Environment-dependent alterations of immune mediators in urban and rural south African children with atopic dermatitis

Background In order to improve targeted therapeutic approaches for children with atopic dermatitis (AD), novel insights into the molecular mechanisms and environmental exposures that differentially contribute to disease phenotypes are required. We wished to identify AD immunological endotypes in South African children from rural and urban environments. Methods We measured immunological, socio-economic and environmental factors in healthy children (n = 74) and children with AD (n = 78), in rural and urban settings from the same ethno-linguistic AmaXhosa background in South Africa. Results Circulating eosinophils, monocytes, TARC, MCP-4, IL-16 and allergen-specific IgE levels were elevated, while IL-17A and IL-23 levels were reduced, in children with AD regardless of their location. Independent of AD, children living in a rural environment had the highest levels of TNF alpha, TNF beta, IL-1 alpha, IL-6, IL-8, IL-21, MCP-1, MIP-1 alpha, MIP-1 beta, MDC, sICAM1, sVCAM1, VEGFA, VEGFD and Tie2, suggesting a generalized microinflammation or a pattern of trained immunity without any specific T-H polarization. In contrast, IL-15, IL-22, Flt1, PIGF and beta FGF were highest in urban children. Rural healthy children had the lowest levels of food allergen-specific IgG4. Early life nutritional factors, medications, animal exposures, indoor environment, sunlight exposure, household size, household income and parental education levels were associated with differences in circulating cytokine levels. Conclusions This study highlights the immunological impact of environmental exposures and socio-economic status in the manifestation of immune endotypes in children with AD living in urban and rural areas, which are important in selecting appropriately matched immunological therapies for treatment of AD.

Automated summary

This study found that children with AD had elevated levels of certain immune markers regardless of their location, while children living in rural areas had higher levels of various cytokines compared to urban children. Factors such as early life nutrition, medications, and environmental exposures were associated with differences in circulating cytokine levels in children with AD.