Asymmetric Overgrowth and a Facial Port Wine Stain Seiringer, Peter; Biedermann, MD, Tilo; Schnopp, MD, Christina
The Journal of pediatrics,
February 2021, 2021-02-00, 20210201, Letnik:
229
Journal Article
...the observed outcome in our omalizumab trial might not entirely reflect drug-associated clinical changes. ...only a very small proportion (probably between 1% and 5 % of all serum IgE molecules) ...in our patients was bound by omalizumab.
Background It was reported that in infants with eczema and food sensitization, the presence of a filaggrin (FLG) null mutation predicts future asthma with a specificity and positive predictive value ...of 100%. Objectives We sought to evaluate the predictive value of food sensitization and food allergy, FLG haploinsufficiency, and their combination in infants with early-onset eczema for persistent eczema and childhood asthma. Methods The German Infant Nutritional Intervention (GINI) and Influence of Lifestyle-related Factors on the Immune System and the Development of Allergies in Childhood (LISA) birth cohorts, as well as a collection of 65 cases of early-onset eczema with and without food allergy were investigated. Results The risk for asthma was significantly increased by food sensitization (positive diagnostic likelihood ratios PLRs of 1.9 95% CI, 1.1-3.4 in the GINI cohort and 5.5 95% CI, 2.8-10.8 in the LISA cohort) and the presence of an FLG mutation (PLRs of 2.9 95% CI, 1.2-6.6 in the GINI cohort and 2.8 95% CI, 1.0-7.9 in the LISA cohort) with a rather high specificity (79.1% and 92.9% in the GINI cohort and 89.0% and 91.7% in the LISA cohort, respectively) but low sensitivity (40.0% and 39.3% in the GINI cohort and 31.6% and 23.5% in the LISA cohort, respectively). Likewise, the risk for persistent eczema was increased. In the clinical cases neither food allergy nor FLG mutations had a significant effect. The combination of both parameters did not improve prediction and reached positive predictive values of 52.3% (GINI cohort), 66.9% (LISA cohort), and 30.6% (clinical cases), assuming an asthma prevalence in children with early eczema of 30%. Conclusion Early food sensitization and the presence of an FLG mutation in infants with early eczema increase the risk for later asthma, but the combination of the 2 factors does not represent a clinically useful approach to reliably identify children at risk.
Conventional therapy for atopic dermatitis has evolved along with better understanding of underlying impaired barrier function, role of microorganisms, and immune abnormalities. Emollients, along ...with antimicrobial and topical anti-inflammatory therapies, remain the cornerstone of conventional therapy. Recent therapeutic advances include use of nonsteroidal therapy for epidermal barrier repair, along with proactive therapy with topical corticosteroids and calcineurin inhibitors. Minimal anti-inflammatory treatment of the underlying residual disease is the immunobiologic rationale for proactive therapy. Further progress in understanding this increasingly common disease will hopefully lead to more targeted therapies.
Abstract Background Atopic dermatitis (AD) is a chronic relapsing skin disease prevalent in 1-3% of adults in Western industrialized countries. Objective To investigate the effectiveness of ...educational training in an outpatient setting on coping with the disease, quality of life (QoL), symptoms and severity in adults with AD. Methods In this German prospective, randomized controlled multi-center study, adult patients with moderate to severe AD were educated by referring to a comprehensive 12 hour training manual consented by a multi-professional study group from different centers (“ARNE=Arbeitsgemeinschaft Neurodermitisschulung für Erwachsene”). Patients were randomly allocated to the intervention group or “waiting control group”. Study visits were performed at baseline and after one year (1-year follow-up). Primary outcomes were defined as a decrease of (1) “catastrophizing cognitions” with respect to itching (JKF questionnaire), (2) “social anxiety” (MHF questionnaire), (3) subjective burden by symptoms of the disease (Skindex-29 questionnaire) and (4) improvement of disease signs and symptoms assessed by scoring atopic dermatitis (SCORAD) index at 1-year follow-up. Data was analyzed by intention-to-treat. Results At 1-year follow-up patients from the intervention group (n=168) showed a significantly better improvement compared to the waiting group (n=147) in the following defined primary study outcomes: coping behavior with respect to itching P <.001; QoL assessed by Skindex-29 questionnaire P <.001 and SCORAD index P<.001. Conclusions This is the first randomized, controlled multi-center study on patient education in adulthood AD. The ARNE training program shows significant beneficial effects on a variety of psychosocial parameters as well as on AD severity.
Background Patients with atopic diseases are characterized by high levels of specific IgE production. However, little is known about the composition of their B-cell repertoires. Objectives We sought ...to analyze the complete PBMC-derived IgE repertoire and to compare clonal expansions between different patients. Methods We have analyzed the IgE-bearing B-cell receptor repertoire in highly atopic patients (>1000 IU/mL) using quantitative RT-PCR, complementarity determining region 3 spectratyping, and sequence analysis. Three representative patients were additionally followed during anti-IgE therapy. Results Atopic patients exhibited 100 to 1000 times more IgE-specific transcripts than control individuals. These patients used a variable region of the heavy immunoglobulin chain (VH) ϵ repertoire highly similar to their IgM and IgG repertoires, with preference of VH3b, VH4, VH3a, and VH1 segments. Each patient harbored individual clonal expansions, most probably as correlation of allergen-specific IgE production. Common expansions within the complementary determining region 3 shared by several individuals with similar sensitization patterns were found in spectratyping analysis. However, these antigen-driven expansions showed differences on the sequence level. In omalizumab-treated patients the clinical improvement was paralleled by a clear increase in the ratio of IgG/IgE transcripts. Conclusion The IgE repertoire in atopic patients follows the VH use patterns seen for other immunoglobulins and seems to preferentially recruit individual rearrangements rather than public expansions. Clinical implications The detailed analysis of the IgE B-cell repertoire is highly suitable to follow changes in IgE uses during different therapy modalities.
To the Editor: In a recent article by Reefer et al,1 the occurrence of antimicrobial IgE in adult patients with atopic eczema was linked to high total IgE levels and a more severe disease pattern. ......in contrast to previous reports,2,3 the authors did not find an overrepresentation of antimicrobial IgE antibodies in patients with "intrinsic" atopic eczema.
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