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Bali Medical Journal (Bali Med. J.

) 2014, Volume 3, Number 1: 45-48


P-ISSN.2089-1180, E-ISSN.2302-2914

ROLE OF ENVIRONMENTAL ALLERGENS ON


ATOPIC DERMATITIS
Wardhana, M.

Department of Dermato-Venereology, Faculty of Medicine, Udayana University,


Bali-Indonesia
Background: Atopic dermatitis (AD) is a chronic eczematous skin disease that develops in a patient
with atopic diathesis, which is characterized by an increased liability to produce IgE antibodies for
allergens mostly derived from environmental or inhalant allergens and food allergens. They are
produced by cell-mediated allergic contact reactions, and recently contact sensitivity to various
environmental allergens has been demonstrated in patients with AD. Atopic patients are recognized by
their ability to produce large amounts of specific IgE antibodies to common substances as
environmental allergens, i.e. house dust mites, grass pollens, animal danders, molds, food, etc. These
antibodies can be detected by skin prick test. The aim of this study was to identify the sensitization
against environmental or inhalants allergens through skin prick tests in the patients with atopic
dermatitis. Material and Methods: This is a retrospective, descriptive study. We revised all medical
records of patients with AD since January 2002 to December 2004 in the Out Patients Unit of Sanglah
General Hospital, Bali-Indonesia. The variables studied were: gender, age, work related, diagnosis
associates to AD, and prick test of environmental allergens. Results: In 3 years periods we had revised
46 of patients with AD that was done skin prick tests. The median age was 38 years (range 29-54
years), 34/46 (73.9 %) of these were male and 12 (26.1 %) female. Twenty nine patients presented pure
AD, and 17 patients had AD with asthma and allergic rhinitis. Only 16 (34.7%) of patients had no
history of allergic disease. Thirsty six of 46 (78.20%) of all tested AD patients had a positive skin prick
tests against inhalant (aeroallergens) 16 patients and food allergens 21 patients. Sixteen patients with
positive of skin test include; dust mite in 12 patients, animal dander in 10 patients, grass pollen in 9
patients and cockroach in 6 patients. Conclusion: We concluded that Environmental work related
particularly dust-mite were significant that contributed to symptoms exacerbation and positive skin
prick test. The skin prick tests are important methods to determine inhalant allergens in work related
that exacerbation of AD patients.

Keywords: Atopic dermatitis, Environmental, allergens, skin prick test.

INTRODUCTION
Atopic dermatitis (AD) is a chronic pollens, animal danders, molds, food, etc. These
eczematous skin disease that develops in a patient antibodies can be detected by skin prick test.2,3
with atopic diathesis, which is characterized by an Atopic dermatitis as the hypersensitivity
increased liability to produce IgE antibodies for reactions caused by allergen-specific IgE binding to
allergens mostly derived from environmental or mast cells, being cross-linked by subsequent
inhalant allergens and food allergens.1,2 allergen exposure, and releasing mediators of
Experimentally, eczematous skin lesions cannot be immediate hypersensitivity that initiate
induced only by immediate IgE-mediated reactions inflammatory cascades. More than 20 % of the
alone, but also by the other factors such as general population suffers from AD, and commonly
psychological stress. As general agreement that more than 30 % of less than 1 year-old children
allergic reaction type I with pointed by increasing of suffering this disease.2,4 Many researchers stated
IgE serum level is important role in the immune that AD have close relationship with environment
pathogenesis of AD. In atopic patients are allergens, but in our department have no accurate
recognized by their ability to produce large amounts data. To know the role of environmental allergens
of specific IgE antibodies to common substances as as trigger factors in AD, skin prick test is important
environmental allergens, i.e. house dust mites, grass methods to determined allergen.
A major component of managing and possibly
Address correspondence to: M. Wardhana preventing these diseases is control of
Department of Dermato-Venereology Faculty of environmental allergens; indoor, outdoor allergen
Medicine, Udayana University, Bali-Indonesia and air pollution. Indoor allergen commonly house
E-mail: made_wardhana@yahoo.com
dust mite (HDM), animal dander, cockroach,

Open access: www.ojs.unud.ac.id 45


Bali Medical Journal (Bali Med. J) 2014, Volume 3, Number 1: 43-46
P-ISSN.2089-1180, E-ISSN.2302-2914

outdoor allergen including grass pollen, and air were negative skin test of all item of allergens (see
pollution is one of many factors that can as trigger table 1).
factors to exacerbate and delineate of AD. Table 1
Environmental control is essential for persons who Skin Prick test reactivity to common environmental
are sensitive to dust mite and animal dander and and food allergens in atopic dermatitis
may be important in persons who are sensitive to
cockroaches. The bedroom is the most important Prevalence
Parameter
room in which to implement environmental control. (N=46)
Carpet in the bedroom or workplace should be Sex
considered. For persons who are sensitive to pet Male 34 (73.9%)
allergens, permanent removal of the pet is Women 12 (26.1%)
recommended. Age (year) 38.4 (29-54)
The aim of this study was to identify the Atopic history
sensitization against environmental or inhalants Yes 30 (65.2%)
allergens through skin prick tests in the patients with No 16 (34.8%)
atopic dermatitis. Environmental
allergens
PATIENTS AND METHODS House dust mite 18 (39.1%)
This is a retrospective, descriptive study. We
Cockroach 14 (30.4%)
revised all medical records of patients with AD
Cat dander 9 (19.7%)
since January 2002 to December 2004 in the Out
Patients Unit of Sanglah General Hospital, Bali- Chicken dander 5 (10.9%)
Indonesia. The variables studied were: gender, age, Dog dander 11 (23.9%)
work related, diagnosis associates to AD, and results Grass pollen 9 (19.7%)
of skin prick test of environmental and food Mold/Fungal 7 (15.2 %)
allergens. Food Allergens
Skin prick tests were performed according to Sea food 15 (32.6%)
standard methods using normal saline as negative Egg 13 (28.2%)
control and histamine (10 mg/mol) as positive Soy 9 (19.7%)
controls. If a reaction occurred within 15 minutes, Peanut 4 (8.7%)
the transverse and vertical diameters of the wheal Cocholate 3 (6.5%)
were measured. Wheals of 2 mm or greater were Meat 12 (26.0%)
regarded as positive result, and if subjects with one Chicken meat 8 (17.4%)
or more positive reactions were considered atopic Peneaple 3 (6.5%)
diathesis. All alergens extract made by Allergy Atopy ( > 1 positive 33 (71.4%)
Clinic Jakarta as stardard skin prick test in skin test)
Indonesia.
DISCUSSION
RESULTS In atopic dermatitis patients, the skin becomes
From January 2002 to December 2004, a total extremely itchy and inflamed, causing redness,
of 46 consecutive skin prick tests (SPT) were swelling, cracking, weeping, crusting, and scaling.
performed on adult atopic dermatitis (aged >15 Atopic dermatitis most often affects infants and
years) at the out patients unit of the Sanglah General young children, but it can continue into adulthood or
Hospital, Bali-Indonesia. The clinical diagnosis of first show up later in life. Environmental allergens
atopic dermatitis was made according to the criteria may sometimes be related to atopic dermatitis.
of Hanifin and Rajka. The severity of diseases was Many persons with atopic dermatitis are allergic to
assessed by use of SCORAD. grass pollen, dust mite and cat dander and others.
In 3 years periods we had revised 46 of Usually this manifests as an immediate reaction
patients with AD that was done skin prick tests. The with itching skin, some time followed by others
median age was 38 years (range 29-54 years), 34/46 allergic sign; runny nose, sneezing and swollen
(73.9 %) of these were male and 12 (26.1 %) eyes, and improves after removal from the allergy
female. Twenty-nine patients presented pure AD, source.4,5
and 17 patients had AD with asthma and allergic Atopic is the hypersensitivity reactions caused
rhinitis. Thirsty of 46 (65.2 %) said that they have a by allergen-specific IgE binding to mast cells, being
history of allergic disease, particularly food cross-linked by subsequent allergen exposure, and
allergen. Only 16(34.7 %) of patients had no history releasing mediators of immediate hypersensitivity
of allergic disease. Thirsty three of 46 (71.4 %) of particularly histamine that initiate inflammatory
all tested in AD patients find more than one item of cascades. There is a clear association between
positive skin prick tests against allergens, and 13 molecular component of house dust mite, grass
pollen, animal dander and AD. The proposed

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Bali Medical Journal (Bali Med. J) 2014, Volume 3, Number 1: 43-46
P-ISSN.2089-1180, E-ISSN.2302-2914

mechanism for the association between the allergens antibody responses in individuals allergic to pollen
and hypersensitivity mechanism relates to the ability proteins.5,6
of allergens to augment allergen-specific IgE
production, as well as alter the normal Th1/Th2 ratio Mold/Fungal Allergens
toward a predominant Th2 profile and their Th2 Many studies conducted indicate that fungal
cytokine such as; IL-4, IL-5 and IL-10. This sensitivity is common among allergic subjects. An
cytokines play important role in accumulating body of evidence suggests that fungal
immunopathogenesis of AD.1,6 sensitization, particularly to Alternaria species, is a
In the table shows the results of the skin test risk factor for the development of asthma or AD,
responses to a panel of common environmental increased severity of asthma, AD. Fungal allergen
allergens and food allergens. exposures are generally considered to take place in
outdoor environments; however, many species can
Dust Mites invade homes through open cracks or windows.4,6
House dust mite is the most commons allergen All kind of allergen enters the body through
(39.1%) as triggers factors in our study. The patients skin surface as contactant and through nasal mucosa
usually work as cleaning services in official as inhalant allergen. In atopic patients is very
government or private offices. Dust mites sensitive against that allergen. Most patients with
(Dermatophagoides pteronyssinus) are members of AD tend to be sensitive to more than one allergen.
the family Acaridae that are about 0.3 mm long, Atopic dermatitis is a genetically complex disease
feed on human skin scales, and are found in places that has a high familial occurrence. Twin studies of
with dust and high levels of humidity. Sensitivity to AD have shown concordance rates of 0.720.86 in
dust mite antigen is a strong predictor of asthma and monozygotic, and 0.210.23 in dizygotic, twin
asthma severity in atopic patients. Household with pairs. That means genetic factors play an important
the highest levels of dust mite infestation include the role in the development of this disease. In AD as
following; carpets, pillows, mattresses, drapes, part of a systemic atopic disorder, candidate genes
stuffed animals, clothing, and upholstered furniture, involving IgE and Th2 cytokines have been
wall.5,6 identified. There has been particular focus on
chromosome 5q31-33, as it contains a clustered
Cockroach family of Th2 cytokine genes. In our studies shown
In the table 1 reveals 30,4 % of patients have 65.2 % have family history atopic diathesis.
positive result against cockroach. Sensitization and A comprehensive treatment plan typically
high exposure to cockroach allergen has been involves a combination of allergen avoidance or
strongly associated with the patients with atopic controlled exposure coupled with appropriate
state, and as risk of asthma. Cockroach allergens are pharmacotherapy.
found in household dust, with the highest
concentrations located in the kitchen. The particles Allergen Avoidance
that carry cockroach allergen are relatively large (at The most fundamental of therapeutic principles
least 10 m in size) and remain airborne for a short is to avoid exposure to allergens that provoke
period of time after a disturbance. immediate hypersensitivity reactions. The same
holds true for indoor pets to which a patient is
Animal dander (Pets) sensitive. Many allergens cannot be avoided
Animal allergens, principally those from cats, completely, such as allergens contained in dust and
dogs, rats, mice, horses, and cows, are also a mold, as well as grass and weed pollens. In these
common cause of acute and chronic allergic asthma. cases, minimizing exposure can have a positive
Allergic sensitization can occur in the home therapeutic benefit. The most important factor in an
environment, as well as in the workplace. All warm- environmental control program is avoidance of dust
blooded animals produce potential allergens in their mite allergen. Exposure to dust mites can be
dander, urine, feces, and saliva. Persons who are reduced, but not eliminated, by regularly vacuuming
sensitive to animal dander are at a higher risk of the house, keeping soft toys and clothes shut away
developing allergic disease and of having and in cupboards, limiting floor carpets, washing linen
exacerbation of AD when exposed to these in hot water and using protective mattress and
allergens.5,6 pillow covers.3,8,9

Grass pollen Drug Therapy


Grass pollen allergy is a major human health The classes of drugs available are used to
problem throughout the world, perennial ryegrass either counteract the effects of most cell mediators
(Lolium perenne) being one of the more important on target cell receptors or decrease the release of
species causing exacerbate allergic diseases. Several mediators from mast cells. Emollient to protect skin
proteins from this grass pollen have been surface is important to avoid contact with skin and
characterized and used to study specific serum to maintenance the humidity of skin. Systemic

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Bali Medical Journal (Bali Med. J) 2014, Volume 3, Number 1: 43-46
P-ISSN.2089-1180, E-ISSN.2302-2914

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