The prevalence of antibody responses against Staphylococcus aureus antigens in patients with atopic dermatitis: a systematic review and meta-analysis

Abstract

Staphylococcus (S.) aureus plays a role in the pathogenesis of atopic dermatitis (AD), possibly via the expression of various virulence antigens. An altered antibody response towards these antigens might contribute to inflammation. We aimed to provide an overview of the varying prevalences and odds of antibody responses against S. aureus antigens in AD patients. Data were systematically obtained from Embase, Medline, Web of Science, Scopus, Cochrane, PubMed and Google Scholar (up to February 12^th 2016). We selected all original observational and experimental studies assessing anti-staphylococcal antibodies in serum of AD patients. Prevalences and odds ratios (ORs) of immunoglobulin (Ig) E, IgG, IgM, IgA against S. aureus in AD patients versus healthy controls were pooled using the random-effects model. We calculated I² statistics to assess heterogeneity and rated study quality using the Newcastle-Ottawa Scale. Twenty-six articles (2369 patients) were included of which 10 controlled studies. Study quality was fair to poor. AD patients had higher prevalences of IgE against staphylococcal enterotoxin (SE) A (OR 8.37, 95% CI 2.93-23.92) and SEB (OR 9.34, 95% CI 3.54-24.93) compared to controls. Prevalences of anti-staphylococcal IgE were 33% for SEA, 35% for SEB and 16% for toxic shock syndrome toxin (TSST)-1. However, study heterogeneity and imprecision should be taken into consideration when interpreting the results. Data on IgG, IgM and IgA as well as other antigens are limited. In conclusion, AD patients more often show an IgE antibody response directed against S. aureus superantigens compared to healthy controls supporting a role for S. aureus in the AD pathogenesis.

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