Atopik dermatitde staphylococcus aureus enterotoksin A ve enterotoksin B spesifik immünglobulin E antikorlarının rolünün araştırılması Investigation of the role of staphylococcus aureus enterotoxin Aa and staphylococcus aureus enterotoxin B specific immunoglobulin E antibodies in atopic dermatitis
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2007
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info:eu-repo/semantics/openAccess
Özet
Atopik dermatit sütçocukluğu döneminde başlayan, kronik seyirli ve tekrarlayıcı bir deri hastalığıdır. Atopik dermatit patogenezinde Staphylococcus aureus enterotoksin A spesifik immünglobulin E ve Staphylococcus aureus enterotoksin B spesifik immünglobulin E' nin rolünü araştırdığımız çalışmamıza yaşları 3 ay-17 yıl arasında olan 99 olgu alındı. Olgular atopik dermatitli hastalar Grup 1 (44 olgu), alerjik solunum yolu olan hastalar Grup 2 (30 olgu) ve sağlam çocuk grubu Grup 3 (25 olgu) olmak üzere üç gruba ayrıldı. Olgulardan ayrıntılı anamnez alındı, fizik muayene yapıldı ve atopik dermatit ağırlık derecesi `'Eczema Area and Severity Index-Ekzema Alanı ve Şiddeti İndeksi'' skorlaması ile değerlendirildi. İstatistiksel analizler için Kolmogorov-Smirnov testi, Mann-Withney U testi, Ki-Kare testi ve Spearman korelasyon katsayısı kullanıldı. Tüm olgulardan kan örneği alınarak serum total immünglobulin E, Staphylococcus aureus enterotoksin A spesifik immünglobulin E ve Staphylococcus aureus enterotoksin spesifik immünglobulin E düzeyleri çalışıldı. Atopik dermatitli olgular ve allerjik solunum yolu olan olgulara ilave olarak ALATOP tarama testi ve deri prik testleri uygulandı. Serum total immünglobulin E düzeyleri açısından üç grup karşılaştırıldığında Grup 2'de total serum immünglobulin E ortanca değeri Grup 3'e göre göre yüksek bulundu. Yaşa göre serum total immünglobulin E pozitifliği açısından gruplar arasında fark saptanmadı. Grup 2'de inhalan allerjenlere karşı ALATOP tarama testi pozitifliği Grup 1'e göre anlamlı olarak yüksek saptandı. ALATOP tarama testi Grup 2'de %53.1 oranında pozitif saptanırken Grup 1'de %11.4 oranında pozitiflik saptandı. Grup 1'deki olguların %9.7'sinde besinlere karşı deri prik testi pozitif iken, %45.2'sinde inhalan allerjenlere karşı deri prik testi pozitifliği saptandı. Grup 2'de ise %60 oranında inhalen allerjenlere karşı deri prik testi pozitifliği saptandı. Grup 1, Grup 2 ve Grup 3 arasında serum Staphylococcus aureus enterotoksin A spesifik immunglobulin E ve Staphylococcus aureus enterotoksin B spesifik immünglobulin E düzeyleri açısından anlamlı fark saptanmadı. Benzer şekilde üç grup arasında serum Staphylococcus aureus enterotoksin A spesifik immünglobulin E ve Staphylococcus aureus enterotoksin B spesifik immünglobulin E pozitifliği açısından da anlamlı fark saptanmadı. Grup 1 hastalığın ağırlık derecesine göre hafif atopik dermatit (Grup 1a) ve orta-ağır atopik dermatit (Grup 1b) olarak iki gruba ayrıldığında iki grup arasında serum Staphylococcus aureus enterotoksin A spesifik immunglobulin E ve serum Staphylococcus aureus enterotoksin B spesifik immünglobulin E düzeyleri ve pozitiflik oranları açısından iki grup arasında anlamlı fark saptanmadı. Yine her iki grup Grup 2 ve Grup 3 ile serum Staphylococcus aureus enterotoksin A spesifik immünglobulin E ve Staphylococcus aureus enterotoksin B spesifik immünglobulin E düzeyleri açısından karşılaştırıldığında Grup 1b' de serum Staphylococcus aureus enterotoksin A spesifik immunglobulin E ortanca değeri Grup 3' den anlamlı olarak yüksek bulunurken (p=0.041), Staphylococcus aureus enterotoksin B spesifik immünglobulin E düzeyleri açısından fark saptanmadı. Atopik dermatitli olgular hastalığın ağırlık derecesine göre `'Eczema Area and Severity Index'' e göre değerlendirildiğinde `'Eczema Area and Severity Index'' ile serum Staphylococcus aureus enterotoksin A spesifik immünglobulin E düzeyleri arasında pozitif bir ilişki saptandı ve hastalığın ağırlık derecesi ile Staphylococcus aureus enterotoksin A spesifik immünglobulin E düzeyleri arasında ilişki olduğu sonucuna varıldı (p=0.003). Atopik dermatitli olgular hastalığın ağırlık derecesine göre `'Eczema Area and Severity Index'' e göre değerlendirildiğinde `'Eczema Area and Severity Index'' ile serum Staphylococcus aureus enterotoksin B immünglobulin E düzeyleri arasında ise anlamlı bir ilişki saptanmadı. Bu veriler Staphylococcus aureus enterotoksin A'nın immünglobulin E aracılı mekanizma ile atopik dermatit patogenezi ve hastalık şiddetindeki önemini desteklemektedir. Sonuç olarak çalışmamızda orta ve ağır şiddetteki atopik dermatitli olgularda antiinflamatuar tedavilerin yanında antistafilokokkal tedavilerle daha etkin klinik yanıt alınacağı sonucuna varılmıştır. Anahtar kelimeler: Atopik dermatit, atopik dermatit ağırlık derecesi, Staphylococcus aureus enterotoksin A, Staphylococcus aureus enterotoksin B
INVESTIGATION OF THE ROLE OF STAPHYLOCOCCUS AUREUS ENTEROTOXIN A AND STAPHYLOCOCCUS AUREUS ENTEROTOXIN B SPECIFIC IGE ANTIBODIES IN ATOPIC DERMATITIS SUMMARY Atopic dermatitis is a chronically relapsing skin disorder which begins in infancy. Ninety-nine children, aged between 3 months and 17 years, were recruited for our study in which we investigated the role of Staphylococcus aureus enterotoxin A specific immunoglobulin E and Staphylococcus aureus enterotoxin B specific immunoglobulin E antibodies in the pathogenesis of atopic dermatitis. Children were divided into three groups, including cases with atopic dermatitis in group I (44 cases), cases with respiratory allergy without atopic dermatitis in group II (30 cases), and cases with nonatopic healthy children in group III (25 cases). A detailed history was taken, physical examination was performed and the severity of atopic dermatitis was evaluated by Eczema Area and Severity Index scoring system in each case with atopic dermatitis. Serum total immunoglobulin E, Staphylococcus aureus enterotoxin A specific immunoglobulin E and Staphylococcus aureus enterotoxin B specific immunoglobulin E levels were determined in all cases. Specific immunoglobulin E antibodies to different inhalant allergens were evaluated by the ALATOP test and by skin prick test in cases with atopic dermatitis and cases with respiratory allergy without atopic dermatitis. Statistical analyses were made by using Kolmogorov-Smirnov test, Mann-Withney U test, Chi-squire test and Spearman correlation test. When total serum immunoglobulin E levels were compared among three groups, the median values were found to be significantly higher Group II than Group III. When total serum immunoglobulin E levels were evaluated as either normal or high by referring to kit values, there was no significant difference in serum total immunoglobulin E levels among three groups. ALATOP test was positive in 53.1% of the children in group II, and 11.4% in group I. Skin prick tests were positive in 9.7% patients with food allergens, and 45.2% with inhalant allergens in group I. Skin prick test against to inhalant allergens were positive in 60% in group II. The levels and positive rates of serum Staphylococcus aureus enterotoxin A specific immunoglobulin E and Staphylococcus aureus enterotoxin B specific immunoglobulin E were compared among three groups. Specific immunoglobulin E levels to Staphylococcus aureus enterotoxin A and Staphylococcus aureus enterotoxin B, as well as the positive rates of Staphylococcus aureus enterotoxin A/Staphylococcus aureus enterotoxin B specific immunoglobulin E antibodies were not statistically different among three groups. When the group with atopic dermatitis was divided as mild (group Ia) and moderate- severe (group Ib) atopic dermatitis according to the severity of disease, there was no significant difference in the levels and positive rates of serum Staphylococcus aureus enterotoxin A specific immunoglobulin E and Staphylococcus aureus enterotoxin B specific immunoglobulin E between the groups. Also, when these two groups were compared with group II and group III according to serum Staphylococcus aureus enterotoxin A specific immunoglobulin E and Staphylococcus aureus enterotoxin B specific immunoglobulin E levels, serum Staphylococcus aureus enterotoxin A specific immunoglobulin E levels were significantly higher in Group Ib than Group III (p=0.041), however serum Staphylococcus aureus enterotoxin B specific immunoglobulin E levels were not different between the groups. When cases with atopic dermatitis evaluated with Eczema Area and Severity Index scoring system for severity of disease, there was a significant correlation between Eczema Area and Severity Index scores and serum Staphylococcus aureus enterotoxin A specific immunoglobulin E levels (p=0.003), however, no significant correlation was found between Eczema Area and Severity Index scores and serum Staphylococcus aureus enterotoxin B specific immunoglobulin E levels. These data supported the importance of Staphylococcus aureus enterotoxin A specific immunoglobulin E mediated mechanism in the pathogenesis of atopic dermatitis and the severity of the disease. As a result of this study, we conclude that combined anti- inflammatory and anti-staphylococcal treatment might be more beneficial for the patients with moderate to severe atopic dermatitis. Key words: Atopic dermatitis, severity scoring of atopic dermatitis, Staphylococcus aureus enterotoxin A, Staphylococcus aureus enterotoxin B
INVESTIGATION OF THE ROLE OF STAPHYLOCOCCUS AUREUS ENTEROTOXIN A AND STAPHYLOCOCCUS AUREUS ENTEROTOXIN B SPECIFIC IGE ANTIBODIES IN ATOPIC DERMATITIS SUMMARY Atopic dermatitis is a chronically relapsing skin disorder which begins in infancy. Ninety-nine children, aged between 3 months and 17 years, were recruited for our study in which we investigated the role of Staphylococcus aureus enterotoxin A specific immunoglobulin E and Staphylococcus aureus enterotoxin B specific immunoglobulin E antibodies in the pathogenesis of atopic dermatitis. Children were divided into three groups, including cases with atopic dermatitis in group I (44 cases), cases with respiratory allergy without atopic dermatitis in group II (30 cases), and cases with nonatopic healthy children in group III (25 cases). A detailed history was taken, physical examination was performed and the severity of atopic dermatitis was evaluated by Eczema Area and Severity Index scoring system in each case with atopic dermatitis. Serum total immunoglobulin E, Staphylococcus aureus enterotoxin A specific immunoglobulin E and Staphylococcus aureus enterotoxin B specific immunoglobulin E levels were determined in all cases. Specific immunoglobulin E antibodies to different inhalant allergens were evaluated by the ALATOP test and by skin prick test in cases with atopic dermatitis and cases with respiratory allergy without atopic dermatitis. Statistical analyses were made by using Kolmogorov-Smirnov test, Mann-Withney U test, Chi-squire test and Spearman correlation test. When total serum immunoglobulin E levels were compared among three groups, the median values were found to be significantly higher Group II than Group III. When total serum immunoglobulin E levels were evaluated as either normal or high by referring to kit values, there was no significant difference in serum total immunoglobulin E levels among three groups. ALATOP test was positive in 53.1% of the children in group II, and 11.4% in group I. Skin prick tests were positive in 9.7% patients with food allergens, and 45.2% with inhalant allergens in group I. Skin prick test against to inhalant allergens were positive in 60% in group II. The levels and positive rates of serum Staphylococcus aureus enterotoxin A specific immunoglobulin E and Staphylococcus aureus enterotoxin B specific immunoglobulin E were compared among three groups. Specific immunoglobulin E levels to Staphylococcus aureus enterotoxin A and Staphylococcus aureus enterotoxin B, as well as the positive rates of Staphylococcus aureus enterotoxin A/Staphylococcus aureus enterotoxin B specific immunoglobulin E antibodies were not statistically different among three groups. When the group with atopic dermatitis was divided as mild (group Ia) and moderate- severe (group Ib) atopic dermatitis according to the severity of disease, there was no significant difference in the levels and positive rates of serum Staphylococcus aureus enterotoxin A specific immunoglobulin E and Staphylococcus aureus enterotoxin B specific immunoglobulin E between the groups. Also, when these two groups were compared with group II and group III according to serum Staphylococcus aureus enterotoxin A specific immunoglobulin E and Staphylococcus aureus enterotoxin B specific immunoglobulin E levels, serum Staphylococcus aureus enterotoxin A specific immunoglobulin E levels were significantly higher in Group Ib than Group III (p=0.041), however serum Staphylococcus aureus enterotoxin B specific immunoglobulin E levels were not different between the groups. When cases with atopic dermatitis evaluated with Eczema Area and Severity Index scoring system for severity of disease, there was a significant correlation between Eczema Area and Severity Index scores and serum Staphylococcus aureus enterotoxin A specific immunoglobulin E levels (p=0.003), however, no significant correlation was found between Eczema Area and Severity Index scores and serum Staphylococcus aureus enterotoxin B specific immunoglobulin E levels. These data supported the importance of Staphylococcus aureus enterotoxin A specific immunoglobulin E mediated mechanism in the pathogenesis of atopic dermatitis and the severity of the disease. As a result of this study, we conclude that combined anti- inflammatory and anti-staphylococcal treatment might be more beneficial for the patients with moderate to severe atopic dermatitis. Key words: Atopic dermatitis, severity scoring of atopic dermatitis, Staphylococcus aureus enterotoxin A, Staphylococcus aureus enterotoxin B
Açıklama
Anahtar Kelimeler
Çocuk Sağlığı ve Hastalıkları, Child Health and Diseases
