Atopic dermatitis: Biomarkers recommendations

  • For patients with presumed atopic dermatitis, there are no specific biomarkers that can be recommended for diagnosis and/or assessment of disease severity. 

Level of Evidence: II Strength of Recommendation: B 

  • Monitoring of immunoglobulin E levels is not recommended for the routine assessment of disease severity. 

Level of Evidence: I Strength of Recommendation: A

Read more about these recommendations

The diagnosis of AD remains clinical, because there is currently no reliable biomarker that can distinguish the disease from other entities. The most commonly associated laboratory feature, an elevated total and/or allergen-specific serum IgE level, is not present in about 20% of affected individuals.28 Some denote “extrinsic” and “intrinsic” groups of disease based on the presence or absence of IgE elevation, but whether these are true variants remains controversial. Some individuals will later develop elevated IgE levels, and recent knowledge of skin barrier defects and studies on epicutaneous sensitization suggest that elevated IgE may be a secondary phenomenon.28 Elevated allergen-specific IgE levels are also nonspecific, because they are found in 55% of the US general population.29 Although the total IgE level does tend to vary with disease severity, it is not a reliable indicator, because some individuals with severe disease have normal values, and IgE may also be elevated in multiple nonatopic conditions (eg, parasitic infection and certain cancers and autoimmune diseases).28,30,31 Increases in tissue mast cells and peripheral eosinophil counts have also been evaluated, but with similar inconsistent association.30,32-34 

Navigate section 1 of the AD guideline: Diagnosis and assessment

Citation note 

When referencing this guideline in a publication, please use the following citation: Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, et al. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014 Feb;70(2):338-51. 

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