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Exacerbation of atopic dermatitis on grass pollen exposure in an environmental challenge chamber

: Werfel, T.; Heratizadeh, A.; Niebuhr, M.; Kapp, A.; Roesner, L.M.; Karch, A.; Erpenbeck, V.J.; Lösche, C.; Jung, T.; Krug, N.; Badorrek, P.; Hohlfeld, J.M.


The journal of allergy and clinical immunology : JACI 136 (2015), Nr.1, S.96-103
ISSN: 0091-6749
ISSN: 1097-6825
ISSN: 1085-8725
Fraunhofer ITEM ()
Atopic dermatitis; Inhalant allergen; Grass pollen; Environmental challenge chamber; exposure

Background: It has frequently been speculated that pruritus and skin lesions develop after topical exposure to aeroallergens in sensitized patients with atopic dermatitis (AD).
Objective: We sought to study cutaneous reactions to grass pollen in adult patients with AD with accompanying clear IgE sensitization to grass allergen in an environmental challenge chamber using a monocenter, double-blind, placebo-controlled study design.
Methods: Subjects were challenged on 2 consecutive days with either 4000 pollen grains/m3 of Dactylis glomerata pollen or clean air. The severity of AD was assessed at each study visit up to 5 days after challenge by (objective) scoring of AD (SCORAD). Additionally, air-exposed and non-air-exposed skin areas were each scored using local SCORAD scoring and investigator global assessments. Levels of a series of serum cytokines and chemokines were determined by using a Luminex-based immunoassay. The primary end point of the study was the change in objective SCORAD scores between prechallenge and postchallenge values.
Results: Exposure to grass pollen induced a significant worsening of AD. Apronounced eczema flare-up of air-exposed rather than covered skin areas occurred. In grass pollen-exposed subjects a significantly higher increase in CCL17, CCL22, and IL-4 serum levels was observed.
Conclusions: This study demonstrates that controlled exposure to airborne allergens of patients with a so-called extrinsic IgE-mediated form of AD induced a worsening of cutaneous symptoms.