ATOPIC DERMATITIS-LIKE SKIN DISEASE IN PEDIATRIC HEART TRANSPLANT PATIENTS

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 特应性皮炎(AD)是一种瘙痒性、炎症性、复发性皮肤病，常见于婴幼儿或儿童早期。特应性是指遗传性IgE介导的对环境过敏原的超敏反应。(1)组织学上，可能存在T细胞、巨噬细胞和嗜酸性粒细胞的真皮炎症。(3，4，5)免疫学上，可观察到Th2淋巴细胞细胞因子谱，包括IL-4，IL-5，IL-10和IL-13增加，干扰素-γ水平降低。(2)最近，外用他克莫司(Protopic)，一种被批准用于儿童和成人AD的治疗方法，已成为皮质类固醇的替代疗法。重症AD对保守治疗无效，有时需要使用全身性免疫调节剂，如环孢素。(6)口服环孢素(5-10 mg/kg/天)和口服他克莫司(0.2-0.4 mg/kg/天)是儿科移植患者常用的药物，因为它们能有效地抑制器官排斥反应。(7)即使进行了全身免疫调节，这些儿童也经常出现与AD相一致的皮疹。我们的目标是对皮疹进行临床评估，以确定它是特应性角膜炎还是其他实体。最初，将使用问卷调查和医疗记录回顾来确定特应性疾病的家族史、皮肤病史和治疗方案。临床检查将包括体检、穿孔活检和细菌拭子。抽血检查特异性IgE水平和细胞因子分析将与患者常规的儿科心脏病护理相协调。GCRC将通过为临床检查提供空间来帮助这一项目。理想情况下，这将简化数据收集过程，并为我们的儿科患者提供一个舒适的环境。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Atopic dermatitis (AD) is a pruritic, inflammatory, relapsing skin disease frequently manifest in infancy or early childhood. The term atopy suggests a genetic IgE mediated hypersensitivity to environmental allergens.(1) Histologically, dermal inflammation with T cells, macrophages and eosinophils may be present.(3,4,5) Immunologically, a Th2 lymphocyte cytokine profile consisting of increased IL-4, IL-5, IL-10, and IL-13, and decreased levels of interferon gamma (IFN-gamma) is observed. (2) Recently topical tacrolimus (Protopic), an approved therapy for AD in children and adults, has become an alternative treatment to corticosteroids. Severe AD, which is refractory to conservative measures sometimes requires the use of a systemic immunomodulator, such as cyclosporine. (6) Oral cyclosporine (5-10 mg/kg/day) and oral tacrolimus (0.2-0.4 mg/kg/day) are commonly used in pediatric transplant patients because of their efficacy in suppressing organ rejection.(7) However, even with systemic immunomodulation, these children often develop a rash that appears consistent with AD. Our goal is to clinically evaluate this rash to determine if it is atopic determatitis or another entity. Initially, a questionnaire and a review of medical records will be used to determine family history of atopy, patient history of skin disease, and therapeutic regimen. The clinical examination will include a physical examination, punch biopsy, and bacterial swab. A blood draw for the examination of specific IgE levels and cytokine analysis will be coordinated with the patients' routine pediatric cardiology care. The GCRC will aid this project by providing space for the clinical exmination. Ideally, this will streamline the data collection process and provide a comfortable atmosphere for our pediatric patients.