Exacerbation of atopic dermatitis on grass pollen exposure in an environmental challenge chamber

J Allergy Clin Immunol. 2015 Jul;136(1):96-103.e9. doi: 10.1016/j.jaci.2015.04.015. Epub 2015 Jun 1.


Background: It has frequently been speculated that pruritus and skin lesions develop after topical exposure to aeroallergens in sensitized patients with atopic dermatitis (AD).

Objective: We sought to study cutaneous reactions to grass pollen in adult patients with AD with accompanying clear IgE sensitization to grass allergen in an environmental challenge chamber using a monocenter, double-blind, placebo-controlled study design.

Methods: Subjects were challenged on 2 consecutive days with either 4000 pollen grains/m(3) of Dactylis glomerata pollen or clean air. The severity of AD was assessed at each study visit up to 5 days after challenge by (objective) scoring of AD (SCORAD). Additionally, air-exposed and non-air-exposed skin areas were each scored using local SCORAD scoring and investigator global assessments. Levels of a series of serum cytokines and chemokines were determined by using a Luminex-based immunoassay. The primary end point of the study was the change in objective SCORAD scores between prechallenge and postchallenge values.

Results: Exposure to grass pollen induced a significant worsening of AD. A pronounced eczema flare-up of air-exposed rather than covered skin areas occurred. In grass pollen-exposed subjects a significantly higher increase in CCL17, CCL22, and IL-4 serum levels was observed.

Conclusions: This study demonstrates that controlled exposure to airborne allergens of patients with a so-called extrinsic IgE-mediated form of AD induced a worsening of cutaneous symptoms.

Keywords: Atopic dermatitis; environmental challenge chamber; exposure; grass pollen; inhalant allergen.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Allergens / adverse effects
  • Allergens / immunology
  • Atmosphere Exposure Chambers / adverse effects
  • Chemokine CCL17 / blood
  • Chemokine CCL22 / blood
  • Dactylis
  • Dermatitis, Atopic / immunology*
  • Disease Progression
  • Eczema / immunology*
  • Environmental Exposure / adverse effects
  • Female
  • Humans
  • Immunoglobulin E / blood
  • Interleukin-4 / blood
  • Male
  • Pollen / immunology
  • Pruritus / immunology*
  • Young Adult


  • Allergens
  • Chemokine CCL17
  • Chemokine CCL22
  • Interleukin-4
  • Immunoglobulin E