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December 2, 1983

Atopic Dermatitis—A New Therapeutic Regimen-Reply

Author Affiliations

Duke University School of Medicine Durham, NC

JAMA. 1983;250(21):2927. doi:10.1001/jama.1983.03340210024010

In Reply.—  Dr Ayres restates a decades-old difference of opinion between dermatologists and allergists concerning the basis of atopic dermatitis and advocates a nonspecific therapeutic approach. In 1983, however, it seems difficult to ignore the overwhelming circumstantial and direct evidence in favor of a role for allergic mechanisms in the pathogenesis of atopic dermatitis. It has been estimated that between 50% and 80% of children with this condition go on to have allergic rhinitis or asthma or both.1 Patients with atopic dermatitis have long been known to have positive immediate wheal and flare reactions to multiple environmental allergens. After the discovery of IgE in 1967 and the development of radioimmunoassays for it, it soon became apparent that patients with eczema have higher serum IgE concentrations than those with any other atopic disorder.2 Moreover, serum samples from patients with eczema were found to have not only the highest number