Atopic dermatitis is very frequent in the first 6 months of life, and the severe exudative form of this skin disorder is by no means rare. Failure to achieve immunization protection is a potentially life-threatening complication of exudative atopic dermatitis that may go unrecognized. We report the case of a 6-month-old infant with severe exudative atopic dermatitis in whom hypoproteinemia and agammaglobulinemia were attributed to the massive exudation after exclusion of other possible causes. The patient failed to respond to standard immunization, and adequate protection with a good antibody response could be achieved only after exudation from the skin lesions had been treated by intensive topical skin therapy and multiple intravenous immunoglobulin substitution. Two otherwise similar earlier case reports did not investigate the immune status. Therefore, to the best of our knowledge, this is the first report to draw attention to absence of immunization protection in exudative atopic dermatitis. Conclusion: We hope that our case report will motivate pediatricians to check the immunization status of patients with exudative atopic dermatitis and take the necessary steps to improve their care.
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Haemophilus polyribosylribitol phosphate
Transient hypogammaglobulinemia of infancy
Akdis CA, Akdis M, Bieber T, Bindsley-Jensen C, Boguniewicz M, Eigenmann P, Hamid Q, Kapp A, Leung DY, Lipozencic J, Luger TA, Muraro A, Novak N, Platts-Mills TA, Rosenwasser L, Scheynius A, Simons FE, Spergel J, Turjanmaa K, Wahn U, Weidinger S, Werfel T, Zuberbier T (2006) Diagnosis and treatment of atopic dermatitis in children and adults: European Academy of Allergology and Clinical Immmunology/American Academy of Allergy, Asthma and Immunology/PRACTALL Consensus Report. J Allergy Clin Immunol 118:152–169
Arkwright PD, Patel L, Moran A, Haeney MR, Ewing CI, David TJ (2000) Atopic eczema is associated with delayed maturation of the antibody response to pneumococcal vaccine. Clin Exp Immunol 122:16–19
Boguniewicz M, Leung DY (2011) Atopic dermatitis: a disease of altered skin barrier and immune dysregulation. Immunol Rev 242:233–246
Keles S, Artac H, Kara R, Gokturk B, Ozen A, Reisli I (2010) Transient hypogammaglobulinemia and unclassified hypogammaglobulinemia: ‘similarities and differences’. Pediatr Allergy Immunol 21:843–851
Shinagawa T, Matsuda S, Ishiguro H, Shikada M, Takakura I, Morimoto T, Niimura F, Oh Y (2007) Hyperaldosteronemia and hypogammaglobulinemia secondary to atopic dermatitis-induced exudation in an infant presenting with growth failure. Tokai J Exp Clin Med 32:18–22
Walker AM, Kemp AS, Hill DJ, Shelton MJ (1994) Features of transient hypogammaglobulinaemia infants screened for immunological abnormalities. Arch Dis Child 70:183–186
Wang AS, Liang MG, Schneider LC (2012) Severe atopic dermatitis and transient hypogammaglobulinemia in children. Pediatr Dermatol 29:73–78
Wollenberg A, Räwer HC, Schauber J (2011) Innate immunity in atopic dermatitis. Clin Rev Allergy Immunol 41:272–281
Yasuno T, Yamasaki A, Maeda Y, Fujiki A, Yaguyu S (2007) Atopic dermatitis and transient hypogammaglobulinemia of infancy improved simultaneously. Pediatr Int 49:406–408
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Lankisch, P., Laws, H., Weiss, M. et al. Agammaglobulinemia and lack of immunization protection in exudative atopic dermatitis. Eur J Pediatr 173, 117–119 (2014). https://doi.org/10.1007/s00431-013-2011-x
- Exudative atopic dermatitis
- Immune status