Th2-and Th22-polarising cytokines became statistically significant in cells from atopic patients relative to those from healthy controls. Fujita et al. (14) also confirmed the pluripotent Th-cell (Th1, Th2, Th17, Th22)-polarising capacity of freshly isolated skin-derived resident and inflammatory DCs, and they emphasised that the recruitment of disease-specific Th subsets is determined primarily by the microenvironment associated with chronic inflammation in AD. In an analogous experimental system, Reefer et al. (19) demonstrated that in DC-T cell co-cultures after TSLP, allergen or SEB stimulation, Th cells from AD patients produce Th2-type cytokines, although that study did not investigate Th22 cytokine expression. In our experiments, we also observed that unstimulated mDCs had a similar capacity to polarise Th1 cells in atopic and non-atopic individuals; however, this ability of atopic mDCs became impaired after stimulation. Consistent with the results of our study, Lebre et al. (20) found that CD1c+ DCs exhibit aberrant functions in AD patients because these cells could not induce a Th1 immune response, even in the presence of a strong Th1 stimulus.Due to the prevalent initiator but complex nature of mDCs in the skin's immune system, many therapeutic approaches target these cells via modifications of their function or the surrounding tissue microenvironment, that is, topical treatment of AD with calcineurin inhibitors and corticosteroids (21,22). Therefore, it is important to develop methods that are suitable for the investigation of the direct effects of newly developed therapies on DCs. Consequently, we want to emphasise a third point: that LSC is a useful technique to monitor mDC functions in vitro. ConclusionsBecause of the low number of mDCs in the peripheral blood and the limited blood sample volume that is available, especially in childhood, it is challenging to directly investigate the function of these cells from patients. To our knowledge, we are the first to directly determine the intracellular cytokine profile and activation of circulating mDCs in AD patients using multiparametric laser scanning cytometry (LSC). Measurements utilising this slide-based technique allow for the analysis of specimens with low cell numbers (10 5 or less) but provide results with statistical relevance. Author contributions GN performed the research, did the LSC measurement, analysed the data and wrote the manuscript; DM and ZSB did the LSC measurement and analysed the data; KG contributed the blood samples, GM, AK and TD contributed to the research design, EGY, ER supervised the study, TB supervised the study and edited the manuscript, ASZ designed the study, wrote the manuscript and supervised the research group. Acknowledgements Conflict of interestsThe authors have declared no conflicting interests. Supporting InformationAdditional Supporting Information may be found in the online version of this article: Appendix S1. Materials and methods. Table S1. Data on patients, activation and maturation markers and cytok...

BackgroundRecent epidemiologic studies have shown that environmental contaminants such as air pollution and tobacco smoke play an important role in the pathophysiology of atopic dermatitis (AD).ObjectiveThe aim of this study was to evaluate the relationship between the severity of AD and indoor air pollution.MethodsThe study population consisted of 425 children from 9 kindergartens, Korea. The authors surveyed the prevalence of AD and evaluated disease severity by the eczema area and severity index (EASI) score and investigator's global assessment (IGA). After measuring indoor air pollution, a program to improve indoor air quality was conducted in 9 kindergartens. Seven months later, the prevalence and disease severity were evaluated.ResultsThe initial prevalence of AD was 8% and the mean EASI score was 2.37. The levels of particulate material 10 (PM10) and carbon dioxide (CO2) were higher in some kindergartens compared to the normal values. Subsequent to the completion of the indoor air quality improvement program, the mean PM10 level was significantly decreased from 182.7 to 73.4 µg/m3. After the completion of the program, the prevalence of AD and the mean EASI were decreased, and the changes were both statistically significant. The mean number of hospital visits decreased from 1.3 per month during the first survey to 0.7 per month during the second survey, which was statistically significant.ConclusionIndoor air pollution could be related to AD. The reduction of PM10 through improving indoor air quality should be considered in kindergartens and schools in order to prevent and relieve AD in children.

BackgroundPrevious clinical trials with evening primrose oil in atopic dermatitis (AD) treatment have shown different results. In addition, the optimal dose and duration of treatment with evening primrose oil have not yet been determined.ObjectiveThe aim of this study is to investigate the dose-response treatment effects of evening primrose oil on clinical symptoms of AD and serum concentrations of polyunsaturated fatty acids.MethodsForty AD patients were enrolled for the study and randomly divided into 2 groups: those who received evening primrose oil 160 mg daily for 8 weeks and those who received 320 mg of evening primrose oil twice daily for 8 weeks. We evaluated the Eczema Area Severity Index (EASI) scores of all AD patients at weeks 0, 2, 4 and 8. In addition, we measured the levels of serum fatty acids, including C16 : 0 (palmitic), C18 : 2n (linoleic), C18 : 3n (linolenic) and C20 : 4 (arachidonic acid) using gas chromatography.ResultsThe serum fatty acid levels C18 : 3n and C20 : 4 were higher in the 320 mg group than in the 160 mg group, with statistical significance. After evening primrose oil treatment, EASI scores were reduced in the 2 groups. The improvement in EASI scores was greater in the 320 mg group than in the 160 mg group. There were no side effects seen in either group during the study in the 2 groups.ConclusionThe results of this study suggest that the 320 mg and 160 mg groups may be equally effective in treating AD patients and show dose-dependent effects on serum fatty acid levels and EASI scores.

BackgroundAtopic dermatitis (AD) is characterized by itching and eczema-like skin lesions, and its symptoms alleviate with age. Recently, the prevalence of AD has increased among adolescents and adults. The increasing prevalence of AD seems to be related to westernized lifestyles and dietary patterns.ObjectiveThe aim of this study was to evaluate the dietary patterns and nutrient intake of patients with AD.MethodsThe study population consisted of 50 children with AD who visited the Department of Dermatology at Kangnam Sacred Heart Hospital, Seoul, Korea from May 2008 to May 2009. Physical condition and calorie intake were evaluated using the Eczema Area and Severity Index score and Food Record Questionnaire completed by the subjects, and the data were analyzed using the Nutritional Assessment Program Can-pro 3.0 (The Korean Nutrition Society, 2005) program to determine the gap between the actual ingestion and average requirements of 3 major nutrients (i.e. carbohydrates, proteins, and lipids), vitamins (i.e. A, B, C, and E), niacin, folic acid, calcium, iron, phosphorus, and zinc in all subjects.ResultsThe intake rate of proteins was 18.02% (recommended dietary allowance [RDA], 7%~20%), of carbohydrates was 67.7% (RDA, 55%~70%), and of lipids was 14.24% (RDA, 15%~30%). Thirty-one subjects (62%) showed deficiency of folic acid, and 21 subjects (42%), of iron supplements.ConclusionEssential nutrient intake tends to be lower in AD patients than in healthy subjects, and this low intake is closely related to the severity of AD.

BackgroundIt is well known that atopic dermatitis (AD) is related to food hypersensitivity, although its prevalence varies among several studies according to age group, severity, country, survey time, and test method.ObjectiveTo examine the prevalence and status of food hypersensitivity among childhood AD patients in Korea.MethodsA total of 95 patients were enrolled in the study. The history of food hypersensitivity was collected by interviews. The severity of AD was evaluated by eczema area and severity index (EASI). We took blood samples to measure serum total and food-specific immunoglobulin E (IgE) levels. Based on the histories and serum IgE levels, open oral food challenge (OFC) testing was performed to confirm food hypersensitivity.ResultsForty-two (44.2%) of the 95 AD patients had histories of food hypersensitivity. They reported that the most common suspicious foods were egg (n=13, 13.7%), pork (n=9, 9.5%) and cow milk (n=8, 8.4%). The mean EASI score was 16.05±9.76. Thirty-nine (41.1%) of the 95 patients showed elevated serum food-specific IgE levels. The specific IgE levels were elevated for egg (n=17, 17.9%), milk (n=12, 12.6%), peanut (n=10, 10.5%) and wheat (n=8, 8.4%). Fifty-one (53.8%) of 95 patients underwent open OFC, and only 7 (13.7%) of these patients showed positive reactions.ConclusionThe overall prevalence of food hypersensitivity in patients with childhood AD in Korea was 8.3% (7/84). The most common foods causing food hypersensitivity were egg and milk. Among the foods causing hypersensitivity, AD patients in Korea often underestimated peanut, while they overestimated pork.