|Year : 2021 | Volume
| Issue : 1 | Page : 66-70
Association between serum immunoglobulin E and soluble E-selectin, and atopic dermatitis
Shawky M El-Farrargy1, Naglaa M Ghanayem2, Shaimaa S.B. Sherief3
1 Department of Dermatology, Andrology and STDs, Menoufia University, Menoufia, Egypt
2 Department of Medical Biochemistry and Molecular Biology, Menoufia University, Menoufia, Egypt
3 Department of Dermatology, Andrology and STDs, El Bagour General Hospital, Menoufia, Egypt
|Date of Submission||20-Aug-2019|
|Date of Decision||30-Sep-2019|
|Date of Acceptance||07-Oct-2019|
|Date of Web Publication||27-Mar-2021|
Shaimaa S.B. Sherief
Shanawan, Shebin El-Kom, Menoufia
Source of Support: None, Conflict of Interest: None
To study and evaluate the role of both serum immunoglobulin E (IgE) and soluble E-selectin in patients with atopic dermatitis (AD).
AD is a chronic inflammatory skin disease that is characterized by intense itching and recurrent eczematous lesions. Although it most often starts in infancy. It is also highly prevalent in adults. Assessment of maintenance of AD could be related to serum IgE and soluble E-selectin. Treatment of AD remains a challenge.
Patients and methods
This case–control study was performed for 40 patients who were age-matched and sex-matched with 20 healthy control cases. The patient group was subdivided into two groups according to their severity. The sample comprised 28 men and 32 women. Their ages ranged between 3 and 28 years.
There was significant statistical differences between the two studied patient groups and the control group regarding total IgE and E-selectin serum levels that were higher in the patient group than the control one. There was also significant statistical increase in the level of serum IgE and soluble E-selectin in severe AD patients compared with mild cases.
There was a positive association between serum IgE, soluble E-selectin, and AD in general and also with severity. So it may be used as a marker for AD.
Keywords: atopic dermatitis, E-selectin, immunoglobulin E
|How to cite this article:|
El-Farrargy SM, Ghanayem NM, Sherief SS. Association between serum immunoglobulin E and soluble E-selectin, and atopic dermatitis. Menoufia Med J 2021;34:66-70
|How to cite this URL:|
El-Farrargy SM, Ghanayem NM, Sherief SS. Association between serum immunoglobulin E and soluble E-selectin, and atopic dermatitis. Menoufia Med J [serial online] 2021 [cited 2021 Dec 6];34:66-70. Available from: http://www.mmj.eg.net/text.asp?2021/34/1/66/312028
| Introduction|| |
Atopic dermatitis (AD), also known as atopic eczema, is a chronic inflammatory skin disease characterized by pruritic, erythematous, and scaly skin lesions often localized to the flexural surfaces of the body .
AD is also associated with an increased risk of other inflammatory diseases, such as arthritis and inflammatory bowel disease, and it causes psychological disturbances .
AD typically starts in early childhood and is widely reported to affect 15–20% of children and 1–3% of adults. AD is a complex, multifactorial disease with a host of genetic and environmental factors contributing to its development .
The pathogenesis of AD is complex. Together with genetic predisposition, epigenetic factors, alterations in skin microbiome, and antimicrobial peptide content of keratinocytes are known to contribute to disease manifestation .
The pathogenesis of AD involves interactions among multiple factors including susceptibility genes, environmental factors, skin barrier defects, and immunological factors .
Common associations and comorbidities of AD that have been supported by studies include other atopic conditions: namely, food allergies, asthma, and allergic rhinitis/rhinoconjunctivitis ,.
The normal serum immunoglobulin E (IgE) level does not mean that atopy does not exist. On the other hand, very high serum IgE level can be accepted as one of the important data showing allergy existence if there is no parasitic infestation .
E-selectin is expressed on the surface of activated endothelial cells upon stimulation by inflammatory cytokines. E-selectin is a marker of severity and inflammation in AD and is found to be important in the pathogenesis of AD .
The present study aimed at studying and evaluating the role of both serum IgE and soluble E-selectin in patients with AD.
| Patients and methods|| |
This case–control study was done for 40 AD patients that was age-matched and sex-matched with 20 healthy control cases. The patient group was subdivided into two groups according to severity. They were recruited from the Dermatology Outpatient Clinic, Faculty of Medicine, Menoufia University Hospital from January 2017 to April 2018. The study was approved by the Ethics Committee of Menoufia Faculty of Medicine; and written prepared consent with justification about the reason, methods, and results was obtained from participants' families. Inclusion criteria included: being Egyptians, age between 1 and 40 years and have fulfilled the criteria of AD clinically. Exclusion criteria: patients under systemic treatment, acute and chronic infection, autoimmune disorders, and patients under corticosteroids treatment.
The assay system utilizes one monoclonal anti-IgE antibody and antihuman soluble E-selectin coating antibody for solid-phase (microtiter wells) immobilization and goat anti-IgE antibody and antihuman E-selectin coating antibody in the antibody–enzyme (horseradish peroxidase) conjugate solution. Polystyrene particles coated with specific antibodies to human serum IgE and E-selectin were aggregated when mixed with samples containing human IgE and E-selectin. These aggregates scatter a beam of light passed through the sample. The intensity of scattered light is proportional to the concentration of the respective protein in the sample.
Using the SPSS version 22 (IBM Corp., Armonk, NY, USA) descriptive data were calculated for the statistical analysis in the form of frequency and distribution for qualitative data. In the statistical comparison between the different groups, the significance of difference was calculated using either intergroup comparison of categorical data or was performed using χ2 test. Qualitative data were expressed as number and percentage and were analyzed by applying χ2 test or Fisher's exact test was used instead whenever the expected value in one or more of the cells in a 2 × 2 table was less than 5. A P value less than 0.05 was considered statistically significant (S) in all analyses.
| Results|| |
The studied patients were divided into group I that included 40 AD patients, 18 men and 22 women with age range from 3 to 28 years (mean ± SD, 23.10 ± 6.21 years). This group was subdivided into two groups according to severity: group Ia included 20 AD patients with mild activity. There were 10 men and 10 women with age range from 3.0 to 28.0 years (mean ± SD, 23.10 ± 6.98 years) and group Ib included 20 AD patients with severe activity. They were eight men and 12 females with age range from 8.5 to 28.0 years (mean ± SD, 21.58 ± 6.21 years). Group II included 20 healthy individuals with matched sex and age, they were free from any allergic diseases, and served as the control group. There were seven men and 13 women with age range from 5.0 to 28.0 years (mean ± SD, 22.65 ± 6.36 years).
In the present study there were significant statistical differences between the studied patient groups regarding scoring the intensity of AD wherever there was nonsignificant statistical differences between the studied patient groups regarding clinical data (onset, duration, atopy, triggering, factors, family history) [Table 1] and [Table 2].
|Table 1: Comparison between the two studied groups regarding clinical characteristics|
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|Table 2: Statistical comparison between the studied groups regarding serum total immunoglobulin E and soluble E-selectin levels|
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In the present study total patient (group I), there was nonsignificant negative correlations between total IgE and E-selectin levels and each of age, onset, and duration of disease. For mild cases (group Ia), there was nonsignificant positive correlation between total IgE and E-selectin levels and each of age and duration of disease, whereas nonsignificant negative correlation existed with the onset of the disease. For severe cases (group Ib), there was nonsignificant negative correlations between total IgE and each of age, onset, and duration of disease. There was nonsignificant negative correlation between E-selectin and each of age and onset of disease, whereas nonsignificant negative correlation existed with the duration of the disease [Table 3].
|Table 3: Correlation coefficient between total immunoglobulin E serum level, total soluble E-selectin, and each of age, onset, and duration of disease in atopic dermatitis patients|
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In the present study, total IgE and E-selectin serum levels were independent factors for differentiation between severe and mild AD patients. At a cutoff value of total IgE serum level of more than 240.60 IU/m, the sensitivity was 90% and specificity was 100%. At a cutoff value of E-selectin serum level of more than 99.5 pg/ml, the sensitivity was 90% and specificity was 100% [Table 4].
|Table 4: Agreement (sensitivity, specificity) for total immunoglobulin E and E-selectin to differentiate between mild and severe cases|
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| Discussion|| |
AD is considered to be a heterogeneous disease like asthma with clinical features and complex pathogenesis. Cluster analysis is needed to define the clinical phenotypes of AD composed of a heterogeneous group . Also, E-selectin is expressed on the surface of activated endothelial cells upon stimulation by inflammatory cytokines. E-selectin is considered to be a marker of severity and inflammation in AD and is found to be important in the pathogenesis of AD .
The present study showed that there was a significant increase in serum IgE levels in AD patients compared with controls. There was significant increase in serum IgE levels in severe cases than in mild and moderate AD patients. These results were come in line with the study by Daeschlein et al. . Wakamori et al.  reported that AD is associated with elevated serum IgE levels, specific IgE environmental allergens such as house dust mites, and tissue and peripheral blood eosinophilia.
The current study showed that IgE and soluble E-selectin were independent factors for the diagnosis of AD patients versus controls and also for differentiation between severe AD versus mild cases.
Vanecova and Bukac  concluded that there was significant dependence between the severity of AD and the level of total IgE. The level of total IgE above 200 IU/ml is recorded in 93% of patients suffering from severe form.
Studies on the pathogenetic mechanisms of AD advocate the use of both clinically based scoring systems, such as the objective scoring the intensity of AD and soluble E-selectin as an objective marker of the inflammation in AD .
The current study found that there was significant statistical differences between the studied groups regarding E-selectin levels. These results agreed with Wolkerstorfer et al.  and Khafagy et al. .
Kulišić et al.  documented that adhesion molecules may play an important role in the homing of T-cell subsets into the allergen-exposed skin of atopic individuals. They concluded that there were significant changes in the epithelial cell expression of E-selectin, which were specially pronounced in the vascular endothelium of the dermis of AD patients. It was concluded that E-selectin is an important adhesion molecule in inflamed AD skin lesions .
The current study showed that serum E-selectin was significantly increased in severe AD patients (group Ib) than in mild AD ones (group Ia). These results agree with those of Tokura  and Kulišić et al. , who indicated E-selectin to be a marker of AD severity.
Vanecova and Bukac  found that the significant dependence was recorded between the severity of AD and parameters such as the level of total IgE, and family history about atopy. The level of total IgE above 200 IU/ml is recorded in 93% of patients suffering from severe form and the positive data about atopy in the family were recorded in 66% of patients with severe forms of AD. No relation was recorded between the severity of AD and the onset of AD.
However Angela et al.  found that the risk was not related to specific IgE level nor a specific food. In the present study, there was nonsignificant negative correlation between total IgE and E-selectin levels and each of age, onset and duration. This agreed with the study of Dhar et al. .
Anja and Karsten  found that the total IgE had a negative correlation (P < 0.0001) with age. In contrast, no significant decrease of total serum IgE as a function of age was observed in patients with AD.
| Conclusion|| |
This study concluded that the serum levels of total IgE and soluble E-selectin were significantly higher in AD patients compared with controls also in severe AD patients than in mild patients. These two markers are independent factors for the diagnosis of AD patients versus controls and mild versus severe cases. Both serum total IgE and soluble E-selectin may be used as markers for the assessment of severity and clinical course of AD.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Spergel JM. Epidemiology of atopic dermatitis and atopic march in children. Immunol Allergy Clin North Am 2010; 30
Dalgard F. The psychological burden of skin diseases a cross-sectional multicenter study among dermatological out-patients in 13 European countries. J Invest Dermatol 2015; 135
Nutten S. Atopic dermatitis: global epidemiology and risk factors. Ann Nutr Metab 2015; 66
Joanna W, Joechim S, Stephen G. IgE-specific New treatment option for severe refractory atopic dermatitis. Immunoadsorption 2019; 56
Boguniewicz M, Donald Y, Leung M. Recent insights into atopic dermatitis and implications for management of infectious complications. J Allergy Clin Immunol 2010; 125
Kyllonen H, Malmberg P, Remitz A, Rytila P, Metso T, Helenius I, et al
. Respiratory symptoms, bronchial hyper-responsiveness, and eosinophilic airway inflammation in patients with moderate-to-severe atopic dermatitis. Clin Exp Allergy 2006; 36
Hwang CY, Chen YJ, Lin MW, Chen TJ, Chu SY, Chen CC, et al
. Prevalence of atopic dermatitis, allergic rhinitis and asthma in Taiwan: a national study 2000 to 2007. Acta Derm Venereol 2010; 90
Vanecova J, Bukac J. The severity of atopic dermatitis and the relation to the level of total IgE, onset of atopic dermatitis and family history about atopy. J Food Agric Immunol 2016; 27
Wolkerstorfer A, Savelkoul HF, de Waard van der Spek FB, Neijens HJ, van Meurs T, Oranje AP. Soluble E-selectinand soluble ICAM-1 levels as markers of the activity of atopic der-matitisinchildren. Pediatr Allergy Immunol 2003; 14
Tokura Y. Extrinsic and intrinsic type of atopic dermatitis. J Dermatol Sci 2010; 58
Kulišić MD, Lacković G, Jurić-Lekić G, Sandra Marinović MS. Atopic dermatitis: morphometric study. Sci Article 2010; 18
Daeschlein G, Scholz S, Lutze S. Repetitive immunoadsorption cycles for treatment of severe atopic dermatitis. Ther Apher Dial 2014; 19
Wakamori T, Katosh N, Hirano S, Kishimoto S, Ozasa K. Atopic dermatitis, dry skin and serum IgE in children in a community in Japan. Int Arch Allergy Immunol 2009; 149
Khafagy NH, Fathy G, Khafagy AH, Mostafa MS, Mostafa EM. Level of serum soluble endothelial leukocyte adhesion molecule-1 in psoriatic patients after narrow-band ultraviolet-B and relation to disease activity: a case–control study. Egypt J Dermatol Venerol 2017; 37
Angela C, Rachel R, Maio C. Natural history of food-triggered atopic dermatitis and development of immediate reactions in children. J Allergy 2016; 4
Dhar S, Malakar R, Chattopadhyay S, Dhar S, Banerjee R, Ghosh A. Correlation of the severity of atopic dermatitiswith absolute eosinophil counts in peripheral blood and serum IgE levels. Indian J Dermatol Venereol Leprol 2005; 71
Anja M, Karsten N. Total and specific serum IgE decreases with age in patients with allergic rhinitis, asthma and insect allergy but not in patients with atopic dermatitis. Immun Aging 2005; 5
[Table 1], [Table 2], [Table 3], [Table 4]