Broeks, S. (Suzanne) (2015) De relatie tussen eczeem en polysensibilisatie. thesis, Medicine.
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Abstract
Introduction: Atopic dermatitis (AD) is usually the first clinical manifestation of the atopic syndrome, and is being viewed as a risk factor for sensitization in later life. A possible explanation for this correlation is a dysfunction of the skin barrier in AD. It is hypothesized that allergens can be introduced to the immune system through the dysfunctional skin barrier in children with AD and this increases the likelihood of sensitization to multiple allergens. Polysensitization (≥5positive on the specific IgE-test) is associated with a more severe atopic phenotype. Consequently, the question rises whether children with AD are more frequently polysensitized than children without AD. Method: In this retrospective cross-sectional study we examined 7941 files of children (17 years or younger) presenting to their physician (both primary and secondary care) with allergic symptoms. These children were referred to the laboratory in Zwolle for allergy testing, either a screening test or tests of specific IgE sensitizations, between 2004 and 2010. Files were selected if they contained documentation of the presence of AD and data on the presence of screening or specific IgE-tests for the ten most common food and inhalant allergens (specific IgE-test considered positive if = >0.35 kU/L). Results: A total of 1743 children were included, 746 of whom (42.8%) did not have any positive specific IgE-test, 217 children (12.4%) were monosensitized, 482 children (27.7%) were sensitized to two to four allergens, and 298 children (17.1%) were sensitized to five or more allergens (polysensitization). Of the 1743 children, 1197 children (68.7%) had had AD ever during their lifetime and 546 children (31.3%) had never had AD. Polysensitization was more common in children with AD (268/1197,22.4%) than in those without (30/546, 5.5%) (p<0.001). Even after adjustment for gender and age in a multiple logistic regression model, AD was strongly associated with polysensitization (OR 4.76, 95% CI 3.21-7.06). Polysensitization was significantly more common in children between 4 and 11 years old, compared to the other children (p<0.001, OR 1.68, 95% CI 1.31-2.16). There were 298 children with polysensitization. In 168 of these children (56.4%), polysensitization was fully explained by five positive test for aeroallergens and in 56 children (18.8%) it was caused by five positive tests for food allergens. The remaining cases of polysensitization were explained by both sensitization to inhalant allergens and food allergens. Polysensitization was equally common in girls (135/874, 15.4%) as in boys (163/869, 18.8%) (p=,63; OR 1,08; 95% BI 0,82 – 1,42). In each sensitization group, the median age of girls was considerably higher than that of boys. The majority of 12-17 years old children with polysensitization were girls (58/86, 67.4%) (p<0.001). Median total IgE values increased with increasing number of positive specific IgE-tests (p<0.001). Conclusion: Polysensitization is more common in children with AD than in children without AD, with the highest prevalence around 4 to 11 years. This finding supports the hypothesis that sensitization could occur through a defective skin barrier.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Brand, Prof. Dr. P.L.P. and Amalia Kindercentrum and Isala klinieken, Zwolle |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:00 |
| Last Modified: | 25 Jun 2020 11:00 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2064 |
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