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