A new autoimmune disease: atopic dermatitis in children
Main Article Content
Keywords
atopic dermatitis, autoimmune disease, clinical signs, immune response, symptoms
Abstract
Atopic dermatitis (AD) is mainly considered an allergy, exacerbated by allergic factors. Is there evidence to suggest the existence of autoimmune components in the pathophysiology of the illness? Studies in the literature that dealt with the occurrence of autoimmunity in children with AD were analyzed. We followed the studies published in PubMed for 10 years, from 2001 to 2021. Clinical signs and symptoms were similar to other autoimmune diseases, having periods of remission and relapses. Other correlations between AD and autoimmune diseases have been described, and patients with AD can also present with a wide range of autoimmune comorbidities. Three major factors contribute to the pathogenesis of AD: damage of the skin barrier, disorders of the immune response, and imbalances of the skin microbiome—all based on genetic changes and influenced by environmental factors. Predominant activation of Th 2 cells, with the increase of Th 1, Th 17, and Th 22 subsets, promotes skin inflammation. All this evidence suggests that AD might be classified as an autoimmune disease, not just as an allergic reaction.
References
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32. Nguyen HLT, Trujillo-Paez JV, Umehara Y, Yue H, Peng G, Kiatsurayanon C, et al. Role of antimicrobial peptides in skin barrier repair in individuals with atopic dermatitis. Int J Mol Sci. 2020;21(20):7607. 10.3390/ijms21207607
33. Zhang BX, Lyu JC, Liu HB, Feng DQ, Zhang DC, Bi XJ, et al. Attenuation of peripheral regulatory T-cell suppression of skin-homing CD8-T cells in atopic dermatitis. Yonsei Med J. 2015;56(1):196–203. 10.3349/ymj.2015.56.1.196
34. Park HJ, Lee SW, Park SH, Van Kaer L, Hong S. Selective expansion of double-negative iNKT cells inhibits the development of atopic dermatitis in Vα14 TCR transgenic NC/Nga mice by increasing memory-type CD8+ T and regulatory CD4+ T cells. J Invest Dermatol. 2021;141(6):1512–21. 10.1016/j.jid.2020.09.030
35. Bassin EJ, Piganelli JD, Little SR. Autoantigen and immunomodulatory agent-based approaches for antigen-specific tolerance in NOD mice. Curr Diab Rep. 2021;21(3):9. 10.1007/s11892-021-01376-6
36. Yang Y, Li X, Ma Z, Wang C, Yang Q, Byrne-Steele M, et al. CTLA-4 expression by B-1a B cells is essential for immune tolerance. Nat Commun. 2021;12(1):525. 10.1038/s41467-020-20874-x
37. Furue M, Chiba T, Tsuji G, Ulzii D, Kido-Nakahara M, Nakahara T, et al. Atopic dermatitis: Immune deviation, barrier dysfunction, IgE autoreactivity and new therapies. Allergol Int. 2017;66(3):398–403. 10.1016/j.alit.2016.12.002
2. Holmes J, Fairclough L, Todd I. Atopic dermatitis and autoimmunity: The occurrence of autoantibodies and their association with disease severity. Arch Dermatol Res. 2019;311(3):141–62. 10.1007/s00403-019-01890-4
3. Ali F, Vyas J, Finlay A. Counting the burden: Atopic dermatitis and health-related quality of life. Acta Derm Venereol. 2020;100(2):adv00161. 10.2340/00015555-3511
4. Katoh N, Ohya Y, Ikeda M, Ebihara T, Katayama I, Saeki H, et al. Japanese guidelines for atopic dermatitis 2020. Allergol Int. 2020;69(3):356–69. 10.1016/j.alit.2020.02.006
5. Arakawa H, Shimojo N, Katoh N, Hiraba K, Kawada Y, Yamanaka K, et al. Consensus statements on pediatric atopic dermatitis from dermatology and pediatrics practitioners in Japan: Goals of treatment and topical therapy. Allergol Int. 2020;69(1):84–90. 10.1016/j.alit.2019.08.006
6. Howell MD, Kim BE, Gao P, Grant AV, Boguniewicz M, Debenedetto A, et al. Cytokine modulation of atopic dermatitis filaggrin skin expression. J Allergy Clin Immunol. 2007; 120(1):150–5. 10.1016/j.jaci.2007.04.031
7. Wickett RR, Visscher MO. Structure and function of the epidermal barrier. Am J Infect Control. 2006;34:S98–110. 10.1016/j.ajic.2006.05.295
8. Lee SH, Jeong SK, Ahn SK. An update of the defensive barrier function of skin. Yonsei Med J. 2006;47(3):293–306. 10.3349/ymj.2006.47.3.293
9. Yang G, Seok JK, Kang HC, Cho YY, Lee HS, Lee JY. Skin barrier abnormalities and immune dysfunction in atopic dermatitis. Int J Mol Sci. 2020;21(8):2867. 10.3390/ijms21082867
10. Kim BS. Atopic dermatitis: Practice essentials, background, pathophysiology [Internet]. Emedicine.medscape.com. 2021. Available from: https://emedicine.medscape.com/article/1049085
11. Duca E, Sur G, Armat I, Samasca G, Sur L. Correlation between Interleukin 31 and clinical manifestations in children with atopic dermatitis: An observational study. Allergol Immunopathol (Madr). 2022; 50(1): 75–9. 10.15586/aei.v50i1.521
12. Kim J, Kim B, Leung D. Pathophysiology of atopic dermatitis: Clinical implications. Allergy Asthma Proc. 2019;40(2):84–92. 10.2500/aap.2019.40.4202
13. Weidinger S, Novak N. Atopic dermatitis. Lancet. 2016; 387 (10023): 1109–22. 10.1016/S0140-6736(15)00149-X
14. Tanei R. Atopic dermatitis in older adults: A review of treatment options. Drugs Aging. 2020;37(3):149–60. 10.1007/s40266-020-00750-5
15. Guttman-Yassky E, Bissonnette R, Ungar B, Suárez-Fariñas M, Ardeleanu M, Esaki H, et al. Dupilumab progressively improves systemic and cutaneous abnormalities in patients with atopic dermatitis. J Allergy Clin Immunol. 2019;143(1):155–72. 10.1016/j.jaci.2018.08.022
16. Pravin K, Dinesh SK, Mahendra AS. Pathophysiology and management of atopic dermatitis: A laconic review. Curr Drug Ther. 2020;15(4):321–36. 10.2174/1574885514666190828152316. Available from: https://www.eurekaselect.com/174512/article
17. Möbus L, Weidinger S, Emmert, H. Epigenetic factors involved in the pathophysiology of inflammatory skin diseases. J Allergy Clin Immunol. 2020;145(4):1049–60. 10.1016/j.jaci.2019.10.015
18. Drislane C, Irvine A. The role of filaggrin in atopic dermatitis and allergic disease. Ann Allergy Asthma Immunol. 2020;124(1):36–43. 10.1016/j.anai.2019.10.008
19. Nakahara T, Kido-Nakahara M, Tsuji G. Basics and recent advances in the pathophysiology of atopic dermatitis. J Dermatol. 2021;48(2):130–9. 10.1111/1346-8138.15664
20. Campione E, Lanna C, Diluvio L, Cannizzaro M, Grelli S, Galluzzo M, et al. Skin immunity and its dysregulation in atopic dermatitis, hidradenitis suppurativa and vitiligo. Cell Cycle. 2020;19(3):257–67. 10.1080/15384101.2019.1707455
21. Fujii M. Current understanding of pathophysiological mechanisms of atopic dermatitis: Interactions among skin barrier dysfunction, immune abnormalities and pruritus. Biol Pharm Bull. 2020;43(1):12–9. 10.1248/bpb.b19-00088
22. Alexander H, Paller A, Traidl-Hoffmann C, Beck LA, De Benedetto A, Dhar S, et al. The role of bacterial skin infections in atopic dermatitis: Expert statement and review from the International Eczema Council Skin Infection Group. Br J Dermatol. 2019;182(6):1331–42. 10.1111/bjd.18643
23. Yang T, Kim B. Pruritus in allergy and immunology. J Allergy Clin Immunol. 2019;144(2):353–60. 10.1016/j.jaci.2019.06.016
24. Chan B, Lam C, Tam L, Wong C. IL33: Roles in allergic inflammation and therapeutic perspectives. Front Immunol. 2019;10:364. 10.3389/fimmu.2019.00364
25. Hendricks A, Eichenfield L, Shi V. The impact of airborne pollution on atopic dermatitis: A literature review. Br J Dermatol. 2020;183(1):16–23. 10.1111/bjd.18781
26. Boguniewicz M, Fonacier L, Leung D. Atopic and contact dermatitis. Clin Immunol. 2019;611–624.e1. 10.1016/B978-0-7020-6896-6.00044-2. Available from: https://www.sciencedirect.com/science/article/pii/B9780702068966000442
27. Paller A, Kong H, Seed P, Naik S. The microbiome in patients with atopic dermatitis. J Allergy Clin Immunol. 2019;143(1):26–35. 10.1016/j.jaci.2018.11.015
28. Tsakok T, Woolf R, Smith CH, Weidinger S, Flohr C. Atopic dermatitis: The skin barrier and beyond. Br J Dermatol. 2019;180(3):464–74. 10.1111/bjd.16934
29. Ahn K, Kim BE, Kim J, Leung DY. Recent advances in atopic dermatitis. Curr Opin Immunol. 2020;66:14–21. 10.1016/j.coi.2020.02.007
30. Furue M, Ulzii D, Vu YH, Tsuji G, Kido-Nakahara M, Nakahara T. Pathogenesis of atopic dermatitis: Current paradigm. Iran J Immunol. 2019;16(2):97–107. 10.22034/IJI.2019.80253
31. Moyle M, Cevikbas F, Harden JL, Guttman-Yassky E. Understanding the immune landscape in atopic dermatitis: The era of biologics and emerging therapeutic approaches. Exp Dermatol. 2019;28(7):756–68. 10.1111/exd.13911
32. Nguyen HLT, Trujillo-Paez JV, Umehara Y, Yue H, Peng G, Kiatsurayanon C, et al. Role of antimicrobial peptides in skin barrier repair in individuals with atopic dermatitis. Int J Mol Sci. 2020;21(20):7607. 10.3390/ijms21207607
33. Zhang BX, Lyu JC, Liu HB, Feng DQ, Zhang DC, Bi XJ, et al. Attenuation of peripheral regulatory T-cell suppression of skin-homing CD8-T cells in atopic dermatitis. Yonsei Med J. 2015;56(1):196–203. 10.3349/ymj.2015.56.1.196
34. Park HJ, Lee SW, Park SH, Van Kaer L, Hong S. Selective expansion of double-negative iNKT cells inhibits the development of atopic dermatitis in Vα14 TCR transgenic NC/Nga mice by increasing memory-type CD8+ T and regulatory CD4+ T cells. J Invest Dermatol. 2021;141(6):1512–21. 10.1016/j.jid.2020.09.030
35. Bassin EJ, Piganelli JD, Little SR. Autoantigen and immunomodulatory agent-based approaches for antigen-specific tolerance in NOD mice. Curr Diab Rep. 2021;21(3):9. 10.1007/s11892-021-01376-6
36. Yang Y, Li X, Ma Z, Wang C, Yang Q, Byrne-Steele M, et al. CTLA-4 expression by B-1a B cells is essential for immune tolerance. Nat Commun. 2021;12(1):525. 10.1038/s41467-020-20874-x
37. Furue M, Chiba T, Tsuji G, Ulzii D, Kido-Nakahara M, Nakahara T, et al. Atopic dermatitis: Immune deviation, barrier dysfunction, IgE autoreactivity and new therapies. Allergol Int. 2017;66(3):398–403. 10.1016/j.alit.2016.12.002
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Nov 1, 2022
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Floca, E., Gaga, R., Sur, G., Lupan, I., Armat, I., Samasca, G., & Sur, L. M. (2022). A new autoimmune disease: atopic dermatitis in children. Allergologia Et Immunopathologia, 50(6), 17-21. https://doi.org/10.15586/aei.v50i6.655
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How to Cite
Floca, E., Gaga, R., Sur, G., Lupan, I., Armat, I., Samasca, G., & Sur, L. M. (2022). A new autoimmune disease: atopic dermatitis in children. Allergologia Et Immunopathologia, 50(6), 17-21. https://doi.org/10.15586/aei.v50i6.655