Severe atopic dermatitis is associated with sensitization to staphylococcal enterotoxin B (SEB)

Background: Staphylococcus aureus has been identified as a possible trigger factor in atopic dermatitis (AD). Some 30-60% of S. aureus strains isolate d from mostly staphylococcal enterotoxins A, B, C, and D (SEA-D) and toxic shock syndrome toxin 1 (TSST-1). Recently, it was demonstrated that the pre sence of IgE antibodies to SEA and SEB is correlated with the severity of s kin lesions in children with AD. To determine the relevance of staphylococc al enterotoxins in adult patients with AD, we investigated the relationship between the severity of skin lesions and sensitization to SEA and SEB. Methods: Clinical severity was determined by the SCORAD index. Circulating IgE antibodies to SEA and SEB, serum eosinophil cationic protein (ECP) leve ls, and urine eosinophil protein X (EPX) levels were measured. Results: The skin condition was significantly worse in patients sensitized to SEB than in unsensitized patients. Serum ECP and urine EPX levels were f ound to be significantly higher in SEB-sensitized patients, confirming the higher degree of cutaneous inflammation. Conclusions: Our results demonstrate a relationship between severity of ski n lesions and sensitization to SEB in adult patients with AD, but a relatio nship between disease activity and sensitization to SEA could not be shown.