Pimecrolius on T cell Responses in Atopic March

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DESCRIPTION (provided by applicant): The overall goal of this project is to understand the atopic march and the role of the skin in this process of systemic allergen sensitization in children with atopic dermatitis (AD). Our overall hypothesis is that AD results in increased skin allergen absorption and systemic allergen sensitization reflected in high IgE levels. This makes patients with AD prone to the development of respiratory allergy (Atopic March). Improving skin barrier function with prophylactic topical pimecrolimus would reduce allergen absorption, allergen sensitization and reduce the prevalence of asthma. This would be evidenced by a decreased expression of cutaneous leukocyte antigen (CLA)+ TH2 cells in the pimecrolimus treated group. The clinical trial of pimecrolimus "A 3-year, randomized, double-blind vehicle controlled study to evaluate the safety and efficacy of Elidel 1% cream in modifying the course of AD in infants" is being supported by Novartis Pharmaceutical Co. provides an unique opportunity to study the mechanism of atopic dermatitis and the atopic march. Our proposed study has three aims in examining the atopic march and possible prevention. The first aim will examine specific and total allergen sensitization by allergen-specific and total IgE. The second aim will be examining mechanistic parts of this study. We will explore the frequency of skin homing T cells, their cytokine expression and the effect of staphylococcal superantigen on their expression. In third aim of the trial, we explore the effects of pimecrolimus as a disease-modifying agent in the prevention of asthma. Asthma phenotype will be examined by spirometry per and post-beta-2-agonist and exhaled nitric oxide.