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Please cite this paper as: CC chemokines as potential immunologic markers correlated with clinical improvement of atopic dermatitis patients by immunotherapy. Experimental Dermatology 2010; 19: 246–251. Although immunotherapy is not accepted as a curative treatment for atopic dermatitis (AD), most studies have shown positive effects of immunotherapy on AD patients. The serum levels of CC chemokine ligand 17 (CCL17), CCL22 and CCL18 have been reported to be highly correlated with disease severity, which suggests important roles for CC chemokines in the pathogenesis of AD. Objective: The purpose of this study was to investigate the changes in clinical and immunologic markers before and after immunotherapy and to find which CC chemokines correlate with clinical improvement after immunotherapy with house dust mite (HDM) allergens in AD patients. Methods and Results: A total of 20 AD patients who were sensitized to HDM allergens through a skin-prick test and Pharmacia CAP system were treated with subcutaneous immunotherapy using HDM allergens (treatment duration 12–60 months). Eczema area and severity index scores in 20 patients with AD decreased significantly after immunotherapy ( P < 0.001). Serum total immunoglobulin E (IgE) and Dermatophagoides pteronyssinus-specific IgE levels tended to decrease after treatment although this was not statistically significant, and the D. farinae-specific IgE level showed no change. Serum CCL17, CCL22 and CCL18 levels decreased significantly from baseline after treatment ( P = 0.043, 0.017 and <0.001, respectively). The percentage reductions in serum CCL17 and CCL22 level were significantly correlated with reductions in disease severity ( P = 0.007, R2 = 0.301 and P = 0.037, R2 = 0.177, respectively). Conclusion: We suggest that CCL17 and CCL22 are good immunological marker candidates that can be used to assess clinical improvement after immunotherapy in AD patients. [ABSTRACT FROM AUTHOR]

Background: Although most patients with atopic dermatitis (AD) show high total and allergen-specific serum immunoglobulin E (IgE) levels, a small subgroup of AD patients have normal total IgE levels and negative serum allergen-specific IgE. This subgroup has been termed ‘intrinsic’ AD (IAD) as a counterpart to ‘extrinsic’ AD (EAD). However, the difference of chemokines between IAD and EAD has not yet been evaluated. Objective: We investigated the expression of CC chemokine ligand (CCL) 17, CCL22, and CCL18 in patients with IAD and EAD, which are known to be highly expressed in AD patients. Methods: We assessed the protein levels of these chemokines in peripheral blood mononuclear cells (PBMCs), sera and lesional skins. We also evaluated CCL18 mRNA levels in monocytes, Langerhans cell (LC)-like dendritic cells (DCs) and inflammatory dendritic epidermal cell (IDEC)-like DCs from both types of AD patients. Results: There were no significant differences in CCL17 and CCL22 expression in PBMCs, sera and lesional skins of patients with IAD and EAD. CCL18 expression did not differ in PBMCs, sera and LC-like DCs from the two subgroups, but strong CCL18 expression was observed in lesional skins and IDEC-like DCs in patients with EAD. Lastly, serum CCL18 levels significantly decreased after immunotherapy. Conclusion: This study suggests that the chemokine micromilieu, especially the level of CCL18, is different between EAD and IAD patients. High FcεRI surface-expressing DCs, such as IDEC, were the major source of CCL18, and produced a prominent CCL18 microenvironment in EAD patients compared with IAD patients. [ABSTRACT FROM AUTHOR]