Background: Identification of biomarkers is required for a systems medicine approach and personalized treatment in AD. These biomarkers may not only aid in diagnosing but also might be suitable to predict the effectiveness of targeted treatment. Objective: We aimed to identify proteomic, microbial, and miRNA biomarkers in atopic dermatitis patients and investigated their course in relation to the clinical response upon anti-IL-4Rα therapy. Methods: Proteomic and miRNA screening was performed in AD patients in comparison to healthy controls. Differentially regulated serum proteins, miRNA, and selected skin microbiota were measured consecutively in 50 AD patients before and upon systemic dupilumab treatment. A random forest classifier was used to predict the outcome of dupilumab therapy based on the initial biomarker patterns. Results: We identified 27 proteomic candidates, miRNA, and 3 microbial strains to be dysregulated in AD. Besides the well-known chemokine CCL17 other proteins i.e., CCL13, CCL22, E-selectin and BDNF were differently regulated and significantly associated with treatment response. By contrast neither the microbial changes nor the miRNA pattern were found to be associated with treatment response upon dupilumab treatment. Conclusion: AD patients display defined dysregulations regarding their systemic proteomic serum profile, miRNA patterns, and their skin microbiome. The proteomic profile and selekted skin bacteria changed profoundly upon anti-IL-4Rα therapy which was associated with an overall clinical response. This was not seen in miRNA-related biomarkers. Our findings support the hypothesis that biomarker profiles reflect treatment responses and may in the future be used to develop a personalized medicine approach for the treatment of atopic dermatitis patients.

Introduction and objective Drugs are a frequent cause of severe anaphylactic reactions. Clinical epidemiology of drug-induced anaphylaxis (DIA) supports the identification of the most frequent eliciting drug groups, risk factors, symptoms and treatment procedures. Our aim was to analyze data to promote better recognition and long-term management of affected individuals. Methods Data from the European Anaphylaxis Registry (2007-2019) with 1,815 cases of drug-induced anaphylaxis were analyzed regarding demographics, elicitors, symptoms, comorbidities, and treatment. Results The most frequent eliciting groups of drugs were analgesics (41.27%) – with non-steroidal anti-inflammatory drugs (NSAIDs) being the most common subgroup (65.42%) – antibiotics (33.17%), local anesthetics (7.38%) and radiocontrast media (5.18%). Adrenaline was used more often in patients with DIA (23.20%) than in anaphylaxis due to other causes (17.82%). The majority of events occurred in female patients (65.34%), although they were admitted to hospital (29.01%) or an intensive care unit (ICU) (9.61%) less often. Skin symptoms were most common (84.02%), while gastrointestinal symptoms were reported less frequently (30.25%). Compared to other anaphylactic reactions in the registry (food/insects) severe reactions occurred significantly more often in DIA (5.62% vs. 1.67%). Hospitalization (31.63%) and ICU admission rates (11.85%) were significantly higher in DIA than anaphylactic reactions to other elicitors (27.58% and 5.45%). Conclusions DIA affects middle aged females more frequently and is more severe in elderly males in the sample observed. Analgesics and antibiotics are the leading causes of DIA. Adrenaline was rarely administered to patients, even though it is recommended by guidelines.