Correlation between serum 25-hydroxyvitamin D3 and the severity of atopic dermatitis in children with allergic or nonallergenic sensitization

Yong Jin Hwang; Jin Wook Choi; Sung Woon Kim; Kwang Hae Choi; Myong Soon Sung

doi:10.4168/aard.2015.3.3.213

Journal List > Allergy Asthma Respir Dis > v.3(3) > 1059100

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Hwang, Choi, Kim, Choi, and Sung: Correlation between serum 25-hydroxyvitamin D3 and the severity of atopic dermatitis in children with allergic or nonallergenic sensitization

Original Article

Allergy, Asthma & Respiratory Disease 2015; 3(3): 213-218.

Published online: 29 May 2015

DOI: https://doi.org/10.4168/aard.2015.3.3.213

Correlation between serum 25-hydroxyvitamin D₃ and the severity of atopic dermatitis in children with allergic or nonallergenic sensitization

Yong Jin Hwang¹, Jin Wook Choi¹, Sung Woon Kim¹, Kwang Hae Choi², Myong Soon Sung³

¹Department of Pediatrics, Busan St. Mary's Hospital, Busan, Korea.

²Department of Pediatrics, Yeungnam University Medical Center, Daegu, Korea.

³Department of Pediatrics, CHA Gumi Medical Center, CHA University, Gumi, Korea.

Correspondence to: Myong Soon Sung. Division of Pediatric Allergy & Pulmonology, Department of Pediatrics, CHA Gumi Medical Center, CHA University, 12 Sinsi-ro 10-gil, Gumi 730-728, Korea. Tel: +82-54-450-9700, Fax: +82-54-450-9970, myong47@daum.net

Received 16 October 2014 Revised 13 March 2015 Accepted 14 March 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/).

Abstract

Purpose

The aim of this study was to assess the relationship between serum 25-hydroxyvitamin D₃ levels and the severity of atopic dermatitis (AD), markers of atopy (total IgE, total eosinophil count, and eosinophil cationic protein) in AD children according to allergen sensitization.

Methods

This cross-sectional study was carried out on 160 AD patients aged 1 to 18 years between March 2012 and August 2014. The AD patients (AD group) were subdivided into 2 categories according to the results of the allergic skin prick and Unicap tests: the allergic and nonallergic AD groups. We compared 25-hydroxyvitamin D₃ levels between the AD and control groups. We also investigated relationships between serum 25-hydroxyvitamin D₃ levels, the severity of AD, and markers of AD (total IgE, total eosinophil count, and eosinophil cationic protein) in the allergic and nonallergic AD groups.

Results

The average 25-hydroxyvitamin D₃ levels were 30.6±11.7 and 23.7±10.0 ng/mL, respectively, in the control and AD groups (P<0.001). The average 25-hydroxyvitamin D₃ levels were 19.7±8.6 and 27.5±9.8 ng/mL, respectively, in the allergic and nonallergic AD groups, with clinical implications (P<0.001). The 25-hydroxyvitamin D₃ levels were not significantly associated with SCORing Atopic Dermatitis index in the allergic (P=0.004, r=-0.092) or nonallergic (P=0.610, r=-0.58) AD groups. The 25-hydroxyvitamin D₃ levels were not significantly associated with the aforementioned markers of atopy in the AD group.

Conclusion

These results suggest that 25-hydroxyvitamin D₃ may play a role in the pathogenesis of AD.

Keywords: Atopic dermatitis, Allergens, 25-hydroxyvitamin D₃

Figures and Tables

Fig. 1

Number of children who were eligible for the study.

Fig. 2

The 25-hydroxyvitamin D₃ levels of allergen and nonallergen patients according to the severity of atopic dermatitis.

Table 1

Comparison of characteristics in the study subjects

Variable	Control (n=150)	Atopic dermatitis				P-value^†
Variable	Control (n=150)	Allergen (+) (n = 80)	Allergen (-) (n = 80)	Total (n = 160)	P-value^*	P-value^†
Boy	61 (40.7)	34 (50.0)	43 (37.5)	70 (43.8)	0.111	0.583
Age (yr)	4.0 ± 4.2 (1-18)	5.8 ± 4.6 (1-17)	3.9 ± 3.3 (1-17)	4.9 ± 4.1 (1-17)	0.003	0.076

Values are presented as number (%) or mean±standard deviation (range).

^*Allergen (-) compared with allergen (+). ^†Control compared with atopic dermatitis.

Table 2

Comparison of SCORAD index and atopic markers in atopic dermatitis patients

Variable	Atopic dermatitis			P-value
Variable	Allergen (+) (n = 80)	Allergen (-) (n = 80)	Total (n = 160)	P-value
SCORAD index	36.5±20.3	29.9±17.3	33.21±19.07	0.028
Severity	80 (100)	80 (100)	160 (100)	0.128
Mild	15 (18.8)	19 (23.8)	34 (21.2)
Moderate	33 (41.2)	41 (51.2)	74 (46.3)
Severe	32 (40.0)	20 (25.0)	52 (32.5)
Total IgE (IU/mL)	818.0±986.7	74.0±157.9	-	<0.001
ECP (µg/L)	16.5±16.7	14.6±18.8	-	0.502
Total eosinophil count (/µL)	580.6±563.5	356.0±224.2	-	0.001

Values are presented as mean±standard deviation or number (%).

SCORAD, SCORing Atopic Dermatitis; ECP, eosinophil cationic protein.

Table 3

The 25-hydroxyvitamin D3 levels in the study subjects

Variable	Control (n=150)	Atopic dermatitis				P-value^†
Variable	Control (n=150)	Allergen (+) (n = 80)	Allergen (-) (n = 80)	Total (n = 160)	P-value^*	P-value^†
25-Hydroxyvitamin D₃ (ng/mL)	30.6 ± 11.7	19.7 ± 8.6	27.5 ± 9.8	23.7 ± 10.0	<0.001	<0.001
Vitamin D status	150 (100)	80 (100)	80 (100)	160 (100)	<0.001	<0.001
Sufficient (≥30)	86 (57.4)	8 (10.0)	30 (37.5)	38 (23.7)
Insufficient (20-29.9)	35 (23.3)	32 (40.0)	28 (35.0)	60 (37.5)
Deficient (<20)	29 (19.3)	40 (50.0)	22 (27.5)	62 (38.8)

Values are presented as mean±standard deviation or number (%).

^*Allergen (-) compared with allergen (+). ^†Control compared with atopic dermatitis.

Table 4

The 25-hydroxyvitamin D3 levels according to age in the study subjects

Age (yr)	Control (n=150)		Atopic dermatitis (n=160)		P-value
Age (yr)	No. (%)	25-Hydroxyvitamin D₃	No. (%)	25-Hydroxyvitamin D₃	P-value
1-5	118 (78.7)	33.81 ± 11.61	112 (70.0)	26.18 ± 9.43	< 0.001
6-10	15 (10.0)	24.00 ± 12.17	22 (13.8)	22.23 ± 9.52	0.021
11	17 (11.3)	18.69 ± 13.89	26 (16.2)	14.07 ± 5.97	0.001

Values are presented as mean±standard deviation unless otherwise indicated.

Table 5

Relation between 25-hydroxyvitamin D3 levels and factors in atopic dermatitis patients with or without allergen

Factor	Allergen (+)		Allergen (-)
Factor	Correlation (r)	P-value	Correlation (r)	P-value
SCORAD Index	-0.092	0.004	-0.058	0.610
Total IgE (IU/mL)	-0.204	0.069	-0.109	0.337
ECP (µg/L)	-0.092	0.419	0.081	0.476
Total eosinophil count (/µL)	-0.138	0.222	0.106	0.348

SCORAD, SCORing Atopic Dermatitis; ECP, eosinophil cationic protein.

References

1. Holick MF. Vitamin D deficiency. N Engl J Med. 2007; 357:266–281.

2. Binkley N, Novotny R, Krueger D, Kawahara T, Daida YG, Lensmeyer G, et al. Low vitamin D status despite abundant sun exposure. J Clin Endocrinol Metab. 2007; 92:2130–2135.

3. Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B. Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr. 2006; 84:18–28.

4. Suh SH. Prevalence of allergic diseases in Korean children, 2010. Public Health Wkly Rep. 2011; 4:425–431.

5. Bieber T. Atopic dermatitis. N Engl J Med. 2008; 358:1483–1494.

6. Benson AA, Toh JA, Vernon N, Jariwala SP. The role of vitamin D in the immunopathogenesis of allergic skin diseases. Allergy. 2012; 67:296–301.

7. Roider E, Ruzicka T, Schauber J. Vitamin D, the cutaneous barrier, antimicrobial peptides and allergies: is there a link? Allergy Asthma Immunol Res. 2013; 5:119–128.

8. Mutgi K, Koo J. Update on the role of systemic vitamin D in atopic dermatitis. Pediatr Dermatol. 2013; 30:303–307.

9. Bikle DD. Vitamin D metabolism and function in the skin. Mol Cell Endocrinol. 2011; 347:80–89.

10. Wang TT, Nestel FP, Bourdeau V, Nagai Y, Wang Q, Liao J, et al. Cutting edge: 1,25-dihydroxyvitamin D3 is a direct inducer of antimicrobial peptide gene expression. J Immunol. 2004; 173:2909–2912.

11. Peroni DG, Piacentini GL, Cametti E, Chinellato I, Boner AL. Correlation between serum 25-hydroxyvitamin D levels and severity of atopic dermatitis in children. Br J Dermatol. 2011; 164:1078–1082.

12. Chiu YE, Havens PL, Siegel DH, Ali O, Wang T, Holland KE, et al. Serum 25-hydroxyvitamin D concentration does not correlate with atopic dermatitis severity. J Am Acad Dermatol. 2013; 69:40–46.

13. Reitamo S, Rustin M, Harper J, Kalimo K, Rubins A, Cambazard F, et al. A 4-year follow-up study of atopic dermatitis therapy with 0.1% tacrolimus ointment in children and adult patients. Br J Dermatol. 2008; 159:942–951.

14. Park JH, Choi YL, Namkung JH, Kim WS, Lee JH, Park HJ, et al. Characteristics of extrinsic vs. intrinsic atopic dermatitis in infancy: correlations with laboratory variables. Br J Dermatol. 2006; 155:778–783.

15. Pugliarello S, Cozzi A, Gisondi P, Girolomoni G. Phenotypes of atopic dermatitis. J Dtsch Dermatol Ges. 2011; 9:12–20.

16. Schmid-Grendelmeier P, Simon D, Simon HU, Akdis CA, Wüthrich B. Epidemiology, clinical features, and immunology of the "intrinsic" (non-IgE-mediated) type of atopic dermatitis (constitutional dermatitis). Allergy. 2001; 56:841–849.

17. Hanifin JM, Raika G. Diagnostic features of atopic dermatitis. Acta Derm Venereol Suppl (Stockh). 1980; 92:44–47.

18. Oranje AP, Glazenburg EJ, Wolkerstorfer A, de Waard-van der Spek FB. Practical issues on interpretation of scoring atopic dermatitis: the SCORAD index, objective SCORAD and the three-item severity score. Br J Dermatol. 2007; 157:645–648.

19. Adinoff AD, Rosloniec DM, McCall LL, Nelson HS. Immediate skin test reactivity to Food and Drug Administration-approved standardized extracts. J Allergy Clin Immunol. 1990; 86:766–774.

20. Rosen CJ. Clinical practice. Vitamin D insufficiency. N Engl J Med. 2011; 364:248–254.

21. El Taieb MA, Fayed HM, Aly SS, Ibrahim AK. Assessment of serum 25-hydroxyvitamin d levels in children with atopic dermatitis: correlation with SCORAD index. Dermatitis. 2013; 24:296–301.

22. Hilger J, Friedel A, Herr R, Rausch T, Roos F, Wahl DA, et al. A systematic review of vitamin D status in populations worldwide. Br J Nutr. 2014; 111:23–45.

23. Choi EY. 25(OH)D status and demographic and lifestyle determinants of 25(OH)D among Korean adults. Asia Pac J Clin Nutr. 2012; 21:526–535.

24. Choi HS, Oh HJ, Choi H, Choi WH, Kim JG, Kim KM, et al. Vitamin D insufficiency in Korea: a greater threat to younger generation: the Korea National Health and Nutrition Examination Survey (KNHANES) 2008. J Clin Endocrinol Metab. 2011; 96:643–651.

25. Akan A, Azkur D, Ginis T, Toyran M, Kaya A, Vezir E, et al. Vitamin D level in children is correlated with severity of atopic dermatitis but only in patients with allergic sensitizations. Pediatr Dermatol. 2013; 30:359–363.

26. Lee SA, Hong S, Kim HJ, Lee SH, Yum HY. Correlation between serum vitamin d level and the severity of atopic dermatitis associated with food sensitization. Allergy Asthma Immunol Res. 2013; 5:207–210.

27. Noh GW, Lee KY. Blood eosinophils and serum IgE as predictors for prognosis of interferon-gamma therapy in atopic dermatitis. Allergy. 1998; 53:1202–1207.

28. Gutgesell C, Heise S, Seubert A, Stichtenoth DO, Frolich JC, Neumann C. Comparison of different activity parameters in atopic dermatitis: correlation with clinical scores. Br J Dermatol. 2002; 147:914–919.

29. Gebhardt M, Wenzel HC, Hipler UC, Herrmann D, Wollina U. Monitoring of serologic immune parameters in inflammatory skin diseases. Allergy. 1997; 52:1087–1094.

30. Kim MN, Shin BJ, Tak WJ, Ro BI, Park AJ. Eosinophil counts in peripheral blood, serum total IgE, eosinophil cationic protein, IL-4 and soluble e-selectin in atopic dermatitis. Korean J Dermatol. 2002; 40:1367–1373.

31. Simon D, Braathen LR, Simon HU. Eosinophils and atopic dermatitis. Allergy. 2004; 59:561–570.

32. Gleich GJ, Adolphson CR. The eosinophilic leukocyte: structure and function. Adv Immunol. 1986; 39:177–253.

33. Nahm DH, Kim ME, Shin YS, Ye YM, Park HS. Prevalence of vitamin D deficiency and clinical efficacy of vitamin D supplementation in patients with atopic dermatitis [abstract]. In : Program and Abstract, the Annual Spring Meeting of the Korean Academy of Asthma, Allergy and Clinical Immunology; 2012 May 25-26; Seoul, Korea. Seoul: the Korean Academy of Asthma, Allergy and Clinical Immunology;2012.

TOOLS

Similar articles