6. Biomarkers for disease severity
Multiple factors have been described to correlate with AE severity.
Measurement of NMFs via Raman spectroscopy has been shown to be a
reliable clinical marker for AE and can be used when deciding for
treatment [97]. Also, the microbiome can be used as a marker for
disease severity, assess risk-prone state of skin, and predict treatment
response in children across human populations [98]. Among them are
bacterial factors as S. aureus abundance, which has been
correlated with disease severity, but also as a biomarker for disease
worsening [64, 99]. However, before the skin microbiome it can be
widely used as clinical biomarker, a standardized method would be
required for microbiome analysis [100]. Also immunological factors
are associated with disease severity, e.g. TARC detected in dried blood
spots [101]. A biomarker signature (p-EASI) based on multiple
immunological biomarkers reliably predicts disease severity, [102,
103]. Local, non-invasive sampling of the skin would be well-tolerated
and allows a thorough analysis of the complex interplay of the skin
barrier, the immune system and microbes in vivo. Allergy-associated
genes and gene-variants are now listed in the databaseAllergyGenDB which thus can be used for hypothesis generation in
research [104]. Thorough endotyping of AE patients would be very
efficient and cost-effective for treatment [105]. One possible
method would be tape stripping, which successfully revealed multiple AE
markers in a current study [106]. Biomarkers are essential for
diagnosis and personalized and tailored therapy, especially in a
multifaceted disease as AE [107].