Personalized approach to diagnostics and therapy of patients with psoriasis

Establishing causal relationship between allergy and psoriasis and determining appropriate sensitization profile may guide clinicians in terms of specific allergological diagnostics and personalized therapy. Our purpose was to study the occurrence of food allergy and certain sensitization profile to food allergens in patients with psoriasis, in order to establish new approaches to specific diagnosis and treatment of the disorder.
The study involved patients with psoriasis vulgaris (n = 51) aged 18 to 66 years. The control group included practically healthy people matched by sex and age (n = 19). All the patients underwent allergological examination: collection of allergic history, determination of total immunoglobulin E (IgE) and eosinophilic cationic protein concentration in blood serum by means of indirect immunofluorescence analysis using Thermo Scientific Multiskan FC semi-automatic analyzer. The sensitization profiles to food and pollen allergens were also studied. Calculation and analysis of these data was carried out using Statistica 8.0 software package.
Concentration of total immunoglobulin E in blood serum in the group of patients with psoriasis was 57.9 IU/ml (31.6-135.1) compared to control group, with 45.1 IU/ml (23.4-144.0). The levels of serum eosinophilic cationic protein was 8.6 ng/ml (4.6-20.3) in the patients with psoriasis, being 7.9 ng/ml (4.6-27.1) in controls. When studying the spectrum of sensitization to food allergens in patients with psoriasis, some specific features were revealed. E.g., sensitization to cow’s milk was detected in 33.3% (n = 17); to beef, in 39.2% of cases (n = 20), to whole chicken egg – 29.4% (n = 15), to chicken, in 39.2% (n = 20); to wheat flour, 37.2% (n = 19); to rye flour, in 31.4% (n = 16); to rice and buckwheat, 21.6% (n = 11), to yeast, in 23.5% of the patients (n = 12). Upon administration of individual elimination diet for 1 month, we observed a decrease or complete regression of itching, decreased severity of infiltration, hyperemia and peeling in the foci of psoriatic skin lesions in 68% of the cases. Normal concentration of total immunoglobulin E and eosinophilic cationic protein in blood serum of patients with psoriasis combined with positive results of skin-prick tests and elimination effect presumes a participation of non-atopic immune pathologies when triggering allergy in psoriatic disease.