Increased vagal modulation in atopic dermatitis
Introduction
Neurogenic and psychoemotional factors have been recognized to exacerbate symptoms and to trigger episodes in diseases belonging to the field of atopy and allergy [1]. One of these diseases that are characterized by chronic relapse and significant discomfort is atopic dermatitis. Dermatitis severity is associated with stress perception, anxiety or depression [2], [3], [4], [5]. In recent years, several pathways via which stress might influence atopic or allergic disease have been identified [6]. First, an abnormal activation of the hypothalamic-pituitary-adrenocortical axis might account for neuro-immune interaction [1], [7], [8]. Second, stress-induced local inflammation can be caused by nerve fiber–mast cell interactions, possibly mediated by neuropeptides such as substance P (SP) [9], and third, increased sympathetic activity has been described [1]. The latter might directly or indirectly affect the inflammatory response with increased numbers of eosinophils, increased levels of IgE and interferon-γ, or decreased concentrations of the anti-inflammatory cytokine interleukin-4 [10]. However, an autonomic dysbalance leading to changes in vagal modulation might play an important role, since anti-inflammatory effects have been described for efferent vagal activity [11], [12].
To date, the cardiac autonomic system has not been examined in atopic dermatitis in detail. In distantly related diseases such as bronchial asthma or allergic rhinitis, however, autonomic alterations have been reported, predominately showing parasympathetic predominance [13], [14].
Interestingly, in the psychiatric diseases that are associated with atopic dermatitis, i.e. depression or anxiety, an autonomic dysbalance with decreased parasympathetic modulation has been described. For instance, both short and long-term complexity measures of heart rate modulation indicating parasympathetic activity have been shown to be reduced in major depression [15], [16] or during treatment [17]. Furthermore, a relative decrease of vagal activity has repeatedly been described for anxiety [18], [19].
Here, we tested the hypothesis that an autonomic dysbalance can be determined for patients suffering from atopic dermatitis by means of heart rate variability (HRV) measures. Furthermore, we aimed to assess whether autonomic alterations mirror those seen in other atopic diseases or those known for the described psychiatric symptoms, i.e. increased or decreased parasympathetic modulation, respectively. For this purpose, we investigated 30 dermatitis patients and 30 controls matched with respect to age, gender and smoking behaviour. In addition to the electrophysiological recordings, scores for disease activity and psychosocial stressors were obtained and correlated with cardiac autonomic parameters.
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Participants
Thirty patients suffering from atopic dermatitis according to the diagnostic criteria of Hanifin and Rajka [20] were recruited for the study (mean age: 34; age range: 24–48; 9 male, 21 female). Exclusion criteria were an age below 18 or above 50 years, any cardiopulmonary (except asthma) or endocrine diseases, current or recent medication with beta-receptor antagonists, calcium channel antagonists or vasodilators. An on-demand medication with analgesic substances such as acetyl salicylic acid
Patient characteristics
Patients did not significantly differ from controls regarding demographic characteristics. For clinical parameters, see Table 1. Mean values of SCL-90-R values did not significantly differ between groups for any of the subscales assessed (see Table 2).
Heart rate variability measures
When comparing heart rate variability parameters obtained from patients and controls, multivariate analysis revealed a significant group effect [F(13,42) = 2.568; p < 0.01]. Post hoc t-tests showed significant group differences for heart rate at rest
Discussion
Here, we describe autonomic dysbalance in patients suffering from atopic dermatitis. Overall, parameters indicating parasympathetic heart rate modulation such as RMSSD are increased in patients as compared to controls. Therefore, the autonomic state in this disease is similarly altered as observed in related conditions such as allergy or atopy [13], [14]. For the latter, increased parasympathetic modulation has repeatedly been reported. Some of the parasympathetic parameters even correlated
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