Long-term Effect of Recombinant Interferon-Gamma on Moderate and Severe Atopic Dermatitis in Childhood / 소아알레르기및호흡기학회지

PURPOSE: A number of studies on the treatment of atopic dermatitis have focused on the therapeutic effects of interferon-gamma (IFN-gamma) in patients with severe atopic dermatitis, although therapeutic protocols such as duration and dosage of recombinant IFN-gamma were different among studies. The beneficial effects of IFN-gamma have probably been attributed mainly to its immune modulating effect on the expression of several immunologic mediators although the mechanism of action of IFN-gamma therapy in atopic dermatitis is not clear. OBJECTIVE: The purpose of the present study was to evaluate the therapeutic effect of recombinant IFN-gamma on moderate to severe atopic dermatitis with changes in immunologic markers such as IgE level and eosionophil cationic protein (ECP). METHODS: Thirty children with moderate to severe atopic dermatitis were selected for the treatment with recombinant IFN-gamma, and 10 children with atopic dermatitis were recruited for the controls without IFN-gamma treatment. They were followed up every 4 weeks for 3 months after IFN-gamma treatment. We evaluated the SCORAD index and immunologic markers including serum IgE and ECP and total eosinophil and neutrophil counts. RESULTS: Significant clinical improvement in reduced SCORAD index was observed 12 weeks after treatment with regimen of recombinant IFN-gamma. This clinical outcome was correlated more with changes in eosinophil counts and ECP levels than with those in serum IgE levels. CONCLUSIONS: The efficacy of recombinant human IFN-gamma therapy for children with moderate to severe atopic dermatitis was maintained without serious side effects for 6 months after final injection of recombinant IFN-gamma. Recombinant IFN-gamma therapy corrected cellular immune deficits, but not humoral immune defects in patients with atopic dermatitis.

A Study of Clinical Manifestations of Acute Rheumatic Fever

PURPOSE: In developed countries, acute rheumatic fever appears to be a vanishing disease. In Korea, the incidence and severity of acute rheumatic fever (ARF) has significantly decreased in recent 30 years. According to this report, Korea sustained low incidence of ARF. METHODS: The medical records of 5 children diagnosed as ARF from January 2000 to September 2006 were reviewed retrospectively about clinical manifestations and laboratory findings. RESULTS: The average incidence of rheumatic fever was 0.17 per annual pediatric in-ward 1,000 patients. During study period, only 1 case had a definite history of preceding infection. Among 5 patients, the incidence of major manifestations were as follows:carditis 5 cases, chorea 1 case, arthritis 1 case and erythema marginatum 2 cases. Clinical findings of carditis were cardiac murmur, cardiomegly, congestive heart failure and pericardial effusion. Significant valvular lesions were mitral and aortic insufficiency. Minor manifestations and other clinical manifestations were fever, arthralgia, dyspnea, coughing, palpitation, weakness and chest pain. Laboratory findings were increased antistreptolysin O titer, positive C reactive protein (CRP) and increased erythrocyte sedimentation rate (ESR). CONCLUSION: The incidence of ARF has reduced but rheumatic carditis varies in severity from moderate to severe cardiac involvement. For many reasons ARF is being diagnosed inappropriately resulting from lack of awareness about the disease due to rarity and secondary prophylaxis. We should be aware of acute rheumatic fever and should pay attention to the treatment of the patients with streptococcal pharyngitis.

DNA Methylation Change of IL-4 Gene from T Cell in Allergic Children / 소아과

PURPOSE: An understanding of the immunological process is required if primary prevention of atopic diseases is to be developed in early childhood. But, it is too hard to distinguish atopy from nonatopy under the age of two clinically, because the expression of phenotype and cytokines is vague in early childhood. We evaluated DNA methylation changes at Th2 interleukin-4 gene in peripheral blood from atopic children. METHODS: We selected 15 allergic children (mild: eight, moderate to severe: seven) and seven normal controls by using family allergy scores and clinical histories. We measured Total IgE and Der f II specific IgE levels and cultured peripheral blood mononuclear cells with Der f II stimulation and extracted DNA from Der f II specific T cells. We examined the change of CpG methylation in DNA from atopic and nonatopic children. RESULTS: In T cells from normal children, IL-4 DNA were predominantly methylated; otherwise, CpG demethylation occurred in Der f II specific T cells from allergic children. CONCLUSION: IL-4 DNA methylation changes occurred in T genes from allergic children and DNA methylation assay in early childhood.