Enhancement of in vitro spontaneous IgE production by topical steroids in patients with atopic dermatitis

Background: Atopic dermatitis (AD) is an inflammatory skin disease. Although topical steroids are widely used for AD, management of severe AD is not satisfactory because of relapse or occasional aggravation of symptoms. Moreover, glucocorticoids induce in vitro IgE production. On the other hand, topical sodium cromoglycate (SCG) solution is a safe and effective treatment for AD. Methods: We treated 43 patients with AD with SCG solution (n = 21) or with topical steroids, beclomethasone dipropionate (BD) ointment (n = 22). After 2 weeks, clinical evaluation and spontaneous immunoglobin production by peripheral blood B cells or surface IgE(+) B cells from patients in the SCG and BD groups were assessed. Results: Both SCG and BD treatment remarkably eczema. However, although SCG treatment decreased spontaneous IgE production by B cells without affecting production of IgG, IgM, or IgA, BD treatment selectively increased spontaneous IgE production. SCG treatment also decreased IgE production by surface IgE(+) B cells, whereas BD treatment increased it. Conclusion: Topical steroid treatment increases in vitro spontaneous IgE production by B cells. This indicates that topical steroids may decrease inflammation; however, a large-scale study on the effect of topical steroids on IgE production in vitro and in vivo may be necessary.