PMID- 12390445
OWN - NLM
STAT- MEDLINE
DCOM- 20030716
LR  - 20191106
IS  - 0905-6157 (Print)
IS  - 0905-6157 (Linking)
VI  - 13
IP  - 4
DP  - 2002 Aug
TI  - Hypoproteinemia in severe childhood atopic dermatitis: a serious complication.
PG  - 287-94
AB  - As a complication of atopic dermatitis (AD), the incidence of hypoproteinemia is 
      increasing among infants with severe AD in Japan. It can be a life-threatening 
      condition owing to hypovolemic shock as a result of hypoproteinemia and vascular 
      infarction as a result of thrombocythemia. However, the pathophysiology of this 
      condition remains unclear. The objectives of the present study were two-fold. The 
      first objective was to determine the main route of protein loss, i.e. through the 
      damaged skin or the gastrointestinal tract, or as a result of insufficient food 
      intake. The second objective was to identify whether allergy or infection was the 
      cause of severe skin inflammation. Fifteen patients with AD were enrolled who had 
      serum protein levels of 3.2-5.8 g/dl. Specific immunoglobulin E (IgE) and skin 
      test to allergens, stool eosinophils, alpha1-antitrypsin clearance, skin 
      Staphylococcus aureus colonization and superantigens (SAgs) produced by the 
      organism, serum SAg-specific IgE antibodies, serum interleukin (IL)-5, IL-6, 
      IL-12, and interferon-gamma (IFN-gamma) were evaluated. Prominent serous skin 
      discharge was seen in all of the patients and was found to have almost the same 
      protein concentration as serum. Marked thrombocytosis, with a maximum of 1,060 x 
      103/ml, was seen. Skin culture revealed S. aureus colonization in all patients. 
      SAg-producing S. aureus were found in 84.6% of the patients. The concentration of 
      serum IL-5 was significantly increased and correlated well with the blood 
      eosinophil count. Hence, the main route of protein loss was believed to be 
      through damaged skin. The cause of severe inflammation was thought to be a 
      combination of allergic inflammation and skin colonization by SAg-producing S. 
      aureus. Serum cytokines showed a T helper 2 (Th2) T-cell-mediated pattern. To 
      prevent hypovolemic shock, vascular occlusion, and growth retardation, it is of 
      vital importance to diagnose hypoproteinemia at an early stage and start 
      appropriate therapy.
FAU - Nomura, Ichiro
AU  - Nomura I
AD  - Department of Allergy, National Children's Hospital, Taishido, Setagayaku, Tokyo, 
      Japan.
FAU - Katsunuma, Toshio
AU  - Katsunuma T
FAU - Tomikawa, Morimitsu
AU  - Tomikawa M
FAU - Shibata, Atsushi
AU  - Shibata A
FAU - Kawahara, Hidetoshi
AU  - Kawahara H
FAU - Ohya, Yukihiro
AU  - Ohya Y
FAU - Abe, Jun
AU  - Abe J
FAU - Saito, Hirohisa
AU  - Saito H
FAU - Akasawa, Akira
AU  - Akasawa A
LA  - eng
PT  - Journal Article
PL  - England
TA  - Pediatr Allergy Immunol
JT  - Pediatric allergy and immunology : official publication of the European Society 
      of Pediatric Allergy and Immunology
JID - 9106718
SB  - IM
MH  - Adolescent
MH  - Age Distribution
MH  - Analysis of Variance
MH  - Blood Cell Count
MH  - Child, Preschool
MH  - Dermatitis, Atopic/blood/*etiology/*immunology
MH  - Digestive System/immunology
MH  - Female
MH  - Humans
MH  - Hypoproteinemia/blood/*complications/*immunology
MH  - Infant
MH  - Japan
MH  - Male
EDAT- 2002/10/23 04:00
MHDA- 2003/07/17 05:00
CRDT- 2002/10/23 04:00
PHST- 2002/10/23 04:00 [pubmed]
PHST- 2003/07/17 05:00 [medline]
PHST- 2002/10/23 04:00 [entrez]
AID - pai1o041 [pii]
AID - 10.1034/j.1399-3038.2002.01041.x [doi]
PST - ppublish
SO  - Pediatr Allergy Immunol. 2002 Aug;13(4):287-94. doi: 
      10.1034/j.1399-3038.2002.01041.x.