Research letter
Experience with intravenous immunoglobulin in severe childhood atopic dermatitis
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array:22 [ "pii" => "S0301054611002436" "issn" => "03010546" "doi" => "10.1016/j.aller.2011.04.007" "estado" => "S300" "fechaPublicacion" => "2012-03-01" "aid" => "311" "copyright" => "SEICAP" "copyrightAnyo" => "2011" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Allergol Immunopathol (Madr). 2012;40:131-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1600 "formatos" => array:3 [ "EPUB" => 5 "HTML" => 1066 "PDF" => 529 ] ] "itemAnterior" => array:18 [ "pii" => "S0301054611001133" "issn" => "03010546" "doi" => "10.1016/j.aller.2011.01.003" "estado" => "S300" "fechaPublicacion" => "2012-03-01" "aid" => "268" "copyright" => "SEICAP" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Allergol Immunopathol (Madr). 2012;40:129-31" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2251 "formatos" => array:3 [ "EPUB" => 7 "HTML" => 1709 "PDF" => 535 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Research letter</span>" "titulo" => "Possible DRESS syndrome in a child with borreliosis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "129" "paginaFinal" => "131" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 469 "Ancho" => 1250 "Tamanyo" => 72916 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Lesions at sites of penicillin administration.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Silva, C. Botelho, S. Cadinha, C. Lisboa, I. Azevedo, J.R. Cernadas" "autores" => array:6 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Silva" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Botelho" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Cadinha" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Lisboa" ] 4 => array:2 [ "nombre" => "I." "apellidos" => "Azevedo" ] 5 => array:2 [ "nombre" => "J.R." "apellidos" => "Cernadas" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0301054611001133?idApp=UINPBA00004N" "url" => "/03010546/0000004000000002/v1_201304101104/S0301054611001133/v1_201304101104/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Research letter</span>" "titulo" => "Experience with intravenous immunoglobulin in severe childhood atopic dermatitis" "tieneTextoCompleto" => true "saludo" => "To the Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "131" "paginaFinal" => "133" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Ahmet Ozen, Safa Baris, Elif Karakoc Aydiner, Deniz Yucelten, Nerin Nadir Bahceciler" "autores" => array:5 [ 0 => array:3 [ "nombre" => "Ahmet" "apellidos" => "Ozen" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Safa" "apellidos" => "Baris" "email" => array:1 [ 0 => "safabaris@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Elif" "apellidos" => "Karakoc Aydiner" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Deniz" "apellidos" => "Yucelten" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Nerin" "apellidos" => "Nadir Bahceciler" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Marmara University Faculty of Medicine, Department of Pediatric Allergy and Immunology, Tophanelioglu cad. No: 13-15 Altunizade, Istanbul, Turkey" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Marmara University Faculty of Medicine, Department of Dermatology, Tophanelioglu cad. No: 13-15 Altunizade, Istanbul, Turkey" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Atopic dermatitis (AD) is a chronic inflammatory skin disease characterised by dysregulated immune responses, which affects approximately 10–15% of children and persists until adulthood in approximately 6% of the population. Treatment generally relies on a balance between control of the condition and quality of life, and safe long-term treatment. The role of intravenous immunoglobulin (IVIG) in severe atopic dermatitis has been investigated in only a few trials with inconclusive results. We herein present our experience with this drug in four patients with severe AD refractory to standard treatment.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Cases</span><p id="par0010" class="elsevierStylePara elsevierViewall">Here we present our experience on four severe AD cases who were treated with IVIG. The use of IVIG in each of these patients was approved by the local Drug and Therapeutic Committee. Informed consent was obtained from all the patients or their parents.</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Patient 1</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 165/12-year-old boy with severe AD had been referred to our unit for further evaluation four years before, when he was 12 years old. He had multiple skin prick test positivity including house dust mite (HDM), egg and milk. He was then started on a series of topical anti-inflammatory medications. Since his respiratory symptoms were refractory to avoidance measures and optimal pharmacological treatment, he commenced sublingual immunotherapy (SLIT) for HDM (ALK, Abello, Madrid, Spain). His skin problems exacerbated during these treatments. Treatment with first and second line drugs, including potent topical steroids and topical calcineurin inhibitors for several months, systemic steroids for three months and cyclosporin 5<span class="elsevierStyleHsp" style=""></span>mg/kg for 12 months (interrupted due to severe infections) failed to control his disease. At 14 years of age, he was started on IVIG (Octagam<span class="elsevierStyleSup">®</span>, Octapharma, Stockholm, Sweden) with a dose of 0.5<span class="elsevierStyleHsp" style=""></span>g/kg given monthly and continued for a total of 16 months (=16 cycles). His AD symptoms started to improve dramatically after the second cycle and completely resolved at the end of the treatment along with a decrease of a total IgE level from 37,400<span class="elsevierStyleHsp" style=""></span>kU/L (1–200<span class="elsevierStyleHsp" style=""></span>IU/L) initially, to 2450 and an eosinophil count from 1900/mm<span class="elsevierStyleSup">3</span> to 200/mm<span class="elsevierStyleSup">3</span>. His AD remains currently in remission off immunoglobulin therapy for the last seven months (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Patient 2</span><p id="par0020" class="elsevierStylePara elsevierViewall">A girl of seven years and three months had a four-year history of persistent AD, which had failed to respond to potent topical corticosteroids, 0.1% topical tacrolimus, daily emollients and oral antihistamine treatments. Laboratory examination revealed a serum total IgE level of 8982<span class="elsevierStyleHsp" style=""></span>kU/L and a positive Radioallergosorbent test for HDM. The initial Scoring Atopic Dermatitis (SCORAD) index was 71. When she was 6.5 years old, she was started on IVIG with a monthly dose of 1<span class="elsevierStyleHsp" style=""></span>g/kg in addition to her usual treatments (Octagam<span class="elsevierStyleSup">®</span>, Octapharma, Stockholm, Sweden) After nine cycles, her AD symptoms improved. The SCORAD index and IgE level decreased to 25 and 3420<span class="elsevierStyleHsp" style=""></span>kU/L respectively, with a minor decrease in eosinophil count.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Patient 3</span><p id="par0025" class="elsevierStylePara elsevierViewall">A 13-year-old girl who has had AD since five years of age presented with extensive disease involving almost her entire body surface area. The disease remained active despite topical steroid therapy for a year, 0.1% topical tacrolimus for three months, and oral antihistamine treatment as needed. Her skin prick testing was positive for HDM, grass, wheat and cockroach. The initial level of IgE was 18,868<span class="elsevierStyleHsp" style=""></span>kU/L, and a SCORAD index of 84. Systemic steroid therapy for four months and phototherapy for two months were commenced, however they yielded no improvement. IVIG therapy with a monthly dose of 1<span class="elsevierStyleHsp" style=""></span>g/kg was initiated (Octagam<span class="elsevierStyleSup">®</span>, Octapharma, Stockholm, Sweden). After five doses, a satisfactory improvement has been noted, and she is still currently under this mode of treatment. The SCORAD index and the IgE level decreased to 25, and 5489<span class="elsevierStyleHsp" style=""></span>kU/L respectively, and eosinophil count also declined from 3700/mm<span class="elsevierStyleSup">3</span> to 1200/mm<span class="elsevierStyleSup">3</span>.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Patient 4</span><p id="par0030" class="elsevierStylePara elsevierViewall">A 23-year-old young man who has had asthma since five years of age and AD for the last five years presented with the exacerbation of his skin symptoms. He had been started on SLIT for HDM (ALK, Abello, Madrid, Spain) for his asthma symptoms, which he had to stop after two months due to a systemic reaction. AD was unresponsive to systemic steroid therapy (methyl prednisolone 60<span class="elsevierStyleHsp" style=""></span>mg) given for two months. Laboratory investigations revealed a total IgE level of 10,700 and a peripheral blood eosinophil count of 1100/mm<span class="elsevierStyleSup">3</span>. He was started on IVIG (0.5<span class="elsevierStyleHsp" style=""></span>g/kg every three weeks, Octagam<span class="elsevierStyleSup">®</span>, Octapharma, Stockholm, Sweden) as an adjunctive treatment to systemic steroid with a baseline SCORAD index of 71. An upper gastrointestinal endoscopy was performed due to his abdominal pain while he was on IVIG therapy. Histological examination revealed Helicobacter pylori gastritis. Eradication therapy of amoxicillin and clarithromycin in addition to a proton pump inhibitor was given for two weeks. At the second week of this treatment his AD symptoms almost completely resolved, allowing him to discontinue systemic steroid treatment. Upon the return of his symptoms after the cessation of this mode of therapy, we considered starting prophylactic antibiotic treatment. Currently, he has been off steroid therapy for the last one month after an eight-month IVIG treatment. Although his AD symptoms are milder compared to his baseline status, he continues to have AD symptoms with a current SCORAD score of 58 with a total IgE of 9400<span class="elsevierStyleHsp" style=""></span>kU/L and eosinophil count of 900/mm<span class="elsevierStyleSup">3</span>.</p><p id="par0035" class="elsevierStylePara elsevierViewall">High-dose IVIG with a dose of 2<span class="elsevierStyleHsp" style=""></span>g/kg/month is used as an immunomodulatory agent and it is thought that it provides the clinical improvement of AD by exerting its anti-inflammatory effects.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The ability of IVIG to downregulate T-cell function and particularly interleukin-4 production has made it a candidate for the treatment of AD.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> IVIG exhibits anti-inflammatory activity in AD by decreasing IFN-γ levels.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Additionally, IVIG contains high concentrations of staphylococcal toxin-specific antibodies that inhibit the in vitro activation of T cells by staphylococcal toxins.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The current data suggest that IVIG can improve skin scores in childhood AD when used as mono-therapy with a dose of 2<span class="elsevierStyleHsp" style=""></span>g/kg. On the contrary, mono-therapy with IVIG does not appear to have the same effect in adult patients.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> However, it may offer an improvement of 50–60% in severe AD when used as an adjunctive treatment.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Regarding the use of lower doses of IVIG, a trial evaluating the efficacy of single cycle IVIG in patients with steroid resistant AD revealed conflicting results with some patients displaying reductions in IgE levels at the third week of treatment and a proportion of patients experiencing some improvement in symptoms.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> However, the follow-up duration was too short and the study population was heterogeneous in that study.</p><p id="par0040" class="elsevierStylePara elsevierViewall">For two of our cases (patients 1 and 4) with a body weight of over 80<span class="elsevierStyleHsp" style=""></span>kg, we used an IVIG infusion with a dose of 0.5<span class="elsevierStyleHsp" style=""></span>g/kg at each cycle not to exceed the maximal dose. For the other two cases IVIG infusions were performed with a dose of 1<span class="elsevierStyleHsp" style=""></span>g/kg/cycle. During IVIG treatment no significant side effects were observed in any of the patients other than few episodes of mild symptoms (chills, nausea, and headache). In all three paediatric patients significant clinical improvements were observed after the first IVIG dose as mono-therapy. On the basis of our particular experience with three children, it is likely that of 0.5–1<span class="elsevierStyleHsp" style=""></span>g/kg doses of IVIG prove efficacy in the childhood period, whereas our limited experience with only one patient suggests that this lower dose in adults may not be as efficacious as that which we used in children. These findings support the previous notion that children with AD have a better response to IVIG than adults.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Our observations raise the question as to whether the clinical improvements observed parallel to the reductions in total IgE levels indicate a causal relationship, or the changes in both parameters are secondary to separate pathogenetic pathways. In the literature, some immunological parameters including eosinophil counts, ECP, IgE, ICAM-1 and ELAM-1 have been shown to correlate well with the improvement in symptoms.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> However, it is also reported that clinical improvements in the severity of AD may not accompany alterations in those parameters. A trial on the efficacy of low-dose anti-IgE therapy in patients with AD with high serum IgE revealed that the reduction of free serum IgE was not a good marker of clinical response to treatment.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> In interpreting all those reports it should be noted that there is a high variability of characteristics of patients and regimens. Therefore, it is not yet possible to draw conclusions from the present studies as to the optimal dose and duration of the IVIG in AD. Future studies should consider this heterogeneity and be designed appropriately to address those issues.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In conclusion, our particular experience with IVIG treatment in severe AD demonstrates that this treatment when used as monotherapy in children is safe and effective in alleviating symptoms as well as lowering IgE levels and eosinophil counts with comparatively lower doses (0.5–1<span class="elsevierStyleHsp" style=""></span>g/kg/dose). The key questions remaining to be answered before defining the exact role of IVIG in severe AD include: (1) Is it also effective in other AD phenotypes such as those with lower IgE levels?; (2) Is it superior to alternative second line drugs such as cyclosporine?; (3) What is the lowest effective dose, and when should treatment stop? Well-designed prospective randomised controlled trials may help to elucidate these questions as well as the precise mechanism of action of IVIG in severe AD.</p></span></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Cases" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Patient 1" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Patient 2" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Patient 3" ] 3 => array:2 [ "identificador" => "sec0025" "titulo" => "Patient 4" ] ] ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">SLIT: Sublingual immunotherapy, Phototx: Phototherapy, Tx: Treatment, SCORAD: Scoring atopic dermatitis, IVIG: Intravenous immunoglobulin (Octagam<span class="elsevierStyleSup">®</span>, Octapharma, Stockholm, Sweden).</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Patient 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Patient 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Patient 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Patient 4 \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 years, five months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Seven years, three months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gender \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IVIG dose and number of cycles \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.5<span class="elsevierStyleHsp" style=""></span>g/kg, ×16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1<span class="elsevierStyleHsp" style=""></span>g/kg, ×9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1<span class="elsevierStyleHsp" style=""></span>g/kg, ×5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.5<span class="elsevierStyleHsp" style=""></span>g/kg, ×8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Prior treatments</span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Systemic steroid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ (For two months prior to IVIG) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cyclosporine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ (12 months) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">− \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>SLIT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ (Still using) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ (Three years. ago, for two months) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Phototx \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ (For two months) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">− \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Systemic antibiotic tx \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">− \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Adjunctive treatment</span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Systemic steroid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ (For six months) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cyclosporine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">− \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>SLIT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">− \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Phototx \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">− \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Systemic antibiotic tx \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Laboratory findings</span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Eosinophil count at baseline (in mm<span class="elsevierStyleSup">3</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1900 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2200 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3700 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1100 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Eosinophil count during IVIG tx \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1800 (after the 8th dose of IVIG tx) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1200 (after the 3rd dose of IVIG tx) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">900 (after the 8th dose of IVIG tx) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Eosinophil count after IVIG tx \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">200 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total IgE baseline (kU/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37,400 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8982 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18,860 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10,740 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total IgE during IVIG tx \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17,200 (after the 4th dose of IVIG tx) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3420 (after the 8th dose of IVIG tx) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5489 (after the 3rd dose of IVIG tx) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9400 (after the 8th dose of IVIG tx) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total IgE after IVIG tx \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2450 (18th month of IVIG) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">SCORAD index</span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Initial SCORAD index \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>SCORAD index during IVIG tx \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (At the 16th dose of IVIG) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 (At the 9th dose of IVIG) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 (At the 4th dose of IVIG) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58 (At the 5th dose of IVIG) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>SCORAD after cessation of IVIG treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Still using \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Still using \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Still using \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab165449.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical and biochemical features of the four patients described.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ 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Dubertret" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2002" "volumen" => "147" "paginaInicial" => "518" "paginaFinal" => "522" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12207594" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adjunctive high-dose intravenous immunoglobulin treatment for resistant atopic dermatitis: efficacy and effects on intracellular cytokine levels and CD4 counts" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Jolles" 1 => "C. Sewell" 2 => "D. Webster" 3 => "A. Ryan" 4 => "B. Heelan" 5 => "A. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 5 | 7 |
| 2024 October | 9 | 12 | 21 |
| 2024 September | 9 | 11 | 20 |
| 2024 August | 10 | 18 | 28 |
| 2024 July | 15 | 15 | 30 |
| 2024 June | 6 | 24 | 30 |
| 2024 May | 11 | 37 | 48 |
| 2024 April | 6 | 17 | 23 |
| 2024 March | 13 | 17 | 30 |
| 2024 February | 9 | 33 | 42 |
| 2024 January | 16 | 35 | 51 |
| 2023 December | 10 | 30 | 40 |
| 2023 November | 8 | 51 | 59 |
| 2023 October | 17 | 86 | 103 |
| 2023 September | 22 | 38 | 60 |
| 2023 August | 15 | 12 | 27 |
| 2023 July | 28 | 41 | 69 |
| 2023 June | 7 | 17 | 24 |
| 2023 May | 10 | 38 | 48 |
| 2023 April | 12 | 15 | 27 |
| 2023 March | 15 | 26 | 41 |
| 2023 February | 9 | 24 | 33 |
| 2023 January | 12 | 23 | 35 |
| 2022 December | 13 | 17 | 30 |
| 2022 November | 23 | 26 | 49 |
| 2022 October | 21 | 22 | 43 |
| 2022 September | 14 | 26 | 40 |
| 2022 August | 11 | 36 | 47 |
| 2022 July | 14 | 31 | 45 |
| 2022 June | 11 | 30 | 41 |
| 2022 May | 23 | 38 | 61 |
| 2022 April | 12 | 24 | 36 |
| 2022 March | 14 | 43 | 57 |
| 2022 February | 11 | 16 | 27 |
| 2022 January | 24 | 29 | 53 |
| 2021 December | 5 | 21 | 26 |
| 2021 November | 7 | 22 | 29 |
| 2021 October | 14 | 27 | 41 |
| 2021 September | 5 | 23 | 28 |
| 2021 August | 7 | 19 | 26 |
| 2021 July | 5 | 27 | 32 |
| 2021 June | 16 | 13 | 29 |
| 2021 May | 12 | 14 | 26 |
| 2021 April | 24 | 20 | 44 |
| 2021 March | 14 | 44 | 58 |
| 2021 February | 15 | 15 | 30 |
| 2021 January | 10 | 13 | 23 |
| 2020 December | 0 | 2 | 2 |
| 2020 November | 0 | 2 | 2 |
| 2020 October | 0 | 1 | 1 |
| 2020 August | 0 | 6 | 6 |
| 2020 July | 0 | 3 | 3 |
| 2020 June | 0 | 4 | 4 |
| 2020 May | 0 | 7 | 7 |
| 2020 April | 0 | 3 | 3 |
| 2020 March | 0 | 6 | 6 |
| 2020 February | 0 | 12 | 12 |
| 2020 January | 0 | 6 | 6 |
| 2019 December | 0 | 4 | 4 |
| 2019 November | 0 | 3 | 3 |
| 2019 October | 0 | 7 | 7 |
| 2019 September | 0 | 5 | 5 |
| 2019 August | 0 | 12 | 12 |
| 2019 July | 0 | 9 | 9 |
| 2019 June | 0 | 15 | 15 |
| 2019 May | 0 | 7 | 7 |
| 2019 April | 0 | 24 | 24 |
| 2019 March | 0 | 6 | 6 |
| 2019 February | 0 | 2 | 2 |
| 2019 January | 0 | 5 | 5 |
| 2018 December | 0 | 7 | 7 |
| 2018 November | 0 | 7 | 7 |
| 2018 August | 0 | 1 | 1 |
| 2018 February | 7 | 5 | 12 |
| 2018 January | 4 | 3 | 7 |
| 2017 December | 15 | 2 | 17 |
| 2017 November | 11 | 5 | 16 |
| 2017 October | 2 | 8 | 10 |
| 2017 September | 9 | 1 | 10 |
| 2017 August | 10 | 3 | 13 |
| 2017 July | 14 | 4 | 18 |
| 2017 June | 10 | 2 | 12 |
| 2017 May | 9 | 3 | 12 |
| 2017 April | 13 | 4 | 17 |
| 2017 March | 6 | 62 | 68 |
| 2017 February | 14 | 6 | 20 |
| 2017 January | 8 | 3 | 11 |
| 2016 December | 15 | 9 | 24 |
| 2016 November | 13 | 6 | 19 |
| 2016 October | 31 | 6 | 37 |
| 2016 September | 9 | 6 | 15 |
| 2016 August | 20 | 4 | 24 |
| 2016 July | 4 | 2 | 6 |
| 2016 June | 15 | 5 | 20 |
| 2016 May | 5 | 8 | 13 |
| 2016 April | 9 | 18 | 27 |
| 2016 March | 13 | 20 | 33 |
| 2016 February | 9 | 15 | 24 |
| 2016 January | 9 | 11 | 20 |
| 2015 December | 12 | 11 | 23 |
| 2015 November | 8 | 4 | 12 |
| 2015 October | 9 | 4 | 13 |
| 2015 September | 9 | 3 | 12 |
| 2015 August | 8 | 2 | 10 |
| 2015 July | 8 | 3 | 11 |
| 2015 June | 5 | 0 | 5 |
| 2015 May | 11 | 4 | 15 |
| 2015 April | 6 | 8 | 14 |
| 2015 March | 9 | 4 | 13 |
| 2015 February | 4 | 3 | 7 |
| 2015 January | 13 | 4 | 17 |
| 2014 December | 16 | 5 | 21 |
| 2014 November | 10 | 4 | 14 |
| 2014 October | 13 | 3 | 16 |
| 2014 September | 16 | 3 | 19 |
| 2014 August | 8 | 2 | 10 |
| 2014 July | 9 | 1 | 10 |
| 2014 June | 5 | 1 | 6 |
| 2014 May | 7 | 1 | 8 |
| 2014 April | 4 | 5 | 9 |
| 2014 March | 25 | 14 | 39 |
| 2014 February | 25 | 8 | 33 |
| 2014 January | 16 | 8 | 24 |
| 2013 December | 25 | 6 | 31 |
| 2013 November | 19 | 8 | 27 |
| 2013 October | 25 | 7 | 32 |
| 2013 September | 23 | 6 | 29 |
| 2013 August | 29 | 9 | 38 |
| 2013 July | 27 | 4 | 31 |
| 2013 June | 17 | 2 | 19 |
| 2013 May | 29 | 4 | 33 |
| 2013 April | 20 | 7 | 27 |
| 2013 March | 25 | 5 | 30 |
| 2013 February | 18 | 7 | 25 |
| 2013 January | 9 | 3 | 12 |
| 2012 December | 7 | 3 | 10 |
| 2012 November | 1 | 2 | 3 |
| 2012 October | 1 | 2 | 3 |
| 2012 September | 1 | 1 | 2 |
| 2012 March | 250 | 0 | 250 |
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