Atopic dermatitis and autoimmunity: the occurrence of autoantibodies and their association with disease severity

Holmes, James; Fairclough, Lucy; Todd, Ian

Abstract

Atopic dermatitis (AD) is a widespread condition that appears to be increasing in prevalence and severity worldwide, yet the underlying mechanisms are not well understood. Recent research has identified various similarities between AD and autoimmune conditions, as well as indicating that there may be an association between AD and autoimmunity. This systematic review evaluates the association between AD and autoimmunity, as well as between severity of disease in AD and autoimmunity, with an emphasis on the associations with autoantibodies. MEDLINE (1946 to December 2017) and Embase (1974 to December 2017) databases were searched. Further relevant articles were retrieved from reference lists. Only studies measuring direct indicators of autoimmunity, in humans, were included. Qualitative analysis was carried out for all
studies. In addition, quantitative analysis was used to evaluate prevalence of IgE autoantibodies and antinuclear antibodies (ANAs) in AD patients and control subjects. The Mantel-Haenszel method was used with a random-effects model. Twenty-eight studies assessed the occurrence of autoantibodies in AD patients and 16 studies were used to evaluate association between disease severity and autoantibodies. Pooled analysis from 14 studies, involving 986 AD patients and 441 control subjects, showed that IgE autoantibodies were significantly more prevalent in patients with AD (P less than 00001) than control subjects. Similar analysis was carried out for ANAs, with eight studies that involved 1045 AD patients and 1273 control subjects. ANAs were significantly more prevalent in patients with AD (P = 0.003). This quantitative analysis supported an association between AD and IgE autoantibodies, as well as between AD and ANAs. There was insufficient data to make similar conclusions for other indicators of autoimmunity. The weight of evidence also suggests an association between IgE autoantibodies and disease severity. There was insufficient evidence to make this link for other indicators of autoimmunity.

Citation

Holmes, J., Fairclough, L., & Todd, I. (2019). Atopic dermatitis and autoimmunity: the occurrence of autoantibodies and their association with disease severity. Archives of Dermatological Research, 311(3), 141-162. https://doi.org/10.1007/s00403-019-01890-4

• Journal Article Type: Article
• Acceptance Date: Feb 9, 2019
• Online Publication Date: Feb 23, 2019
• Publication Date: Apr 1, 2019
• Deposit Date: Feb 20, 2019
• Publicly Available Date: Mar 4, 2019
• Journal: Archives of Dermatological Research
• Print ISSN: 0340-3696
• Electronic ISSN: 1432-069X
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 311
• Issue: 3
• Pages: 141-162
• DOI: https://doi.org/10.1007/s00403-019-01890-4
• Keywords: Atopic dermatitis; Autoimmunity; Autoantibody; IgE; IgG; IgA; Anti-nuclear autoantibodies
• Public URL: https://nottingham-repository.worktribe.com/output/1572010
• Publisher URL: https://link.springer.com/article/10.1007%2Fs00403-019-01890-4
• Additional Information: Received: 3 July 2018; Revised: 5 December 2018; Accepted: 9 February 2019; First Online: 23 February 2019; : ; : The authors declare that they have no conflict of interest.; : This article does not contain any studies with human participants or animals performed by any of the authors.
• Contract Date: Feb 20, 2019