The hyper IgE syndrome: clinical and therapeutic aspects.
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Biomedical subjects
Publications and source records attributed to E Galli.
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The T-cell subpopulations as defined by monoclonal antibodies OKT4 and OKT8 have been evaluated in 17 children with severe atopic dermatitis and high IgE levels. Normal percentage and absolute number of total T-cells and helper and suppressor/cytotoxic subsets were found. No relationship could be established between the distribution of T-cell subsets, serum IgE levels or the severity of the eczema.
In the recent years immunological abnormalities, including defective polymorphonuclear neutrophils (PMN) chemotaxis and both quantitative and functional defects in T-lymphocytes, have been reported in atopic dermatitis (AD). To date there is still a controversy regarding the causes of PMN chemotaxis defect and the possible mechanism underlying this abnormality in patients with AD. The aim of this study was to investigate the PMN chemotactic function in 18 children affected with AD and high levels of serum IgE, and in 4 children with Hyper IgE Syndrome (HIES). Our results showed a marked PMN chemotaxis defect (p less than 0.01) in the patients with HIES, while in the subjects with AD PMN cellular chemotaxis was normal and there was no correlation between the results of chemotaxis and serum IgE levels.
Food allergy plays an important role in the pathogenesis of atopic dermatitis. Exclusion of eggs and milk from the diet of children during the first few months of life has been proven to significantly reduce the severity of eczema in children aged between 2 and 8 years. We studied the efficacy of exclusion of milk and/or egg from the diet of 59 children with severe atopic dermatitis. A detailed personal and family history was obtained. Total and specific IgE levels were determined on one hand, and intracutaneous tests were evaluated on the other. All allergens suspected of being implicated in the genesis of atopic dermatitis were eliminated from the diet. Clinical improvement was observed in 80% of cases after dietary exclusion. The younger children responded best, and the response to diet was not influenced by the severity of the eczema. No relation was observed between the family history of atopy and response to diet. Neither total nor specific IgE titers presented significant differences when the responder groups were compared.
The aim of the present study was to evaluate the efficacy of an oral specific hyposensitization therapy in children with atopic dermatitis and positive prick skin tests and/or RAST to Dermatophagoides pteronyssinus (D.pt.). A total of 60 patients, in three different clinical groups, were selected for a three years clinical trial. Group A: children with atopic dermatitis and allergic asthma and/or rhinitis; groups B and C: children with exclusively atopic dermatitis. Groups A and B received specific hyposensitization therapy. Group C was the control group. The clinical evaluation of the dermatological lesions, at the end of our study, didn't show any significant difference among the three groups. Moreover, the onset of respiratory symptoms between the two groups with exclusively atopic dermatitis was similar and not related to the positivity of prick skin tests and/or RAST to seasonal allergens. Our study suggests that specific hyposensitisation therapy with extracts of D.pt., although with no side effects, does not affect the natural history of atopic dermatitis.
In 1987 Registered Nurses Ernesta 'Tina' Galli and Joanne Lindsay embarked on a unique venture--a private agency* organized and run by nurses that engages free-lance nurses to fill the need for nursing assistance both at home and in public and private institutions. The response has been overwhelming. Today they have branches throughout Italy and have expanded their services to include research and primary health care. Below, their story.
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