A prospective study in children with a severe form of atopic dermatitis: clinical outcome in relation to cytokine gene polymorphisms

Background and Objective: <br/> <br/> The course of atopic dermatitis (AD) in childhood is characterized by typical changes in phenotype, including a shift from skin involvement to respiratory allergy usually around the third year of age. We thus designed a prospective study to monitor the outcome of severe AD and to investigate the association between cytokine gene polymorphisms and clinical manifestations. Methods: <br/> <br/> Clinical and laboratory follow-up of 94 patients with severe AD and 103 healthy controls was performed using routine methodology. Allele, genotype, and haplotype frequencies of single nucleotide polymorphisms of 13 selected cytokine/receptor genes were analyzed using PCR with sequence-specifi c primers. Results: <br/> <br/> In our study, genotypes of 7 polymorphisms—IL-4 -1098G/T and -590C/T, IL-6 -174C/G and nt565A/G, and IL-10 -1082A/G, -819C/T, and -592A/C were signifi cantly associated with atopic AD (P<.05). A signifi cant association was also found for TNF-α AA and IL-4 GC haplotypes and AD. We confirm the progressive clinical improvement of AD together with a decrease in the severity index SCORAD (SCORing atopic dermatitis) during childhood (P<.05). We found signifi cant differences between IL-4Rα +1902 A/G and positivity of tree pollen–specifi c IgE (P<.05) in the AD group. Moreover, a weak association was also found between IL-10 -819C/T and IL-10 -590A/C and the appearance of allergic rhinitis (P<0.1). Conclusions: <br/> <br/> We confirmed a clinical shift in allergic phenotype in the fi rst 3 years of life, and showed an association between IL-4, IL-6, and IL-10 polymorphisms and AD. Our data indicate that IL-4α and IL-10 polymorphisms may be considered predictive factors of respiratory allergy in children with AD