Autologous Immunoglobulin Therapy in Patients With Severe Recalcitrant Atopic Dermatitis: A Preliminary Report

The management of severe recalcitrant atopic dermatitis (AD) is a challenging issue for clinicians and patients. We hypothesized that repeated intramuscular injections of autologous immunoglobulin (autologous immunoglobulin therapy: AIGT) might induce clinical improvements in patients with AD by stimulation of the active immune response to antigen-binding-site of pathogenic antibodies. We tried AIGT in 3 adult patients with severe recalcitrant AD whose clinical conditions could not be effectively controlled by medical treatments (including oral cyclosporine) for more than 2 years. Autologous immunoglobulin was purified from the autologous plasma by affinity chromatography using Protein A. The patients were treated by an intramuscular injection of 50 mg of autologous immunoglobulin twice a week for 4 weeks. A clinical severity score of AD (SCORAD value) showed a decrease greater than 30% at 8 weeks after the initiation of AIGT compared with the baseline before the initiation of AIGT in all 3 patients with severe recalcitrant AD. No significant side effects from treatment were observed. Further studies with larger numbers of patients are required to evaluate the clinical usefulness of AIGT for AD.

Correlation between House Dust Mite Allergen Concentrations in Scalp Dander and Clinical Severity of Atopic Dermatitis in Children / 소아알레르기및호흡기학회지

PURPOSE: There are compelling evidences that house dust mites are important in the pathogenesis of atopic dermatitis. Recently, detection of house dust mite allergens from clothing, skin, and dust from human hair has been reported. To evaluate the importance of house dust mite exposure in the clinical severity of atopic dermatitis. METHODS: We measured house dust mite allergens (Der f1 from Dermatophagoides farinae and Der p1 from D. pteronyssinus) in scalp dander from 27 children with atopic dermatitis and 41 children with asthma only by enzyme-linked immunosorbent assay and examined correlation between house dust mite allergen concentrations in scalp dander and clinical severity of atopic dermatitis in children. RESULTS: Der f1 was detectable in scalp dander samples of 32 patients (47%) from overall 68 patient and Der p1 was detectable in 33 patients (49%). House dust mite allergens (Der f1 or Der p1) were detectable in scalp dander samples of 46 patients (70%) from overall 68 patient. There was no significant differences in house dust mite allergen levels between atopic dermatitis patients and patients with asthma only. There was a tendency of inverse correlation between frequency of scalp washing and concentration of Der f1 in scalp dander extract (r=-0.24, P=0.052). There was a significant correlation between severity grade of atopic dermatitis and concentration of Der f1 in scalp dander (r=0.39, P0.05). CONCLUSION: There was a significant correlation between house dust mite allergen concentrations in scalp dander and clinical severity in children with atopic dermatitis. And these results suggest that exposure to house dust mite allergen is important in the pathogenesis of atopic dermatitis.

A Case of Tethered Cord Syndrome

Tethered cord syndrome is one of the spinal dysraphism with low-lying conus medullaris frequently associated with spinal lipoma, diastematomyelia and thick filum. The clinical manifestation is variable from no overt symptoms for a long time to back pain, scoliosis, progressive neurological deficit of legs and incontinence. Therefore the diagnosis requires a strong clinical suspicion and aggressive investigation. We experienced a case of 1 day-old male infant who was presented with small soft mass on sacral area. Spinal ultrasonography and spine MRI revealed tethered cord associated with intradural lipoma. We reported a case of tethered cord syndrome with brief review of literatures.