positive rate of food allergens, inhalant allergens, fungal allergens and plant allergens detected by MAST of the four subgroups by age. The younger children start with allergy to food allergens. Egg white and milk are the most common allergens (a). Allergy to inhalant (b) and fungal allergens (c) is rare in the first two years, and gradually increases at adolescent/young adult age. Allergy to plant allergens increases with age (d). Dermatol Sinica, March

7 etable mix) ( crab) ( clam / shellfish mix) ( fish, Cod) (port) (beef) (egg white) (egg yolk) (milk) (shrimp) (yeast, Brewers) (soybean) ( peanut) Fig IgE (Mite, Df, 60.2%) ( Mite, Dp, 59.2%) (43.2%) (34.7%) (21.3%) (18.1%) (18.1%) ( 17.9 %) (16.0%) (16.0%) class 4 class 3 class1 class1 / 0 (13.0%) ( 12.8%) (12.4%) (10.3%) (9.3%) (9.3%) (8.3%) (6.9%) (6.9%) (6.9%) (5.9%) IgE 10% b AD 35 Fig IgE, IgE (Fig. 3-a) IgE IgE ( Mite, Df) ( Mite, Dp) IgE (Fig. 3-b) IgE (Fig. 3-c) (Fig. 3-d) c (3-1) (Df, Dp) (Fig. 4) (Df Dp) ( 75% ) 7 Dermatol Sinica, March 2004

8 Fig. 4 Positive rate and severity score of the main inhalant allergens (house dust, mite (Df, Dp), cockroach) in four age groups. The result shows a highest positive rate and severity score at adolescent / young adult age. * p < 0.05 ** p < 0.01 *** p < Dermatol Sinica, March

9 Fig. 5 Positive rate and severity score of the four main food allergens (egg white, milk, crab and shrimp) in four age groups. Egg white (37.1%) and milk (31.4%) are the most common food allergens at infantile age but the severity score are low. Crab (22.8%) and shrimp (21.2%) are the most common food allergens in adolescent or adult group with low severity score. * p < 0.05 ** p < 0.01 *** p < Dermatol Sinica, March 2004

10 (3-2) (37.1%) (31.4%) (Fig. 5) (Fig. 5) e IgE IgE Dati F. Ringel K.P. Ig :<1.5 IU / ml, 1- yr-olds: 15 IU / ml, 1 ~ 5-yr-olds: 60 IU / ml, 6~9-yr-olds: 90 IU / ml, 10 ~ 15-yr-olds: 200 IU / ml, > 15-yr-olds: 100 IU / ml ( 77.7% ) IgE IgE 100 IU / ml (n=120, 23.7%) IU / ml (n=149, 29.4%) IU / ml (n=87, 17.2%) 1000 IU / ml (n=151, 29.8%) IgE d IgE 507 AD 155 ( 30.6%) 35 IgE (0-11 LUS, MAST class 0) 18 ( 3.6%) 72 ( 15.2% ) IgE MAST class 4 3 IgE 100 IU / ml 26.7% (32 / 120) IgE 7 (4.6%) IgE 1000 IU / ml 35 IgE class0 IgE 2 IgE ( IU / ml) 100 IU / ml (n=15, 42.9%) Table II. Number of allergen-specific IgE in four IgE antibody levels. Thirty-two patients (26.7%) with lower IgE antibody level (<100 Iu / ml) have more than one allergen-specific IgE antibody. In contrast, only seven patients (4.6%) with high IgE antibody level (>1000 Iu / ml) have no allergen-specific IgE antibody. Number IgE level >6 IgE<100 IU/ml (n=120) (73.3%) (5.8%) (11.7%) (4.2%) (3.3%) (0.8%) (0%) (0.8%) IgE100~ IU/ml(n=149) (35.6%) (2.7%) (20.8%) (11.4%) (11.4%) (4.7%) (4.7%) (8.7%) IgE 500~ IU/ml(n=87) (8.0%) (6.9%) (9.2%) (19.5%) (11.5%) (14.9%) (10.3%) (19.5%) IgE> IU/ml(n=151) (4.6%) (0.7%) (3.3%) (6.0%) (10.6%) (7.9%) (11.3%) (55.6%) Dermatol Sinica, March

11 Fig. 6 Positive ratio and severity score of allergen-specific IgE antibodies detected by MAST in AD with ARD (n=239) and pure AD (n=268) groups. Dermatophagoides farinae (DF) shows the highest positive ratio (60.2%) with higher severity score. In general, the positive rate of inhalant and food allergens are higher in AD with ARD group than pure AD group. * p < 0.05 ** p < 0.01 *** p < Dermatol Sinica, March 2004

12 IU / ml (n=15, 42.9%) IgE IU/ml IgE 1926 IU / ml 43 ( 37.7%) 1000 IU / ml IgE 1655 IU / ml IgE IgE IgE (Table II) f AD with ARD Pure AD IgE IgE IgE AD ( IgE 1967 IU / ml 1275 IU / ml p<0.001) AD with ARD Pure AD 59% 29.1% (p < 0.001) 76.2% 45.9% (p < 0.001) 45.2% 25.4% (p < 0.001) 14.6% 8.2% (p=0.0244) 21.8% 14.9% (p=0.0502) 25.5% 17.5% (p=0.0302) 23.2% 14.6% ( p=0.0285) 24.7% 11.9% ( p=0.002) (Fig. 6) AD 1 IgE IgE AD 1 IgE 7 78% AD IgE AD 1, 3 IgE IgE AD MAST IgE IgE 35 IgE % MAST 6 ( 73.8%) ( 42.9 %) (22.7%) MAST 6 9, 10 IgE IgE 11 80~85%AD IgE IgE 7, 11, 12 (Dp) Alternaria alternata Aspergillus fumigatus Candida albicans Malassezia Dermatol Sinica, March

13 furfur Trichophyton IgE 12 Scalabrin DM 1999 IgE AD ( Fig. 6) 12 IgE IgE 12 IgE 12 AD AD 50% 20% 30% 10% 15% AD 70% AD 89% 94% 15 80% 14, AD ( 9 90% 16 ) 64.9% (36.5%) (35.1%) (21.6%) (6.8%) 17 43% (37.1%) (31.4%) ( 17.1 %) (14.3%) (8.6%) 30% (21.2%) (17.5%) (13.1%) (12.4%) (12.4%) 13, 14, 16, REFERENCE 1.Darsow U, Ring J: Airborne and dietary allergens in atopic eczema: a comprehensive review of diagnostic tests. Clin Exp Dermatol 25: , Hogan PA: Atopic dermatitis. Med J Aust 164: , Rothe MJ, Grant-Kets JML: Atopic dermatitis: an update. J Am Acad Dermatol 35: 1-13, Tsai JJ, Kao MH, Huang SL: The difference of common aeroallergen between Taipei and Kim- Men. J Formos Med Assoc 96: , Dermatol Sinica, March 2004

14 5.Tagami H: Japanese dermatological association criteria for the diagnosis of atopic dermatitis. [Japanese] Nippon Hifuka Gakkai Zasshi 104: 1210, Dati F, Ringel KP: Reference values for serum IgE in healthy non-atopic children and adults. Clin Chem 28: 1556, Leung DY: Role of IgE in atopic dermatitis. Curr Opin Immunol 5: , Nakagawa T, Iwasaki E, Baba M, et al.: Evaluation of allergen-specific IgE antibodies by a newly developed mast allergy system. [Japanese] Arerugi - Jpn J Allergol 38: , Cameron MM: Can house dust mite-triggered atopic dermatitis be alleviated using acaricides?. Br J Dermatol 137: 1-8, Kubota Y, Koga T, Imayama S, et al.: Mite-antigen-stimulated cytokine production by peripheral blood mononuclear cells of atopic dermatitis patients with positive mite patch tests. Contact Derm 31: , Tanaka M, Aiba S, Matsumura N, et al.: IgE-mediated hypersensitivity and contact sensitivity to multiple environmental allergens in atopic dermatitis. Arch Dermatol 130: , Scalabrin DM, Bavbek S, Perzanowski MS, et al.: Use of specific IgE in assessing the relevance of fungal and dust mite allergens to atopic dermatitis: a comparison with asthmatic and nonasthmatic control subjects. J Allergy Clin Immunol 104: , Stogmann W, Kurz H: Atopic dermatitis and food allergy in infancy and childhood. [German] Wien Med Wochenschr 146: , Van Bever HP, Docx M, Stevens WJ. Food and food additives in severe atopic dermatitis. Allergy 44: , Furusho K: Pathophysiology of atopic dermatitisfood. Rinsho Derma [Japanese] 40: , Burks W, Helem R, Stanley S, et al.: Food allergens. Curr Opin Allergy Clin Immunol 1: , Resano A, Crespo E, Fernandez Benitez M, et al.: Atopic dermatitis and food allergy. J Invest Allergol Clin Immunol 8: , Eigenmann PA, Calza AM: Diagnosis of IgEmediated food allergy among Swiss children with atopic dermatitis. Pediatr Allergy Immunol 11: , Dermatol Sinica, March

W. Chiang, I.F. Tsai, W.C. Tsai, and B.H. Chen to investigate allergen frequency in southern Taiwan, to determine the effect of age on allergen respon

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