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PubMed2004

Relative importance of IL-4 and IL-13 in lesional skin of atopic dermatitis.

BACKGROUND: Although both interleukin-4 (IL-4) and IL-13 induce immunoglobulin E (IgE) production in vitro, the relative contribution of the two cytokines in various skin lesions of atopic dermatitis remains unclear. OBJECTIVE: We examined the relative importance of IL-4 and IL-13 in lesional skin of atopic dermatitis for IgE production. METHODS: The study group comprised 28 atopic dermatitis patients with serum IgE levels more than 2000 IU/ml. The expression levels of IL-4 mRNA and IL-13 mRNA versus that of glyceraldehyde-3-phosphate dehydrogenase (GAPDH) were determined using a semiquantitative reverse transcription-polymerase chain reaction (RT-PCR) method in samples of normal-appearing skin from seven patients, very mild lesions from eight patients, subacute lesions from ten patients and lichenified lesions from ten patients with atopic dermatitis, and in samples of normal skin from six healthy control subjects. RESULTS: IL-4 mRNA expression was identified in only two of the eight very mild lesions, one of the ten subacute lesions, and none of the ten lichenified lesions, whereas IL-13 mRNA expression was identified in 27 of the 28 skin lesions of atopic dermatitis. The IL-13 mRNA/GAPDH mRNA ratios (x100) in the subacute lesions (94.4+/-20.6) and lichenified lesions (71.4+/-40.4) were significantly greater than in the skin of healthy controls (13.1+/-17.7; P<0.01, P<0.05, respectively). CONCLUSIONS: Upregulation of IL-13 mRNA in subacute and chronic lesions of atopic dermatitis along with scant expression of IL-4 mRNA suggest that IL-13 is a crucial cytokine in lesional skin.

Adult↗
PubMed2005

Risk of contact allergy and dermatitis at a wind turbine plant using epoxy resin-based plastics.

AIMS: To identify workplace and individual risk factors for occupational contact allergy and dermatitis. METHODS: A cross-sectional study was carried out at an international company producing wind turbine systems in Denmark. A cohort of 724 production workers at four facilities was highly exposed to epoxy resin as well as other chemicals. A screening questionnaire (participation rate 84.7%) was followed by an interview by an occupational physician and a dermatological examination, including patch testing, for a comprehensive list of potential workplace sensitizers. RESULTS: Clinically diagnosed dermatitis was found among 214 workers (35.8%) and contact allergy to materials used in the workplace was found in 66 workers (10.9% of the total population and 20.3% of those who underwent patch testing). Of the 66 workers with a work-related allergy, 40 (60.6%) were allergic to epoxy compounds, 25 (37.9%) to hardeners and ten (15.2%) to other workplace materials, where one person showed an allergy only to these materials. Experiencing contact allergy was related to older age and longer employment in the workplace-however, neither of these risk factors was significant. The main risk factor for current dermatitis was contact allergy to materials used in the workplace, determined by patch testing, OR=5.4 (95% CI 3.9-9.9). Fewer days of absence from work was also related to current dermatitis, OR=2.0 (95% CI 1.2-3.5). CONCLUSIONS: In a cohort of workers with extensive exposure to chemicals related to epoxy-resin systems, contact dermatitis and allergy was prevalent. Older age and longer duration of employment at the workplace were individual risk factors for allergy to workplace materials, whilst work-related allergies and longer duration of employment at the workplace were significant risk factors for current dermatitis.

Adolescent↗
PubMed2001

The role of patch testing for chemical and protein allergens in atopic dermatitis.

Many patients who present for evaluation of allergic contact dermatitis have an atopic diathesis. Although the immunologic basis of atopic dermatitis differs from that of allergic contact dermatitis--and patients with atopic dermatitis are less easily sensitized under experimental conditions--atopic patients do develop allergic contact dermatitis, and patch testing is a valuable part of their medical care. Delayed (7-day) patch test readings are especially important in atopic patients to distinguish allergy from irritancy and to evaluate for steroid allergy. The utility of atopy patch tests to aeroallergens such as dust mite is increasingly recognized; aeroallergens may be the cause of a type of protein contact dermatitis.

Allergens↗
PubMed1989

The relationship between positive aeroallergen patch test reactions and aeroallergen exacerbations of atopic dermatitis.

Previously we have demonstrated that patient contact with specific aeroallergens can cause flares of atopic dermatitis. In this study we report six additional cases that further document the relationship between positive aeroallergen patch test reactions and aeroallergen exacerbation of atopic dermatitis. In total, we have seen 18 patients (8 male, 10 female; ages 1-54 years) who have noted marked improvement in their skin symptomatology when antigen elimination (or moderation) was instituted as part of their general management. Delineation of inciting allergen was accomplished by a combination of prick tests and patch tests to aeroallergens. On prick testing all patients had markedly positive immediate wheal and flare reactions to a variety of aeroallergen extracts (tree, grass, and weed pollen, house dust mite, animal protein, and mold spores). The same patients were subsequently patch tested on uninvolved, nonabraded skin with allergen extracts at the same concentrations that had given positive prick tests. Patch tests were applied for 48 hr, removed, and interpreted at 48 and 72 hr. Patients reacted to specific aeroallergens with an eczematous eruption at 48 or 72 hr or at both time points. Positive delayed cutaneous reactions correlated strongly with aeroallergens identified in the patient's environment and/or suspected by the patients as inducers of dermatitis. Delayed cutaneous reactions were negative to allergens not historically relevant. Avoidance of aeroallergens that elicited an eczematous reaction at patch test sites resulted in marked improvement or resolution of dermatitis in all patients. Environmental rechallenge with incriminated allergens resulted in flares of dermatitis. We conclude that aeroallergen contact plays an important role in select patients with atopic dermatitis and that the responsible allergens can be elucidated by a combination of prick and patch tests.

Aerosols↗
PubMed1982

Evidence for histamine-mediated inhibition of monocyte chemotaxis in atopic dermatitis.

Leukocyte chemotaxis was studied in 11 patients with severe childhood onset atopic dermatitis at a time when their disease was relatively quiescent. Pyoderma had been an important complication of the dermatitis in these patients. The chemotactic responsiveness of patient neutrophils and monocytes was on the average not significantly different from that of healthy control subjects, although three patients were identified who had significantly impaired responses. No correlation between IgE levels and leukocyte chemotaxis was observed. Because excessive amounts of histamine have been recovered from the skin of patients with atopic dermatitis, we evaluated the effects of histamine on the chemotactic responsiveness of leukocytes from these patients. Histamine caused a small dose-related increase in chemotaxis of neutrophils from both patients and control subjects (10(-7)M to 10(-5)M histamine). In contrast, histamine had no effect on the chemotaxis of monocytes from control subjects but inhibited the chemotactic responsiveness of monocytes from atopic dermatitis patients. These findings suggest that an abnormal sensitivity of monocytes to histamine is an intrinsic feature of atopic dermatitis that may be detectable when the disease is quiescent. Furthermore, this abnormality may contribute to the impairment of monocyte chemotaxis that has been previously observed in patients with active atopic dermatitis.

Chemotaxis↗
PubMed1991

Necrolytic migratory erythema without glucagonoma versus canine superficial necrolytic dermatitis: is hepatic impairment a clue to pathogenesis?

The case of a 57-year-old diabetic man with necrolytic migratory erythema in the absence of glucagonoma is reported. The clinical and pathologic features of his dermatitis and subsequent clinical course are compared with those of canine superficial necrolytic dermatitis, an unusual cutaneous necrotizing eruption of dogs that is identical histologically to necrolytic migratory erythema. In addition to a necrolytic dermatitis, both our patient and most dogs with superficial necrolytic dermatitis have diabetes mellitus and hepatic failure in the absence of glucagonoma. Thus hyperglucagonemia most likely is not a factor in the origin of the necrotizing dermatitis in this patient or in dogs. The role of hepatocellular dysfunction in the pathogenesis of necrolytic migratory erythema and superficial necrolytic dermatitis is considered.

Animals↗
PubMed1993

Recombinant interferon gamma therapy for atopic dermatitis.

BACKGROUND: Atopic dermatitis is characterized by immunologic abnormalities including evidence for reduced interferon gamma production. Therapeutic options for treatment of atopic dermatitis are limited and unsatisfactory. Previous open trials have suggested efficacy for recombinant interferon-gamma (rIFN-gamma) in treatment of severe atopic dermatitis. We describe the results of treatment with rIFN-gamma, assessing clinical, immunologic, and laboratory safety parameters in 83 patients with moderate to severe atopic dermatitis. OBJECTIVE: Our purpose was to determine in a randomized, placebo-controlled, double-blind multicenter study the effects of recombinant human interferon gamma therapy in patients with atopic dermatitis. METHODS: Patients received 50 micrograms/m2 rIFN-gamma (n = 40) or placebo (n = 43) by daily subcutaneous injection for 12 weeks. Seventy-eight patients completed the treatment course; two patients receiving rIFN-gamma (one because of constitutional side effects) and three receiving placebo discontinued treatment before completion. Physician and patient overall response evaluations, clinical severity scores, body surface area involvement, and laboratory parameters were monitored throughout the trial. RESULTS: Patients in both treatment groups were similar except that the rIFN-gamma group was older and had a longer disease duration. Forty-five percent of rIFN-gamma-treated patients and 21% of placebo-treated patients achieved greater than 50% improvement in physicians' overall response evaluations (p = 0.016). As estimated by patients, responses also showed significant improvement in the rIFN-gamma group compared with the placebo group (53% vs 21%, p = 0.002). Significant reductions in erythema (p = 0.035) and in excoriations or erosions (p = 0.045) occurred in rIFN-gamma-treated patients. Other atopic symptoms such as conjunctivitis (p < 0.002) were also reduced in the rIFN-gamma group. Occasional headaches, myalgias, or chills occurred in 30% to 60% of rIFN-gamma-treated patients but were effectively prevented by pretreatment acetaminophen and by dosing at bedtime. Grade II granulocytopenia occurred in five rIFN-gamma patients but normalized with continued treatment. Reduction to alternate-day dosing was necessary for six patients in the rIFN-gamma group and two in the placebo group. Seven had mild elevations of hepatic transaminase levels that did not affect therapy. The mean eosinophil count was significantly reduced (p = 0.003), whereas a nonsignificant increase in serum IgE levels occurred in the active treatment group. CONCLUSION: This study demonstrated that rIFN-gamma given by daily subcutaneous injection over a 12-week period was safe, well accepted, and effective in reducing inflammation, clinical symptoms, and eosinophilia in severe atopic dermatitis.

Adolescent↗
PubMed1993

Atopic dermatitis in children: who cares? Who pays?

BACKGROUND: Atopic dermatitis is an important cause of morbidity in children of all ages. Despite its high prevalence, there has been no examination of ways in which care for atopic dermatitis is delivered. OBJECTIVE: This study reviewed the costs for care of childhood atopic dermatitis in an urban setting and estimated the national cost for treatment of the disease. METHODS: We used data from one children's hospital to study the use of the emergency room for atopic dermatitis and used national data sets to estimate the cost of care in the United States. RESULTS: A large proportion of visits occur in the emergency department, during daytime office hours, and mostly by patients who have public insurance. The total national cost for treatment of childhood atopic dermatitis is $364 million annually, which is a conservative estimate. CONCLUSION: Given its high prevalence, associated morbidity, and cost, resources must be better allocated to improve the organization of care for patients with atopic dermatitis.

Adolescent↗
PubMed1995

Control of Sarcoptes scabiei var. suis with ivermectin: influence on scratching behaviour of fattening pigs and occurrence of dermatitis at slaughter.

The behaviour of fattening pigs, the occurrence of erythematous papular dermatitis in pigs at slaughter and the effects of treatment for mange with ivermectin at the start of the fattening period were evaluated at ten farms. At each farm, trial pigs were randomly allotted to a control or a treated group. At the start of the trial, the control group was injected intramuscularly with 5 mg kg-1 levamisole, and the treated group was injected subcutaneously with 300 micrograms kg-1 ivermectin. Skin scrapings, taken from each pig before medication at the start of the trial, and at slaughter, were examined for presence of sarcoptic mites. Pig behaviour was monitored at 2 week intervals from Week 5 to Week 13 of the trial. Carcasses of trial pigs were inspected for dermatitis at slaughter. Low to moderate Sarcoptes scabiei var. suis infestations were demonstrated at the start of the trial on five farms (S+ farms). At slaughter, the mean percentage of Sarcoptes-positive pigs per pen on S+ farms was 34.8% (range 11-60%) for the control group as compared with 0.5% (range 0-2.7%) for the ivermectin-treated group (P < 0.01). No S. scabiei was recovered from any pig at any time from the five other farms (mange-free (S-) farms). The low initial levels of mange in the controls at S+ farms resulted in a consistently high scratching index. Ivermectin treatment resulted in a significantly (P < 0.01) lower prevalence of scratching, comparable with the prevalence observed at S- farms. High prevalences of generalized dermatitis at slaughter were observed in control pigs from all S+ farms. Ivermectin treatment resulted in much lower prevalences, reflected in a significantly (P < 0.01) lower grand mean dermatitis index per pen for this group as compared with the controls. The majority of pigs from both treatment groups at all S- farms were free of papular lesions. These results indicate that low levels of sarcoptic mange at the start of fattening, left untreated, will result in a high prevalence of scratching during the fattening period and high prevalences of Sarcoptes and dermatitis at slaughter. Treatment with ivermectin at the start of fattening results in behaviour and dermatitis prevalences similar to those observed in mange-free herds.

Animal Husbandry↗
PubMed2006

Malignancies and mortality in patients with coeliac disease and dermatitis herpetiformis: 30-year population-based study.

BACKGROUND AND AIM: To assess the long-term risks of malignant diseases and mortality in patients with coeliac disease and dermatitis herpetiformis in a centre, where the prevalence of these diseases is high. The risks have probably been overestimated, as patients with subtle forms have earlier remained undetected. PATIENTS: The study comprised 17,245 person-years of follow-up in 1147 patients. METHODS: The observed numbers of malignancies and causes of deaths were assessed, and compared to those expected, and standardised incidence ratio and standardised mortality ratio given. RESULTS: The occurrence of all malignant conditions was equal to that in the population both in coeliac disease and dermatitis herpetiformis: standardised incidence ratios of 1.2 (95% confidence intervals 0.9-1.5) and 1.0 (0.6-1.5), respectively. Five patients with coeliac disease and seven with dermatitis herpetiformis had developed non-Hodgkin lymphoma; standardised incidence ratios of 3.2 (1.0-7.5) and 6.0 (2.4-12.4), respectively. Four patients with coeliac disease and one with dermatitis herpetiformis had enteropathy-associated T-cell lymphoma, associated with inadequate dietary compliance. Mortality was increased (standardised mortality ratio 1.26; 1.00-1.55) in coeliac disease, but decreased in dermatitis herpetiformis (standardised mortality ratio 0.52; 0.36-0.72). CONCLUSION: The overall prognosis in our patients was good. Non-Hodgkin lymphoma emerged in patients with undiagnosed or poorly treated coeliac disease. The mortality rate in dermatitis herpetiformis was even lower than in the population. Our data support the early diagnosis and dietary treatment of these conditions.

Adolescent↗
PubMed2004

Mast cells and eosinophils in feline allergic dermatitis: a qualitative and quantitative analysis.

Mast cells (MCs) and eosinophils are prominent in the perivascular infiltrate of cats with allergic dermatitis. In the skin of allergic cats MCs were mainly observed diffusely in the superficial dermis, while eosinophils were found mainly in the deep dermis in a perivascular pattern. MC counts were significantly higher in cats with allergic dermatitis (P < 0.05) than in healthy control cats, but the number varied widely. Moreover, the numbers of eosinophils in the skin of allergic and control cats differed significantly (P < 0.05) none being found in the latter. There was no significant correlation between numbers of mast cells and eosinophils in the same biopsy sample. In the allergic cats, a significantly lower number of MCs was detected by staining for tryptase than by staining for chymase or by Astra blue staining. Additionally, the chymase: tryptase ratio in healthy cats was reversed in cats with allergic dermatitis. These changes were observed in lesional and nonlesional skin of cats with allergic dermatitis. The findings indicate a generalized effect on MCs in allergic dermatitis. In addition, eosinophils are an important indicator of allergic dermatitis.

Animals↗
PubMed2004

Dermatitis herpetiformis: close to unravelling a disease.

Dermatitis herpetiformis is characterised by granular IgA precipitates in the papillary dermis. In contrast to other autoimmune blistering diseases, where tissue-deposited and circulating autoantibodies recognise the same target within the skin, in dermatitis herpetiformis a serum IgA reacting with a component of the healthy papillary dermis has not been detected. Recently, the antigenic specificity of pathognomic skin-bound IgA has been clarified: the immune precipitates contain epidermal transglutaminase, an enzyme not previously detected in the papillary region of normal skin. Furthermore, serum IgA in dermatitis herpetiformis has been found to bind epidermal transglutaminase. These findings may relate to the fact, that dermatitis herpetiformis is associated with gluten sensitive enteropathy, coeliac disease, which is characterised by IgA type autoantibodies to a closely related enzyme, tissue transglutaminase. The two transglutaminases are highly homologous, and therefore, cross reactivity of the two antibodies might explain why patients with gluten sensitive enteropathy, with or without skin disease, generally have serum autoantibodies to both enzymes. There is growing evidence that dermatitis herpetiformis should be considered as the skin manifestation of gluten sensitivity developing in those patients with mild coeliac disease, who produce epidermal transglutaminase autoantibodies of high avidity and affinity. Both the skin and the small bowel diseases are gluten dependent and are strongly associated with HLA DQ with no genetic differences to explain the two phenotypes. The question should be asked whether the rash in dermatitis herpetiformis is a classic autoimmune blistering disease or whether it has an immune complex basis, which is the most likely alternative.

Animals↗
PubMed2004

Scratching of their skin by NC/Nga mice leads to development of dermatitis.

Effects of scratching behavior on dermatitis, transepidermal water loss (TEWL) and serum IgE concentrations were examined in NC/Nga (NC) mice with toenails (WIT) and without toenails (WOT). The first study was a preventive treatment done to cut off hind toenails before dermatitis induction and the second study was a therapeutic treatment by cutting off hind toenails of NC mice with severe dermatitis. In the preventive study, scratching behavior significantly increased in both WIT and WOT after dermatitis induction. Skin severity score, TEWL, number of mast cells and serum IgE concentration statistically increased in WIT but not in WOT after dermatitis induction. Histological changes coincided with the skin severity score in WIT, while no changes were observed in WOT. In the therapeutic study, skin severity score in WOT but not in WIT statistically decreased after cutting off the hind toenails. TEWL and numbers of mast cells in WOT were statistically lower compared with findings in WIT. Thus scratching up the skin with toenails seemed to be the most important factor leading to dermatitis in NC mice.

Animals↗
PubMed2001

Herpes simplex virus dermatitis in patients using latanoprost.

PURPOSE: To describe the possible association of latanoprost with herpetic dermatitis of the periocular skin. METHOD: Interventional case reports. A 79-year-old woman with open-angle glaucoma developed a vesicular dermatitis of the left lower eyelid 14 months after starting latanoprost therapy. An 84-year-old man with pigmentary glaucoma developed a vesicular dermatitis of the right upper lid after 2 months of treatment with latanoprost and 8 days of treatment with tobramycin/dexamethasone for presumed bacterial conjunctivitis. In both cases, the dermatitis was characteristic of a herpetic infection. RESULTS: Latanoprost was discontinued in both cases. The woman was treated with vidarabine 3% ointment, and the man was not treated with antiviral agents. In both patients, the dermatitis healed uneventfully. The lesions of the man were cultured, and a biopsy was performed; herpes simplex virus type 1 was recovered from the culture and confirmed by immunofluorescence testing. CONCLUSION: Latanoprost, which has been associated with reactivation of herpetic keratitis, may also cause reactivation of herpetic dermatitis of the periocular skin.

Aged↗
PubMed2003

Association between novel GM-CSF gene polymorphisms and the frequency and severity of atopic dermatitis.

BACKGROUND: Genetic factors are known to be important in determining an individual's predisposition to atopic dermatitis. The specific genes that are clinically important in this process are still largely unknown. OBJECTIVE: Because dendritic cells initiate immune responses and thus are critical to the priming of an individual to potential allergens, we hypothesized that genetic factors controlling the activity of these cells determine an individual's propensity to atopic dermatitis. METHODS: We studied known functional polymorphisms of the IL-1beta and TNF-alpha genes and describe novel polymorphisms of the GM-CSF gene in 113 children with atopic dermatitis and 114 controls. All 3 factors are known to be important modulators of the function of skin Langerhans' (dendritic) cells. RESULTS: The inheritance of a homozygous GM-CSF -677*C/C genotype was associated with complete absence of severe atopic dermatitis within this cohort of children (P <.001). Furthermore, the odds ratio of having atopic dermatitis in children who were not of this genotype was 7.5 (2.2-25). CONCLUSION: The GM-CSF genotype is an important genetic marker predicting an individual's predisposition to atopic dermatitis.

Adolescent↗
PubMed1999

Treatment of atopic dermatitis: role of tacrolimus ointment as a topical noncorticosteroidal therapy.

Atopic dermatitis is a chronic, relapsing form of eczema characterized by scaling, itchy, inflamed skin that can be triggered by an interplay of genetic, immunologic, and environmental factors. Immune dysregulation appears to play an important role in the cause of atopic dermatitis. Topical corticosteroid agents have been the mainstay of therapy for atopic dermatitis because of their broad immunomodulatory effects. However, topical corticosteroid agents are not ideal agents because when used over the long term, they may cause cutaneous atrophy and immunosuppression. Systemic corticosteroidal agents, certain antihistiminic agents, systemic cyclosporin, and phototherapy have proven value in treating patients with atopic dermatitis. In the search for a noncorticosteroidal topical agent, tacrolimus stands out as being uniquely suited for this condition. Tacrolimus affects a broad spectrum of inflammatory mediators and processes known to be relevant to atopic dermatitis pathogenesis. Tacrolimus demonstrates good percutaneous penetration and appears to have no potential to cause cutaneous atrophy. There are multiple double-blind, controlled studies demonstrating the safety and efficacy of this agent in treating atopic dermatitis. The agent may be of particular benefit in children, among whom an alternative to the chronic use of corticosteroid agents, either topically or systemically, is highly desirable.

Administration, Topical↗
PubMed2005

[Chromium-induced vasculitis-like purpuric allergic contact dermatitis].

INTRODUCTION: Purpuric allergic contact dermatitis is a rare and poorly understood condition. CASE REPORT: A 27-year-old male patient with a personal history of atopic dermatitis since childhood consulted for chronic papular-purpuric rash present for 7 years. Moderate pruritus was seen. Profuse lesions were observed on the palms and soles and on the upper and lower limbs, with sparing of the trunk. These lesions consisted of purpuric papules, in some cases with crusts, forming large plaques. The clinical picture was initially suggestive of vasculitis, but this diagnosis was ruled out by histological examination and laboratory tests. Skin patch tests were evocative of chromium-induced contact dermatitis. Retrospective directed history-taking confirmed the relevance of the latter test since it revealed regular wearing of leather clothing. Lasting cure was achieved following eradication of the allergen. DISCUSSION: Reports of contact purpuric dermatitis are rare. This condition has been described principally for allergens consisting of rubber or dyes used in clothing. Our case was notable on account of the severity of the lesions, mimicking vasculitis, as well as the novelty of the incriminated allergen, chromium, found in leather garments. It underlines the value of routine skin patch tests in the event of chronic non-specific dermatitis. To our knowledge, this is the first reported case of chromium-induced purpuric allergic contact dermatitis.

Adult↗
PubMed2002

Peripheral blood mononuclear cell responses to major and minor Dermatophagoides allergens in canine atopic dermatitis.

Atopic dermatitis is a chronic inflammatory and pruritic skin disease commonly seen in dogs and humans. Most cases involve hypersensitivity to the house dust mites (HDM) Dermatophagoides farinae and Dermatophagoides pteronyssinus. Human atopic dermatitis is associated with the HDM derived allergens Der f 1 and 2, and Der p 1 and 2. Serological data, however, suggest that a 98/104kD protein is the most important allergen in dogs with atopic dermatitis. The aim of this study was to characterise the specificity of circulating T-cells in canine atopic dermatitis for HDM derived allergens. Peripheral blood mononuclear cells (PBMCs) from dogs with atopic dermatitis that were skin test positive for D. farinae and D. pteronyssinus were cultured with crude extracts of D. farinae, D. pteronyssinus and D. microceras, a 98/104kD allergen purified from D. farinae, Der f 1 and Der f 2. There was significantly greater responsiveness of PBMCs to the D. farinae and D. pteronyssinus extracts compared to the D. microceras extract, and similarly to the purified 98/104kD allergen compared to Der f 1 and Der f 2. The close association between serological findings and PBMC proliferation implies that the 98/104kD HDM protein is a major target of immune recognition and that T-cells also participate in the pathogenesis of canine atopic dermatitis by supporting IgE production.

Allergens↗