Association of CD69 Up-Regulation on CD4+ CLA+ T cells versus patch test, strip patch test and clinical history in nickel sensitization

European Journal of Medical Research

S Höxtermann²  P Altmeyer²  J Kamphowe²  O Kuss¹  H Dickel² 

[1] Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin Luther University of Halle-Wittenberg, Halle (Saale), Germany;Department of Dermatology and Allergology, Ruhr University Bochum, Bochum, Germany

关键词: receiver operating characteristic;    clinical history;    strip patch test;    patch test;    CD69 up-regulation;    flow cytometric assay;    nickel sulfate;    Allergic contact dermatitis;   

Others  :  834446
DOI  :  10.1186/2047-783X-15-7-303

 received in 2009-11-10, accepted in 2010-03-01,  发布年份 2010

【 摘 要 】

Objective

The patch test (PT) with its modification - the strip patch test (SPT) - is the standard in vivo procedure to diagnose an allergic contact dermatitis (ACD). To date, none of the in vitro tests for the diagnosis of ACD fulfils the requirements of an easy, valid and reliable test. To investigate the prediction ability of a flow cytometric assay of CD69 up-regulation on CD4+ CLA+ T cells in nickel-sensitive and non-nickel-sensitive patients.

Methods

In a prospective, investigator-blinded, clinical study a total of 85 nickel-sensitive (n = 44; 51.8%) and non-nickel-sensitive patients (n = 41; 48.2%) were enrolled. The association between CD69 up-regulation on CD4+ CLA+ T cells on the one hand and PT, SPT, and clinical history on the other hand was measured. Association is expressed with c statistic values (receiver operating characteristic analysis) and corresponding 95% CIs.

Results

The associations were c = 0.57 (95% CI: 0.42-0.72) between CD69 up-regulation and PT, c = 0.49 (95% CI: 0.36-0.62) between CD69 up-regulation and SPT, and c = 0.51 (95% CI: 0.37-0.64) between CD69 up-regulation and clinical history.

Conclusions

CD69 up-regulation on CD4+ CLA+ T cells in vitro could not predict neither a positive PT or SPT result nor a positive clinical history to nickel sulfate. The combination of clinical history and patch testing still remains the basis for diagnosing ACD.

【 授权许可】

   
2010 I. Holzapfel Publishers

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Jadassohn J: Zur Kenntnis der medicamentösen Dermatosen. Verhandlungen der Deutschen Dermatologischen Gesellschaft, 5. In Kongreß, Graz, 1895. Braumüller, Wien; 1896:103-129.
• [2]Nethercott JR: Practical problems in the use of patch testing in the evaluation of patients with contact dermatitis. Curr Probl Dermatol 1990, 2:97-123.
• [3]Nethercott JR: Sensitivity and specificity of patch tests. Am J Contact Dermat 1994, 5:136-142.
• [4]Shuster S: Patch-test sensitivity and reproducibility in individuals and populations. Am J Contact Dermat 1992, 3:74-78.
• [5]Belsito DV, Storrs FJ, Taylor JS, Marks JG Jr, Adams RM, Rietschel RL, Jordan WP, Emmett EA: Reproducibility of Patch Tests: A United States Multicenter Study. Am J Contact Dermat 1992, 3:193-200.
• [6]Brasch J, Henseler T, Aberer W, Bäuerle G, Frosch PJ, Fuchs T, Fünfstück V, Kaiser G, Lischka GG, Pilz B, Sauer C, Schaller J, Scheuer B, Szliska C, Reproducibility of patch tests: A multicenter study of synchronous left-versus right-sided patch tests by the German Contact Dermatitis Research Group. J Am Acad Dermatol 1994, 31:584-591.
• [7]Spier HW, Natzel R: Chromatallergie und Zementekzem. Gewerbedermatologischer und analytischer Beitrag. Hautarzt 1953, 4:63-65.
• [8]Spier HW, Sixt I: Untersuchungen über die Abhängigkeit des Ausfalles der Ekzem-Läppchenproben von der Hornschichtdicke. Quantitativer Abriß-Epikutantest. Hautarzt 1955, 6:152-159.
• [9]Frosch PJ, Weickel R, Schmitt T, Krastel H: Nebenwirkungen von ophthalmologischen Externa. Z Hautkr 1988, 63:126-136.
• [10]Fernandes MFM, de Mello JF, Pires MC, Vizeu MCM: Comparative study of patch test using traditional method vs. prior skin abrading. J Eur Acad Dermatol Venereol 2007, 21:1351-1359.
• [11]Dickel H, Kamphowe J, Geier J, Altmeyer P, Kuss O: Strip patch test vs. conventional patch test: investigation of dose-dependent test sensitivities in nickel- and chromium-sensitive subjects. J Eur Acad Dermatol Venereol 2009, 23:1018-1025.
• [12]Dickel H, Scola N, Altmeyer P: The strip patch test - indication in occupational dermatology demonstrated with a case history. J Dtsch Dermatol Ges 2009, 11:965-967.
• [13]Lachapelle JM, Maibach HI: Patch Testing and Prick Testing - A Practical Guide (Official Publication of the ICDRG). 2nd Auflage, Springer-Verlag, Berlin Heidelberg; 2009.
• [14]Cederbrant K, Hultman P, Marcusson JA, Tibbling L: In vitro lymphocyte proliferation as compared to patch test using gold, palladium and nickel. Int Arch Allergy Immunol 1997, 112:212-217.
• [15]Cederbrant K, Anderson C, Andersson T, Marcusson-Stahl M, Hultman P: Cytokine production, lymphocyte proliferation and T-cell receptor Vbeta expression in primary peripheral blood mononuclear cell cultures from nickel-allergic individuals. Int Arch Allergy Immunol 2003, 132:373-379.
• [16]Brehler R, Merk H: In-vitro-Tests zum Nachweis von Kontaktallergien. Hautarzt 2005, 56:1141-1143.
• [17]Traidl-Hoffmann C, Ring J: Is there an in vitro test for type IV allergy discriminating between sensitization and allergic disease? Clin Exp Allergy 2008, 38:1412-1415.
• [18]Werfel T, Boeker M, Kapp A: Rapid expression of the CD69 antigen on T cells and natural killer cells upon antigenic stimulation of peripheral blood mononuclear cell suspensions. Allergy 1997, 52:465-469.
• [19]Granchi D, Ciapetti G, Savarino L, Stea S, Filippini F, Sudanese A, Rotini R, Giunti A: Expression of the CD69 activation antigen on lymphocytes of patients with hip prosthesis. Biomaterials 2000, 21:2059-2065.
• [20]Avgustin B, Kotnik V, Skoberne M, Malovrh T, Skralov nik-Stern A, Tercelj M: CD69 expression on CD4+ T lymphocytes after in vitro stimulation with tuberculin is an indicator of immune sensitization against Mycobacterium tuberculosis antigens. Clin Diagn Lab Immunol 2005, 12:101-106.
• [21]Beeler A, Zaccaria L, Kawabata T, Gerber BO, Pichler WJ: CD69 upregulation on T cells as an in vitro marker for delayed-type drug hypersensitivity. Allergy 2008, 63:181-188.
• [22]Moed H, Boorsma DM, Stoof TJ, von Blomberg BME, Bruynzeel DP, Scheper RJ, Gibbs S, Rustemeyer T: Nickel-responding T cells are CD4+ CLA+ CD45RO+ and express chemokine receptors CXCR3, CCR4 and CCR10. Br J Dermatol 2004, 151:32-41.
• [23]Schnuch A, Aberer W, Agathos M, Becker D, Brasch J, Elsner P, Frosch PJ, Fuchs T, Geier J, Hillen U, Löffler H, Mahler V, Richter G, Szliska C, für die Deutsche Kontaktallergie-Gruppe: Durchführung des Epikutantests mit Kontaktallergenen. Leitlinien der Deutschen Dermatologischen Gesellschaft (DDG) und der Deutschen Gesell schaft für Allergie und klinische Immunologie (DGAKI). J Dtsch Dermatol Ges 2008, 6:770-775.
• [24]Dickel H, Bruckner TM, Erdmann SM, Fluhr JW, Frosch PJ, Grabbe J, Löffler H, Merk HF, Pirker C, Schwanitz HJ, Weisshaar E, Brasch J: The "strip" patch test: results of a multicentre study towards a standardization. Arch Dermatol Res 2004, 296:212-219.
• [25]Fregert S: Manual of contact dermatitis. 2nd Auflage, Munksgaard, Copenhagen; 1981.
• [26]Lochmatter P, Beeler A, Kawabata TT, Gerber BO, Pichler WJ: Drug-specific in vitro release of IL-2, IL-5, IL-13 and IFN-gamma in patients with delayed-type drug hypersensitivity. Allergy 2009, 64:1269-1278.
• [27]Everness KM, Gawkrodger DJ, Botham PA, Hunter JAA: The discrimination between nickel-sensitive and non-nickel-sensitive subjects by an in vitro lymphocyte transformation test. Br J Dermatol 1990, 122:293-298.
• [28]Pate GE, Wu V, Webb JG: Nickel allergy: lack of correlation between systemic TH1 immune response and skin patch testing. J Invasive Cardiol 2005, 17:574.
• [29]Kimber I, Quirke S, Cumberbatch M, Ashby J, Paton D, Aldridge RD, Hunter JAA, Beck MH: Lymphocyte transformation and thiuram sensitization. Contact Dermatitis 1991, 24:164-171.
• [30]Lindemann M, Böhmer J, Zabel M, Grosse-Wilde H: ELISpot: a new tool for the detection of nickel sensitization. Clin Exp Allergy 2003, 33:992-998.
• [31]Gober MD, Gaspari AA: Allergic contact dermatitis. Edited by Nickoloff BJ, Nestle FO. Dermatologic immunity. Basel Freiburg Paris London New York Bangalore Bangkok Shanghai Singapore Tokyo Sydney: Karger; 2008:1-26.
• [32]Vocanson M, Hennino A, Rozières A, Poyet G, Nicolas JF: Effector and regulatory mechanisms in allergic contact dermatitis. Allergy 2009, 64:1699-1714.
• [33]Schoenberger SP, Crotty S: Immunologic memory. Edited by Paul WE. Fundamental immunology. 6th ed. Philadelphia Baltimore New York London Buenos Aires Hong Kong Sydney Tokyo: Lippincott Williams & Wilkins, a Wolters Kluwer business; 2008:862-897.
• [34]Murphy PM: Chemokines. Edited by Paul WE. Fundamental immunology. 6th Auflage. Philadelphia Baltimore New York London Buenos Aires Hong Kong Sydney Tokyo: Lippincott Williams & Wilkins, a Wolters Kluwer business; 2008:804-833.