Atopic Dermatitis

Atopic dermatitis (AD) is a chronic and relapsing disease affecting an increasing number of patients. Usually starting in early childhood, AD can be the initial step of the so-called atopic march, i.e. followed by allergic rhinitis and allergic asthma. AD is a paradigmatic genetically complex disease involving gene-gene and gene-environment interactions. Genetic linkage analysis as well as association studies have identified several candidate genes linked to either the epidermal barrier function or to the immune system. Stress, bacterial or viral infections, the exposure to aero- or food-allergens as well as hygienic factors are discussed to aggravate symptoms of AD. Athough generalized Th2-deviated immune response is closely linked to the condition of AD, the skin disease itself is a biphasic inflammation with an initial Th2 phase and while chronic lesions harbour Th0/Th1 cells. Regulatory T cells have been shown to be altered in AD as well as the innate immune system in the skin. The main treatment-goals include the elimination of inflammation and infection, preserving and restoring the barrier function and controlling exacerbating factors. The overall future strategy in AD will be aimed to control skin inflammation by a more proactive management in order to potentially prevent the emergence of sensitization as well as to design customized management based on genetic and pathophysiologic information.     

特应性皮炎与行为异常

特应性皮炎作为一种慢性炎症性皮肤病严重影响患者的身心健康,行为学方面的异常也影响着患者的生活质量,其严重时可表现为注意缺陷多动症。睡眠紊乱及感觉调制障碍是行为异常可能的原因,特应性皮炎、注意缺陷多动症以及伴随的睡眠紊乱的因果关系需要进一步研究,特应性皮炎仍然需要完整的医学诊断、预防及治疗的联合策略。     

Recalcitrant Atopic Dermatitis Treated with Omalizumab

Atopic dermatitis (AD) is a chronic cutaneous inflammatory disease. Various categories of therapeutic medications are used for treating AD. Omalizumab is a monoclonal anti-IgE antibody that binds to IgE molecules at the high-affinity receptor (FcεRI) binding site. Therefore, omalizumab can be used as a potential new systemic treatment agent for recalcitrant AD patients with elevated IgE levels. A 34-year-old man had been treated for AD with several topical and oral agents. However, he was refractory to these therapies and his serum IgE levels were very high. We treated him with omalizumab. After 8 months of the treatment, his symptoms were notably improved and the SCORAD index was decreased. Thus, we report on the first case of recalcitrant AD that was successfully treated with omalizumab in Korea.     

TSLP Polymorphisms in Atopic Dermatitis and Atopic March in Koreans

BackgroundAtopic march (AM) is the progression from atopic dermatitis (AD) to allergic rhinitis and asthma. The development of AD is as high as 20% in children worldwide and continues to increase. AD seems to be caused by both genetic and environmental factors. Recently, polymorphisms of the thymic stromal lymphopoietin (TSLP) gene associated with allergic disorders were reported in ethnic groups from various countries.ObjectiveIdentification of TSLP polymorphisms in Koreans with AD or AM.MethodsWhole-exome sequencing was performed in 20 AD and 20 AM patients.ResultsNine single nucleotide polymorphisms (SNPs) of TSLP were detected (rs191607411, rs3806933, rs2289276, rs2289277, rs2289278, rs139817258, rs11466749, rs11466750, rs10073816). These SNPs have been correlated with susceptibility to allergic diseases in ethnic groups from China, Japan, Turkey, and Costa Rica in previous studies. Remarkably, one of 20 patients in the AD group lacked all SNPs, compared to six of 20 patients in the AM group. Odds ratios showed that Korean patients without the nine TSLP variants had an 8.14 times higher risk of moving from AD to AM. Two haplotype blocks were validated in 60 AD and 59 AM patients using Sanger sequencing. The haplotype blocks (rs3806933 and rs2289276) and (rs11466749 and rs11466750) were in high linkage disequilibrium, respectively (D′=0.97, D′=1).ConclusionThe increase of major allele frequency of respective nine TSLP variants may enhance the risk of AM. These data will contribute to improved genetic surveillance system in the early diagnosis technology of allergic disease.     

特应性皮炎的遗传学及免疫学研究进展

特应性皮炎(AD)为遗传过敏性疾病,患者及其家族的基因筛选结果显示,AD与其他炎症性皮肤病、自身免疫疾病存在染色体区域的交迭。候选基因的研究为探讨AD的发病机理提供了新的视野。由皮肤浸润的T细胞、树突状细胞、肥大细胞和血管内皮细胞所产生的多种趋化细胞因子配体(CCL)和受体(CCR)在AD的发病机制中起到了重要作用。细胞因子的不同表达状态和基因识别的高效方法将有助于进一步仔细研究AD的综合特点,也有助于定义AD的诊断标准和治疗。     

遗传过敏性皮炎致敏因素分析

目的：了解遗传过敏性皮炎（AD）患者接触过敏的情况以及各种常见变应原特异性IgE的阳性检出率。方法：对90例AD患者进行斑贴试验和血清Mast SIgE检测。结果：斑试阳性率为52．22%,与非AD患者的斑试阳性率比较无显著性差异（P＞0．05）,硫酸镍、4－苯二胺、芳香混合物的阳性率分别为16．67％、10．0％和6．67％。AD患者屋尘螨、粉尘螨的SIgE阳性检出率分别为50．0％、47．8％,屋尘的SIgE阳性检出率为44．4％。结论：AD患者斑试阳性率与非AD患者的斑试阳性率比较无显著性差异。硫酸镍、4－苯二胺、芳香混合物和螨类、屋尘、真菌、花粉等是广东地区AD患者常见的变应原。     

Atopic background in patients with occupational hand eczema

Of 368 patients with hand eczema examined during the years 1978-79, at a Department of Occupational Dermatology, 39% had a history of atopic disease (dermatitis, asthma, or rhinitis). 28% of the patients had or had had atopic dermatitis. The % of atopics in the patient material was highest in the age range 20-24 years, in which 57% of the patients had a history of atopic dermatitis, compared with only 11% in the age range above 35 years. Of all patients with a history of atopy, 22% had developed allergic contact dermatitis, while the corresponding figure for non-atopics was 45% (p less than = 0.001). Positive patch test reactions occurred in a significantly smaller number of individuals with past or present atopic disease than in non-atopics. Atopics had not changed jobs because of hand eczema to a greater extent, but had healed to a lesser extent after change of occupation than non-atopics (p less than 0.01).     

遗传过敏性皮炎血清特异性IgE分析

目的 了解遗传过敏性皮炎（ＡＤ）患者各种常见特异性ＩｇＥ的阳性检出率以及合并哮喘及过敏性鼻炎对其阳性检出率的影响。方法 对９０例ＡＤ患者血清行Ｍａｓｔ ＳＩｇＥ检测。结果 ＡＤ患者屋尘螨、粉尘螨的ＳＩｇＥ阳性率分别为５０．０％、４７．８％,屋尘的ＳＩｇＥ阳性检出率为４４．４％,真菌交链孢属、曲霉菌属、芽枝菌属阳性检出率分别是３４．４％、３５．６％、３２．２％,其余花粉、牛奶、虾、蛋及动物皮毛亦有较     

Intravenous Immunoglobulin Treatment in a Child with Resistant Atopic Dermatitis

In a subgroup of patients suffering from atopic dermatitis (AD), treatment is quite difficult even after taking oral immunosuppressants. High-dose intravenous immunoglobulin (IVIG) treatment has been reported to be beneficial for them in a few uncontrolled trials. Herein we report a case of intractable AD in a 5-year-old girl who had significant clinical improvement after receiving 3 cycles of IVIG treatment (2 g/kg) without notable side effects. Since the first infusion of IVIG, the patient''s skin lesions improved steadily and the improvement persisted until the 8-month follow-up. The eczema area and severity index score decreased remarkably, while immunologic parameters did not correlate with clinical improvement. This case suggests that IVIG therapy can be quite effective and safe for children with resistant AD.     

婴幼儿特应性皮炎的过敏原分析

目的了解食物和吸入过敏原在婴幼儿特应性皮炎中所占的比例以及主要的食物过敏原。方法对95例患儿进行婴幼儿过敏原筛查(phadiatop infant),并同85例健康儿童进行比较。同时对患儿血清进行吸入过敏原筛查(phadiatop)及多价食物过敏原筛查(fx5E),并从95例中随机抽取60例进行几种常见食物的特异性IgE(sIgE)检测。结果95例患儿组婴幼儿过敏原筛查阳性55例(57.89%),85例正常儿童中阳性16例(18.82%)两者比较差异有显著性意义(P<0.01)。患儿组多价食物过敏原阳性54例(56.8%),吸入过敏原阳性19例(20%),两者比较差异有显著性意义(P<0.01)。食物特异性IgE检测中血清浓度在3级以上的,鸡蛋白为23.3%,牛奶为11.7%,小麦为10%,蛋黄为6.7%,花生为6.7%,黄豆为1.67%。结论婴幼儿特应性皮炎患儿中过敏原检测阳性率高于正常儿童,其中食物IgE的阳性率比吸入IgE的阳性率更高,食物过敏原在婴幼儿特应性皮炎中占有重要地位。     

精神应激在特应性皮炎中的作用

特应性皮炎是一种慢性、复发性、炎症性皮肤疾病,发病机制不明。特应性皮炎病情的复发与精神应激事件密切相关。本文综述了精神应激在特应性皮炎发病中的作用,一方面通过复杂的神经内分泌免疫网络影响炎症细胞的功能,另一方面,精神应激破坏皮肤屏障功能,诱发级联免疫反应,加重病情。