Atopic dermatitis is a chronic relapsing pruritic skin disease, which affects up to 5% of the

adult population and up to 10% of children. It often progresses to asthma and allergic rhinitis
later in life.[1] Atopic dermatitis is characterized by two phases: an initial phase with acute
lesions, predominated by T helper cell type 2 (Th2) cytokines followed by a second Th1-
dominated phase that is associated with eczematous chronic atopic dermatitis lesions. In this
regard, atopic dermatitis is different from other forms of acute allergic manifestations, as it
exhibits a mixture of type I and type IV-like hypersensitivity reactions. The Th1 response is
associated with the predominance of interferon-γ and IL-12, whereas the Th2 immune response
is associated with the predominance of IL-4, IL-5 and IL-13

IL-4: IL-4 stimulates and maintains TH2 cell proliferation and switches B cells to IgE
synthesis.
IL-5: IL-5 is key in the maturation, chemotaxis, activation, and survival of eosinophils. IL-
5 primes basophils for histamine and leukotriene release.
IL-6: IL-6 promotes mucus production.
IL-13: IL-13 has many of the same effects as IL-4.
Tumor necrosis factor-alpha: Tumor necrosis factor-alpha is a pro-inflammatory cytokine
which activates neutrophils and eosinophils and increases monocyte chemotaxis

Histamine: This mediator acts on histamine 1 (H1) and histamine 2 (H2) receptors to cause
contraction of smooth muscles of the airway and GI tract, increased vasopermeability and
vasodilation, enhanced mucus production, pruritus, cutaneous vasodilation, and gastric acid
secretion.
Tryptase: Tryptase is a major protease released by mast cells. Its role is not completely
understood, but it can cleave C3, C3a, and C5 in addition to playing a role in airway remodeling.
[11, 8]
Tryptase is found in all human mast cells but in few other cells and thus is a good marker
of mast cell activation.
Proteoglycans: Proteoglycans include heparin and chondroitin sulfate. The role of the latter
is unknown; heparin seems to be important in storing the preformed proteases and may play a
role in the production of alpha-tryptase.
Chemotactic factors: An eosinophilic chemotactic factor of anaphylaxis causes eosinophil
chemotaxis; an inflammatory factor of anaphylaxis results in neutrophil chemotaxis.
Eosinophils release major basic protein and, together with the activity of neutrophils, can cause
significant tissue damage in the later phases of allergic reactions.