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Vol.9 No.1 March, 2008
100 6 5 5081 9 0 8 1 6 6 1
T e l (02) 2311-4670Fax (02) 2311-4732ht tp: / /www.ai r .org. tw
19391392T e l (02) 2311-4670Fax (02) 2311-4732ht tp: / /www.asthma.org. tw
( ----1000-1500 )
Vol.9 No.1 March 2008 1
( )............................ 2
............................................................... 3
(Are probiotics & prebotics good bacteria?) ... 5
New agents show promise in themanagement of atopic dermatitis ....................... 8
................................ 10
-............................................................... 13
................................................................. 14
................................ 15
A. 1. 97 3 23 3 30 4 13
Updated Information Relate with Pediatric AsthmaManagement
2. 4 13
3. 4 26 27
4. 97 5 18 ( )14 0016 00 9
B. 1. 22 nd European Immunogenetics and Histocompatibility
Conference, April 02, 2008 - April 05, 2008.Toulouse FranceE-mail: thomsen@toulouse.inserm.fr
2. Allergy and Clinical Immunology, April 04, 2008 - April 04,2008. Minneapolis United States E-mail: cme@umn.edu
3. The 7th Annual Conference of The Egyptian Society ofAsthma and COPD, April 16, 2008 - April 17, 2008. CairoEgypt E-mail: hisham.abdou@gmail.com
4. Immunopharmacology 2008, April 19, 2008 - April 22, 2008.Varadero Beach Cuba E-mail: gabino.garrido@infomed.sld.cu
5. The 5th International Congress on Familial Mediterranean Fe-ver and Systemic Autoinflammatory Diseases. April 04, 2008 -April 08, 2008. Rome Italy. E-mail: segr-fmfsaid08@pyramide.it
6. 3-rd National Congress of Immunology, May 08, 2008 - May10, 2008. Varna Bulgaria. E-mail: kr.metod@mail.vega.bg
7. Cytokines 2008, May 10, 2008 - May 15, 2008. Kololi Gambia.E-mail: england@mangosee.com
Vol.9 No.1 March 200822222
8
3
GOT:66 IU/L GPT:
144IU/L
Giemsa stain
H2
( )
-
bcl-2
c -kit
-6 (IL-6)
(
)
( darier )
75
8. 25 Years of HIV, May 19, 2008 - May 21, 2008. Paris France. E-mail: 25yearsHIV@pasteur.fr9. 3rd Tutzing Autoimmunity Conference, May 20, 2008 - May 23, 2008. Tutzing Germany. E-mail: daria.
barczat@conventus.de10. Discovery Strategies: Modeling Human Autoimmune Diseases in the Laboratory Mouse, May 27, 2008
- May 29, 2008. San Francisco United States. E-mail: toni.joerres@jax.org
Vol.9 No.1 March 2008 33333
darier
Giemsa stain toluidine
blue stain
Epidermolys is
Bullosa
X X
( )
( H 1 H 2 )
cromoglycate
15 Strachan
innate adaptive
(Genotype/
Phenotype) ( )
Th1 Th2
Th1 Th2
Th2 Th1 Th2 IL-4
IL-13 B class switch IgE
Th2
Crohn's disease,
Th2
Innate
Th1 Th2
Th1 Th2
Vol.9 No.1 March 200844444
Th1 Th2
T
innate immunity
(1)
80%(2)
(2)
( )
A
A
A
EBV CMV
IgE
IgG(3)
IFN-
Treg IL-10
(4)
(Muramic acid)
(5)
Probiotics
(6)
CpG
Vol.9 No.1 March 2008 55555
References
1. Schaub B, Lauener R, von Mutius E. The many
faces of the hygiene hypothesis. J Allergy Clin
Immunol 117 969-77, 2006
2. Wassall HJ, Devenny AM, Daud Khan S, Ninan
TK, Russell G. A comparison of virus-associated
and multi-trigger wheeze in school children. J
Asthma 42 737-44, 2005
3. Lemanske RF, Jackson DJ, Gangnon RE, et al.
Rhinovirus illnesses during infancy predict subse-
quent childhood wheezing. J Allergy Clin
Immunol 116 571-7, 2005
4. Matricardi PM, Rosmini F, Riondino S, et al. Ex-
posure to foodborne and orofecal microbes versus
airborne viruses in relation to atopy and allergic
asthma: epidemiological study. Bmj 320 412-7.
2000
5. Yazdanbakhsh MP, M., Kremsner PG, van Ree R.
Allergy, parasites, and the hygiene hypothesis.
Science 296 490-4, 2002
6. Schram-Bijkerk D, Doekes G, Douwes J, et al.
Bacterial and fungal agents in house dust and
wheeze in children: the PARSIFAL study. Clin
Exp Allergy 35 1272-8, 2005
7. Kalliomaki M, Salminen S, Poussa T, Arvilommi
H, Isolauri E. Probiotics and prevention of atopic
disease: 4-year follow-up of a randomised placebo-
controlled trial. Lancet 361 1869-71, 2003
(?) (?)
A
EBV
( )
(Are probiotics & prebotics good bacteria?)
1 1 2 2
1 2
(probiotics)
Probiotic pro for
biotic life
Vol.9 No.1 March 200866666
(Clostridium)
(probiotics)
A
( ) C ( ) S ( )
(colonize) (microflora)
400
(1)
(community-acquired diar-
rheal infection) (irritable colon)
Enterobacter &S t r e p t o c o c c u s s p p
Bifidobacterium & Bacteroides spp
Bacteroid & Bifidobacterium
Clostridium sp
(oligosaccharide)
Co l i l f o rm, S t r ep to coccus sp ,
Clostridium difficile
Klebsiella, Citrobacter, Enterobactor Candida
albincans
Clostridium difficile
Bifidobacterium
(necrotizing enterocolitis)(3)
(<1500g)
Bifidobacterium 3
Bifidobacterium Lactobaccilus
(Bacteroides) (Clostridia)
(Enterobacteria)((3)
3 Lactobacillus acidophilus,
Lactobaccilus GG & Saccharomyces sp.
1 Bifidobacteria
& Lactobaccili
I g A c y t o k i n a s e s
Bifidobacterium
Gram(-) endotoxin TNF
(2)
Bifidobacterium
(4)
( Lactobaccili Bifidobacteria)
(colonization)
(inverse association)
( ) IgE
(8, 9,10)
Vol.9 No.1 March 2008 77777
(incidence) IgE
Th2 cytokines(IL-4)
IgE (11)
(1)
8 Th1 cytokine interferon
(2)
(intestinal mucosal barrier) (9,10,
12)
Lactobacillus GG (LGG)1x1010CFUdaily
LGG(9,12)
1-2 2
( S boulardii)(2)
(4) Colony
Forming Unit (CFU)(9)
(Prebiotics )
(5)
( )
Dr. Frank Greer
(complex
starch) (polysaccharides)
(oligosaccharide)(4)
(
) (adjunctive therapy)(3,4)
( 5-10x1010CFU/day)(9)
Reference:
1. :
16 1, 2007
2. Charrois TL, Sandhu G, Vohra S: Probiotics. Pedi-
atrics in Review 27 137-139, 2006
3. G Deshpande G, S. Rao S, Patole S: Probiotics for
prevention of necrotising enterocolitis in preterm
neonates with very birth weight. a systematic re-
view of randomised controlled trials. Lancet
369 1614-20, 2007
4. Berkler E: Probiotics. 'Good bacteria'? AAP News
28 1 & 9, 2007
5. (Probiotics)VS (Prebiotics):
http//www.wedar.com/health/show.asp?id-4165.
6. Furrie E. Probitoics and allergy: http//www.ncbi.
nlm.nih.gov/s i tes /entrez?db=pubmed&uid
=16313688&cmd=showdetailvie...2007/12/22
7. Wang MF, Lin HC,Wang YY: Treatment of peren-
nial allergic rhinitis with lactic acid bacteria.
Pediatr Allergy Immunol 15 152-8, 2004
8. Kukkonen K, Savilahti E, Haahtela, et el.:
Probiotics and prebiotic galacto-oligosaccharides
in the prevention of al lergic disease. A
Vol.9 No.1 March 200888888
randomized, double-blind, placebo-controlled
trial. J Allergy Clin Immunol 119(1) 192-8, 2007
9. Kligler B, Hanaway, Cohressen A :Probiotics in
Children. Pediatr Clin North Am 54(6) 949-67,
2007
10. Rosenfeldt V, Benfeldt E, Valerius NH, et al.:
Effect of probiotics on gastrointestinal symptoms
and small intestinal permeability in children
with atopic dermatitis. J Pediatr 145(5) 612-6,
2004
11. Yazdanbakhsh M, Kremsner PG. Van RR: Allergy,
parasites and the hygiene hypothesis. Science
296 490-494, 2002 Abstract
12. , .:
8 9-11, 2007
10-25%
1-3
1-3%
(immunosupressive), (anti-inflammatory),
(anti-pruritic)
(immunomodulators tacrolimus pimecrolimus)
( c y c l o s p o r i n )
(phototherapy)
2000-2001 calcineurin in-
hibitors tacrolimus pimecrolimus
40
(moisturizers)
tacrolimus pimecrolimus
New agents show promise in themanagement of atopic dermatitis
1 2 1 1
1 2
2005 FDA(
)(1,2)
2006 FDA(1,3)
MimyX Atopiclair
M i m y X c r e a m ( S 2 3 6 ) S t i e f e l
Laboratories, LTD (1,4)
(radiation dermatitis)
(atopic dermatitis)
(al lergic contact dermatit is) MimyX
palmitoylethanolamide (PEA) olive oil( )
Vol.9 No.1 March 2008 99999
vegetable oil( ) glycerine( ) squalene
( ) lecithin( ) PEA
(fatty acid amide) (anti-
inflammatory property)
(mast cell activation) IL-4
(stratum corneum) (natural lipid
barrier function) (triglyceride)
(ceramide)
(transepidermal water loss)
4% (
)
Triamcinolone Cream(0.1%) 18
MimyX 1% hydrocortisone(
)
2006
(cohort study) (1,2) MimyX
(itching) (redness) (dryness)
(excoriation) 50% 923
80%
65%
A t o p i c l a i r ( M A S 0 6 3 D P ) S i n c l a i r
Phamaceuticals, LTD
glycyrrhetinic acid
( l i c o r i c e r o o t )
(antielastase) (anti-collagenase)
telmesteine (anti-oxidant)
(antiproteasic activity) [grape vine]
(Vitis vinifera extracts)
(protease)
(hyaluronic acid) shea nut
butter( ) shea nut butter(1,5,
6)
218
18-
Copy from Atopiclair - non steroidal relief of
atopic dermatitis(eczema) and contact dermatitis
@atopiclair.com 2007
84 218 3 22
7(1,2,7)
2%(8) Atopiclair phase IV
2-17 60
43
22 80% (2,
8)
MimyX Atopiclair
(2) MimyX 70
61.99 Atopiclair 100 81.22
Vol.9 No.1 March 20081010101010
Reference1. Smith M.L: New agents show promise in the
management of atopic dermatitis. AAP news 2718, 2006
2. Abrmovits W, Boguniewicz M: A multicenter,randomized, vehicle-controlled clinical study toexamine the efficacy and safety of MAS063DP(Atopiclair[TM]) in the management of mild tomoderate atopic dermatitis in adults. J Drugs Der-matology 5(3) 236-44, 2006
3. FDA Approvals: Lunar iDXA, Urgent PC, MimyX.http:/www.medscape.com/viewarticle/515720
4. Stiefel Laboratory Release: Study Show NewAtopic Dermatitis Therapy Significantly De OnsetOf Flares. http://www.biospace.com/news story.aspx?StoryID=1157
5. Aotpic Dermatitis (eczema): http://www.atopiclair.
com/medical professional.phy6. Siklar Z. Bostanci I, Atli O, Dallar Y: An Infantile
Cushing Syndrome Due to Misuse of TopicalSteroid. Pediatric Dermatology 21(5) 561-3,2004 Sept-Oct
7. Patrizi A, Capitanio B, Neri I, et al.: A Double-blind, randomized, vehicle-controlled clinicalstudy to evaluate the efficacy and safety ofMAS063DP (ATOPICLAIR in the managementof atopic dermatitis in paediatric patients. Pediatr.Allergy Immunol 21 1-7, 2008 Feb
8. Belloni G, Pinelli S, Veraldi S: A randomised,double-blind, vehicle-controlled study to evaluatethe efficay and safety of MAS063D (Atopiclair), inthe treatment of mild to moderate atopicdermatitis. European Journal of Dermatology 15(1) 31-6, 2005
1999 2006
>75%
1956 Lyell
Toxic epidermal necrolysis (
TEN)
Erythema Multiforme(
) Steven-Johnson syndrome(
SJS)
.
SJS ( 10%) TEN( 30%).
0.4~1.2
( ) (1)
(2)
carbamazepine, phenytoin (3)
(4)
( )
(CD95-fas ligand)
Nikolsky sign
(1~3 )
(1~3 )
Vol.9 No.1 March 2008 1111111111
3~4
.
30%
BUN
SCORTEN (toxic epidermal
necrolysis - specific severity-of-illness score)
(1)
(2)
( )
(
) ( )
( )
(
) (
)
3~4
(1)
(
) (2)
(3)
(4)
(5)
( )
1. Steven-Johnson syndrome and toxic epidermal
necrolysis in children. Milton H Nirken, MD.
www.Uptodate.com, 2008
2. Long-term follow-up of patients treated for toxic
epidermal necrolysis. J Burn Care Res 27 26-33,
2006
3. Chronic pulmonary complications associated with
toxic epidermal necrolysis: report of a severe case
with anti-Ro/SS-A and a review of the published
work. Journal of Dermatology 33 616-22, 2006
4. Pulmonary complications in toxic epidermal
necrolysis: a prospective clinical study. Intensive
Care Med 23 1237-44, 1997
5. Clinical characteristics of childhood erythema
multiforme, Steven-Johnson syndrome and toxic
epidermal necrolysis in Taiwanese children. J
Microbiol Immunol Infect 37 366-70, 2004
Vol.9 No.1 March 2008 1313131313
(Staphylococcus aureus)
Job Syndrome(Hyper IgE
syndrome)
Job Syndrome
1918
5000
X
---
21
(1)
(2)
(pneumocuccal
vaccine) ( )
B-
(3)
2 (
)
(ev idence based
medicine)
DPT
polio
Vol.9 No.1 March 20081414141414
( )
(
)
chitotriosidase I
(CHIT1) acidic mammalian chitinase (AMC)
chitinase-3- like proteins 3 and 4
/
2004 6 Science Th2
AMC
AMC
BALF( -
) [1]
Science[2] 9
[3]
1.
2. AMC (polymorphism)
[4]
1. AMC
mRNA
2.
Th1
3.
4. Reese 2007 Nature
Th2
---- IL-4 IL-13
AMC
AMC [5]
A. 2
B.
1.
Th1 Th2
2.
1. Zhou Z,et al. Science 304 1678-82, 2004
2. Couzin J. Science 304 1577, 2004
3. Willis-Karp M, Caprt CL. New Eng J Med 351
1455-7, 2004
4. Bierbaum S, et al.Am J Respir Crit Care Med 172
(12) 1505-9, 2005 Dec 15
5. Reese TA,et al. Nature 447(7140) 92-6, 2007
Vol.9 No.1 March 2008 1515151515
SLE
(plasmapheresis, PP)
(double filtration, DF)
5
1 2 10
(platelet count: 12000/mm3)
(iv)
3 (PP 4 )
PP 5
2 15
(platelet count: 8000/
mm3)
(plasmapheresis, PP) 3 4
PP
3 12 SLE
(hemoglobin
7.4gm/dl)
( i v )
(plasmapheresis, PP) 6
DFPP( ) 4
PP
PP
(autoimmune thrombocytopenia, AT)
AT
(IVMP) 3 7
IVMP
AT
(plasmapheresis,
PP) AT PP
8
( 1 2) 18 ( 3) 3
5
2 3 IVMP
PP
( )
(plasmapheresis, PP) 6
DF( )
( T h e r a p e u t i c p l a s m a
exchange)
1 1.5
40ml/kg
Therapeutic Plasmapheresis: 1.1.1.1.1.
P lasma exchange . 2 . Double f i l t ra t ionPlasma exchange . 2 . Double f i l t ra t ionPlasma exchange . 2 . Double f i l t ra t ionPlasma exchange . 2 . Double f i l t ra t ionPlasma exchange . 2 . Double f i l t ra t ion
plasmapheresis. 3.Plasma perfusionplasmapheresis. 3.Plasma perfusionplasmapheresis. 3.Plasma perfusionplasmapheresis. 3.Plasma perfusionplasmapheresis. 3.Plasma perfusion
Plasmapharesis (PP)
,
1.1.1.1.1.
. 2.. 2.. 2.. 2.. 2. . 3.. 3.. 3.. 3.. 3.
Double filtration(DF)
DF( )
Vol.9 No.1 March 20081616161616
B2
[ ]
1. Antibodies: Anti-GBM Ab disease; MG
2. Immune complex: SLE
3. Cryoglobulin: Cryoglobulinemia
4. Myeloma protein: Myeloma nephropathy
5. Endotoxin,cytokine: Sepsis
6. Cholesterol, LDL-c: Familial hypercholesterolemia
1. :
Anti-thrombotic or fibrinolytic factor: HUS/TTP
2. (Immunomodulation):
Removal of complement products: SLE
Effect of immune regulation: Transplantation
1.
2. Plasma exchange
60kg 5% =3000cc
24U FFP
3. Double filtration plasmapheresis
10% = 300cc
Albumin 25% 50cc 1 bottle
N/S 250cc
1.
5
2.
1-2 , 1-2
3. IVIG PP
(M.G)
(AIDP)
(TTP/
HUS)
(Goodpasture)
(RPGN)
CIDP, Hepatic failure, Familial
hypercholesterolemia, etc
Citrate
hypocalcemia
,
, CMV, HTLV-III)
anaphylaxis
fibrinolytic cascade, /
( Citrate
)
( )
(autoimmune-induced thrombocytopenia, AT)
( IVIG )
PP /
DF
chloroquine
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