Increased levels of urinary leukotriene E4 in children with severe atopic eczema/dermatitis syndrome

Background: Leukotrienes are thought to play a role in the pathogenesis of atopic eczema/dermatitis syndrome (AEDS). Urinary leukotriene E4 (U-LTE4) is a marker of whole-body cysteinyl-leukotriene production. Aims of the study: To evaluate the role of leukotrienes in children with AEDS by measuring levels of U-LTE4, and to evaluate whether levels of U-LTE4 may reflect disease activity and allergic sensitization in AEDS. Methods: U-LTE4 was measured by enzyme-linked immunosorbent assay in 87 children with mild (n = 32), moderate (n = 34) and severe (n = 21) AEDS, as well as in 72 nonatopic healthy controls. Fifty-eight of the children with AEDS were sentitized to common allergens, and 29 were not. Results: Levels of U-LTE4 were higher in children with severe AEDS (140; 66-166 mug/mmol creatinine, median; quartiles) than in controls (52; 30-90, P < 0.05), whereas levels of U-LTE4 in moderate and mild disease were similar to controls. U-LTE4 levels were similar in children with or without sensitization to common allergens, but severe AEDS children with sensitization had higher levels of U-LTE4 than those without sensitization. Conclusion: The results suggest a role for leukotrienes in the pathogenesis of severe AEDS, and may support a role for leukotriene-antagonists in the treatment of this disorder. Levels of U-LTE4 may reflect the disease severity and sensitization to allergens in AEDS.