Brief communications Elevated serum immunoglobuHn E levis in patients with juvenile dermatomyos is Takeshi Hiketa, MD," Masaru Ohashi, MD, ~ Yoshinari Matsumoto, MD, ~ Junko Morikawa, MD, ~ and Ryuichiro Sasaki, M D b Nagoya. Japan
Dermatomyositis (DMS), recognized as a multisystem disorder mediated through autoimmune mechanisms, affects both children and adults. A juvenile type o f this disorder, called juvenile dermatomyositis (JDMS), is now considered to be somewhat different from the adult type, or adult dermatomyositis ( A D M S ) , especially from a histopathologic point of view. A m o n g many children with JDMS, deposition of immunoglobulin complexes can be observed, particularly within the walls of intramuscular arteries and veins. ~ However, the etiology and pathogenesis of JDMS has remained elusive. Cochrane and Koffler 2 suggested that IgE may play an important role in autoimmune diseases by mediating the release of chemical mediators and by facilitating the local deposition of immune complexes. A m o n g patients with systemic lupus erythematosus (SLE), higher serum IgE levels can be seen during the active state of the disease when compared with the inactive state. 3 A deficiency o f suppressor T cells in the active SLE state may also contribute to elevations in the serum IgE levels. In a previous study we demonstrated a significantly higher frequency of pruritus in patients with JDMS when compared with patients with A D M S in J a p a n ? Most of the patients with JDMS in the present study who complained o f severe itch showed elevated serum IgE levels accompanied by atopic disease clinically diagnosed before the onset of JDMS. Our findings suggest a correlation between elevated serum IgE levels in patients with JDMS and atopic disease or a
From the Departments of Dermatology a and Preventive Medicine, b Nagoya University School of Medicine, Nagoya, Japan. Presented in part at the Fifth International Epidemiological Association (IEA) Scientific Meeting in the Asia-Pacific Region, Nagoya, Japan, May 10, 1991, and also at the Second China-Japan Joint Meeting of Dermatology, Shanghai, China, Nov. 20, 1990. Reprint requests: Takeshi Hiketa, MD, Department of Dermatology, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466, Japan. 1/1/38529
Abbreviations used
DMS: JDMS: ADMS: SLE: AD:
Dermatomyositis Juvenile dermatomyositis Adult dermatomyositis Systemic lupus erythematosus Atopic dermatitis
peculiarly defective immunosuppressive mechanism, as seen in cases of SLE. This study was designed to clarify this issue, and to determine whether atopic disease affects the occurrence of JDMS.
SUBJECTS A N D METHODS All patients with DMS in this study were those observed at Nagoya University Hospital over a period of 11 years. from 1980 through 1990. No specific method was used for selecting patients to participate in this study; patients who came to the hospital for treatment over the years were considered. All patients met at least three of the diagnostic criteria for DMS as proposed by Bohan and Peter? All patients with "active" disease who clearly demonstrated elevated muscle enzymes and muscular weakness at the time of examination were studied after diagnosis had been established and before treatment was begun. Patients with "inactive" disease who were in clinical and biochemical remission at the time of examination were studied during periodic visits for routine medical checkups. Eighteen patients with JDMS (11 males and 7 femalesJ, ranging from 4 to 15 years of age, with a mean age of 11.0 years participated. Nine patients were in an active state, and the other nine were in an inactive state at the time serum samples were obtained. Two sets of control sera were used. The first set of juvenile controls consisted of sera from 36 normal children living in Nagoya City who matched the JDMS patients by age ( -+-t year), sex. and residential area. The second set consisted of sera from 39 patients with ADMS (I0 men and 29 women), ranging from 26 to 76 years of age, with a mean age of 52.3 years. Twenty-one patients were in an active state, and 18 were in an inactive state. Total serum IgE levels were determined by use of a double antibody radioimmunoassay (Pharmacia Diagnostics AB, 405
406
Hiketa et al.
J ALLERGYCLIN IMMUNOL SEPTEMBER1992
p
Dermatomyositis (DMS), recognized as a multisystem disorder mediated through autoimmune mechanisms, affects both children and adults. A juvenile type o f this disorder, called juvenile dermatomyositis (JDMS), is now considered to be somewhat different from the adult type, or adult dermatomyositis ( A D M S ) , especially from a histopathologic point of view. A m o n g many children with JDMS, deposition of immunoglobulin complexes can be observed, particularly within the walls of intramuscular arteries and veins. ~ However, the etiology and pathogenesis of JDMS has remained elusive. Cochrane and Koffler 2 suggested that IgE may play an important role in autoimmune diseases by mediating the release of chemical mediators and by facilitating the local deposition of immune complexes. A m o n g patients with systemic lupus erythematosus (SLE), higher serum IgE levels can be seen during the active state of the disease when compared with the inactive state. 3 A deficiency o f suppressor T cells in the active SLE state may also contribute to elevations in the serum IgE levels. In a previous study we demonstrated a significantly higher frequency of pruritus in patients with JDMS when compared with patients with A D M S in J a p a n ? Most of the patients with JDMS in the present study who complained o f severe itch showed elevated serum IgE levels accompanied by atopic disease clinically diagnosed before the onset of JDMS. Our findings suggest a correlation between elevated serum IgE levels in patients with JDMS and atopic disease or a
From the Departments of Dermatology a and Preventive Medicine, b Nagoya University School of Medicine, Nagoya, Japan. Presented in part at the Fifth International Epidemiological Association (IEA) Scientific Meeting in the Asia-Pacific Region, Nagoya, Japan, May 10, 1991, and also at the Second China-Japan Joint Meeting of Dermatology, Shanghai, China, Nov. 20, 1990. Reprint requests: Takeshi Hiketa, MD, Department of Dermatology, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466, Japan. 1/1/38529
Abbreviations used
DMS: JDMS: ADMS: SLE: AD:
Dermatomyositis Juvenile dermatomyositis Adult dermatomyositis Systemic lupus erythematosus Atopic dermatitis
peculiarly defective immunosuppressive mechanism, as seen in cases of SLE. This study was designed to clarify this issue, and to determine whether atopic disease affects the occurrence of JDMS.
SUBJECTS A N D METHODS All patients with DMS in this study were those observed at Nagoya University Hospital over a period of 11 years. from 1980 through 1990. No specific method was used for selecting patients to participate in this study; patients who came to the hospital for treatment over the years were considered. All patients met at least three of the diagnostic criteria for DMS as proposed by Bohan and Peter? All patients with "active" disease who clearly demonstrated elevated muscle enzymes and muscular weakness at the time of examination were studied after diagnosis had been established and before treatment was begun. Patients with "inactive" disease who were in clinical and biochemical remission at the time of examination were studied during periodic visits for routine medical checkups. Eighteen patients with JDMS (11 males and 7 femalesJ, ranging from 4 to 15 years of age, with a mean age of 11.0 years participated. Nine patients were in an active state, and the other nine were in an inactive state at the time serum samples were obtained. Two sets of control sera were used. The first set of juvenile controls consisted of sera from 36 normal children living in Nagoya City who matched the JDMS patients by age ( -+-t year), sex. and residential area. The second set consisted of sera from 39 patients with ADMS (I0 men and 29 women), ranging from 26 to 76 years of age, with a mean age of 52.3 years. Twenty-one patients were in an active state, and 18 were in an inactive state. Total serum IgE levels were determined by use of a double antibody radioimmunoassay (Pharmacia Diagnostics AB, 405
406
Hiketa et al.
J ALLERGYCLIN IMMUNOL SEPTEMBER1992
p
