Reviews and feature article
Does “autoreactivity” play a role in atopic dermatitis?

https://doi.org/10.1016/j.jaci.2012.02.002Get rights and content

The role of autoimmunity in atopic dermatitis (AD) is unclear. We sought to critically examine the occurrence, correlation with severity, and possible causative role of autoreactivity in patients with AD. Our systematic review of studies identified from MEDLINE included 31 experiments that described autoreactivity in patients with AD. We defined autoreactivity as in vitro or in vivo evidence of immune response to autologous human, generic human, or recombinant human proteins or other tissue/cellular components. Autoreactivity prevalence in patients with AD ranged from 23% to 91% in 14 studies involving 2644 participants, although it did not appear to vary with age, sex, or disease duration. In contrast to studies of AD, IgE autoreactivity was not found in healthy subjects or in those with allergic rhinoconjunctivitis, psoriasis, systemic lupus erythematosus, or other inflammatory diseases (8 studies of 816 participants). Two reports found a positive correlation between autoreactivity and AD severity. We suggest that autoreactivity might be playing a causative role in AD based on the magnitude and specificity of the associations found; plausible mechanisms through IgE autoantibodies, IgG autoantibodies, and TH1 autoreactivity; and experimental elicitation of eczematous lesions after provocation. Whether autoantibodies contribute to AD chronicity now needs to be examined in longitudinal studies.

Section snippets

Systemic review

We searched MEDLINE from inception to the end of December 2011 to address the following 3 questions: (1) What is the prevalence of autoreactivity in patients with eczema? (2) Is autoreactivity a marker of disease severity? (3) What is the evidence for a potential role of autoreactivity in AD pathogenesis? We included in vitro or in vivo original studies with subjects of all ages and ethnic groups that investigated the phenomenon of autoreactivity in the context of AD or eczema. Autoreactivity

How common is autoreactivity in patients with AD?

Thirty-one of 1408 studies were deemed suitable for inclusion in this systematic review, as shown in the study flow chart in Fig 1 and listed in the supplemental reference list (see references E1, E2, E3, E4, E5, E6, E7, E8, E9, E10, E11, E12, E13, E14, E15, E16, E17, E18, E19, E20, E21, E22, E23, E24, E25, E26, E27, E28, E29, E30, E31 in this article’s Online Repository at www.jacionline.org). Fourteen of these 31 articlesE1, E2, E3, E4, E5, E6, E7, E8, E9, E10, E11, E12, E13, E14 reported on

Main findings

Our review has systematically identified and appraised a significant body of evidence that suggests a potential role for autoreactivity in AD pathogenesis. The phenomenon of IgE autoreactivity in patients with AD suggests that it is a relatively specific phenomenon because no such association can be shown in healthy control subjects, atopic patients with mild respiratory diseases, or patients with other chronic inflammatory skin conditions. A significant proportion of patients with AD

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Disclosure of potential conflict of interest: The authors declare that they have no relevant conflicts of interest.

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