British Journal of Dermatology (1979) 100,491.

Clinical and Laboratory Investigations

Immune status in atopic eczema: a survey N.A.BYROM AND D.M.TIMLIN Departments of Chemical Pathology and Computer Medicine, Westminster Hospital and Medical School, London SWi Accepted for publication 27 October 1978

SUMMARY

We have searched the literature for data on the in vitro assessment of immune status in atopic eczema patients, and have found much confusion. The major findings are tabulated. It is concluded that atopic eczema is a form of immune deficiency, although it is unclear whether this is a primary or secondary defect. Most authors find a T-lymphocyte deficit while eosinophils, B lymphocytes and serum IgE are increased. Serum IgE levels appear to be correlated with severity of eczema symptoms. We have previously suggested that T-lymphocyte levels are overestimated in eczema when fetal calf serum is used in the E-rosette assay. Analysis of the literature for the effect of this serum in the assay confirms that there is a T-lymphocyte deficit in atopic eczema, but that the serum masks it. Thus, much of the confusion surrounding this issue can be resolved.

Many papers have been written on the immune status of patients with atopic disorders. Most report one or more abnormalities (e.g. a T-lymphocyte deficit, skin-test hyporeactivity to intradermal antigens, and/or hyperimmunoglobulinaemia E), although such findings are highly controversial. This paper analyses the reports of the vast majority of studies of immunity in atopic eczema patients and simimarizes the major findings. For simplicity, the results of the very wide range of tests for Tlymphocyte function have been omitted. The ability of a lymphocyte to form a spontaneous (E) rosette with sheep red blood cells identifies that cell as a thymus-dependent (T) cell (Jondal, Holm & Wigzell, 1972; Wybran et al, 1973), and this test has been used by most authors investigating cellular immunity in atopy. Elsewhere in this issue is a paper relating to thirty children with atopic eczema, analysed in the authors' laboratory according to the parameters discussed here. METHODS

Atopic eczema survey The literature was searched for papers on the immime status of patients with atopic eczema. In all, forty papers were found (Table i): thirty-four on eczema (over 1,208 patients); six on atopic allergy Correspondence: Dr N.A. Byrom, Department of Chemical Pathology, Westminster Medical School, 17 Page Street, London, SWiP 2AR. CXD07-0963/79/0500-0491 $02.00 © 1979 British Association of Dermatologists

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