Use of intravenous immunoglobulin in the treatment of childhood atopic dermatitis.
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ABSTRACT: Quantification of quality of life (QoL) related to disease severity is important in patients with atopic eczema (AE), because the assessment provides additional information to the traditional objective clinical scoring systems. To measure health-related QoL (HRQoL) in patients with AE; to analyse discriminant, divergent and convergent validity by examining the association between various QoL methods; and to examine the association between disease severity assessed by an objective Severity Scoring of Atopic Dermatitis (SCORAD) and QoL. HRQoL was assessed at two visits at a 6-monthly interval in 101 patients with AE and 30 controls with one dermatology-specific questionnaire [Dermatology Life Quality Index (DLQI) or Children's DLQI (CDLQI)], one generic instrument (SF-36) and three visual analogue scales (VASs) of severity and pruritus. Objective SCORAD was used to measure disease severity. Patients with AE had significantly lower QoL than healthy controls and the general population. DLQI /CDLQI, pruritus, and patient and investigator overall assessment of eczema severity were significantly (P < 0.0001) and positively correlated with SCORAD, while the generic questionnaire showed only poor correlation. A gender difference was found for the mental component score of SF-36 (P = 0.019). AE has an impact on HRQoL. Patients' mental health, social functioning and role emotional functioning seem to be more affected than physical functioning. A simple VAS score of patients' assessment of disease severity showed the highest and most significant correlations with most of the HRQoL methods used. There is evidence to support the ability of patients with AE to make an accurate determination of their disease severity and QoL.British Journal of Dermatology 04/2006; 154(4):719-25. · 3.67 Impact Factor
Article: Nutritional status according to sensitized food allergens in children with atopic dermatitis.[show abstract] [hide abstract]
ABSTRACT: Food allergies can affect the growth and nutritional status of children with atopic dermatitis (AD). This study was conducted to determine the association between the number of sensitized food allergens and the growth and nutritional status of infants and young children with AD. We studied 165 children with AD, aged 5 to 47 months, and who visited the Atopy Clinic of the Seoul Medical Center. We recorded the birth weight, time at which food weaning began, scoring of atopic dermatitis (SCORAD) index, eosinophil counts in peripheral blood, and total serum IgE and specific IgE to six major allergens (egg white, cow's milk, soybean, peanut, wheat, and fish). The height and weight for age and weight for height were converted to z-scores to evaluate their effects on growth and nutritional status. Specific IgE levels ≥0.7 kUA/L, measured via the CAP assay, were considered positive. As the number of sensitized food allergens increased, the mean z-scores of weight and height for age decreased (P=0.006 and 0.018, respectively). The number directly correlated with the SCORAD index (r=0.308), time at which food weaning began (r=0.332), eosinophil counts in peripheral blood (r=0.266), and total serum IgE (r=0.394). Inverse correlations were observed with the z-scores of weight for age (r=-0.358), height for age (r=-0.278), and weight for height (r=-0.224). A higher number of sensitized food allergens was associated with negative effects on the growth and nutritional status of infants and young children with AD. Therefore, a thorough evaluation of both growth and nutritional status, combined with adequate patient management, is crucial in pediatric AD patients presenting with numerous sensitized food allergies.Allergy, asthma & immunology research 01/2011; 3(1):53-7. · 1.91 Impact Factor
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ABSTRACT: Patients with both severe atopic dermatitis and Kawasaki disease or idiopathic thrombocytopenic purpura were treated with high dose intravenous gammaglobulin. There was a marked improvement in the dermatitis.Archives of Disease in Childhood 05/1994; 70(4):335-6. · 2.88 Impact Factor
© Copyright The Korean Academy of Asthma, Allergy and Clinical Immunology • The Korean Academy of Pediatric Allergy and Respiratory Disease
Atopic dermatitis (AD) is a chronically recurrent inflammato-
ry skin disorder characterized by pruritus, a specific distribu-
tion, and a family history. It has recently been reported that the
incidence of AD has increased in Korea.1,2 Pruritus, sleep loss,
dietary restrictions, and psychosocial factors significantly de-
crease the quality of life for AD patients.3,4 Recently, the Europe-
an Academy of Allergy and Clinical Immunology and the Amer-
ican Academy of Allergy, Asthma, and Immunology published
the PRACTALL consensus report for the diagnosis and treat-
ment of AD in children and adults.5 The report suggests a step-
wise management that includes the addition of multiple thera-
peutic agents on the basis of the disease severity.
The PRACTALL consensus report defines severe or recalcitrant
AD as AD that cannot be controlled with topical treatment.6 In
the 2009 Korean Work Group Report on the treatment of severe/
recalcitrant AD, severe AD is defined as AD with a SCORAD in-
dex higher than 50 and that cannot be controlled with conven-
tional treatment,7 while the 2008 Guideline of Atopic Dermatitis
in Korean Children defines severe AD by a SCORAD index high-
er than 40.8 Specific criteria for the definition of recalcitrant and
severe AD are necessary.
For the management of severe AD, the PRACTALL consensus
report recommends systemic therapy such as antimicrobial
treatment, systemic corticosteroids, cyclosporin A, azathioprine,
anti-histamines, phototherapy, and immunotherapy. Several
reports, including the 2009 Korean Work Group Report, have
described intravenous immunoglobulin (IVIg) treatment as one
of various immunoregulatory treatments. Nevertheless, this
treatment was not included in the PRACTALL report.7,9,10
IVIg treatment displays immunomodulatory and anti-inflam-
matory properties, and its effectiveness in several immune-me-
diated conditions such as Kawasaki disease and idiopathic
thrombocytopenic purpura has been demonstrated.11 IVIg is
considered a candidate for the treatment of AD because of its
ability to downregulate T-cell function, particularly interleu-
Use of Intravenous Immunoglobulin in the Treatment of Childhood
Myung Hyun Sohn, Kyu-Earn Kim*
Department of Pediatrics and Institute of Allergy, BK 21 Project for Medical Sciences, Yonsei University College of Medicine, Seoul, Korea
kin-4 production.12,13 A small number of observations on the ef-
ficiency of IVIg in AD have been reported, but prospective and
randomized studies for its clinical efficiency in childhood AD
are sparse. A randomized, placebo-controlled prospective study
in childhood AD patients is therefore required.14
Jee et al.14 recently reported therapeutic effects of IVIg in child-
hood AD; however, this study involved moderate to severe AD
patients, and it did not include severe AD patients because the
disease severity might have affected the treatment results. Fur-
ther randomized studies with strict criteria for recalcitrant/se-
vere AD are warranted. In addition, the IVIg effective dose, the
dosing interval for initiation and maintenance, the identifica-
tion of biomarkers (e.g., ECP, ICAM-1, and IL-5/INF-gamma) to
determine efficiency, and clear criteria for IVIg indications all
Currently, we lack evidence-based data supporting the use of
IVIg and other immunomodulators in childhood AD. Before
IVIg can be recommended, its cost-benefit ratio, course, dura-
tion, and adverse reactions compared with alternative thera-
peutic options must be determined. The effects of novel thera-
pies such as IVIg for recalcitrant/severe AD patients should be
verified through repeated research and numerous research dis-
1. Suh M, Kim HH, Sohn MH, Kim KE, Kim C, Shin DC. Prevalence of
allergic diseases among Korean school-age children: a nationwide
Allergy Asthma Immunol Res. 2011 April;3(2):65-66.
pISSN 2092-7355 • eISSN 2092-7363
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits
unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Correspondence to: Kyu-Earn Kim, MD, PhD, Department of Pediatrics,
Gangnam Severance Hospital, Yonsei University College of Medicine, 712
Eonjuro, Gangnam-gu, Seoul 135-720, Korea.
Tel: +82-2-2019-3353; Fax: +82-2-3461-9473; E-mail: email@example.com
Received: March 11, 2011; Accepted: March 14, 2011
•There are no financial or other issues that might lead to conflict of interest.
Sohn et al.
Allergy Asthma Immunol Res. 2011 April;3(2):65-66. doi: 10.4168/aair.2011.3.2.65
Volume 3, Number 2, April 2011
cross-sectional questionnaire study. J Korean Med Sci 2011;26:
2. Hong SJ, Ahn KM, Lee SY, Kim KE. The prevalences of asthma and
allergic diseases in Korean children. Pediatr Allergy Respir Dis 2008;
3. Holm EA, Wulf HC, Stegmann H, Jemec GB. Life quality assess-
ment among patients with atopic eczema. Br J Dermatol 2006;154:
4. Cho HN, Hong S, Lee SH, Yum HY. Nutritional status according to
sensitized food allergens in children with atopic dermatitis. Allergy
Asthma Immunol Res 2011;3:53-7.
5. Akdis CA, Akdis M, Bieber T, Bindslev-Jensen C, Boguniewicz M,
Eigenmann P, Hamid Q, Kapp A, Leung DY, Lipozencic J, Luger TA,
Muraro A, Novak N, Platts-Mills TA, Rosenwasser L, Scheynius A,
Simons FE, Spergel J, Turjanmaa K, Wahn U, Weidinger S, Werfel T,
Zuberbier T, European Academy of Allergology and Clinical Im-
munology/American Academy of Allergy, Asthma and Immunolo-
gy. Diagnosis and treatment of atopic dermatitis in children and
adults: European Academy of Allergology and Clinical Immunolo-
gy/American Academy of Allergy, Asthma and Immunology/
PRACTALL Consensus Report. J Allergy Clin Immunol 2006;118:
6. Long CC, Funnell CM, Collard R, Finlay AY. What do members of
the National Eczema Society really want? Clin Exp Dermatol 1993;
7. Park JS, Kim BJ, Park Y, Lee SY, Kim WK, Kim JE, Yum HY, Nahm
DH, Kim HH, Hong SJ, Oh JW, Lee AY, Kim KH, KAAACI Work
Group on Severe/Recalcitrant Atopic Dermatitis. KAAACI work
group report on the treatment of severe/recalcitrant atopic derma-
titis. Korean J Asthma Allergy Clin Immunol 2010;30:255-70.
8. Korean Academy of Pediatric Allergy and Respiratory Disease.
Guideline of atopic dermatitis in Korean children. 1st ed. Seoul:
Kwangmun Press; 2008.
9. Kimata H. High dose gammaglobulin treatment for atopic derma-
titis. Arch Dis Child 1994;70:335-6.
10. Gelfand EW, Landwehr LP, Esterl B, Mazer B. Intravenous immune
globulin: an alternative therapy in steroid-dependent allergic dis-
eases. Clin Exp Immunol 1996;104 Suppl 1:61-6.
11. Hanna K, Poulin-Costello M, Preston M, Maresky N. Intravenous
immune globulin use in Canada. Can J Clin Pharmacol 2003;10:11-6.
12. Leung DY. Atopic dermatitis: immunobiology and treatment with
immune modulators. Clin Exp Immunol 1997;107 Suppl 1:25-30.
13. Jolles S, Hughes J, Rustin M. Intracellular interleukin-4 profiles dur-
ing high-dose intravenous immunoglobulin treatment of therapy-
resistant atopic dermatitis. J Am Acad Dermatol 1999;40:121-3.
14. Jee SJ, Kim JH, Baek HS, Lee HB, Oh JW. Long-term efficacy of in-
travenous immunoglobulin therapy for moderate to severe child-
hood atopic dermatitis. Allergy Asthma Immunol Res 2011;3:89-