New Aspects of the Clinical and Immunological Approach in Patients with Atopic Dermatitis

Introduction Studies on the particularities of the immune response in various evolutionary forms of AD in patients of different ages are controversial. Immune factors play a decisive role in AD evolution, facilitating the development of disturbing disorders of the pathological process. The characteristic of the humoral chain influences the establishment of lesional forms that would be a helpful for the selection of immunomodulatory remedies. Material and methods The case-control study included 110 AD patients and 110 "apparently healthy" children, assigned to age groups under 2 years of age (group I) and 2 to 18 years (group II). The serum IgA, IgG, IgM and IgE-total immunoglobulin levels as well as the cytokine profile (IL-2, IL-4, TNF-alpha) were determined using immuno-enzymatic methods and divided according to the severity of the disease (SCORAD), lesional forms and IgE-associated forms of the disease. Results The study revealed a decrease in serum levels of IgA, an increase in total IgE and serum IL-2, IL-4, TNF-alpha levels compared to the respective control groups. These deviations were more pronounced in patients over the age of 2 years (group II) in severe and moderate forms. Significant increase for TNF-alpha and less expressed for IL-2 in exudative form (both groups) was observed, the increase of IL-4 being more evident in the lichenified forms of AD (group II). The evolutionary trend for TNF-alpha was ascending for exudative form in children over 2 years (group II) and descending in those under 2 years of age (group I). Significant positive correlations between total IgE and IL-4 in erythemato-squamous and lichenified erythemato-squamous forms were observed; negative correlations between total IgE and TNF-alpha in severe forms and between IL-4 and TNF-alpha in the exudative form of AD. A notable difference in the cytokine (IL-2, IL-4, TNF-alpha) and immunoglobulin (IgA, IgG, IgM) indices in age groups in patients with extrinsic and intrinsic AD was not observed. At the same time, there was a decrease in IgA indices in both groups, more evident in intrinsic form, the IgE-total dynamics being net ascending in extrinsic form. An increase in age-related IL-2 and TNF-alpha indices has been noted, IL-4 age deviations exhibiting an increase in extrinsic and decrease in intrinsic form. Conclusions A biphasic evolutionary trend of immune response in patients with AD has been demonstrated, which is predominantly Th2-type with total IgE and IL-4 increase, in early stages (under 2 years), which presents more frequently in its erythemato-squamous and exudative, extrinsic forms. In active forms (over 2 years), with lichenification, intrinsic forms, the immune response was of Th1 type (TNF-alpha, IL-2 increase).