Allergy & Clinical Immunology
Pathophysiology of autoreactivity in atopic dermatitis
Atopic dermatitis (AD) is a chronic inflammation of the skin that affects ca. 20% of the children and 3% of the adults. The pathophysiology of AD is a complex interaction of environment, genetic predisposition, skin barrier, and T - and B cell mediated immune responses. Increased understanding of the disease endotypes may increase the disease management. However, disease endotyping in AD is just beginning to develop. A combined allergic-autoimmune endotype has been proposed with the presence of autoreactive IgE and autoreactive T cells directed to skin epitopes. Autoreactive IgE antibodies have been found in adults with severe and chronic AD, suggesting a progression from a Th2 mediated immune response to an autoimmune process against the skin, which may contribute to the disease severity and chronicity. In a previous study, we could show that about 50% of healthy children show IgE-autoreactivity, whereas in adults, auto-IgE is a finding almost exclusively in patients with AD. Currently we further investigate on this and we aim to characterize the patients with autoreactive antibodies and we investigate the clinical relevance and cellular pathways of autoreactive IgE-antibodies in the pathophysiology of AD.
Currently, little is known about the treatment of acute urticaria. A few guidelines and reviews on acute urticaria have been published for some years ago. Discrepancies between guidelines and studies on the treament of acute urticaria generates a gap in disease management. In the present study, we aim to study different evidence-based treatment strategies and develop a state-of-the-art guideline for the management of acute urticaria.
Connective tissue diseases
Dermatomyositis (DM) is disorder of the connective tissue, which is characterized by purple-red eruptions and thickened hyperkeratotic papules on sun exposed sites, ragged cuticles and periungual dilated capillary loops. Patients with DM have an increased risk of comorbid disorders that can include weakness of the muscles, autoimmune disorders, dysphagia, respiratory diseases, cardiac diseases etc.
Autoreactive antibodies are often present and are either specific for myositis (myositis-specific autoantibodies (MSA)) or not directly related to DM (myositis-associatedd autoantibodies (MAA)).
There is accumulating evidence that IgE plays a role in autoimmunity. Auto-IgE has been found in several skin (related) diseases, such as atopic dermatitis, chronic urticaria and rheumatoid artritis. Whether autoreactive IgE antibodies are present in DM is unknown. In addition, the cellular targets and their clinical relevance still needs to be investigated.