Exhaled Breath Condensate (EBC) Analysis: Latest Non-Invasive Practical Methods For Diagnosing Athopic Dermatitis And Monitoring Response To Corticosteroid Therapy
DOI:
https://doi.org/10.66344/jpad.v31i4.1748Abstract
Background Patch tests and blood tests are the most commonly used methods for diagnosing atopic dermatitis. However, these methods are invasive and time-consuming, hence limit their benefits. The practical and non-invasive method with a high level of sensitivity and specificity is required to find specific biomarkers as a novel method in diagnosing atopic dermatitis.
Methods A search was conducted in Google Scholar, PubMed, and SAGE. Inclusion criteria were the following: English literature, using experimental methods, and clinical studies. The keywords used in the search were "exhaled condensate" OR "EBC" AND "breath metabolism" OR "respiration" AND "electronic nose" OR "E-nose" OR "enose" AND "atopic dermatitis" OR "eczema" OR "atopic" OR "atopy" OR "atopic".
Results The breathomics concept included detection of changes in the profile of exhaled breath condensates (EBC) or volatile organic compounds (VOC) in the exhaled breath. Specific biomarkers were found during gas chromatography-mass spectrometry (GC-MS) analysis on EBC: an increase in NO, IL-4, leukotrienes, and 8-isoprostane, as well as a decrease in IFN-Ɣ and pH of EBC which were strong indications in diagnosing atopic dermatitis and monitoring the response to corticosteroid therapy in patients.
Conclusion EBC-specific biomarker analysis is a practical and non-invasive method with high sensitivity and specificity. This method may assist clinicians to diagnose atopic dermatitis and monitor the response to corticosteroid therapy, particularly in a mass clinical setting.
References
1. Fitzpatrick T, Kang S. Fitzpatrick's dermatology. 9th ed. McGraw-Hill Companies; 2019.
2. Fuiano N, Diddi G, Delvecchio M, Incorvaia C. Diagnostic performance of the atopy patch test with inhalant allergens. J Investig Allergol Clin Immunol.2015;25(1):34–9.
3. Peroni DG, Bodini A, Corradi M, Coghi A, Boner AL, Piacentini GL. Markers of oxidative stress are increased in exhaled breath condensates of children with atopic dermatitis. Br J Dermatol.2012;166(4):839-43.
4. Cavaleiro Rufo J, Paciência I, Mendes FC, Farraia M, Rodolfo A, Silva D, et al. Exhaled breath condensate volatilome allows sensitive diagnosis of persistent asthma. Allergy Eur J Allergy Clin Immunol. 2019;74(3):527–34.
5. Van Der Zee P, Van Walree I, Fijen JW, Van Houte AJ, Van Velzen-Blad H, Rijkers G, et al. Cytokines and chemokines are detectable in swivel-derived exhaled breath condensate (SEBC): A pilot study in mechanically ventilated patients. Dis Markers.2020; 2020:2696317.
6. Phillips M, Cataneo RN, Chaturvedi A, Kaplan PD, Libardoni M, Mundada M, et al. Detection of an Extended Human Volatome with Comprehensive Two-Dimensional Gas Chromatography Time-of-Flight Mass Spectrometry. PLoS One.2013;8(9):1–8.
7. Ichikawa T, Matsunaga K, Minakata Y, Yanagisawa S, Ueshima K, Akamatsu K, et al. Possible Impact of Salivary Influence on Cytokine Analysis in Exhaled Breath Condensate. Anal Chem Insights.2007;2:85-92.
8. Zamuruyev KO, Borras E, Pettit DR, Aksenov AA, Simmons JD, Weimer BC, et al. Effect of temperature control on the metabolite content in exhaled breath condensate. Anal Chim Acta.2018; 1006(2017):49-60. Available from: https://doi.org/10.1016/j.aca.2017.12.025
9. Uchida Y, Soma T, Nakagome K, Kobayashi T, Nagata M. Implications of prostaglandin D2 and leukotrienes in exhaled breath condensates of asthma. Ann Allergy Asthma Immunol.2019;123(1):81-8. Available from
https://doi.org/10.1016/j.anai.2019.04.008
10. Wadsworth SJ, Sin DD, Dorscheid DR. Clinical update on the use of biomarkers of airway inflammation in the management of asthma. J Asthma Allergy.2011;4:77–86.
11. Brunetti L, Francavilla R, Tesse R, Strippoli A, Polimeno L, Loforese A, et al. Exhaled breath condensate pH measurement in children with asthma, allergic rhinitis and atopic dermatitis. Pediatr Allergy Immunol. 2006;17(6):422–7.
12. Caffarelli C, Dascola CP, Peroni D, Ricò S, Stringari G, Varini M, et al. Airway acidification in childhood asthma exacerbations. Allergy Asthma Proc.2014; 35(3):51–6.
13. Paget-Brown AO, Ngamtrakulpanit L, Smith A, Bunyan D, Hom S, Nguyen A, et al. Normative data for pH of exhaled breath condensate. Chest. 2006;129(2):426–30.
Available from: http://dx.doi.org/10.1378/chest.129.2.426
14. Miniello VL, Brunetti L, Tesse R, Natile M, Armenio L, Francavilla R. Lactobacillus reuteri modulates cytokines production in exhaled breath condensate of children with atopic dermatitis. J Pediatr Gastroenterol Nutr.2010;50(5):573–6.
15. Yan DC, Chung FF, Lin SJ, Wan GH. The relationships among Dermatophagoides pteronyssinus exposure, exhaled nitric oxide, and exhaled breath condensate pH levels in atopic asthmatic children. Medicine (Baltimore).2016;95(39):e4825.
16. Price DB, Bosnic-Anticevich S, Pavord ID, Roche N, Halpin DMG, Bjermer L, et al. Association of elevated fractional exhaled nitric oxide concentration and blood eosinophil count with severe asthma exacerbations. Clin Transl Allergy.2019; 9(1):1–18. Available from:
https://doi.org/10.1186/s13601-019-0282-7
17. Yeh KW, Chen CT, Lee PC, Huang JL, Yan DC, Chen LC, et al. Outdoor air pollutants exposure associated with pulmonary function and EBC pH value in atopic asthmatic and non-asthmatic children. J Asthma 2021;58(10):1278-84.
18. Melamed I. The Benefit of Montelukast in Atopic Dermatitis Induced by Food Allergies. Glob J Allergy.2017;3:013–8.
19. Karimi L, Vijverberg SJH, Farzan N, Ghanbari M, Verhamme KMC, Maitland-van der Zee AH. FCER2 T2206C variant associated with FENO levels in asthmatic children using inhaled corticosteroids: The PACMAN study. Clin Exp Allergy. 2019; 49(11):1429–36.
20. Carpagnano GE, Malerba M, Lacedonia D, Susca A, Logrieco A, Carone M, et al. Analysis of the fungal microbiome in exhaled breath condensate of patients with asthma. Allergy Asthma Proc.2016; 37(3):e41–6.
21. Kononikhin AS, Zakharova N V., Yusupov AE, Ryabokon AM, Fedorchenko KY, Indeykina MI, et al. Study of the Molecular Composition of Exhaled Breath Condensate by High-Resolution Mass Spectrometry. Russ J Phys Chem B.2019;13(6):951–5.
22. Trowell S, Berna A, Padovan B, Locke V. Methods of detecting plasmodium infection. 2018.
23. Miekisch W, Schubert JK. From highly sophisticated analytical techniques to life-saving diagnostics: Technical developments in breath analysis. TrAC-Trends Anal Chem. 2006;25(7):665–73.
24. Kelly RS, Dahlin A, McGeachie MJ, Qiu W, Sordillo J, Wan ES, et al. Asthma Metabolomics and the Potential for Integrative Omics in Research and the Clinic. Chest.2017;151(2):262–77.
Available from: http://dx.doi.org/10.1016/j.chest.2016.10.008
25. Zhang X, Quinn K, Cruickshank-Quinn C, Reisdorph R, Reisdorph N. The application of ion mobility mass spectrometry to metabolomics. Curr Opin Chem Biol.2018; 42:60–6.
Available from: http://dx.doi.org/10.1016/j.cbpa.2017.11.001
26. Enose.nl. 2020. Specialists In Artificial Olfaction. Available at: https://www.enose.nl/.
27. Gardner JW, Shin HW, Hines EL. Electronic nose system to diagnose illness. Sensors Actuators, B Chem.2000;70(1–3):19–24.
28. Di Natale C, Macagnano A, Davide F, D’Amico A, Paolesse R, Boschi T, et al. An electronic nose for food analysis. Sensors Actuators, B Chem.1997;44(1–3):521–6.
29. Gao F, Zhang X, Wang M, Wang P. Breathprinting Based Diagnosis, Selected Case Study: GCMS and E-Nose Collaborative Approach. Breath Analysis. Elsevier Inc.; 2019. 163–181 p. Available from: http://dx.doi.org/10.1016/B978-0-12-814562-3.00010-2
30. Karakaya D, Ulucan O, Turkan M. Electronic Nose and Its Applications: A Survey. Int J Autom Comput. 2020; 17(2):179–209.
31. Bertino L, Guarneri F, Cannavò SP, Casciaro M, Pioggia G, Gangemi S. Oxidative stress and atopic dermatitis. Antioxidants.2020; 9(3):1–15.
Downloads
Published
Issue
Section
License
Copyright (c) 2022 Maureen Miracle Stella, Kevin Tandarto, Regina Regina
This work is licensed under a Creative Commons Attribution 4.0 International License.
Submission declaration
Authors retain the copyright to their work and grant the 'Journal of Pakistan Association of Dermatologists (JPAD)' the right of first publication under a Creative Commons Attribution 4.0 International (CC BY 4.0) license. This license allows others to share, adapt, and reuse the work for any purpose, including commercial use, as long as appropriate credit is given to the original authors and the journal.
By submitting a manuscript, authors confirm that the work has not been published previously (except as an abstract, lecture, or academic thesis), is not under review elsewhere, and has been approved by all authors and relevant authorities. Once accepted, the article will be openly accessible under the CC BY 4.0 license, ensuring wide dissemination and reuse with proper attribution.
