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Background@#Staphylococcus lugdunensis is an emerging pathogen in skin and soft tissue infections. However, until recently, the role of S. lugdunensis as a skin pathogen remained underrated. @*Objective@#The purpose of this study was to investigate the clinical characteristics and antibiotic susceptibility of S.lugdunensis isolated from skin diseases. @*Methods@#This is a retrospective chart review of 48 cases in which S. lugdunensis was isolated from bacterial skin cultures between 2016 and 2021. @*Results@#Among the 48 patients, the mean age was 41.0 years, 54.2% were male, and 12.5% of the patients had immunosuppressive diseases. Nearly 87.4% of infections occurred below the waist and the dominant sources of isolation were epidermal cyst (31.3%) and hidradenitis suppurativa (29.2%). The rate of resistance of S. lugdunensis against β-lactam antibiotics were as follows: penicillin, 83.3%; oxacillin, 37.5%; and methicillin, 29.2%. @*Conclusion@# S. lugdunensis is emerging as one of the primary pathogens of skin infections. When S. lugdunensis is isolated, dermatologists should consider that it is not just a component of the skin flora but can also be a pathogen. If S. lugdunensis is identified as the cause of infection, it should be managed with appropriate antibiotic therapy.
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Pembrolizumab is an immune checkpoint inhibitor that selectively blocks the programmed cell death (PD)-1 receptor. Although it has a dramatic effect on the treatment of advanced malignancies, instability of immune tolerance may cause immune-related adverse events in the skin. A 62-year-old male with a history of metastatic urothelial carcinoma was referred to the dermatology department and presented with a widespread mucocutaneous rash. Itching appeared 7 days after the first administration of pembrolizumab, and on the third day after the second administration, an erythematous maculopapular rash that coalesced into large flaccid bullae on the whole body with a positive Nikolsky’s sign developed. A biopsy revealed a subepidermal bulla with basal keratinocyte necrosis. Pembrolizumab was discontinued due to the diagnosis of toxic epidermal necrolysis (TEN), and intravenous methylprednisolone was started. Herein, we report a case of TEN induced by pembrolizumab to highlight immune-related cutaneous adverse events in patients receiving anti-PD-1 therapy.
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Background@#Psoriasis is a chronic T17 cell-driven immune-mediated inflammatory disease. However, patients with psoriasis may have elevated total serum immunoglobulin E (IgE) levels, which is a hallmark of Th2 inflammation.In previous case reports, psoriasis patients with elevated total serum IgE levels did not respond well to treatment or had exacerbated eczema lesions. @*Objective@#We sought to investigate the clinical characteristics of psoriasis patients with elevated total serum IgE levels. @*Methods@#This is a retrospective chart review of 130 patients with psoriasis who were tested for total serum IgE levels from November 1, 2009, to October 31, 2019. We compared the demographics, clinical characteristics, disease severity, and treatment regimen for each elevated IgE group (>214 U/mL) and normal IgE group (≤214 U/mL). @*Results@#Among 130 patients with psoriasis, 41 (31.5%) had elevated total serum IgE levels. Elevated total serum IgE levels were positively associated with the severity of disease; psoriasis lesions including those on the scalp, hands, feet, and flexures, which are difficult to treat, were observed to be significantly higher in patients with elevated total serum IgE levels. There was no correlation between age, sex, disease duration, or presence of pruritus and total serum IgE levels. @*Conclusion@#This study identified the clinical characteristics of psoriasis patients with elevated total serum IgE levels in Korea.
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Sarcoidosis is a chronic multi-organ disorder of unknown etiology, characterized by the development of non-caseating granulomas. Scar sarcoidosis is a cutaneous manifestation of sarcoidosis that originates in old cutaneous scars. Sarcoidosis may develop in scars that occur after surgery, vaccination, cosmetic tattoos, and herpes zoster infection. Upper eyelid blepharoplasty is the most popular aesthetic facial surgery performed in the Asian population. Despite the large number of blepharoplasty procedures performed over the last century, relatively few reports have described scar sarcoidosis involving a blepharoplasty scar. We report a rare case of sarcoidosis that originated in a post-blepharoplasty scar, together with a literature review. Scar sarcoidosis should be considered in the differential diagnosis in patients who present with post-blepharoplasty changes in an old scar.
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Background@#Vulvar pruritus is a common complaint among women presenting to dermatologists. However, few studies have analyzed the dermatologic conditions that cause it. @*Objective@#This retrospective study aims to evaluate the clinical features and causes of pruritic skin lesions of the female external genitalia. @*Methods@#This study included 161 female patients with vulvar pruritus between 2008 and 2018 at CHA Bundang Medical Center. Data were collected by reviewing the electronic medical records retrospectively. The age, diagnosis, and histopathologic findings of the patients were reviewed. @*Results@#The patients’ mean age was 49 years. On physical examination, 71.4% of patients (n=115) had definite skin lesions, and 28.6% (n=46) had ‘vulvar pruritus without skin rash’. The most common diagnostic category, confirmed by skin biopsy, was inflammatory dermatoses (53.4%, n=86), including lichen sclerosus et atrophicus, lichen simplex chronicus, nonatopic eczema, atopic eczema, and psoriasis. Moreover, 7.5% of patients (n=12) were diagnosed with infectious diseases, including candidiasis, herpes simplex virus, syphilis, and scabies; 5.6% (n=9) were diagnosed with neoplastic diseases, including vulvar intraepithelial neoplasia, squamous cell carcinoma, extramammary Paget’s disease, and Bowen’s disease. @*Conclusion@#The causes of vulvar itch are vast, and often, multiple causes coexist simultaneously. Therefore, it requires a systemic approach to establish the correct diagnosis. Dermatologists should actively participate in the diagnosis and treatment.
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Background@#Patients with stable psoriasis showing clearear-clear response can consider extending the dosing interval of biologics. However, few studies have reported the treatment outcomes following irregular dosing intervals of biologics in patients with psoriasis. @*Objective@#We compared treatment outcomes after regular and irregular dosing intervals of biologics in patients with psoriasis. @*Methods@#This single-center, retrospective observational study included patients who received biologics for treatment of plaque psoriasis between January 1, 2014 and December 31, 2019. We compared patient demographics, clinical characteristics, biologics administered, and treatment outcomes based on the regularity of the dosing interval. @*Results@#Among 95 patients investigated, 63 (66.3%) received biologics at regular dosing intervals. We observed no significant intergroup differences in the final Psoriasis Area Severity Index (PASI) scores (1.2 vs. 1.8, p=0.16) and in the percentage improvement in PASI scores from baseline levels (−89.8% vs. −90.8%, p=0.68). The rate at which biologics were switched was higher in the irregular-dosing group than in the regular-dosing group; however, the difference was statistically nonsignificant (28.1% vs. 12.7%, p=0.06). We observed a significant intergroup difference in patients who were administered guselkumab at baseline (12 [21.8%] vs. 0 [0.0%], p=0.01). @*Conclusion@#This study showed that compared with regular dosing intervals, irregular dosing intervals of biologics were associated with high rates of switching of these agents, although we observed no statistically significant differences with regard to PASI scores. Therefore, it is important to adhere to the standard dosing schedule prescribed for biologics, and guselkumab may improve patient compliance.
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The skin is the first line of defense of our body, and it is composed of the epidermis and dermis with diverse immune cells. Various in vitro models have been investigated to recapitulate the immunological functions of the skin and to model inflammatory skin diseases. The simplest model is a two-dimensional (2D) co-culture system, which helps understand the direct and indirect cellto-cell interactions between immune and structural cells; however, it has limitations when observing three-dimensional (3D) interactions or reproducing skin barriers. Conversely, 3D skin constructs can mimic the human skin characteristics in terms of epidermal and dermal structures, barrier functions, cell migration, and cell-to-cell interaction in the 3D space. Recently, as the importance of neuro-immune-cutaneous interactions in the inflammatory response is emerging, 3D skin constructs containing both immune cells and neurons are being developed. A microfluidic culture device called “skin-on-a-chip,” which simulates the structures and functions of the human skin with perfusion, was also developed to mimic immune cell migration through the vascular system. This review summarizes the in vitro skin models with immune components, focusing on two highly prevalent chronic inflammatory skin diseases: atopic dermatitis and psoriasis. The development of these models will be valuable in studying the pathophysiology of skin diseases and evaluating the efficacy and toxicity of new drugs.
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Background@#Vulvar pruritus is a common complaint among women presenting to dermatologists. However, few studies have analyzed the dermatologic conditions that cause it. @*Objective@#This retrospective study aims to evaluate the clinical features and causes of pruritic skin lesions of the female external genitalia. @*Methods@#This study included 161 female patients with vulvar pruritus between 2008 and 2018 at CHA Bundang Medical Center. Data were collected by reviewing the electronic medical records retrospectively. The age, diagnosis, and histopathologic findings of the patients were reviewed. @*Results@#The patients’ mean age was 49 years. On physical examination, 71.4% of patients (n=115) had definite skin lesions, and 28.6% (n=46) had ‘vulvar pruritus without skin rash’. The most common diagnostic category, confirmed by skin biopsy, was inflammatory dermatoses (53.4%, n=86), including lichen sclerosus et atrophicus, lichen simplex chronicus, nonatopic eczema, atopic eczema, and psoriasis. Moreover, 7.5% of patients (n=12) were diagnosed with infectious diseases, including candidiasis, herpes simplex virus, syphilis, and scabies; 5.6% (n=9) were diagnosed with neoplastic diseases, including vulvar intraepithelial neoplasia, squamous cell carcinoma, extramammary Paget’s disease, and Bowen’s disease. @*Conclusion@#The causes of vulvar itch are vast, and often, multiple causes coexist simultaneously. Therefore, it requires a systemic approach to establish the correct diagnosis. Dermatologists should actively participate in the diagnosis and treatment.
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Background@#Patients with stable psoriasis showing clearear-clear response can consider extending the dosing interval of biologics. However, few studies have reported the treatment outcomes following irregular dosing intervals of biologics in patients with psoriasis. @*Objective@#We compared treatment outcomes after regular and irregular dosing intervals of biologics in patients with psoriasis. @*Methods@#This single-center, retrospective observational study included patients who received biologics for treatment of plaque psoriasis between January 1, 2014 and December 31, 2019. We compared patient demographics, clinical characteristics, biologics administered, and treatment outcomes based on the regularity of the dosing interval. @*Results@#Among 95 patients investigated, 63 (66.3%) received biologics at regular dosing intervals. We observed no significant intergroup differences in the final Psoriasis Area Severity Index (PASI) scores (1.2 vs. 1.8, p=0.16) and in the percentage improvement in PASI scores from baseline levels (−89.8% vs. −90.8%, p=0.68). The rate at which biologics were switched was higher in the irregular-dosing group than in the regular-dosing group; however, the difference was statistically nonsignificant (28.1% vs. 12.7%, p=0.06). We observed a significant intergroup difference in patients who were administered guselkumab at baseline (12 [21.8%] vs. 0 [0.0%], p=0.01). @*Conclusion@#This study showed that compared with regular dosing intervals, irregular dosing intervals of biologics were associated with high rates of switching of these agents, although we observed no statistically significant differences with regard to PASI scores. Therefore, it is important to adhere to the standard dosing schedule prescribed for biologics, and guselkumab may improve patient compliance.
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The skin is the first line of defense of our body, and it is composed of the epidermis and dermis with diverse immune cells. Various in vitro models have been investigated to recapitulate the immunological functions of the skin and to model inflammatory skin diseases. The simplest model is a two-dimensional (2D) co-culture system, which helps understand the direct and indirect cellto-cell interactions between immune and structural cells; however, it has limitations when observing three-dimensional (3D) interactions or reproducing skin barriers. Conversely, 3D skin constructs can mimic the human skin characteristics in terms of epidermal and dermal structures, barrier functions, cell migration, and cell-to-cell interaction in the 3D space. Recently, as the importance of neuro-immune-cutaneous interactions in the inflammatory response is emerging, 3D skin constructs containing both immune cells and neurons are being developed. A microfluidic culture device called “skin-on-a-chip,” which simulates the structures and functions of the human skin with perfusion, was also developed to mimic immune cell migration through the vascular system. This review summarizes the in vitro skin models with immune components, focusing on two highly prevalent chronic inflammatory skin diseases: atopic dermatitis and psoriasis. The development of these models will be valuable in studying the pathophysiology of skin diseases and evaluating the efficacy and toxicity of new drugs.
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Background@#A rifampicin (RF)-clindamycin (CL) combination therapy is recommended as the first-line treatment for moderate to severe hidradenitis suppurativa (HS). Although the long-term use of RF requires caution due to the possibility of developing resistant bacteria, only a few studies have investigated alternatives for this combination therapy. @*Objective@#To evaluate the efficacy of systemic CL mono-therapy and assess the prevalence and CL resistance of bacterial growth in HS patients. @*Methods@#A total of 53 HS patients treated with CL mono-therapy were included. The efficacy was evaluated by identifying the rate of HS Clinical Response (Hi-SCR) achievers and comparing HS Physician’s Global Assessment (HS-PGA) before (W0) and after (W8) the treatment. Purulent material from HS skin lesions was collected on the W0. Bacterial flora and antibiotic sensitivity were determined by bacterial cultures. @*Results@#Of 53 HS patients, 34 were eligible for evaluation of the efficacy of the therapy. Twenty-one patients (61.76%) achieved Hi-SCR. The mean scoring of HS-PGA had significantly decreased from 3.24 to 2.15 (p=0.001). The prevalence of CL resistance was 15.00%. No significant differences in the efficacy of the therapy according to the presence of CL-resistant bacteria on the W0 were observed (p=0.906). Adverse events occurred in 26.42% of patients. @*Conclusion@#Systemic CL mono-therapy may be a safe and useful alternative to RF-CL combination therapy, and no significant difference in the efficacy of the therapy depending on the presence of CL-resistant bacteria was observed.
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Sarcoidosis is a multisystem granulomatous disease of unknown etiology. A range of factors including tuberculous infection, beryllium exposure, and cold climate have been implicated in the pathogenesis of the condition. A 45-year-old woman presented with a 4-month history of an asymptomatic eyelid swelling and multiple erythematous papules on the neck. Histological examination of the neck, orbital soft tissue, and lacrimal gland was consistent with sarcoidosis. Ziehl−Neelsen stains and polymerase chain reactions (PCRs) for tuberculosis on the skin biopsy specimens were negative. However, the orbital soft tissue specimen was positive for non-tuberculous mycobacteria (NTM) PCR. The patient was finally diagnosed with sarcoidosis associated with NTM. Treatment with systemic steroid and hydroxychloroquine was started, resulting in an improvement of skin lesions. We herein report a case of sarcoidosis associated with NTM infection with review of the literature, as only little is known regarding the role of mycobacteria in sarcoidosis.
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BACKGROUND@#Bowen's disease (BD) is treated by multiple treatment modalities.@*OBJECTIVE@#To assess the effectiveness of photodynamic therapy (PDT) and ingenol mebutate (IMB) in treating BD and determine the factors affecting the treatment outcome.@*METHODS@#Patients with histologically confirmed BD from January 1, 2006, to December 31, 2017, were identified from the database of CHA Bundang Medical Center. Those treated with PDT or IMB were included. Patient, tumor characteristics, and treatment response data were retrospectively collected from the database.@*RESULTS@#Overall, 44 and 24 BD were treated with PDT and IMB, respectively. Mean time to the first follow-up visit was 1.2 (0.5~4) months. Mean follow-up duration was 7.6 (1~36) months. The mean number of treatment sessions for PDT is 2 sessions (1~5), while that of IMB was equally 1 session. The complete response rates at the first follow-up visit were 66.7% and 53.0% and recurrence rates were 10.3% and 15.3% for PDT and IMB, respectively. However, the treatment outcome and recurrence rate between both treatment modalities were not significantly different (p=0.349 and p=0.993, respectively). In factor analysis, the complete response rate significantly decreased with older patients in IMB (p=0.012). Adverse events, occurred in 20.5% and 45.8% of patients treated with PDT and IMB, respectively.@*CONCLUSION@#PDT and IMB are effective noninvasive treatment modalities for BD. However, PDT is a safer treatment modality, considering its fewer adverse events. Particularly, with age being a factor that reduces IMB outcome, in older patients, PDT can be considered as preferred treatments over IMB.
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Background@#Rosacea is a common skin disease associated with increased expression of cathelicidin, kallikrein 5 (KLK5), toll-like receptor (TLR) 2, and abnormal barrier function. Recently, it was reported that hyaluronan (HA) could influence immune function via various receptors and HA oligosaccharides (oligo-HAs) could suppress TLR-dependent cytokine expression. @*Objective@#We investigated if oligo-HAs could influence on inflammation and epidermal barrier induced by LL-37, which had a major role in rosacea. @*Methods@#We cultured normal human keratinocytes and treated them with LL-37 and oligo-HAs or the LL-37 alone. A rosacea-like BALB/c mouse model injected with LL-37 was used to determine the role of oligo-HAs in rosacea in vivo. @*Results@#Interleukin-8 (IL-8) and tumor necrosis factor (TNF)-α release was suppressed when keratinocytes were co-treated with oligo- HAs and LL-37 compared with keratinocytes treated with LL-37 only. Treatment with oligo-HAs resulted in decreased transepidermal water loss as well as improved redness. Decreased inflammatory cell infiltration, IL-17A and KLK5 expression and increased CD44 and filaggrin expression were also noted. @*Conclusion@#Our findings suggest that oligo-HA improves rosacea-like phenotype through anti-inflammatory and epidermal barrier improving effect.
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PURPOSE: Atopic dermatitis (AD) is a chronic eczematous dermatitis that has a high prevalence and diverse clinical features. Although several hypotheses about its multifactorial pathogenesis have been suggested, the cause is not yet fully understood. A better understanding of the clinical features may helpful inelucidating the pathogenesis of AD. METHODS: This retrospective study analyzed the questionnaires, medical charts, and laboratory examination results of 5,000 patients diagnosed with AD at a single tertiary hospital in Korea. RESULTS: The demographics, allergic comorbidities, family history, severity, and treatment experiences of the patients were analyzed. Most of the patients were adults, 76.3% of whom were classified as havingan extrinsic type of AD. The mean eczema area and severity index (EASI) score was found to be 13.68, and adult patients were found to have higher severity than the other age groups. The anatomical involvements were different among the age groups, with more involvements of the head and neck in adults. The patients reported seasonal changes and stress as the factors that aggravated their symptoms the most. Topical steroids and oral cyclosporine were the most used medications at our clinic, whereas 10.1% of the patients underwent allergen-specific immunotherapy. CONCLUSION: This analysis of 5,000 patients would lead to a better understanding of various subtypes and diverse clinical features of AD in Koreans. Distinct characteristics were observed among different age groups; thus, treatment strategies may need to be differentiated accordingly.
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Adulto , Humanos , Comorbidade , Ciclosporina , Demografia , Dermatite Atópica , Eczema , Cabeça , Imunoterapia , Coreia (Geográfico) , Pescoço , Prevalência , Estudos Retrospectivos , Estações do Ano , Esteroides , Centros de Atenção TerciáriaRESUMO
BACKGROUND: Little knowledge is available on the characteristic differences between patients with atopic dermatitis (AD) with and without atopic march after childhood. OBJECTIVE: To observe and compare the phenotypes of patients with AD in regards to atopic march tendency at a single point. METHODS: We enrolled patients with AD aged between 10 and 30 years. The patients were divided into the atopic march and non-atopic march groups on the basis of an investigator-designed survey questionnaire, and their serum-specific immunoglobulin E (IgE) levels or results of the skin prick test were compared. RESULTS: In a total of 182 patients enrolled in the study, 93 patients with atopic march and 89 patients with non-atopic march were observed. When their serum-specific IgE levels or results of the skin prick test were compared between the two groups, there was no significant difference, except for a in the atopic march group. Analysis of AD severity, family history of allergic diseases, and total IgE levels between the two groups showed no statistically significant differences. CONCLUSION: Our findings suggest that although no apparent phenotype characteristics could differentiate the presence of atopic march, the history of the patient's allergic diseases should be revalidated, and clinicians should watch out for future developments of atopic march when a patient shows a high-class sensitization rate to dust mite.
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Humanos , Dermatite Atópica , Poeira , Imunoglobulina E , Imunoglobulinas , Ácaros , Fenótipo , PeleRESUMO
BACKGROUND: Growth factors play important roles in wound healing. However, the evidence for the effects of growth factors on post-thyroidectomy scars is limited. OBJECTIVE: We performed a prospective study to assess the preventive and therapeutic effect of a multi-growth factor (MGF)-containing cream on post-thyroidectomy scars. METHODS: Twenty-one patients with thyroidectomy scars applied MGF cream twice a day. We assessed the changes in erythema, pigmentation, skin elasticity, and skin hydration status using the erythema index, melanin index, cutometer, and corneometer, respectively. In addition, Vancouver scar scale (VSS) and patient satisfaction were assessed at 10 days after surgery (baseline), 2 weeks, 6 weeks, and 12 weeks after baseline. RESULTS: The mean total VSS scores were significantly lower at 6 weeks (3.24±1.51 vs. 1.91±1.38) and 12 weeks (3.24±1.51 vs. 1.71±1.59) compared to the baseline. The degree of pigmentation was significantly lower at 12 weeks compared to the baseline, and the skin elasticity, and the skin hydration status were significantly higher at 12 weeks compared to the baseline. Over 85% of the patients were satisfied with the use of MGF cream without any adverse effect. CONCLUSION: MGF cream might have additive or supportive effect for scar formation after thyroidectomy.
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Humanos , Cicatriz , Elasticidade , Eritema , Peptídeos e Proteínas de Sinalização Intercelular , Melaninas , Satisfação do Paciente , Pigmentação , Estudos Prospectivos , Pele , Pigmentação da Pele , Tireoidectomia , CicatrizaçãoRESUMO
PURPOSE: In extrinsic atopic dermatitis (AD), house dust mites (HDM) play a role in eliciting or aggravating allergic lesions. The nature of skin inflammation in AD has raised a growing interest in allergen-specific immunotherapy (SIT). Thus, we assessed clinical improvement and laboratory parameters for evaluation of the benefit of long-term SIT. MATERIALS AND METHODS: A total of 217 AD patients who were treated with SIT for at least 3 years were retrospectively assessed, by using their investigator global assessment, pruritus scores, loss of sleep (LOS), total serum IgE, and eosinophil counts collected. Patients were additionally classified into subgroups according to age, initial AD severity and mono- or multi-sensitization to include different individual factors in the evaluation of SIT efficacy. Lastly, we compared laboratory data of good responders to SIT with that of poor responders to SIT. RESULTS: Improvement after SIT therapy was observed in 192 out of 217 patients (88.4%). Among these patients, 138 (63.5%) achieved excellent, near-complete or complete clinical remission. Significant reduction of pruritus, LOS, and the mean value of total serum IgE were observed (p0.05). CONCLUSION: We emphasize the usefulness of long-term HDM SIT as a disease-modifying therapy for AD.
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Adolescente , Adulto , Animais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Alérgenos/imunologia , Dermatite Atópica/terapia , Dessensibilização Imunológica/métodos , Relação Dose-Resposta a Droga , Pyroglyphidae/imunologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
PURPOSE: Regulatory T (Treg) cells are key modulators in the immune system. Recent studies have shown that atopic dermatitis (AD) patients have higher numbers of Treg cells; however, little is known about the specific phenotype and function of Treg cells in AD. MATERIALS AND METHODS: To identify differentially expressed proteins in peripheral induced Treg cells in AD and naturally derived Treg cells in normal controls, CD4?CD25? Treg cells were isolated from thymus tissue of normal mice and the spleens of AD mice. Membrane proteins were extracted, and quantitative proteomics labeling with Tandem Mass Tags (TMT) was performed, followed by one-dimensional liquid chromatography/tandem mass spectrometry analysis. RESULTS: Using TMT labeling, we identified 510 proteins, including 63 membrane proteins and 16 plasma membrane proteins. CD47 was one of the upregulated proteins in Treg cells in AD spleens. Although CD47 was expressed in all CD4? and CD8? T cells, a significantly higher expression of CD47 was observed in the Treg cells of AD mice and AD patients than in those of normal mice and healthy controls. Furthermore, Treg cells from the spleen showed a significantly higher expression of CD47 than those from the thymus. CONCLUSION: We found that CD47 is highly expressed in the Treg cells of AD mice, particularly in the spleen. Based on our results, we propose that CD47(high) Treg cells are likely induced Treg cells and that upregulated CD47 in the Treg cells of AD patients may play a role in the increased population of Treg cells in AD.
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Animais , Humanos , Camundongos , Membrana Celular , Dermatite Atópica , Sistema Imunitário , Espectrometria de Massas , Proteínas de Membrana , Fenótipo , Proteômica , Baço , Linfócitos T , Linfócitos T Reguladores , Timo , Regulação para CimaRESUMO
PURPOSE: Specific immunoglobulin G4 (sIgG4) and immunoglobulin E (IgE)-blocking factors produced by subcutaneous immunotherapy (SCIT) play a critical role in the induction of allergen tolerance. However, comparative studies of available SCIT reagents on the induction of sIgG4 are limited. We compared increases in sIgG4 for three different house dust mite (HDM) SCIT reagents. MATERIALS AND METHODS: Seventy-two HDM sensitized allergic patients were enrolled and classified into four groups: 1) control (n=27), 2) SCIT with Hollister-Stier® (n=19), 3) Tyrosine S® (n=16), and 4) Novo-Helisen® (n=10). Levels of specific IgE (sIgE), sIgG4, and IgE blocking factor to Dermatophagoides farinae (D. farinae) were measured using ImmunoCAP (sIgE, sIgG4) and enzyme-linked immunosorbent assay (ELISA) (IgE-blocking factors). Levels were measured before and 13.9±6.6 months after the SCIT. The allergen specificity and the induction levels of sIgE and sIgG4 were confirmed by immunoblot analysis. RESULTS: After SCIT, sIgG4 levels to D. farinae increased significantly; however, the increases differed significantly among the SCIT groups (p<0.001). Specific IgG4 levels to D. farinae were highest in Hollister-Stier® (3.7±4.1 mg/L), followed by Novo-Helisen® (2.2±2.3 mg/L) and Tyrosine S® (0.7±0.5 mg/L). In addition, patients who were administered using Hollister-Stier® showed the most significant decrease in IgE/IgG4 ratio (p<0.001) and increase in blocking factor (p=0.009). Finally, according to IgE immunoblot results, the Hollister-Stier® group showed the most significant attenuation of IgE binding patterns among others. CONCLUSION: Currently available SCIT reagents induce different levels of specific IgG4, IgE/IgG4 ratio, and IgE-blocking factor.