Evaluation of the staphylococcal exotoxins and their specific IgE in childhood atopic dermatitis

Background: Superantigenic exotoxins produced by Staphylococcus aureus and their specific IgE antibodies are thought to be important precipitating factors of atopic dermatitis (AD), but there are few reports evaluating these 2 factors at the same time, Objective: We examined whether the presence of the exotoxins sampled from the skin of patients with AD and the levels of anti-exotoxin IgE antibodies in their sera correlated with their severity of AD, Methods: Patients with mild-to-severe AD, 1 to 22 years of age, were evaluated by using Leicester's scoring system. Specific IgE antibodies against these exotoxins were determined by using ELISA. S aureus was isolated from 3 different areas of the skin. We examined whether the exotoxin (staphylococcal enterotoxin [SE]A, SEE, SEC, SED, and toxic shock syndrome toxin-1) could be detected. Results: The levels of SEE-specific IgE were correlated with the severity of AD. Ave of 6 patients having very high SEB-specific IgE antibody titers were under 6 years of age, and SEE was most frequently isolated (41%). There was no difference in severity between patients with or without exotoxin-producing S aureus. The severity of 9 patients who had both exotoxin:producing S aureus on the skin and specific IgE antibody against the same exotoxin in sera was significantly higher than that of the other patients. Conclusions: Anti-SEE IgE titers correlate well with the severity: of AD. The presence of exotoxin-producing S aureus may precipitate AD through its specific IgE antibody.