Le système immunitaire humain est majoritairement commandé par les cellules dendritiques et les lymphocytes T auxiliaires. Lorsque les cellules dendritiques détectent un pathogène, elles vont instruire les lymphocytes T auxiliaires afin qu’ils adoptent le phénotype approprié à la menace rencontrée. Les lymphocytes T auxiliaires peuvent être divisés en plusieurs sous-populations, caractérisées par la production de cytokines spécifiques. Chaque sous-population de lymphocyte T auxiliaire possède des fonctions propres et est impliquée dans l’élimination de pathogènes distincts. Si les réponses des lymphocytes T auxiliaires ne sont pas finement régulées, ils peuvent devenir pathogéniques, et dans ce cas, considérés comme cibles potentielles pour des thérapies. Dans ce contexte, j’ai concentré mon travail de doctorat sur l’étude de la diversité des sous- populations de lymphocytes T auxiliaires et de leur régulation. Premièrement, j’ai démontré que les cellules dendritiques activées par la TSLP sont capables d’induire la polarisation de lymphocytes T folliculaires. Ensuite, j’ai participé à la construction d’un modèle mathématique capable de prédire la réponse lymphocytaire T auxiliaire en fonction de signaux dérivés des cellules dendritiques. Ce modèle nous a permis d’identifier un rôle spécifique pour l’IL-12p70, dépendant du contexte IL-1, dans l’induction d’IL-17F sans IL-17A. Enfin, j’ai monitoré huit populations de lymphocytes T auxiliaires et folliculaires dans le sang périphérique de patients atteints de dermatite atopique traités par Dupilumab, une immunothérapie ciblant la sous-unité alpha du récepteur de l’IL-4 et j’ai pu montré que la diminution du pourcentage de lymphocytes Th17 correlait avec l’amélioration du score clinique EASI. Globalement, mon travail sur la diversité de phénotypes Th apporte une ressource mécanistique importante, avec une potentielle application en immunothérapie. / Human immunity is essentially driven by dendritic cells and T helper cells. When dendritic cells detect a pathogen, they will instruct T helper cells to adopt the adapted phenotype for the specific threat encountered. T helper cells are subdivided in multiple subsets, characterized by particular sets of cytokines. Each T helper subset has specific functions and is involved in the clearance of distinct pathogens. If T helper responses are not precisely regulated, they can become pathogenic, in this case T helper pathways can be considered as potential targets for therapy. In this context, I focused my PhD work on studying T helper cell subset diversity and regulation. First, I demonstrated the ability of TSLP-activated dendritic cell to induce T follicular helper cell polarization. Then I participated in building a mathematical model capable of predicting T helper cell response to dendritic-cell derived signals. This model allowed us to identify the specific role of IL-12p70, in an IL-1 context, to induce IL-17F without IL-17A. Finally, I monitered eight T helper and T follicular helper cell populations in peripheral blood from atopic dermatitis patients treated with Dupilumab, an immunotherapy targeting the IL-4 receptor alpha subunit, and was able to show a correlation between decrease of Th17 cell percentage and improvement of EASI clinical score. Overall, my work on Th phenotype diversity provides key mechanistic insight with potential application in immunotherapy.

Background: Lifestyle and environmental factors are known to contribute to allergic disease development, especially very early in life. However, the link between diet composition and allergic outcomes remains unclear. Methods: In the present population-based cohort study we evaluated the dietary intake of 10-year-old children and analyses were performed with particular focus on atopic dermatitis or food allergy, allergic diseases known to be affected by dietary allergens. Dietary intake was assessed via semi-quantitative food frequency questionnaires. Based on these data, individual nutrient intake as well as children’s Dietary Inflammatory Index (C-DIITM) scores were calculated. Information about atopic manifestations during the first 10 years of life and confounding factors were obtained from standardized questionnaires during pregnancy and annually thereafter. Results: Analyses from confounder-adjusted logistic regression models (n = 211) revealed that having atopic outcomes was associated with having a pro-inflammatory pattern at the age of 10 years: OR = 2.22 (95% CI: 1.14–4.31) for children with atopic dermatitis and OR = 3.82 (95% CI: 1.47–9.93) for children with food allergy in the first 10 years of life Conclusion: A pro-inflammatory dietary pattern might worsen the atopic outcome and reduce the buffering capacity of the individual against harmful environmental exposures or triggers. For pediatricians it is recommended to test for the individual tolerance of allergenic foods and to increase the nutrient density of tolerable food items to avoid undesirable effects of eating a pro-inflammatory diet.

Mastzellen sind ubiquitär im Bindegewebe vorkommende Zellen, welche eine Vielzahl von Mediatoren physiologischer und pathologischer Prozesse exprimieren. Ihre Zahl ist in gesunden Geweben gering, am höchsten jedoch in der Haut und Schleimhäuten von Nase, Auge und Gastrointestinaltrakt sowie in der Lunge. Die Ergebnisse unserer Arbeitsgruppe zeigen, dass unter pathologischen Bedingungen, insbesondere bei entzündlichen Reaktionen und Erkrankungen des atopischen Formenkreises, die Mastzellzahlen um ein Vielfaches steigen. Dabei werden die Vorläuferzellen des Blutes, welche aus einer CD34+/c-Kit+ hämatopoetischen Stammzelle des Knochenmarkes rekrutiert werden, aktiviert und durch chemotaktisch wirkende Faktoren zur Einwanderung in die Gewebe stimuliert. Unter Verwendung von in vitro Kulturmodellen konnte gezeigt werden, dass diese Vorläuferzellen im Blut die Expression von c-Kit und CD34 herunterregulieren und als Zellpool im peripheren Blut zirkulieren. Nach Aktivierung der Zellen wurde c-Kit wieder nachgewiesen. Die Zellen wandern ins Gewebe ein und differenzieren dort unter Einfluss von Zytokinen, welche durch andere Gewebszellen freigesetzt werden, aus. Es wurden Wechselwirkungen in der Haut zwischen Mastzellen und Fibroblasten, Melanozyten, Keratinozyten und Nervenzellen gezeigt. Als Mittler dieser Wechselwirkungen konnten, neben den in der Literatur beschriebenen Faktoren, von uns SCF, GM-CSF, NGF und andere Neurotrophine zum Beispiel BDNF, NT-3 und NT-4 gezeigt werden. Die Regulation und Freisetzung dieser Faktoren ist bei pathologisch veränderter Haut, wie bei Atopischer Dermatitis, Psoriasis, Haarwachstumsstörungen, Tumoren der Haut und in der Wundheilung verändert. Die Modulation der Expression dieser Faktoren und ihrer Rezeptoren durch verschiedene Therapeutika, wie Glukokortikoide, Antihistaminika, Retinoide und UV-Bestrahlung konnte in verschiedenen Kulturmodellen gezeigt werden. Diese Erkenntnisse können in Zukunft bei der Entwicklung neuer Therapeutika zur Behandlung von verschiedenen Erkrankungen der Haut, Lunge sowie Darm und, da in zunehmendem Maße auch von Mastzellfunktionen in anderen Organen, wie Hirn, Herz, Leber und Niere berichtet wird, auch hier weiterführend beitragen. / Mast cells are ubiquitary connective tissue cells derived from bone marrow CD34+/c-Kit+ stem cells. They are able to produce various regulators of physiological and pathological processes. Normally, they are present in low numbers with highest density in skin and nasal, ophthalmic, gastrointestinal and pulmonary mucosa. The number is increased up to 100-fold in various pathological processes as inflammatory reactions and atopic diseases. During this processes mast cell precursors from peripheral blood are activated, migrate in the tissues by the effects of chemotactically acting factors. In order to elucidate the mechanisms involved in this processes, we established different in vitro cell culture models. Our results suggest that the precursor cells circulating in the peripheral blood do not express c-Kit. When the cells are activated, c-Kit expression is upregulated and the cells are able to migrate in the tissue, where they differentiate influenced by cytokines released from tissue cells. The interaction between mast cells and fibroblasts, melanocytes, keratinocytes and nerve cells were studied. Stem cell factor, GM-CSF, nerve growth factor and other neurotrophins as BDNF, NT-3 and NT-4 could be demonstrated as mediators of this interactions. The regulation and release of these factors are modified in pathological skin diseases as atopic dermatitis, psoriasis, changes in the hair cycle and skin tumors and in wound healing. Modulation of expression of these factors and its receptors by therapeutics as glucocorticoids, antihistamines, retinoids and UV-radiation was shown in different culture models. Our results may contribute to develop new therapeutics for skin, pulmonary and intestinal diseases and give new insights in mast cell functions in brain, liver and kidney.

Polyunsaturated fatty acids (PUFA) have been used with some success in the treatment of canine atopic dermatitis (CAD). Correspondent in vitro studies revealed that PUFA play a crucial role in the exocytosis of mast cells. n3 PUFA such as α-linolenic acid (LNA), eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), as well as the n6 PUFA linoleic acid (LA) have been shown to arrest the secretion of inflammatory mediators. Contrary, the n-6 PUFA arachidonic acid (AA) has been proven to promote the production of mast cell inflammatory mediators. However, we are still lacking a complete picture of the mode of action. The goal of this work was to further characterize the modulatory effects of PUFA supplementation on the plasma membrane lipid composition of mast cells. Furthermore the consequences of a membrane modulation of mast cells by PUFA on the localization and activity on of the membrane bound enzyme phospholipases D (PLD) were investigated. Canine mastocytoma cells (C2) were supplemented with one of the following PUFA: LNA, EPA, DHA, LA or AA. To investigate the influence of PUFA on the lipid composition of membrane microdomains, lipid rafts were separated from non-raft plasma membranes of mast cells for the first time using a detergent-free isolation technique. Results show that PUFA are significantly increased in rafts as well as in non-rafts microdomains (Publication 1). The incorporation of PUFA into the membrane goes along with an increase of the unsaturation status and the fluidity of the membrane. This rise in membrane fluidity may result in a reorganization of membrane signaling molecules and enzymes such as the PLD. To define the impact of a PUFA supplementation on PLD trafficking, C2 were transfected with green fluorescent protein (GFP) fusion plasmids encoding PLD1 or PLD2. Since the transfection ability of the suspension cell line C2 is limited, a special transfection protocol was established, suitable for non-adherent cell lines. Transfection succeeded using chicken egg white as coating material for the cell culture plates. The transfection efficiency rose to 50% versus 5% in uncoated plates. In addition to the obvious increase in the transfection efficiency, the new technique is simple and economic and might be suitable for a wide range of suspension cell lines (Publication 2). Using this optimized protocol the influence of PUFA on the trafficking of PLD isoforms was studied. LNA, EPA, DHA and LA but not AA prevented the stimulation-induced translocation of PLD1 to the plasma membrane. Since the translocation of PLD1 is important for mast cell exocytosis, LNA, EPA, DHA and LA do have an inhibiting effect on the stimulation-induced release of pro-inflammatory mediators. All PUFA tested boosted the total PLD activity. In order to rule out, which PLD isoform was affected by the PUFA, the mast cells were supplemented with DHA or AA in the presence of specific PLD isoform inhibitors. DHA completely abolished the inhibitiory effect of the PLD1 inhibitor but had no effect on the inhibitory effect of PLD2 inhibitor. On the other hand, AA suppressed the inhibitory effect of both PLD1 and PLD2 inhibitor (Publication 3). Taking together, the studies provide a mechanistic base for the role of PUFA in the exocytosis processes of mast cells. PUFA of the n3 and the n6 families impact the lipid composition of membrane microdomains, which in turn lead to a modulation of the physiochemical properties of the membrane. LNA, EPA, DHA and LA suppress the release of inflammatory mediators through their inhibitory action on the stimulation-induced translocation of the PLD1. Contrariwise, AA permits the stimulation-induced migration of PLD1 to the plasma membrane and increases the activity of both PLD isoforms. Therefore, LNA, EPA, DHA and LA but not AA inhibit the release of mast cell inflammatory mediators upon stimulation. / Mehrfach ungesättigte Fettsäuren (PUFA) können mit einigem Erfolg zur Behandlung der caninen atopischen Dermatitis (CAD) eingesetzt werden. In vitro-Studien zeigten, dass PUFA eine entscheidende Rolle in der Exozytose von Mastzellen spielen. N-3-PUFA wie α-Linolensäure (LNA), Eicosapentaensäure (EPA), Docosahexaensäure (DHA) sowie die n-6-PUFA Linolsäure (LA) können die Sekretion von Entzündungsmediatoren vermindern. Arachidonsäure (AA) als n-6 mehrfach ungesättigte Fettsäure hingegen fördert die Entzündungsmediatoren-Freisetzung aus den Mastzellen. Eine vollständige Aufklärung der Wirkungsweise fehlt aber weiterhin. Das Ziel dieser Arbeit war eine weitergehende Charakterisierung der modulierenden Effekte einer PUFA-Supplementierung auf die Lipidzusammensetzung der Plasmamembran von Mastzellen. Darüber hinaus wurden die Auswirkungen von PUFA auf die Lokalisation und Aktivität des Membran-gebundenen Enzyms Phospholipase D (PLD) untersucht. Canine Mastozytom-Zellen (C2) wurden mit einer der folgenden PUFA kultiviert: LNA, EPA, DHA, LA oder AA. Um den Einfluss von PUFA auf die Lipidzusammensetzung der Membran-Mikrodomänen zu untersuchen, konnten sowohl Lipid Raft als auch Nicht-Raft Plasmamembran-Anteile von Mastzellen zum ersten Mal mittels einer Detergenzien-freien Isolationsmethode getrennt werden. Hervorzuheben ist, dass PUFA signifikant vermehrt in Raft- sowie in Nicht-Raft Membranmikrodomänen eingelagert werden (Publikation 1). Die Integration von PUFA in die Membran geht mit einer Steigerung der Doppelbindungsanzahl und der Fluidität der Membran einher. Diese Erhöhung der Membranfluidität kann zu einer Reorganisation von membranären Signalmolekülen und Enzymen wie der PLD führen. Um die Auswirkungen einer PUFA-Supplementierung auf den intrazellulären Transport der PLD in C2 zu bestimmen, wurden die Zellen mit PLD1- oder PLD2-codierenden grün fluoreszierenden Protein-(GFP-)Fusionsplasmiden transfiziert. Da die Transfektionsfähigkeit der Suspensions-Zelllinie C2 begrenzt ist, wurde ein für nicht-adhärente Zelllinien geeignetes Transfektionsprotokoll etabliert. Mit Hühnereiweiß als Beschichtungsmaterial für die Zellkultur-Platten stieg die Transfektionseffizienz auf 50% im Vergleich zu 5% bei unbeschichteten Platten. Neben der deutlichen Erhöhung der Transfektionseffizienz ist die neu etablierte Technik einfach durchzuführen sowie wirtschaftlich und kann für eine Vielzahl von Suspension-Zelllinien geeignet sein (Publikation 2). Unter Verwendung dieses optimierten Protokolls wurde der Einfluss von PUFA auf die Translokation der PLD-Isoformen untersucht. LNA, EPA, DHA und LA, nicht aber AA verhindern die stimulationsinduzierte Translokation der PLD1 an die Plasmamembran. Die Translokation der PLD1 ist wichtig für die Mastzell-Exozytose. LNA, EPA, DHA und LA haben hier eine hemmende Wirkung auf die stimulationsinduzierte Freisetzung von proinflammatorischen Mediatoren. Alle getesteten PUFA verstärken die Gesamt-PLD-Aktivität. Um zu unterscheiden, welche PLD-Isoform durch PUFA beeinflusst ist, wurden die Mastzellen mit DHA oder AA in Gegenwart von PLD-Isoform-Inhibitoren supplementiert. DHA hebt die inhibitorische Wirkung des PLD1-Inhibitors vollständig auf, zeigte aber keinen Einfluss auf die hemmende Wirkung des PLD2-Inhibitors. Andererseits unterdrückt AA die hemmende Wirkung des PLD1- als auch des PLD2-Inhibitors (Publikation 3). Zusammenfassend bietet die Studie eine mechanistische Basis für die Rolle von PUFA bei Exozytose-Prozessen von Mastzellen. PUFA der n-3- und n-6-Familie beeinflussen die Lipidzusammensetzung von membranären Mikrodomänen, was wiederum zu einer Modulation der physikalisch-chemischen Eigenschaften der Membran führt. LNA, EPA, DHA und LA verhindern die Freisetzung von Entzündungsmediatoren durch ihre hemmende Wirkung auf die stimulationsinduzierte Translokation der PLD1. Umgekehrt erlaubt AA eine stimulationsinduzierte Migration der PLD1 zur Plasmamembran und steigert die Aktivität der beiden Isoformen der PLD. Somit hemmen LNA, EPA, DHA und LA, aber nicht AA die Freisetzung von Mastzell-Entzündungsmediatoren nach Stimulation.

Some previously described environmental associations for atopic eczema may be due to reverse causation. We explored the role of reverse causation by comparing individual- and school-level results for multiple atopic eczema risk factors. The International Study of Asthma and Allergies in Childhood (i.e, ISAAC) Phase Three surveyed children in schools (the sampling unit) regarding atopic eczema symptoms and potential risk factors. We assessed the effect of these risk factors on atopic eczema symptoms using mixed-effect logistic regression models, first with individual-level exposure data and second with school-level exposure prevalence. Overall, 546,348 children from 53 countries were included. At ages 6–7 years, the strongest individual-level associations were with current paracetamol use (odds ratio [OR] = 1.45, 95% confidence interval [CI] = 1.37–1.54), which persisted at school-level (OR = 1.55, 95% CI = 1.10–2.21), early-life antibiotics (OR = 1.41, 95% CI = 1.34–1.48), and early-life paracetamol use (OR = 1.28, 95% CI = 1.21–1.36), with the former persisting at the school level, whereas the latter was no longer observed (OR = 1.35, 95% CI = 1.00–1.82 and OR = 0.94, 95% CI = 0.69–1.28, respectively). At ages 13–14 years, the strongest associations at the individual level were with current paracetamol use (OR = 1.57, 95% CI = 1.51–1.63) and open-fire cooking (OR = 1.46, 95% CI = 1.33–1.62); both were stronger at the school level (OR = 2.57, 95% CI = 1.84–3.59 and OR = 2.38, 95% CI = 1.52–3.73, respectively). Association with exposure to heavy traffic (OR = 1.31, 95% CI = 1.27–1.36) also persisted at the school level (OR = 1.40, 95% CI = 1.07–1.82). Most individual- and school-level effects were consistent, tending to exclude reverse causation. / Revisión por pares

Ching, Ka Wai. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves [69-80]). / Abstract also in Chinese. / Abstract (in English) --- p.ii / Abstract (in Chinese) --- p.v / Acknowledgement --- p.viii / Table of Contents --- p.ix / List of Tables --- p.xii / List of Figures --- p.xiii / Glossary of Terms and Abbreviations --- p.xv / Chapter Chapter 1: --- Introduction --- p.1 / Chapter 1.1 --- Introduction of Atopic Eczema (AE) --- p.1 / Chapter 1.1.1 --- Definition and classification of AE --- p.1 / Chapter 1.1.2 --- Epidemiology --- p.3 / Chapter 1.1.2.1 --- The hygiene hypothesis --- p.5 / Chapter 1.2 --- Pathogenesis and Etiology --- p.6 / Chapter 1.2.1 --- Biphasic type-1/type-2 T-helper lymphocyte (Thl/Th2) immunological responses --- p.6 / Chapter 1.2.2 --- Nature and involvements of immunoglobin E (IgE) --- p.8 / Chapter 1.2.3 --- Microbial colonization --- p.9 / Chapter 1.2.4 --- Cytokines involvement --- p.10 / Chapter 1.2.5 --- Pruritus inducing neurotrophic factors --- p.11 / Chapter 1.2.6 --- "Food allergens, aeroallergens" --- p.12 / Chapter 1.2.7 --- Dysregulation of innate immune system --- p.13 / Chapter 1.2.7.1 --- Dysregulation of antimicrobial peptides --- p.14 / Chapter 1.2.7.2 --- Skin barrier impairment --- p.14 / Chapter 1.2.8 --- Genetic predisposition --- p.15 / Chapter 1.3 --- Assessments of Atopic Eczema (AE) --- p.17 / Chapter 1.3.1 --- AE severity assessment --- p.17 / Chapter 1.3.1.1 --- Scoring of atopic dermatitis (SCORAD) system --- p.17 / Chapter 1.3.1.2 --- Nottingham eczema severity score (NESS) --- p.20 / Chapter 1.3.2 --- Dermatological parameter - skin hydration (SH) and transepidermal water loss (TEWL) --- p.22 / Chapter 1.4 --- Chitinase (CHIA) --- p.22 / Chapter 1.4.1 --- Chitin and CHIA --- p.22 / Chapter 1.4.2 --- Association of acid mammalian chitinase (AMCase) with asthma --- p.23 / Chapter 1.4.3 --- Hygiene hypothesis implies: AMCase and allergy relationship --- p.24 / Chapter Chapter 2: --- Hypothesis and Objectives --- p.25 / Chapter 2.1 --- Hypothesis - based on CHIA involvements in canine AE --- p.25 / Chapter 2.2 --- Hypothesis --- p.25 / Chapter 2.3 --- Objective 226}0ؤ based on AMCase single nucleotide polymorphism (SNPs) in asthma susceptibility --- p.25 / Chapter 2.4 --- Objectives --- p.27 / Chapter Chapter 3: --- Methodology --- p.28 / Chapter 3.1 --- Recruitment of cases and controls --- p.28 / Chapter 3.2 --- Assessment of clinical parameters --- p.29 / Chapter 3.2.1 --- Scoring of atopic dermatitis (SCORAD) system --- p.29 / Chapter 3.2.2 --- Nottingham eczema severity score (NESS) --- p.29 / Chapter 3.2.3 --- Dermatologic parameters --- p.29 / Chapter 3.2.3.1 --- Cutaneous bacterial colonization --- p.29 / Chapter 3.2.3.2 --- Skin hydration (SH) and transepidermal water loss (TEWL) --- p.30 / Chapter 3.3 --- Peripheral blood collection and genomic deoxyribonucleic acid (DNA) extraction --- p.30 / Chapter 3.4 --- Acid mammalian chitinase (AMCase) polymorphism genotyping --- p.31 / Chapter 3.4.1 --- Polymerase chain reactions (PCR) amplification of AMCase gene --- p.31 / Chapter 3.4.1.1 --- List of PCR reagents --- p.32 / Chapter 3.4.1.2 --- Electrophoresis reagents --- p.33 / Chapter 3.4.2 --- Restriction fragment length polymorphism (RFLP) analysis of AMCase and confirmation with direct sequencing --- p.33 / Chapter 3.5 --- Statistical analysis --- p.34 / Chapter Chapter 4: --- Results and Data Analysis --- p.36 / Chapter 4.1 --- Results --- p.36 / Chapter 4.1.1 --- Demographic data of cases and controls --- p.36 / Chapter 4.1.2 --- PCR amplification and RFLP analysis of AMCase gene --- p.37 / Chapter 4.1.3 --- PCR cycle sequencing of the PCR fragments --- p.40 / Chapter 4.2 --- Data analysis --- p.41 / Chapter 4.2.1 --- Data overview --- p.41 / Chapter 4.2.2 --- Genotypes distribution of AMCase polymorphisms --- p.43 / Chapter 4.2.2.1 --- Allele frequency comparison of AMCase single nucleotide polymorphism (SNPs) by chi-square --- p.43 / Chapter 4.2.2.2 --- Allele frequency comparison of AMCase SNPs by logistic regression analysis --- p.44 / Chapter 4.2.3 --- Haplotype frequency estimation via maximum likelihood algorithm --- p.45 / Chapter 4.2.4 --- Association of AMCase polymorphism with Atopic Eczema (AE) clinical parameters --- p.47 / Chapter 4.2.4.1 --- Peripheral blood eosinophil counts --- p.48 / Chapter 4.2.4.2 --- Serum immunoglobin E (IgE) level --- p.49 / Chapter 4.2.4.3 --- Dermatologic factors --- p.49 / Chapter 4.2.4.3.1 --- Cutaneous Staphylococcus aureus colonization --- p.49 / Chapter 4.2.4.3.2 --- Skin hydration (SH) and transepidermal water loss (TEWL) --- p.50 / Chapter Chapter 5: --- Discussion --- p.52 / Chapter 5.1 --- Data overview --- p.52 / Chapter 5.2 --- AMCase rs3806448 polymorphism was significantly different among AE cases and controls --- p.53 / Chapter 5.2.1 --- Allele frequency comparison of AMCase SNPs polymorphisms by chi-square --- p.53 / Chapter 5.2.2 --- Allele frequency comparison of AMCase SNPs polymorphisms by logistic regression analysis --- p.54 / Chapter 5.2.3 --- The possible genetic modification by rs3806448 homozygous recessive genotype --- p.55 / Chapter 5.3 --- "Significant difference of haplotype frequency, 2212 among case-control comparison" --- p.56 / Chapter 5.4 --- Strong associations between AMCase SNPs polymorphisms and clinical parameters of AE --- p.57 / Chapter 5.4.1 --- Peripheral blood eosinophil counts --- p.57 / Chapter 5.4.2 --- Dermatologic factors --- p.58 / Chapter 5.4.2.1 --- Cutaneous Staphylococcus aureus colonization --- p.58 / Chapter 5.4.2.2 --- Skin hydration (SH) and transepidermal water loss (TEWL) --- p.59 / Chapter 5.5 --- Limitation of the present study --- p.59 / Chapter Chapter 6: --- Conclusion and Future Prospect --- p.62 / Chapter 6.1 --- Conclusion --- p.62 / Chapter 6.2 --- Future prospect --- p.62 / Chapter Chapter 7: --- Appendices --- p.64 / Chapter Chapter 8: --- References --- p.69

Background: Evidence-based treatment algorithms, successfully established for asthma, are missing for atopic eczema (AE). Objectives: To investigate whether treatment according to an evidence-based algorithm is an effective and applicable concept for the management of AE. Methods: Based on a systematic literature review, we developed an evidence-based severity-score-oriented treatment algorithm for AE and compared its effectiveness to that of an individualised symptom-oriented treatment (individual therapy) in a randomised controlled trial. Sixty-three participants were randomised to algorithm (n = 32) or individual therapy (n = 31) and treated accordingly for 12 months. Study end points included difference between baseline SCORAD and mean SCORAD under treatment (primary end point), quality of life and treatment utilisation. Analysis was by intention to treat (registration: ClinicalTrials.gov:NCT00148746). Results: No statistically significant differences in clinical or subjective response were observed between groups. Treatment following the algorithm and individual treatment both effectively controlled AE. Mean SCORAD reductions were 47% (95% confidence interval, CI = 38–55; algorithm) and 42% (95% CI = 29–54; individual). Clinical response was paralleled by improved quality of life in both groups. Physicians adhered to the algorithm option in 93% of their treatment decisions. Conclusion: Treatment following an evidence-based algorithm is an effective and applicable concept for the management of AE but does not show clear advantages compared to individualised treatment in a dermatological setting. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Background: Financial constraints challenge evidence of the effectiveness of dermatological inpatient management. Objective: To evaluate the effectiveness of hospitalization in atopic dermatitis and psoriasis regarding initial and sustained benefits. Methods: Prospective study on adults with psoriasis vulgaris (n = 22) and atopic dermatitis (n = 14). At admission, discharge, and 3 months after discharge, validated outcomes of objective and subjective disease severity were assessed by trained investigators. Results: Hospitalization resulted in substantial benefit in quality of life and clinical disease severity. Looking at mean scores, the observed benefit appeared stable until 3-month follow-up. The analysis of individual patient data revealed significant changes in disease severity between discharge and 3-month follow-up with some patients relapsing, others further improving. Reasons for hospitalization and treatment performed were not related to sustained benefit. Conclusions: In psoriasis vulgaris and atopic dermatitis, hospitalization effectively improved quality of life and clinical disease severity. Further research should focus on prognostic factors for sustained improvement. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Background: Pimecrolimus cream (Elidel®, SDZ ASM 981), a non-steroid inhibitor of inflammatory cytokines, is effective in the treatment of atopic dermatitis (AD). We assessed whether early treatment of AD signs/symptoms reduces the need for topical corticosteroids. Objective: To investigate the efficacy and safety of pimecrolimus cream 1% in the long-term management of adult AD. Methods: 192 adults with moderate to severe AD were randomised (1:1) for twice daily (b.i.d.) treatment of early signs or symptoms of AD with either pimecrolimus cream 1% or vehicle cream (control group) to prevent progression to flares. Treatment was given as needed for 24 weeks. In the event of flares, a moderately potent corticosteroid (prednicarbate 0.25% cream) was permitted as rescue medication in both groups. The percentage of days on which a topical corticosteroid was used to treat disease flares was the main outcome measure. Results: Corticosteroid medication was used on 14.2% (95% confidence interval, CI: 8.3–21.1) of the days of the 24-week treatment period in the pimecrolimus group and on 37.2% (95% CI: 30.4–44.0) of the days in the control group (p < 0.001). In total, 44.8% (43/96) of patients in the pimecrolimus group did not experience a flare compared with 18.8% (18/96) of patients in the control group. The median time to first flare was 144 days in the pimecrolimus group and 26 days in the control group (p < 0.001). Pimecrolimus treatment was also associated with improvement in signs and symptoms of AD, pruritus, patients’ self-assessment and quality of life. Conclusions: Pimecrolimus cream 1% b.i.d. is an effective, well-tolerated, long-term treatment for AD in adults, substantially reducing the number of flares compared to a conventional therapy and consequently reducing or eliminating the need for corticosteroid treatment. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2005. / Härtill 6 uppsatser.