Maria Böhme

Clinical features of atopic dermatitis at two years of age: a prospective, population-based case-control study.

While atopic dermatitis (AD) usually presents early in life, few prospective studies focus on young children with AD. The objective of this study was to characterize, phenotypically and prospectively, young children with AD. From a community birth cohort of 2,256 children, consecutive children with AD (n = 221) were followed to 2 years of age, when they were re-examined and screened for atopic sensitization (skin-prick test to foods; Phadiatop). Ninety-nine controls were also examined. AD debuted during the first year in 88% of cases. At the 2-year examination, when the children had already undergone topical treatment, 157/221 (71%) had ongoing eczema ranging among mild (45%), moderate (53%) and severe (2%). Airway problems indicating asthma had occurred in 9% of cases and 6% of controls (not significant), and allergic rhinoconjunctivitis in 5% and 0%, respectively (p<0.05). The skin-prick test to common food allergens was positive in 27% of cases and Phadiatop was positive in 15%. In 67% both tests were negative. Eczema severity did not differ between sensitized and non-sensitized children. Positive Phadiatop was more common in boys than in girls with ongoing AD (22% vs 3%, p<0.01), and more boys than girls had ongoing AD (82% vs 59%, p<0.001); otherwise, no differences attributable to gender were found.

Atopic dermatitis and concomitant disease patterns in children up to two years of age.

There are few prospective studies of atopic dermatitis and co-existing diseases such as respiratory infections in children up to 2 years of age. Using annual questionnaires, we studied the cumulative incidence of atopic dermatitis and concomitant symptoms indicating other atopic diseases and respiratory infections in 0-2-year-old children in a prospective birth cohort of 4089 children. We found associations between atopic dermatitis and asthma (ratio of proportion 1.45, 95% CI 1.16-1.80), allergic rhinoconjunctivitis (RP 2.25, CI 1.77-2.85), adverse reactions to foods (RP 3.20, CI 2.83-3.62), urticaria (RP 2.04, CI 1.80-2.31), acute otitis media (RP 1.13, CI 1.05-1.21), more than one pneumonia during the first and/or second year of life (RP 2.17, CI 1.14-4.15), and use of antibiotics at least twice yearly (RP 1.29, CI 1.07-1.56). The association between atopic dermatitis and respiratory infections persisted after stratification for asthma. There was a higher proportion of atopic disease manifestations, but not respiratory infections, in children with onset of atopic dermatitis during the first year of life than during the second. The study shows that during the first 2 years of life there is a significant association not only between atopic dermatitis and other atopic disease manifestations, but also between atopic dermatitis and respiratory infections manifested in an increased rate of acute otitis media, pneumonia and use of antibiotics.

Family history and risk of atopic dermatitis in children up to 4 years

Background The aetiology of atopic dermatitis (AD) is presumably multi‐factorial, with interactions between genetic and environmental factors.

Parental smoking increases the risk for eczema with sensitization in 4-year-old children

6. Helgesson G, Lynöe N. Should physicians fake diagnoses to help their patients? J Med Ethics 2008;34:133-6. 7. Macauley R. The Hippocratic underground: civil disobedience and health care reform. Hast Ctr Rep 2005;35:38-45. 8. VanGeest J, Weiner S, Johnson T, Cummins D. Impact of managed care on physicians’ decisions to manipulate reimbursement rules: an explanatory model. J Health Ser Res Policy 2007;12:147-52. 9. Kaiser Family Foundation. Kaiser health tracking poll: many Americans still delaying care, struggling to pay medical bills. April 2009. Available at: http:// www.kff.org/kaiserpolls/upload/7891.pdf. Accessed December 14, 2009. 10. Casalino LP, Nicholson S, Gans DN, Hammons T, Morra D, Karrison T, et al. What does it cost physician practices to interact with health insurance plans? Health Affairs Web Exclusive. April 2009;28:w533-w543. Available at: http://content.health affairs.org/cgi/content/abstract/hlthaff.28.4.w533. Accessed December 14, 2009. 11. American Medical Association. Opinion 1.02: the relation of law and ethics: code of ethics. Updated June 1994. Available at: http://www.ama-assn.org/ama/pub/ physician-resources/medical-ethics/code-medical-ethics/opinion102.shtml. Accessed December 14, 2009. 12. Carter SL. Integrity. New York: Basic Books; 1996.

Filaggrin mutations increase the risk for persistent dry skin and eczema independent of sensitization

United States and found that nearly one third of prescriptions contained combinations of protease-containing allergen extracts (fungal or insect) and pollen allergen extracts. Cost and patient compliance were cited by prescribers as the most common reason for combining allergen groups. In our study, cost should not be a factor as USACAEL does not place the financial burden for AIT on individual patients, providers, or clinics. Patient compliance may be a driving factor, as one injection can be perceived as less painful and more convenient. Esch found that glycerinated extracts were requested for only about half of these prescriptions, whereas all USACAEL extracts are glycerinated, though the glycerin content of each individual extract formulation is variable. This may also factor into the observed prescribing patterns, as studies have demonstrated that the presence of glycerin in allergen extracts may preserve potency. To date, no study has looked at the clinical impact of AIT when mixing mold with pollen. In conclusion, we have observed a significant reduction in AIT prescriptions that contain molds mixed with pollen. There seems to be a strong temporal relationship between the publication of specific mixing recommendations in the AIT Practice Parameters and these observed changes in prescribing patterns. Despite these recommendations, a significant number of prescriptions continue to mix mold with pollen, particularly among SI prescriptions. The reasons behind such prescribing patterns and its clinical impact deserve further study. Satyen Gada, MD Bret Haymore, MD Lorne McCoy, BS Susan Kosisky, MA Michael Nelson, MD, PhD

Infantile eczema: Prognosis and risk of asthma and rhinitis in preadolescence.

vaccination. This observation suggests that higher frequencies of MA andDNB cells and lower frequencies of IL-21R–expressing B cells at T0 could serve as predictive markers for poor outcome of vaccination as it did in this study for the H3N2 influenza strain. Further studies need to be designed to test this hypothesis with different types of vaccines and possibly in the context of other diseases characterized by chronic immune activation.

Novel STAT3 Mutation Causing Hyper-IgE Syndrome: Studies of the Clinical Course and Immunopathology

PurposeReporting a clinical case with a novel mutation in the signal transducer and activator of transcription 3 (STAT3) gene resulting in autosomal dominant hyper-immunoglobulin E syndrome (AD-HIES). Here we also had the opportunity to perform in-depth immunologic investigations to further understand the immunopathology of this primary immunodeficiency.MethodsThe patient, a baby boy, was clinically assessed according to the scoring system developed by Grimbacher et al. and STAT3 was investigated by DNA sequencing. Immunologic work-up consisted of lymphocyte phenotyping and proliferation assays, measurement of soluble mediators and routine investigations.ResultsAccording to the Grimbacher score the patient was likely to have AD-HIES and a novel heterozygous STAT3 mutation (c.1110-3C>A), causing a splice error, was identified. Lymphocyte phenotyping revealed decreased numbers of interleukin (IL)-17 producing T-helper lymphocytes and aberrant B-lymphocyte subsets. Proliferative in vitro lymphocyte responses against C. albicans, staphylococcal enterotoxins and pokeweed mitogen were supernormal at presentation, whereas only the elevated response to pokeweed mitogen persisted. The soluble mediators IL−5, −10, −12, −13, −15 and granulocyte colony stimulatory factor were elevated in serum.ConclusionA novel heterozygous STAT3 mutation causing defective splicing of exon 12 was identified. Lymphocyte phenotyping revealed deranged subpopulations. Despite the clinical picture with severe C. albicans and staphylococcal infections, the patient’s lymphocytes mounted responses to these pathogens. The hypereosinophilia and high immunoglobulin E levels might partly be explained by elevated IL−5 and −13 as a result of lack of negative feedback from defective STAT3 signaling.