No abstract

Common variable immunodeficiency is the most common severe primary immunodeficiency. Most common variable immunodeficiency patients have progressive hypogammaglobulinemia involving all immunoglobulin classes, poor or absent antibody responses, and recurrent bacterial infections, usually of the sino-respiratory tract. Some may present with complicated cutaneous infections like furunculosis (J Allergy Clin Immunol; 109: 581) or recurrent cutaneous warts. Here, we report the case of an 18-year-old male diagnosed with common variable immunodeficiency who had extensive cutaneous warts that resolved within 2 months of starting weekly infusions of subcutaneous immunoglobulin.

Angioedema occurs when there is fluid leakage into the deep dermis of the skin and underlying subcutaneous tissues. Affected individuals usually present with swelling of the face or extremities. Acquired angioedema is an uncommon but potentially life-threatening disease in the older adult population. After the individual is cleared of the initial danger period, a thorough workup for an underlying etiology must be done. We report a 62-year-old male presenting with significant tongue swelling who was diagnosed with acquired angioedema. He had autoantibodies to C1 esterase inhibitor and was subsequently diagnosed with a lymphoma. Angioedema should be recognized by clinicians as a potential presentation of a more ominous malignancy.

Bone studies of HIV-infected children using dual X-ray absorptiometry (DXA) suggest bone mineral density (BMD) abnormalities. Pediatric studies are often performed using DXA instead of computed tomography (CT), which accounts for 3-dimensional differences in bone size of growing children. We evaluated whether CT would match DXA measurements in this population. For this purpose, the BMD of 16 perinatally HIV-infected patients, ages 6 to 22 was assessed. Subjects were matched by age, gender, and race to controls. BMD was assessed via DXA and QCT. Clinical anthropometric data, body mass index, immunologic and virologic parameters and laboratory markers for osteoblastic and osteoclastic activity were performed. No statistically significant differences in age and anthropometric parameters between subjects and controls were found. Individual CT and DXA z-scores were significantly different when subjects were evaluated as a group (p = 0.0002) or when males and females were analyzed independently (p = 0.001 and 0.03). DXA z-scores were below 1 SD, while CT z-scores were above the mean. 31% of subjects were identified as having poor bone mineralization by DXA while none had osteopenia/osteoporosis by CT. There was no correlation between immunologic/virologic parameters and BMD by either method. Increased osteoclastic activity was noted in 10 patients receiving tenofovir. In summary, decreased BMD diagnosed by DXA in pediatric HIV-infected subjects was not confirmed by CT. Increased bone turnover in patients on tenofovir was suggested by laboratory markers. Prospective studies using CT as the imaging standard are needed for evaluation of bone mineral changes in HIV-infected children.

PURPOSE OF THE STUDY. To investigate the association between asthma traits, atopy, and obesity-related markers in Chinese adolescents.STUDY POPULATION. Chinese children (N ϭ 486) who were randomly selected from a Hong Kong obesity study of adolescents had their allergy features assessed.METHODS. Anthropometric measurements were made, with BMI greater than local age-and gender-specific 85th percentile defining overweight and BMI greater than 95th percentile defining obesity. Fasting blood samples were collected to measure levels of allergen-specific immunoglobulin E (to dust mite, cat, and cockroach), lipids, and inflammatory biomarkers.RESULTS. The median age was 15.0 years (interquartile range: 14.0 -16.0 years), and the median BMI was 19.3 kg/m 2 (interquartile range: 17.5-21.7 kg/m 2 ). There were 62 overweight children (12.8%) and 36 obese children (7.4%). There were 239 atopic subjects (49.2%). Neither overweight nor obesity status was associated with asthma, allergic rhinitis, or eczema (P Ͼ .25). Atopy was also not associated with age-adjusted BMI, waist circumference, serum lipid profiles, or fasting glucose levels. Atopy and presence of allergen-specific immunoglobulin E did not differ between overweight or obese children and those with normal BMI (P Ͼ .25). Subgroup analysis suggested that cockroach sensitization was more common among boys who were obese or overweight (P ϭ .045). The white blood cell (WBC) count was significantly higher among atopic versus nonatopic children (mean: 6.5 ϫ 10 9 vs 6.2 ϫ 10 9 cells per L; P ϭ .006). Logistic regression revealed higher WBC count to be a risk factor for atopy (odds ratio: 18.97; P ϭ .004).CONCLUSIONS. Obesity is not associated with asthma or atopy. A high WBC count is an important risk factor for atopy in boys and girls. Gender does not exert any consistent effect on the association between obesity and allergy sensitization in children.REVIEWER COMMENTS. In developed countries, childhood asthma and obesity have been increasing in prevalence, and there is increased interest in determining whether there is an association between the 2. Both involve inflammatory processes, but often the findings are as inconclusive as determining whether the chicken or the egg came first. In this cross-sectional study, the authors found no strong correlation between atopy and obesity. This suggests that other factors, including genetic and environmental effects, are separately affecting atopic and obesity features, especially by the time a child has reached adolescence. A prospective study of birth cohorts may further define whether there is a significant relationship between weight gain, development of atopic features, and changes in obesity-and atopy-related laboratory values.