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Early respiratory and ocular involvement in X-linked hypohidrotic ectodermal dysplasia


X-linked hypohidrotic ectodermal dysplasia (XLHED; ectodysplasin deficiency) has been classically described as affecting hair, sweat glands, and dentition. What may be underappreciated is the effect ectodysplasin deficiency has on glands surrounding the airways and eyes and the resulting chronic health issues. In this study, 12 male children (age range 6–13 years) and 14 male adults with XLHED (18–58 years of age) were investigated by pulmonary function tests, measurement of fractional exhaled nitric oxide, and by ophthalmologic assessments. Twelve healthy individuals (six children, six adults) served as controls. Signs of airway constriction and inflammation were detected in eight children with XLHED, including the youngest subject, and in ten adult XLHED patients. Increased tear osmolarity, reduced tear film break-up time, and other ocular abnormalities were also present at an early age. Five of 12 XLHED subjects not reporting a history of asthma and 7 of the 12 patients not reporting a history of dry eye issues showed at least two abnormal test results in the respective organ system. The presence of residual sweat ducts, suggestive of partial ectodysplasin gene expression, correlated with milder disease in two XLHED subjects with mutations affecting the collagen-like domain of ectodysplasin. Conclusion: The high prevalence of asthma-like symptoms in XLHED patients as young as 6 years and a similar prevalence of dry eye problems indicate that screening evaluation, regular monitoring, and consideration of therapeutic intervention should begin in early childhood.

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We thank Tessa Lorenze Field for excellent technical assistance and would like to express our gratitude to all individuals who participated in this study. This study was funded partially by the German–Swiss–Austrian ectodermal dysplasia patient support group and by a grant from Edimer Pharmaceuticals (Cambridge, USA).

Conflict of interest

Kenneth Huttner and Ramsey Johnson are employees of Edimer Pharmaceuticals. K.H. contributed substantially to the study design. R.J. performed the confocal microscopy. Holm Schneider is a member of the clinical advisory board of Edimer Pharmaceuticals and received project funding from this company. Otherwise, the company was neither involved in collection, analysis or interpretation of data, nor in the writing of the report or the decision to submit it for publication. The first draft of this manuscript was written by J.D. and H.S. None of the authors has been paid to produce this article.

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Correspondence to Holm Schneider.

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Dietz, J., Kaercher, T., Schneider, A. et al. Early respiratory and ocular involvement in X-linked hypohidrotic ectodermal dysplasia. Eur J Pediatr 172, 1023–1031 (2013). https://doi.org/10.1007/s00431-013-1985-8

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  • Ectodermal dysplasia
  • Ectodysplasin
  • Seromucous glands
  • Inflammation
  • Asthma
  • Dry eye