title: Atopic dermatitis or hyper-IgE syndrome?
abstract: A case of atopic dermatitis (AD), recurrent infections, and elevated immunoglobulin E (IgE) level is presented. Clinical characteristics, pathophysiology, diagnosis, and management in this patient are reviewed. Clinical pearls and pitfalls include the following: (1) deep-seeded Staphylococcus aureus infections occur rarely in AD and should raise the possibility of immunodeficiency syndromes such as hyper-IgE syndrome (HIES); (2) HIES is characterized by a clinical triad consisting of elevated serum IgE levels, recurrent staphylococcal skin abscesses, and pneumonia with pneumatocele formation; (3) although serum IgE levels in AD have been noted to be as high as 10,000 IU/mL, severe cases of AD such as that presented here can exceed this range; (4) the efficacy of anti-IgE therapy in AD or HIES is unknown and may be limited by dosing requirements.
authors.affiliation: The Johns Hopkins Asthma and Allergy Center, Baltimore, Maryland 21224, USA.
authors.forename: Nkiruka U
authors.initials: NU
authors.lastname: Ohameje
authors.forename: James W
authors.initials: JW
authors.lastname: Loveless
authors.forename: Sarbjit S
authors.initials: SS
authors.lastname: Saini
mesh_terms: D000888:Antibodies, Anti-Idiotypic; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D002648:Child; D003876:Dermatitis, Atopic / Q000175:diagnosis* / Q000188:drug therapy; D003937:Diagnosis, Differential; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D007589:Job Syndrome / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D000069444:Omalizumab
chemical_list: D000888:Antibodies, Anti-Idiotypic; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007155:Immunologic Factors; D000069444:Omalizumab