It is known that one of the leading places in the pathogenesis of atopic
dermatitis (AD) is occupied by immunological disorders. A number of authors
established an imbalance in the indicators of the cellular link of immunity,
characterized by a decrease in the relative and absolute number of T- and
B-lymphocytes, T-suppressors (Sokolova T.S. et al ., 1983; Botvinyeva V.V. et
al ., 1986; Rapoport Zh. J. et al ., 1986; and others). Many researchers have
found a decrease in the level of immunoglobulins of classes G and A in the
serum of sick children (Revyakina V.A., 1986; Berlin G., Enerbach Y., 1984;
Klemola , 1987, etc.). Practically in all works devoted to this problem, the
presence of a high level of total immunoglobulin E in sick children is noted
(Gushchin I.S. et al ., 1986; Revyakina V.A., 1986; 1993, etc.).
However, most works provide an assessment of the immunological status of
children with (AD) depending on the clinical variant of the disease without
taking into account the age-related dynamics of immunological parameters. We
examined 25 children with clinical signs of exacerbation of atopic dermatitis.
The patients were divided into two age groups: I – from 5 months to 2 years (12
people), II – from 3 to 6 years (13 people). When making a diagnosis, the
clinical and morphological picture of the disease, the severity of the course
and the degree of activity of the skin process were taken into account. In 7
children, an exudative form of atopic dermatitis was established, in 11 –
erythematous-squamous, and in 7 – erythematous-squamous with lichenification .
In all patients, clinical manifestations on the skin appeared on the 1st year
of life.
Immunological examination of children was carried out in the early stages of
hospitalization before the start of active treatment according to generally
accepted methods. The control group consisted of 100 healthy children aged 1 to
6 years, who did not have chronic and recurrent diseases and had not been ill
for 2 months before the examination. When analyzing the results of the
immunological study, there were no significant differences in indicators
depending on the form (BP), which served as the basis for taking into account
only the age of the examined children.
The average values of immunological parameters of children with (AD) in
different periods of the disease were compared with those of children in the
control group of the same age and with each other .
As follows from the data in the table, clinically pronounced atopic dermatitis
is accompanied by an imbalance in the parameters of cellular and humoral
immunity. In children of the 1st age group in the acute phase, against the
background of a significant increase in the number of leukocytes, a decrease in
the relative and absolute number of B-lymphocytes was noted. The humoral link
of immunity was characterized by a significant decrease in the level of
immunoglobulins of classes A and M. Individual analysis of immunograms in 7
children under the age of 2 years showed a decrease in the concentration of IgA
below 0.3 g/l, the absence of immunoglobulin A in the blood serum was not found
in none of the children. In children aged 3-6 years (Group II), with
exacerbation of atopic dermatitis, dysfunction of the cellular link of immunity
was expressed in a significant decrease in the number of leukocytes and
lymphocytes, as well as the relative and absolute number of T-lymphocytes. The
number of B-lymphocytes in these children practically did not differ from the
control group (P < 0.05). At the same time, the concentrations of
immunoglobulins A and M were significantly lower, and the level of IgG
significantly exceeded its value in the control group of children.
Statistical analysis of the IgE indicator did not seem appropriate, since its
level in the examined patients ranged from 50 to 1100 IU/ml. In 5 patients with
a typical clinical picture of atopic dermatitis, the level of serum IgE did not
exceed the norm, and these were mainly children aged 3–6 years. In age group I
in children under 1 year of age, the level of IgE was significantly increased,
and disseminated rashes, often with infection, prevailed in the clinic, and
chronic skin diseases and bronchial asthma were noted in the family history.
When comparing the immunological parameters of children with (AD) of both age
groups during the period of clinical manifestations, a significant increase in
the number of leukocytes, a decrease in the relative number of T-lymphocytes
and the level of IgA , as well as the absolute number of B-lymphocytes were
revealed.
Thus, disorders in the immune system of children of different ages with atopic
dermatitis in the period of acute clinical manifestations were heterogeneous
and depended on the age of the children.
The search for approaches to predicting the exacerbation of atopic dermatitis
prompted us to investigate the immune status of children in the period of
clinical remission. The results of the study of cellular and humoral immunity
are presented in Table 1. From Table 1 it follows that in children of both age
groups there was a normalization of the content of immunoglobulins A and M in
the blood serum. At the same time, the level of immunoglobulin G remained
significantly reduced in children with (AD) compared with the control group of
children. Imbalance in the parameters of the humoral link of immunity is
supplemented in young children by a significant increase in the relative and
absolute number of B-lymphocytes; in children aged 3-6 years, along with the
continuing deficiency of T-lymphocytes, there is a significant decrease in the
content of B-lymphocytes.
Thus, the results of our study convince us that the assessment of changes in
the cellular and humoral components of immunity in children with atopic
dermatitis should be carried out taking into account the age of the patients.
In the period of clinical remission, an imbalance in the parameters of cellular
immunity persists. To a greater extent, it is expressed in children aged 3-6
years and, in comparison with the indicators of children in the control group,
is characterized as a lack of cellular and humoral immunity. The conducted
study indicates the need to eliminate risk factors for exacerbations of the
disease during the period of clinical remission and, possibly, differentiated,
on an individual basis, the use of immunocorrective therapy.