ELEVATED LEVELS OF SOLUBLE HLA CLASS-I (SHLA-I) IN CHILDREN WITH SEVERE ATOPIC-DERMATITIS

Background: Atopic dermatitis is characterized by increased production of IgE and interleukin-4, immediate skin test reactivity to allergens , increased expression of CD23 on mononuclear cells, and decreased pro duction of interferon-gamma. Soluble HLA-I molecule levels are elevate d in conditions where T cells are activated such as viral infections, autoimmune diseases, and organ transplantation. Objective: We wished t o determine if sHLA-I heterodimers were also elevated in patients with atopic dermatitis and if sHLA-I elevations correlated with disease ac tivity. Methods: Fourteen children with atopic dermatitis resistant to conventional treatment were followed over an 8-week period during an ongoing trial of treatment with topical sodium cromoglycate. Extent of skin involvement, disease severity, absolute eosinophil counts, IgE a nd HLA-I levels were determined at the time of enrollment into the stu dy. Additional sHLA-I levels were measured after 4 and 8 weeks of ther apy. Results: Mean sHLA-I levels were significantly elevated in atopic dermatitis patients, 2.07 +/- 1.14 versus 1.00 +/- 0.22 mu g/mL in co ntrols (P < .0001). Nine of 14 patients (64%) had elevated sHLA-I anti gens. Soluble HLA-I levels did not correlate with the extent of diseas e, disease severity score, eosinophil count, or IgE levels. There was a remarkable consistency in sHLA-I levels at baseline and after 4 and 8 weeks of therapy, even with significant clinical improvement. Conclu sion: We conclude that sHLA-I heterodimers are elevated in 64% of our patients with atopic dermatitis and that elevations persist after clin ically effective therapy. This conclusion supports recommendations for prolonged preventative and treatment measures in this atopic disease.