Atopy: Difference between revisions
→Causes: Removed point about study in Guinea-Bissau. Original point was not clear. Could not access source, but until it is verified, it should stay removed so as to not contribute to misinformation. |
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'''Atopy''' is the tendency to produce an exaggerated [[Immunoglobulin E|IgE]] immune response to otherwise harmless environmental substances, while an allergic disease can be defined as the clinical manifestation of this inappropriate IgE immune response.<ref>{{Cite book|last=Ralston, Stuart H., Herausgeber. Penman, Ian D., Herausgeber. Strachan, Mark W. J., Herausgeber. Hobson, Richard P., Herausgeber. Britton, Robert, Illustrator. Davidson, Leybourne S. 1894-1981 Begründer des Werks.|title=Davidson's principles and practice of medicine|isbn=978-0-7020-7028-0|oclc=1040673074|date=2018-04-23}}</ref> |
'''Atopy''' is the tendency to produce an exaggerated [[Immunoglobulin E|IgE]] immune response to otherwise harmless environmental substances, while an allergic disease can be defined as the clinical manifestation of this inappropriate IgE immune response.<ref>{{Cite book|last=Ralston, Stuart H., Herausgeber. Penman, Ian D., Herausgeber. Strachan, Mark W. J., Herausgeber. Hobson, Richard P., Herausgeber. Britton, Robert, Illustrator. Davidson, Leybourne S. 1894-1981 Begründer des Werks.|title=Davidson's principles and practice of medicine|isbn=978-0-7020-7028-0|oclc=1040673074|date=2018-04-23}}</ref> |
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Atopy may have a [[heredity|hereditary]] component, although contact with the [[allergen]] or irritant must occur before the hypersensitivity reaction can develop.<ref name="urlMosby's Medical Dictionary:atopy">{{cite web|url=http://www.elsevier.com/wps/find/bookdescription.cws_home/716563/description#description |title=Mosby's Medical Dictionary:atopy |url-status = dead| |
Atopy may have a [[heredity|hereditary]] component, although contact with the [[allergen]] or irritant must occur before the hypersensitivity reaction can develop.<ref name="urlMosby's Medical Dictionary:atopy">{{cite web|url=http://www.elsevier.com/wps/find/bookdescription.cws_home/716563/description#description |title=Mosby's Medical Dictionary:atopy |url-status = dead|archive-url=https://web.archive.org/web/20110710192530/http://www.elsevier.com/wps/find/bookdescription.cws_home/716563/description |archive-date=2011-07-10 }}</ref> Maternal psychological trauma ''in utero'' may also be a strong indicator for development of atopy.<ref name=":0">{{Cite journal|last1=Wright|first1=Rosalind J|last2=Enlow|first2=Michelle Bosquet|date=2008-09-01|title=Maternal stress and perinatal programming in the expression of atopy|journal=Expert Review of Clinical Immunology|volume=4|issue=5|pages=535–538|doi=10.1586/1744666X.4.5.535|issn=1744-666X|pmc=2762209|pmid=19838310}}</ref> |
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The term ''atopy'' was coined by Coca and Cooke in 1923.<ref>Coca AF, Cooke RA. (1923) [http://www.jimmunol.org/cgi/content/abstract/8/3/163 On the classification of the phenomenon of hypersensitiveness] J Immunol</ref><ref name="RingPrzybilla2006">{{cite book|author1=Johannes Ring|author2=Bernhard Przybilla|author3=Thomas Ruzicka|title=Handbook of atopic eczema|url=https://books.google.com/books?id=jTktMX60bPwC&pg=PA3|accessdate=4 May 2010|year=2006|publisher=Birkhäuser|isbn=978-3-540-23133-2|pages=3–}}</ref> Many physicians and scientists use the term "atopy" for any [[Immunoglobulin E|IgE]]-mediated reaction (even those that are appropriate and proportional to the antigen), but many [[Pediatrics|pediatricians]] reserve the word "atopy" for a genetically mediated predisposition to an excessive IgE reaction.<ref name="PawankarHolgate2009">{{cite book|author1=Ruby Pawankar|author2=Stephen T. Holgate|author3=Lanny J. Rosenwasser|title=Allergy Frontiers: Classification and Pathomechanisms|url=https://books.google.com/books?id=TJj3hqINS8sC&pg=PA33|accessdate=4 May 2010|date=7 April 2009|publisher=Springer|isbn=978-4-431-88314-2|pages=33–}}</ref> The term is from [[Ancient Greek|Greek]] ἀτοπία meaning "the state of being out of place", "absurdity".<ref>{{cite web |url=https://www.etymonline.com/word/atopy |title=atopy |author=<!--Not stated--> |date=2019 |website=Online Etymology Dictionary |publisher=Douglas Harper |access-date=26 Sep 2019 |
The term ''atopy'' was coined by Coca and Cooke in 1923.<ref>Coca AF, Cooke RA. (1923) [http://www.jimmunol.org/cgi/content/abstract/8/3/163 On the classification of the phenomenon of hypersensitiveness] J Immunol</ref><ref name="RingPrzybilla2006">{{cite book|author1=Johannes Ring|author2=Bernhard Przybilla|author3=Thomas Ruzicka|title=Handbook of atopic eczema|url=https://books.google.com/books?id=jTktMX60bPwC&pg=PA3|accessdate=4 May 2010|year=2006|publisher=Birkhäuser|isbn=978-3-540-23133-2|pages=3–}}</ref> Many physicians and scientists use the term "atopy" for any [[Immunoglobulin E|IgE]]-mediated reaction (even those that are appropriate and proportional to the antigen), but many [[Pediatrics|pediatricians]] reserve the word "atopy" for a genetically mediated predisposition to an excessive IgE reaction.<ref name="PawankarHolgate2009">{{cite book|author1=Ruby Pawankar|author2=Stephen T. Holgate|author3=Lanny J. Rosenwasser|title=Allergy Frontiers: Classification and Pathomechanisms|url=https://books.google.com/books?id=TJj3hqINS8sC&pg=PA33|accessdate=4 May 2010|date=7 April 2009|publisher=Springer|isbn=978-4-431-88314-2|pages=33–}}</ref> The term is from [[Ancient Greek|Greek]] ἀτοπία meaning "the state of being out of place", "absurdity".<ref>{{cite web |url=https://www.etymonline.com/word/atopy |title=atopy |author=<!--Not stated--> |date=2019 |website=Online Etymology Dictionary |publisher=Douglas Harper |access-date=26 Sep 2019 }}</ref> |
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==Signs and symptoms== |
==Signs and symptoms== |
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==Causes== |
==Causes== |
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Atopic reactions are caused by localized [[hypersensitivity]] reactions to an [[allergen]]. Atopy appears to show a strong [[genetic disorder|hereditary component]]. One study concludes that the risk of developing atopic dermatitis (3%) or atopy in general (7%) "increases by a factor of two with each first-degree family member already suffering from atopy".<ref> |
Atopic reactions are caused by localized [[hypersensitivity]] reactions to an [[allergen]]. Atopy appears to show a strong [[genetic disorder|hereditary component]]. One study concludes that the risk of developing atopic dermatitis (3%) or atopy in general (7%) "increases by a factor of two with each first-degree family member already suffering from atopy".<ref> |
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{{cite journal |first1 = W.|last1=Küster|first2=M.|last2=Petersen|first3=E.|last3=Christophers|first4=M.|last4=Goos|first5=W.|last5=Sterry | title = A family study of atopic dermatitis | journal = Archives of Dermatological Research | volume = 282 | issue = 2 / January, 1990 | pages = 98–102 | date = December 12, 2004 | doi = 10.1007/BF00493466 |pmid=2353830|s2cid=9396200 |
{{cite journal |first1 = W.|last1=Küster|first2=M.|last2=Petersen|first3=E.|last3=Christophers|first4=M.|last4=Goos|first5=W.|last5=Sterry | title = A family study of atopic dermatitis | journal = Archives of Dermatological Research | volume = 282 | issue = 2 / January, 1990 | pages = 98–102 | date = December 12, 2004 | doi = 10.1007/BF00493466 |pmid=2353830|s2cid=9396200}}</ref> As well, maternal stress and perinatal programming is increasingly understood as a root cause of atopy, finding that "...trauma may be a particularly robust potentiator of the cascade of biological events that increase vulnerability to atopy and may help explain the increased risk found in low-income urban populations.” <ref name=":0" /> |
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Environmental factors are also thought to play a role in the development of atopy, and the 'hygiene hypothesis' is one of the models that may explain the steep rise in the incidence of atopic diseases, though this hypothesis is incomplete and in some cases, contradictory to findings.<ref name=":0" /> This hypothesis proposes that excess 'cleanliness' in an infant's or child's environment can lead to a decline in the number of infectious stimuli that are necessary for the proper development of the immune system. The decrease in exposure to infectious stimuli may result in an imbalance between the infectious-response ("protective") elements and the allergic-response ("false alarm") elements within the immune system.<ref>{{cite journal | author = Grammatikos AP | year = 2008 | title = The genetic and environmental basis of atopic diseases |
Environmental factors are also thought to play a role in the development of atopy, and the 'hygiene hypothesis' is one of the models that may explain the steep rise in the incidence of atopic diseases, though this hypothesis is incomplete and in some cases, contradictory to findings.<ref name=":0" /> This hypothesis proposes that excess 'cleanliness' in an infant's or child's environment can lead to a decline in the number of infectious stimuli that are necessary for the proper development of the immune system. The decrease in exposure to infectious stimuli may result in an imbalance between the infectious-response ("protective") elements and the allergic-response ("false alarm") elements within the immune system.<ref>{{cite journal | author = Grammatikos AP | year = 2008 | title = The genetic and environmental basis of atopic diseases | journal = Ann. Med. | volume = 40 | issue = 7| pages = 482–95 | doi = 10.1080/07853890802082096 | pmid = 18608118 | s2cid = 188280 }}</ref> |
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Some studies also suggest that the maternal diet during pregnancy may be a causal factor in atopic diseases (including asthma) in offspring, suggesting that consumption of antioxidants, certain lipids, and/or a Mediterranean diet may help to prevent atopic diseases.<ref> |
Some studies also suggest that the maternal diet during pregnancy may be a causal factor in atopic diseases (including asthma) in offspring, suggesting that consumption of antioxidants, certain lipids, and/or a Mediterranean diet may help to prevent atopic diseases.<ref> |
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the lives of the Steiner school pupils that might have contributed to this lower rate of |
the lives of the Steiner school pupils that might have contributed to this lower rate of |
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atopy, which included breastfeeding, lack of immunization, avoidance of antibiotics and medications that reduce fevers, consumption of bio-dynamic and organic foods, and other physical aspects of the children’s lives. |
atopy, which included breastfeeding, lack of immunization, avoidance of antibiotics and medications that reduce fevers, consumption of bio-dynamic and organic foods, and other physical aspects of the children’s lives. |
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{{cite journal | last1 = Devereux|first1=Graham|last2=Seaton|first2=A. | title = Diet as a risk factor for atopy and asthma | journal = J Allergy Clin Immunol | volume = 115 | issue = 6 | pages = 1109–1117 | date = December 2004 | doi = 10.1016/j.jaci.2004.12.1139 |
{{cite journal | last1 = Devereux|first1=Graham|last2=Seaton|first2=A. | title = Diet as a risk factor for atopy and asthma | journal = J Allergy Clin Immunol | volume = 115 | issue = 6 | pages = 1109–1117 | date = December 2004 | doi = 10.1016/j.jaci.2004.12.1139 | pmid = 15940119}}</ref> |
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The multicenter PARSIFAL study in 2006, involving 6630 children age 5 to 13 in 5 European countries, suggested that reduced use of [[antibiotic]]s and [[antipyretic]]s is associated with a reduced risk of allergic disease in children.<ref name="Flöistrup 2006">{{cite journal | url = http://www.louisbolk.nl/downloads/mhuber/0601allergic.pdf | pmid = 16387585 | doi=10.1016/j.jaci.2005.09.039 | volume=117 | title=Allergic disease and sensitization in Steiner school children | date=January 2006 | author=Flöistrup H, Swartz J, Bergström A | display-authors = etal | journal=J. Allergy Clin. Immunol. | issue = 1 | pages=59–66 }}</ref> |
The multicenter PARSIFAL study in 2006, involving 6630 children age 5 to 13 in 5 European countries, suggested that reduced use of [[antibiotic]]s and [[antipyretic]]s is associated with a reduced risk of allergic disease in children.<ref name="Flöistrup 2006">{{cite journal | url = http://www.louisbolk.nl/downloads/mhuber/0601allergic.pdf | pmid = 16387585 | doi=10.1016/j.jaci.2005.09.039 | volume=117 | title=Allergic disease and sensitization in Steiner school children | date=January 2006 | author=Flöistrup H, Swartz J, Bergström A | display-authors = etal | journal=J. Allergy Clin. Immunol. | issue = 1 | pages=59–66 }}</ref> |
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===Genetics=== |
===Genetics=== |
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There is a strong genetic predisposition toward atopic allergies, especially on the maternal side. Because of the strong familial evidence, investigators have tried to map susceptibility genes for atopy.<ref>{{cite journal | author = Blumenthal MN | year = 2005 | title = The Role of Genetics in the Development of Asthma and Atopy |
There is a strong genetic predisposition toward atopic allergies, especially on the maternal side. Because of the strong familial evidence, investigators have tried to map susceptibility genes for atopy.<ref>{{cite journal | author = Blumenthal MN | year = 2005 | title = The Role of Genetics in the Development of Asthma and Atopy | journal = Curr Opin Allergy Clin Immunol | volume = 5 | issue = 141–5| pages = 141–5 | doi = 10.1097/01.all.0000162306.12728.c2 | pmid = 15764904 | s2cid = 30698973 }}</ref><ref>{{cite journal |vauthors=Hoffjan S, Nicolae D, Ober C| year = 2003 | title = Association Studies for Asthma and Atopic Diseases: A Comprehensive Review of the Literature | journal = Respir Res | volume = 4 | issue = 14| page = 14748924 | doi = 10.1186/1465-9921-4-14 | pmid = 14748924 | pmc = 314398 }}</ref> Genes for atopy ([[C11orf30]], [[STAT6]], [[SLC25A46]], [[HLA-DQB1]], IL1RL1/IL18R1, TLR1/TLR6/TLR10, LPP, MYC/PVT1, IL2/ADAD1, HLA-B/MICA)<ref>{{cite journal|last1=Bønnelykke|first1=Klaus|last2=Matheson|first2=Melanie C|last3=Pers|first3=Tune H|last4=Granell|first4=Raquel|last5=Strachan|first5=David P|last6=Alves|first6=Alexessander Couto|last7=Linneberg|first7=Allan|last8=Curtin|first8=John A|last9=Warrington|first9=Nicole M|last10=Standl|first10=Marie|last11=Kerkhof|first11=Marjan|last12=Jonsdottir|first12=Ingileif|last13=Bukvic|first13=Blazenka K|last14=Kaakinen|first14=Marika|last15=Sleimann|first15=Patrick|last16=Thorleifsson|first16=Gudmar|last17=Thorsteinsdottir|first17=Unnur|last18=Schramm|first18=Katharina|last19=Baltic|first19=Svetlana|last20=Kreiner-Møller|first20=Eskil|last21=Simpson|first21=Angela|last22=Pourcain|first22=Beate St|last23=Coin|first23=Lachlan|last24=Hui|first24=Jennie|last25=Walters|first25=Eugene H|last26=Tiesler|first26=Carla M T|last27=Duffy|first27=David L|last28=Jones|first28=Graham|last29=Ring|first29=Susan M|last30=McArdle|first30=Wendy L|last31=Price|first31=Loren|last32=Robertson|first32=Colin F|last33=Pekkanen|first33=Juha|last34=Tang|first34=Clara S|last35=Thiering|first35=Elisabeth|last36=Montgomery|first36=Grant W|last37=Hartikainen|first37=Anna-Liisa|last38=Dharmage|first38=Shyamali C|last39=Husemoen|first39=Lise L|last40=Herder|first40=Christian|last41=Kemp|first41=John P|last42=Elliot|first42=Paul|last43=James|first43=Alan|last44=Waldenberger|first44=Melanie|last45=Abramson|first45=Michael J|last46=Fairfax|first46=Benjamin P|last47=Knight|first47=Julian C|last48=Gupta|first48=Ramneek|last49=Thompson|first49=Philip J|last50=Holt|first50=Patrick|last51=Sly|first51=Peter|last52=Hirschhorn|first52=Joel N|last53=Blekic|first53=Mario|last54=Weidinger|first54=Stephan|last55=Hakonarsson|first55=Hakon|last56=Stefansson|first56=Kari|last57=Heinrich|first57=Joachim|last58=Postma|first58=Dirkje S|last59=Custovic|first59=Adnan|last60=Pennell|first60=Craig E|last61=Jarvelin|first61=Marjo-Riitta|last62=Koppelman|first62=Gerard H|last63=Timpson|first63=Nicholas|last64=Ferreira|first64=Manuel A|last65=Bisgaard|first65=Hans|last66=Henderson|first66=A John|title=Meta-analysis of genome-wide association studies identifies ten loci influencing allergic sensitization|journal=Nature Genetics|date=30 June 2013|volume=45|issue=8|pages=902–906|doi=10.1038/ng.2694|pmid=23817571|pmc=4922420}}</ref> tend to be involved in allergic responses or other components of the immune system. C11orf30 seems to be the most relevant for atopy as it may increase susceptibility to poly-sensitization.<ref>{{cite journal|last1=Amaral|first1=André F. S.|last2=Minelli|first2=Cosetta|last3=Guerra|first3=Stefano|last4=Wjst|first4=Matthias|last5=Probst-Hensch|first5=Nicole|last6=Pin|first6=Isabelle|last7=Svanes|first7=Cecilie|last8=Janson|first8=Christer|last9=Heinrich|first9=Joachim|last10=Jarvis|first10=Deborah L.|title=The locus increases susceptibility to poly-sensitisation|journal=Allergy|date=December 2014|pages=328–333|doi=10.1111/all.12557|volume=70|issue=3|pmid=25546184|hdl=10044/1/21574|s2cid=25960081|url=http://spiral.imperial.ac.uk/bitstream/10044/1/21574/6/Amaral_Allergy_revised_unmarked_forSPIRAL_11-3-2015.pdf}}</ref> |
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===''Staphylococcus aureus''=== |
===''Staphylococcus aureus''=== |
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Bleach baths provide temporary control of eczema.<ref>{{Cite journal | last1 = Nguyen | first1 = T. | last2 = Zuniga | first2 = R. | title = Skin conditions: New drugs for managing skin disorders | journal = FP Essentials | volume = 407 | pages = 11–16 | year = 2013 | pmid = 23600334}}</ref> [[Ciprofloxacin]] is an allergen that may cause [[contact dermatitis]], symptoms of which are indistinguishable from eczema.<ref>{{Cite journal | last1 = Lee | first1 = S. W. | last2 = Cheong | first2 = S. H. | last3 = Byun | first3 = J. Y. | last4 = Choi | first4 = Y. W. | last5 = Choi | first5 = H. Y. | title = Occupational hand eczema among nursing staffs in Korea: Self-reported hand eczema and contact sensitization of hospital nursing staffs | doi = 10.1111/1346-8138.12036 | journal = The Journal of Dermatology | volume = 40 | issue = 3 | pages = 182–187 | year = 2013 | pmid = 23294332 |
Bleach baths provide temporary control of eczema.<ref>{{Cite journal | last1 = Nguyen | first1 = T. | last2 = Zuniga | first2 = R. | title = Skin conditions: New drugs for managing skin disorders | journal = FP Essentials | volume = 407 | pages = 11–16 | year = 2013 | pmid = 23600334}}</ref> [[Ciprofloxacin]] is an allergen that may cause [[contact dermatitis]], symptoms of which are indistinguishable from eczema.<ref>{{Cite journal | last1 = Lee | first1 = S. W. | last2 = Cheong | first2 = S. H. | last3 = Byun | first3 = J. Y. | last4 = Choi | first4 = Y. W. | last5 = Choi | first5 = H. Y. | title = Occupational hand eczema among nursing staffs in Korea: Self-reported hand eczema and contact sensitization of hospital nursing staffs | doi = 10.1111/1346-8138.12036 | journal = The Journal of Dermatology | volume = 40 | issue = 3 | pages = 182–187 | year = 2013 | pmid = 23294332 }}</ref> [[Filaggrin]] mutations are associated with atopic eczema and may contribute to the excessive dryness of the skin and the loss of the barrier function of normal skin.<ref>{{cite journal |vauthors=O'Regan GM, Sandilands A, McLean WH, Irvine AD| year = 2008 | title = Filaggrin in Atopic Dermatitis | doi = 10.1016/j.jaci.2008.08.002 | journal = J Allergy Clin Immunol | volume = 122 | issue = 4 | pages = 689–93| pmid = 18774165 }}</ref> It may be possible that the filaggrin mutations and the loss of the normal skin barrier expose crevices that make it possible for ''Staphylococcus aureus'' to colonize the skin.<ref>{{cite journal | author = Breuer K, [[Alexander Kapp (dermatologist and allergist)|Kapp A]], Werfel T | year = 2001 | title = Bacterial Infections and Atopic Dermatitis | journal = Allergy | volume = 56 | issue = 11 | pages = 1034–41| pmid = 11703215 | doi = 10.1034/j.1398-9995.2001.00146.x | s2cid = 28897487 }}</ref> Atopic eczema is often associated with genetic defects in genes that control allergic responses. Thus, some investigators have proposed that atopic eczema is an allergic response to increased ''Staphylococcus aureus'' colonization of the skin.<ref>{{cite journal |vauthors=Abramson JS, Dahl MV, Walsh G, Blumenthal MN, Douglas SD, Quie PG| year = 1982 | title = Antistaphylococcal IgE in Patients with Atopic Dermatitis | journal = J Am Acad Dermatol | volume = 7 | issue = 1 | pages = 105–110| doi = 10.1016/s0190-9622(82)80017-0 | pmid = 7107990 }}</ref> A hallmark indicator of atopic eczema is a positive “wheal-and-flare” reaction to a skin test of ''S. aureus'' antigens. In addition, several studies have documented that an IgE-mediated response to ''S. aureus'' is present in people with atopic eczema.<ref>{{cite journal |vauthors=Parish WE, Welbourn E, Champion RH| year = 1976 | title = Hypersensitivity to Bacteria in Eczema. Ii. Titre and Immunoglobulin Class of Antibodies to Staphylococci and Micrococci | journal = Br J Dermatol | volume = 95 | issue = 3 | pages = 285–93| doi = 10.1111/j.1365-2133.1976.tb07016.x | pmid = 974019 | s2cid = 5842899 }}</ref><ref>{{cite journal |vauthors=Motala C, Potter PC, Weinberg EG, Malherbe D, Hughes J| year = 1986 | title = Anti-''Staphylococcus aureus''-Specific IgE in Atopic Dermatitis | journal = J Allergy Clin Immunol | volume = 78 | issue = 4 Pt 1 | pages = 583–9| pmid = 3771950 | doi = 10.1016/0091-6749(86)90075-8 }}</ref> |
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== Changes in prevalence == |
== Changes in prevalence == |
Revision as of 18:56, 3 December 2020
Atopy | |
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Other names | Atopic syndrome |
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Eczema—a typical atopic manifestation | |
Pronunciation | |
Specialty | Dermatology, immunology |
Atopy is the tendency to produce an exaggerated IgE immune response to otherwise harmless environmental substances, while an allergic disease can be defined as the clinical manifestation of this inappropriate IgE immune response.[2]
Atopy may have a hereditary component, although contact with the allergen or irritant must occur before the hypersensitivity reaction can develop.[3] Maternal psychological trauma in utero may also be a strong indicator for development of atopy.[4]
The term atopy was coined by Coca and Cooke in 1923.[5][6] Many physicians and scientists use the term "atopy" for any IgE-mediated reaction (even those that are appropriate and proportional to the antigen), but many pediatricians reserve the word "atopy" for a genetically mediated predisposition to an excessive IgE reaction.[7] The term is from Greek ἀτοπία meaning "the state of being out of place", "absurdity".[8]
Signs and symptoms
Atopic sensitization is considered IgE positivity or prick test positivity to any common food or air born allergen.[9] Atopic conditions are considered: atopic dermatitis, allergic rhinitis (hay fever), allergic asthma. The likelihood of having asthma, rhinitis and atopic dermatitis together is 10 times higher than could be expected by chance.[10] Atopy is more common among individuals with a number of different conditions, such as eosinophilic esophagitis, non-celiac gluten sensitivity.[11][12]
Allergic reactions can range from sneezing and rhinorrhoea to anaphylaxis and even death.[13]
Pathophysiology
In an allergic reaction, initial exposure to an otherwise harmless exogenous substance (known as an allergen) triggers the production of specific IgE antibodies by activated B cells.[13] These IgE antibodies bind to the surface of mast cells via high-affinity IgE receptors, a step that is not itself associated with a clinical response.[13] However, upon re-exposure, the allergen binds to membrane-bound IgE which activates the mast cells, releasing a variety of mediators.[13] This type I hypersensitivity reaction is the basis of the symptoms of allergic reactions, which range from sneezing and rhinorrhoea to anaphylaxis.[13] Allergens can be a number of different substances, for example pollen, dander, dust mites, foods.
Causes
Atopic reactions are caused by localized hypersensitivity reactions to an allergen. Atopy appears to show a strong hereditary component. One study concludes that the risk of developing atopic dermatitis (3%) or atopy in general (7%) "increases by a factor of two with each first-degree family member already suffering from atopy".[14] As well, maternal stress and perinatal programming is increasingly understood as a root cause of atopy, finding that "...trauma may be a particularly robust potentiator of the cascade of biological events that increase vulnerability to atopy and may help explain the increased risk found in low-income urban populations.” [4]
Environmental factors are also thought to play a role in the development of atopy, and the 'hygiene hypothesis' is one of the models that may explain the steep rise in the incidence of atopic diseases, though this hypothesis is incomplete and in some cases, contradictory to findings.[4] This hypothesis proposes that excess 'cleanliness' in an infant's or child's environment can lead to a decline in the number of infectious stimuli that are necessary for the proper development of the immune system. The decrease in exposure to infectious stimuli may result in an imbalance between the infectious-response ("protective") elements and the allergic-response ("false alarm") elements within the immune system.[15]
Some studies also suggest that the maternal diet during pregnancy may be a causal factor in atopic diseases (including asthma) in offspring, suggesting that consumption of antioxidants, certain lipids, and/or a Mediterranean diet may help to prevent atopic diseases.[16]
The multicenter PARSIFAL study in 2006, involving 6630 children age 5 to 13 in 5 European countries, suggested that reduced use of antibiotics and antipyretics is associated with a reduced risk of allergic disease in children.[17]
Genetics
There is a strong genetic predisposition toward atopic allergies, especially on the maternal side. Because of the strong familial evidence, investigators have tried to map susceptibility genes for atopy.[18][19] Genes for atopy (C11orf30, STAT6, SLC25A46, HLA-DQB1, IL1RL1/IL18R1, TLR1/TLR6/TLR10, LPP, MYC/PVT1, IL2/ADAD1, HLA-B/MICA)[20] tend to be involved in allergic responses or other components of the immune system. C11orf30 seems to be the most relevant for atopy as it may increase susceptibility to poly-sensitization.[21]
Staphylococcus aureus
Bleach baths provide temporary control of eczema.[22] Ciprofloxacin is an allergen that may cause contact dermatitis, symptoms of which are indistinguishable from eczema.[23] Filaggrin mutations are associated with atopic eczema and may contribute to the excessive dryness of the skin and the loss of the barrier function of normal skin.[24] It may be possible that the filaggrin mutations and the loss of the normal skin barrier expose crevices that make it possible for Staphylococcus aureus to colonize the skin.[25] Atopic eczema is often associated with genetic defects in genes that control allergic responses. Thus, some investigators have proposed that atopic eczema is an allergic response to increased Staphylococcus aureus colonization of the skin.[26] A hallmark indicator of atopic eczema is a positive “wheal-and-flare” reaction to a skin test of S. aureus antigens. In addition, several studies have documented that an IgE-mediated response to S. aureus is present in people with atopic eczema.[27][28]
Changes in prevalence
In adults, the prevalence of IgE sensitization to allergens from house dust mite and cat, but not grass, seem to decrease over time as people age.[29] However, the biological reasons for these changes are not fully understood.
Treatments
The treatment of atopic disorders depends on the organ(s) involved. It can vary from local treatment options, often topical corticosteroids, to systemic treatment options with oral corticosteroids, biological treatments (e.g. Omalizumab, Mepolizumab) or allergen immunotherapy.[30][31][32] An anaphylactic reaction on the other hand is treated with adrenaline, given as an intramuscular injection.[33]
See also
References
- ^ Merriam-Webster Dictionary: Atopy
- ^ Ralston, Stuart H., Herausgeber. Penman, Ian D., Herausgeber. Strachan, Mark W. J., Herausgeber. Hobson, Richard P., Herausgeber. Britton, Robert, Illustrator. Davidson, Leybourne S. 1894-1981 Begründer des Werks. (2018-04-23). Davidson's principles and practice of medicine. ISBN 978-0-7020-7028-0. OCLC 1040673074.
{{cite book}}
: CS1 maint: multiple names: authors list (link) CS1 maint: numeric names: authors list (link) - ^ "Mosby's Medical Dictionary:atopy". Archived from the original on 2011-07-10.
- ^ a b c Wright, Rosalind J; Enlow, Michelle Bosquet (2008-09-01). "Maternal stress and perinatal programming in the expression of atopy". Expert Review of Clinical Immunology. 4 (5): 535–538. doi:10.1586/1744666X.4.5.535. ISSN 1744-666X. PMC 2762209. PMID 19838310.
- ^ Coca AF, Cooke RA. (1923) On the classification of the phenomenon of hypersensitiveness J Immunol
- ^ Johannes Ring; Bernhard Przybilla; Thomas Ruzicka (2006). Handbook of atopic eczema. Birkhäuser. pp. 3–. ISBN 978-3-540-23133-2. Retrieved 4 May 2010.
- ^ Ruby Pawankar; Stephen T. Holgate; Lanny J. Rosenwasser (7 April 2009). Allergy Frontiers: Classification and Pathomechanisms. Springer. pp. 33–. ISBN 978-4-431-88314-2. Retrieved 4 May 2010.
- ^ "atopy". Online Etymology Dictionary. Douglas Harper. 2019. Retrieved 26 Sep 2019.
- ^ Simpson, Angela; Tan, Vincent Y. F.; Winn, John; Svensén, Markus; Bishop, Christopher M.; Heckerman, David E.; Buchan, Iain; Custovic, Adnan (June 2010). "Beyond Atopy". American Journal of Respiratory and Critical Care Medicine. 181 (11): 1200–1206. doi:10.1164/rccm.200907-1101oc. ISSN 1073-449X. PMID 20167852.
- ^ Sun, Hai-Lun; Yeh, Chih-Jung; Ku, Min-Sho; Lue, Ko-Huang (2012-01-01). "Coexistence of allergic diseases: Patterns and frequencies". Allergy and Asthma Proceedings. 33 (1): e1-4. doi:10.2500/aap.2012.33.3506. ISSN 1088-5412. PMID 22370527.
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- ^ Küster, W.; Petersen, M.; Christophers, E.; Goos, M.; Sterry, W. (December 12, 2004). "A family study of atopic dermatitis". Archives of Dermatological Research. 282 (2 / January, 1990): 98–102. doi:10.1007/BF00493466. PMID 2353830. S2CID 9396200.
- ^ Grammatikos AP (2008). "The genetic and environmental basis of atopic diseases". Ann. Med. 40 (7): 482–95. doi:10.1080/07853890802082096. PMID 18608118. S2CID 188280.
- ^ A Swedish research study titled “Atopy In Children Of Families With An Anthroposophic Lifestyle” comparing the rate of bronchial asthma, allergies, dermatitis, and other atopic diseases among Steiner school pupils and pupils in public schools originally appeared in the May 1, 1999 edition of the British medical journal The Lancet. The findings indicated that Steiner school pupils were “at a significantly lower risk of atopy” than children attending public schools. The researchers investigated a variety of factors in the lives of the Steiner school pupils that might have contributed to this lower rate of atopy, which included breastfeeding, lack of immunization, avoidance of antibiotics and medications that reduce fevers, consumption of bio-dynamic and organic foods, and other physical aspects of the children’s lives. Devereux, Graham; Seaton, A. (December 2004). "Diet as a risk factor for atopy and asthma". J Allergy Clin Immunol. 115 (6): 1109–1117. doi:10.1016/j.jaci.2004.12.1139. PMID 15940119.
- ^ Flöistrup H, Swartz J, Bergström A; et al. (January 2006). "Allergic disease and sensitization in Steiner school children" (PDF). J. Allergy Clin. Immunol. 117 (1): 59–66. doi:10.1016/j.jaci.2005.09.039. PMID 16387585.
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: CS1 maint: multiple names: authors list (link) - ^ Blumenthal MN (2005). "The Role of Genetics in the Development of Asthma and Atopy". Curr Opin Allergy Clin Immunol. 5 (141–5): 141–5. doi:10.1097/01.all.0000162306.12728.c2. PMID 15764904. S2CID 30698973.
- ^ Hoffjan S, Nicolae D, Ober C (2003). "Association Studies for Asthma and Atopic Diseases: A Comprehensive Review of the Literature". Respir Res. 4 (14): 14748924. doi:10.1186/1465-9921-4-14. PMC 314398. PMID 14748924.
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- ^ Amaral, André F. S.; Minelli, Cosetta; Guerra, Stefano; Wjst, Matthias; Probst-Hensch, Nicole; Pin, Isabelle; Svanes, Cecilie; Janson, Christer; Heinrich, Joachim; Jarvis, Deborah L. (December 2014). "The locus increases susceptibility to poly-sensitisation" (PDF). Allergy. 70 (3): 328–333. doi:10.1111/all.12557. hdl:10044/1/21574. PMID 25546184. S2CID 25960081.
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- ^ O'Regan GM, Sandilands A, McLean WH, Irvine AD (2008). "Filaggrin in Atopic Dermatitis". J Allergy Clin Immunol. 122 (4): 689–93. doi:10.1016/j.jaci.2008.08.002. PMID 18774165.
- ^ Breuer K, Kapp A, Werfel T (2001). "Bacterial Infections and Atopic Dermatitis". Allergy. 56 (11): 1034–41. doi:10.1034/j.1398-9995.2001.00146.x. PMID 11703215. S2CID 28897487.
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: CS1 maint: multiple names: authors list (link) - ^ Abramson JS, Dahl MV, Walsh G, Blumenthal MN, Douglas SD, Quie PG (1982). "Antistaphylococcal IgE in Patients with Atopic Dermatitis". J Am Acad Dermatol. 7 (1): 105–110. doi:10.1016/s0190-9622(82)80017-0. PMID 7107990.
- ^ Parish WE, Welbourn E, Champion RH (1976). "Hypersensitivity to Bacteria in Eczema. Ii. Titre and Immunoglobulin Class of Antibodies to Staphylococci and Micrococci". Br J Dermatol. 95 (3): 285–93. doi:10.1111/j.1365-2133.1976.tb07016.x. PMID 974019. S2CID 5842899.
- ^ Motala C, Potter PC, Weinberg EG, Malherbe D, Hughes J (1986). "Anti-Staphylococcus aureus-Specific IgE in Atopic Dermatitis". J Allergy Clin Immunol. 78 (4 Pt 1): 583–9. doi:10.1016/0091-6749(86)90075-8. PMID 3771950.
- ^ Amaral, André F.S.; Newson, Roger B.; Abramson, Michael J.; Antó, Josep M.; Bono, Roberto; Corsico, Angelo G.; de Marco, Roberto; Demoly, Pascal; Forsberg, Bertil; Gislason, Thorarinn; Heinrich, Joachim; Huerta, Ismael; Janson, Christer; Jõgi, Rain; Kim, Jeong-Lim; Maldonado, José; Martinez-Moratalla Rovira, Jesús; Neukirch, Catherine; Nowak, Dennis; Pin, Isabelle; Probst-Hensch, Nicole; Raherison-Semjen, Chantal; Svanes, Cecilie; Urrutia Landa, Isabel; van Ree, Ronald; Versteeg, Serge A.; Weyler, Joost; Zock, Jan-Paul; Burney, Peter G.J.; Jarvis, Deborah L. (November 2015). "Changes in IgE sensitization and total IgE levels over 20 years of follow-up". Journal of Allergy and Clinical Immunology. 137 (6): 1788–1795.e9. doi:10.1016/j.jaci.2015.09.037. PMC 4889785. PMID 26586040.
- ^ Wollenberg, A.; Barbarot, S.; Bieber, T.; Christen-Zaech, S.; Deleuran, M.; Fink-Wagner, A.; Gieler, U.; Girolomoni, G.; Lau, S.; Muraro, A.; Czarnecka-Operacz, M. (May 2018). "Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I". Journal of the European Academy of Dermatology and Venereology. 32 (5): 657–682. doi:10.1111/jdv.14891. PMID 29676534.
- ^ Reddel, Helen K.; Bateman, Eric D.; Becker, Allan; Boulet, Louis-Philippe; Cruz, Alvaro A.; Drazen, Jeffrey M.; Haahtela, Tari; Hurd, Suzanne S.; Inoue, Hiromasa; de Jongste, Johan C.; Lemanske, Robert F. (September 2015). "A summary of the new GINA strategy: a roadmap to asthma control". European Respiratory Journal. 46 (3): 622–639. doi:10.1183/13993003.00853-2015. ISSN 0903-1936. PMC 4554554. PMID 26206872.
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- ^ Petrides, C; Doherty, S; Patel, N (May 2019). "G462(P) Anaphylaxis nice guidelines: are we following the guidelines or is there is still a need to improve adherence". Trainees. BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health. doi:10.1136/archdischild-2019-rcpch.447. S2CID 208459511.
External links
- Case Studies in Environmental Medicine (CSEM): Environmental Triggers of Asthma – Agency for Toxic Substances and Disease Registry, U.S. Department of Health and Human Services.