Introduction: Dengue severity is influenced by viral load and the host’s immune response. Aedes aegypti saliva increases cellularity at the bite site, which may promote viral replication. Atopic dermatitis (AD) is associated with hypersensitivity to Aedes saliva and Th2-skewed immune response, potentially increasing viral target cells in the skin and impairing the immune response to dengue. This study investigated the association between exposure to Aedes saliva, T-cell function, and dengue severity among dengue patients with AD, particularly in children, in whom the incidence of AD and the severity of dengue are higher. Methods: This observational cross-sectional study was conducted on 62 secondary dengue patients aged 1– 12 years. The ISAAC questionnaire was used to assess the history of AD. T-cell functions were evaluated by measuring the levels of IFNγ, IL10, IL13, and CCL2 cytokines in the PHA-stimulated whole blood cultures exposed to Aedes aegypti salivary gland extract (SGE) using the ELISA. Results: The incidence of dengue hemorrhagic fever (DHF) was higher among dengue patients with AD than in those without AD (p=0.010). In the PHA-stimulated whole blood cultures exposed to SGE, higher CCL2 levels were observed in DHF patients than in dengue fever (DF) patients (p=0.044), and higher IL13 levels were found in dengue patients with AD compared to those without AD (p=0.026). In PHA-stimulated whole blood cultures without SGE, lower IFNγ levels were found in DHF patients than in DF patients (p=0.035). Conclusion: AD may be associated with a higher incidence of DHF and increased T-cell IL-13 production in response to SGE. DHF may be associated with increased T-cell CCL2 production in response to SGE, which may reflect greater cell infiltration at the bite site, and reduced T-cell IFN-γ production in response to dengue infection. Keywords: Aedes saliva, AD, dengue, T-cell functions
Astuti et al. (Sun,) studied this question.