X-linked hyper-immunoglobulin M syndrome: Molecular genetic study and long-time follow-up of three generations of a Chinese family

Sheng-Chieh Lin, Shyh-Dar Shyur, Wen I. Lee, Yi-Chun Ma, Li-Hsin Huang

研究成果: 雜誌貢獻文章

6 引文 (Scopus)

摘要

Background: X-linked hyper-immunoglobulin M (IgM) syndrome (XHIGM) is a rare immunodeficiency disease caused by mutations of the CD40 ligand gene. Patients are subject to recurrent infections and have normal or elevated levels of IgM but markedly decreased serum IgG. Objective: We describe molecular genetic studies and clinical manifestations in three generations of one family, as well as results of long-term treatment of 2 young men with the disorder. Methods: Of 37 living family members, mutational analysis of the CD40 ligand gene was performed in 36 members. Laboratory data for patients and carriers were reviewed. Results: Four male family members had died of unexplained causes. The 3 patients with XHIGM syndrome and the 5 carriers all had a novel mutation located at Tyr 169 Asn (T526A) in exon 5, the tumor necrosis factor domain of the CD40 ligand gene. In the 3 patients, CD40 ligand expression in activated CD4+ T cells was below 1%. In the carriers, about half of activated CD4+ cells expressed CD40 ligand. One carrier had malignant lymphoma. Long-term (>20 years) intravenous immunoglobulin therapy in 2 patients improved IgG levels but did not fully suppress the high levels of IgM, nor did it prevent late complications (bronchiectasis and sclerosing cholangitis). Conclusions: Diagnosis of a genetic immunodeficiency, especially an X-linked disease such as XHIGM syndrome, should prompt a survey of the entire family. Copyright © 2006 S. Karger AG.
原文英語
頁(從 - 到)1-8
頁數8
期刊International Archives of Allergy and Immunology
140
發行號1
DOIs
出版狀態已發佈 - 2006
對外發佈Yes

指紋

CD40 Ligand
Immunoglobulin M
Molecular Biology
X-Linked Combined Immunodeficiency Diseases
Immunoglobulin G
Genes
Sclerosing Cholangitis
Mutation
Passive Immunization
Bronchiectasis
Intravenous Immunoglobulins
Rare Diseases
Exons
Lymphoma
Tumor Necrosis Factor-alpha
Light Fixation Seizure Syndrome
T-Lymphocytes
Infection
Serum

引用此文

X-linked hyper-immunoglobulin M syndrome: Molecular genetic study and long-time follow-up of three generations of a Chinese family. / Lin, Sheng-Chieh; Shyur, Shyh-Dar; Lee, Wen I.; Ma, Yi-Chun; Huang, Li-Hsin.

於: International Archives of Allergy and Immunology, 卷 140, 編號 1, 2006, p. 1-8.

研究成果: 雜誌貢獻文章

@article{560cf40507c64f4989b423dd0614d1cd,
title = "X-linked hyper-immunoglobulin M syndrome: Molecular genetic study and long-time follow-up of three generations of a Chinese family",
abstract = "Background: X-linked hyper-immunoglobulin M (IgM) syndrome (XHIGM) is a rare immunodeficiency disease caused by mutations of the CD40 ligand gene. Patients are subject to recurrent infections and have normal or elevated levels of IgM but markedly decreased serum IgG. Objective: We describe molecular genetic studies and clinical manifestations in three generations of one family, as well as results of long-term treatment of 2 young men with the disorder. Methods: Of 37 living family members, mutational analysis of the CD40 ligand gene was performed in 36 members. Laboratory data for patients and carriers were reviewed. Results: Four male family members had died of unexplained causes. The 3 patients with XHIGM syndrome and the 5 carriers all had a novel mutation located at Tyr 169 Asn (T526A) in exon 5, the tumor necrosis factor domain of the CD40 ligand gene. In the 3 patients, CD40 ligand expression in activated CD4+ T cells was below 1{\%}. In the carriers, about half of activated CD4+ cells expressed CD40 ligand. One carrier had malignant lymphoma. Long-term (>20 years) intravenous immunoglobulin therapy in 2 patients improved IgG levels but did not fully suppress the high levels of IgM, nor did it prevent late complications (bronchiectasis and sclerosing cholangitis). Conclusions: Diagnosis of a genetic immunodeficiency, especially an X-linked disease such as XHIGM syndrome, should prompt a survey of the entire family. Copyright {\circledC} 2006 S. Karger AG.",
keywords = "CD40 ligand gene, Intravenous immunoglobulin therapy, X-linked hyper-immunoglobulin M syndrome, asparagine, CD4 antigen, CD40 ligand, immunoglobulin, immunoglobulin G, immunoglobulin M, tumor necrosis factor, tyrosine, adult, antigen expression, bronchiectasis, cause of death, Chinese, clinical article, clinical feature, controlled study, exon, familial disease, female, follow up, genetic analysis, heterozygote, human, human cell, human tissue, hyperimmunoglobulinemia M, immune deficiency, immunoglobulin blood level, immunotherapy, infant, laboratory test, long term care, lymphocyte activation, lymphoma, male, medical record review, molecular genetics, mutagenesis, mutational analysis, priority journal, protein domain, review, sclerosing cholangitis, T lymphocyte, treatment duration, X chromosome linked disorder, Adolescent, Adult, Amino Acid Substitution, Asian Continental Ancestry Group, CD40 Ligand, Child, Child, Preschool, Common Variable Immunodeficiency, DNA Mutational Analysis, Female, Follow-Up Studies, Genetic Diseases, X-Linked, Heterozygote Detection, Humans, Immunoglobulin G, Immunoglobulin M, Infant, Male, Pedigree, Syndrome",
author = "Sheng-Chieh Lin and Shyh-Dar Shyur and Lee, {Wen I.} and Yi-Chun Ma and Li-Hsin Huang",
note = "被引用次數:5 Export Date: 7 April 2016 CODEN: IAAIE 通訊地址: Shyur, S.-D.; Department of Pediatrics, Mackay Memorial Hospital, Taipei, No. 92, Sec. 2, Chung-Shan N. Road, Taipei, 104, Taiwan; 電子郵件: abc1016@ms2.mmh.org.tw 化學物質/CAS: asparagine, 70-47-3, 7006-34-0; CD40 ligand, 226713-27-5; immunoglobulin G, 97794-27-9; immunoglobulin M, 9007-85-6; immunoglobulin, 9007-83-4; tyrosine, 16870-43-2, 55520-40-6, 60-18-4; CD40 Ligand, 147205-72-9; Immunoglobulin G; Immunoglobulin M 參考文獻: Kroczek, R.A., Graf, D., Brugnoni, D., Giliani, S., Korthuer, U., Ugazio, A., Senger, G., Notarangelo, L.D., Defective expression of CD40 ligand on T cells causes X-linked immunodeficiency with hyper-IgM (1994) Immunol Rev, 138, pp. 39-59; Banatvala, N., Davies, J., Kanariou, M., Strobel, S., Levinsky, R., Morgan, G., Hypogammaglobulinaemia associated with normal or increased IgM (the hyper IgM syndrome): A case series review (1994) Arch Dis Child, 71, pp. 150-152; Fuleihan, R.L., Hyper IgM syndrome: The other side of the coin (2001) Curr Opin Pediatr, 13, pp. 528-532; Notarangelo, L.D., Hayward, A.R., X-linked immunodeficiency with hyper-IgM (XHIM) (2000) Clin Exp Immunol, 120, pp. 399-405; Lee, W.I., Torgerson, T.R., Schumacher, M.J., Yel, L., Zhu, Q., Ochs, H.D., Molecular analysis of a large cohort of patients with the hyper immunoglobulin M (IgM) syndrome (2005) Blood, 105, pp. 1881-1890; Rosen, F.S., Kevy, S.V., Merier, E., Janeway, C.A., Gitlin, D., Recurrent bacterial infections and dysgammaglobulinemia: Deficiency of 7S gamma-globulins in the presence of elevated 19S gamma-globulins (1961) Pediatrics, 28, pp. 182-195; Winkelstein, J.A., Marino, M.C., Ochs, H., Fuleihan, R., Scholl, P.R., Geha, R., Stiehm, R., Conley, M.E., The X-linked hyper-IgM syndrome: Clinical and immunologic features of 79 patients (2003) Medicine, 82, pp. 373-384; Conley, M.E., Rohrer, J., Minegishi, Y., X-linked agammaglobulinemia (2000) Clin Rev Allergy Immunol, 19, pp. 183-204; Cunningham-Rundles, C., Bodian, C., Common variable immunodeficiency: Clinical and immunological features of 248 patients (1999) Clin Immunol, 92, pp. 34-48; Ochs, H.D., Stieham, E.R., Winkelstein, J.A., The hyper-IgM syndrome (2004) Immunologic Disorder in Infants and Children, Ed 5, pp. 380-390. , in Stieham ER, Ochs HD, Winkelstein JA (eds): Philadelphia, Elsevier; Levy, J., Espanol-Boren, T., Thomas, C., Fischer, A., Tovo, P., Bordigoni, P., Resnick, I., Notarangelo, L.D., Clinical spectrum of X-linked hyper-IgM syndrome (1997) J Pediatr, 131, pp. 47-54; Cunningham, C.K., Bonville, C.A., Ochs, H.D., Seyama, K., John, P.A., Rotbart, H.A., Weiner, L.B., Enteroviral meningoencephalitis as a complication of X-linked hyper IgM syndrome (1999) J Pediatr, 134, pp. 584-588; Schneider, L.C., X-linked hyper IgM syndrome (2000) Clin Rev Allergy Immunol, 19, pp. 205-215; Lopez-Granados, E., Cambronero, R., Ferreira, A., Garcia-Rodriguez, M.C., Three novel mutations reflect the variety of defects causing phenotypically diverse X-linked hyper-IgM syndrome (2003) Clin Exp Immunol, 133, pp. 123-131; Hendricks, R.W., Kraakman, M.E.M., Craig, I.W., Espanol, T., Schuurman, R.K.B., Evidence that in X-linked immunodeficiency with hyperimmunoglobulinemia M the intrinsic immunoglobulin heavy chain class switch mechanism is intact (1990) Eur J Immunol, 23, pp. 2368-2371; Hollenbaugh, D., Wu, L.H., Ochs, H.D., Nonoyama, S., Grosmaire, L.S., Ledbetter, J.A., Noelle, R.J., Aruffo, A., The random inactivation of the X chromosome carrying the defective gene responsible for the X-linked hyper IgM syndrome in female carriers of HIGM1 (1994) J Clin Invest, 94, pp. 616-622; De Saint Basile, G., Tabone, M.D., Durandy, A., Phan, F., Fischer, A., Le Deist, F., CD40 ligand expression deficiency in a female carrier of the X-linked hyper-IgM syndrome as a result of X chromosome lyonization (1999) Eur J Immunol, 29, pp. 367-373; Leone, V., Tommasini, A., Andolina, M., Runti, G., De Vonderweid, U., Campello, C., Notarangelo, L.D., Ventura, A., Elective bone marrow transplantation in a child with X-linked hyper-IgM syndrome presenting with acute respiratory distress syndrome (2002) Bone Marrow Transplant, 30, pp. 49-52; Thomas, C., De Saint Basile, G., Le Deist, F., Theophile, D., Benkerrou, M., Haddad, E., Blanche, S., Fischer, A., Brief report: Correction of X-linked hyper-IgM syndrome by allogeneic bone marrow transplantation (1995) N Engl J Med, 333, pp. 426-429; Gennery, A.R., Khawaja, K., Veys, P., Bredius, R.G.M., Notarangelo, L.D., Mazzolari, E., Fischer, A., Davies, E.G., Treatment of CD40 ligand deficiency by hematopoietic stem cell transplantation: A survey of the European experience, 1993-2002 (2004) Blood, 103, pp. 1152-1157; Hadzic, N., Pagliuca, A., Rela, M., Portmann, B., Jones, A., Veys, P., Heaton, N.D., Mieli-Vergani, G., Correction of the hyper-IgM syndrome after liver and bone marrow transplantation (2000) N Engl J Med, 342, pp. 320-324; Knutsen, A.P., Steffen, M., Wassmer, K., Wall, D.A., Umbilical cord blood transplantation in Wiskott Aldrich syndrome (2003) J Pediatr, 142, pp. 519-523; Fagioli, F., Biasin, E., Berger, M., Nesi, F., Saroglia, E.H., Miniero, R., Martino, S., Tovo, P.A., Successful unrelated cord blood transplantation in two children with severe combined immunodeficiency syndrome (2003) Bone Marrow Transplant, 31, pp. 133-136; Hollenbaugh, D., Grosmaire, M.S., Kullas, C.D., The human T cell antigen gp39, a member of the TNF gene family, is a ligand for the CD40 receptor: Expression of a soluble form of gp39 with B cell co-stimulatory activity (1992) EMBO J, 11, pp. 4313-4321",
year = "2006",
doi = "10.1159/000091744",
language = "English",
volume = "140",
pages = "1--8",
journal = "International Archives of Allergy and Immunology",
issn = "1018-2438",
publisher = "S. Karger AG",
number = "1",

}

TY - JOUR

T1 - X-linked hyper-immunoglobulin M syndrome: Molecular genetic study and long-time follow-up of three generations of a Chinese family

AU - Lin, Sheng-Chieh

AU - Shyur, Shyh-Dar

AU - Lee, Wen I.

AU - Ma, Yi-Chun

AU - Huang, Li-Hsin

N1 - 被引用次數:5 Export Date: 7 April 2016 CODEN: IAAIE 通訊地址: Shyur, S.-D.; Department of Pediatrics, Mackay Memorial Hospital, Taipei, No. 92, Sec. 2, Chung-Shan N. Road, Taipei, 104, Taiwan; 電子郵件: abc1016@ms2.mmh.org.tw 化學物質/CAS: asparagine, 70-47-3, 7006-34-0; CD40 ligand, 226713-27-5; immunoglobulin G, 97794-27-9; immunoglobulin M, 9007-85-6; immunoglobulin, 9007-83-4; tyrosine, 16870-43-2, 55520-40-6, 60-18-4; CD40 Ligand, 147205-72-9; Immunoglobulin G; Immunoglobulin M 參考文獻: Kroczek, R.A., Graf, D., Brugnoni, D., Giliani, S., Korthuer, U., Ugazio, A., Senger, G., Notarangelo, L.D., Defective expression of CD40 ligand on T cells causes X-linked immunodeficiency with hyper-IgM (1994) Immunol Rev, 138, pp. 39-59; Banatvala, N., Davies, J., Kanariou, M., Strobel, S., Levinsky, R., Morgan, G., Hypogammaglobulinaemia associated with normal or increased IgM (the hyper IgM syndrome): A case series review (1994) Arch Dis Child, 71, pp. 150-152; Fuleihan, R.L., Hyper IgM syndrome: The other side of the coin (2001) Curr Opin Pediatr, 13, pp. 528-532; Notarangelo, L.D., Hayward, A.R., X-linked immunodeficiency with hyper-IgM (XHIM) (2000) Clin Exp Immunol, 120, pp. 399-405; Lee, W.I., Torgerson, T.R., Schumacher, M.J., Yel, L., Zhu, Q., Ochs, H.D., Molecular analysis of a large cohort of patients with the hyper immunoglobulin M (IgM) syndrome (2005) Blood, 105, pp. 1881-1890; Rosen, F.S., Kevy, S.V., Merier, E., Janeway, C.A., Gitlin, D., Recurrent bacterial infections and dysgammaglobulinemia: Deficiency of 7S gamma-globulins in the presence of elevated 19S gamma-globulins (1961) Pediatrics, 28, pp. 182-195; Winkelstein, J.A., Marino, M.C., Ochs, H., Fuleihan, R., Scholl, P.R., Geha, R., Stiehm, R., Conley, M.E., The X-linked hyper-IgM syndrome: Clinical and immunologic features of 79 patients (2003) Medicine, 82, pp. 373-384; Conley, M.E., Rohrer, J., Minegishi, Y., X-linked agammaglobulinemia (2000) Clin Rev Allergy Immunol, 19, pp. 183-204; Cunningham-Rundles, C., Bodian, C., Common variable immunodeficiency: Clinical and immunological features of 248 patients (1999) Clin Immunol, 92, pp. 34-48; Ochs, H.D., Stieham, E.R., Winkelstein, J.A., The hyper-IgM syndrome (2004) Immunologic Disorder in Infants and Children, Ed 5, pp. 380-390. , in Stieham ER, Ochs HD, Winkelstein JA (eds): Philadelphia, Elsevier; Levy, J., Espanol-Boren, T., Thomas, C., Fischer, A., Tovo, P., Bordigoni, P., Resnick, I., Notarangelo, L.D., Clinical spectrum of X-linked hyper-IgM syndrome (1997) J Pediatr, 131, pp. 47-54; Cunningham, C.K., Bonville, C.A., Ochs, H.D., Seyama, K., John, P.A., Rotbart, H.A., Weiner, L.B., Enteroviral meningoencephalitis as a complication of X-linked hyper IgM syndrome (1999) J Pediatr, 134, pp. 584-588; Schneider, L.C., X-linked hyper IgM syndrome (2000) Clin Rev Allergy Immunol, 19, pp. 205-215; Lopez-Granados, E., Cambronero, R., Ferreira, A., Garcia-Rodriguez, M.C., Three novel mutations reflect the variety of defects causing phenotypically diverse X-linked hyper-IgM syndrome (2003) Clin Exp Immunol, 133, pp. 123-131; Hendricks, R.W., Kraakman, M.E.M., Craig, I.W., Espanol, T., Schuurman, R.K.B., Evidence that in X-linked immunodeficiency with hyperimmunoglobulinemia M the intrinsic immunoglobulin heavy chain class switch mechanism is intact (1990) Eur J Immunol, 23, pp. 2368-2371; Hollenbaugh, D., Wu, L.H., Ochs, H.D., Nonoyama, S., Grosmaire, L.S., Ledbetter, J.A., Noelle, R.J., Aruffo, A., The random inactivation of the X chromosome carrying the defective gene responsible for the X-linked hyper IgM syndrome in female carriers of HIGM1 (1994) J Clin Invest, 94, pp. 616-622; De Saint Basile, G., Tabone, M.D., Durandy, A., Phan, F., Fischer, A., Le Deist, F., CD40 ligand expression deficiency in a female carrier of the X-linked hyper-IgM syndrome as a result of X chromosome lyonization (1999) Eur J Immunol, 29, pp. 367-373; Leone, V., Tommasini, A., Andolina, M., Runti, G., De Vonderweid, U., Campello, C., Notarangelo, L.D., Ventura, A., Elective bone marrow transplantation in a child with X-linked hyper-IgM syndrome presenting with acute respiratory distress syndrome (2002) Bone Marrow Transplant, 30, pp. 49-52; Thomas, C., De Saint Basile, G., Le Deist, F., Theophile, D., Benkerrou, M., Haddad, E., Blanche, S., Fischer, A., Brief report: Correction of X-linked hyper-IgM syndrome by allogeneic bone marrow transplantation (1995) N Engl J Med, 333, pp. 426-429; Gennery, A.R., Khawaja, K., Veys, P., Bredius, R.G.M., Notarangelo, L.D., Mazzolari, E., Fischer, A., Davies, E.G., Treatment of CD40 ligand deficiency by hematopoietic stem cell transplantation: A survey of the European experience, 1993-2002 (2004) Blood, 103, pp. 1152-1157; Hadzic, N., Pagliuca, A., Rela, M., Portmann, B., Jones, A., Veys, P., Heaton, N.D., Mieli-Vergani, G., Correction of the hyper-IgM syndrome after liver and bone marrow transplantation (2000) N Engl J Med, 342, pp. 320-324; Knutsen, A.P., Steffen, M., Wassmer, K., Wall, D.A., Umbilical cord blood transplantation in Wiskott Aldrich syndrome (2003) J Pediatr, 142, pp. 519-523; Fagioli, F., Biasin, E., Berger, M., Nesi, F., Saroglia, E.H., Miniero, R., Martino, S., Tovo, P.A., Successful unrelated cord blood transplantation in two children with severe combined immunodeficiency syndrome (2003) Bone Marrow Transplant, 31, pp. 133-136; Hollenbaugh, D., Grosmaire, M.S., Kullas, C.D., The human T cell antigen gp39, a member of the TNF gene family, is a ligand for the CD40 receptor: Expression of a soluble form of gp39 with B cell co-stimulatory activity (1992) EMBO J, 11, pp. 4313-4321

PY - 2006

Y1 - 2006

N2 - Background: X-linked hyper-immunoglobulin M (IgM) syndrome (XHIGM) is a rare immunodeficiency disease caused by mutations of the CD40 ligand gene. Patients are subject to recurrent infections and have normal or elevated levels of IgM but markedly decreased serum IgG. Objective: We describe molecular genetic studies and clinical manifestations in three generations of one family, as well as results of long-term treatment of 2 young men with the disorder. Methods: Of 37 living family members, mutational analysis of the CD40 ligand gene was performed in 36 members. Laboratory data for patients and carriers were reviewed. Results: Four male family members had died of unexplained causes. The 3 patients with XHIGM syndrome and the 5 carriers all had a novel mutation located at Tyr 169 Asn (T526A) in exon 5, the tumor necrosis factor domain of the CD40 ligand gene. In the 3 patients, CD40 ligand expression in activated CD4+ T cells was below 1%. In the carriers, about half of activated CD4+ cells expressed CD40 ligand. One carrier had malignant lymphoma. Long-term (>20 years) intravenous immunoglobulin therapy in 2 patients improved IgG levels but did not fully suppress the high levels of IgM, nor did it prevent late complications (bronchiectasis and sclerosing cholangitis). Conclusions: Diagnosis of a genetic immunodeficiency, especially an X-linked disease such as XHIGM syndrome, should prompt a survey of the entire family. Copyright © 2006 S. Karger AG.

AB - Background: X-linked hyper-immunoglobulin M (IgM) syndrome (XHIGM) is a rare immunodeficiency disease caused by mutations of the CD40 ligand gene. Patients are subject to recurrent infections and have normal or elevated levels of IgM but markedly decreased serum IgG. Objective: We describe molecular genetic studies and clinical manifestations in three generations of one family, as well as results of long-term treatment of 2 young men with the disorder. Methods: Of 37 living family members, mutational analysis of the CD40 ligand gene was performed in 36 members. Laboratory data for patients and carriers were reviewed. Results: Four male family members had died of unexplained causes. The 3 patients with XHIGM syndrome and the 5 carriers all had a novel mutation located at Tyr 169 Asn (T526A) in exon 5, the tumor necrosis factor domain of the CD40 ligand gene. In the 3 patients, CD40 ligand expression in activated CD4+ T cells was below 1%. In the carriers, about half of activated CD4+ cells expressed CD40 ligand. One carrier had malignant lymphoma. Long-term (>20 years) intravenous immunoglobulin therapy in 2 patients improved IgG levels but did not fully suppress the high levels of IgM, nor did it prevent late complications (bronchiectasis and sclerosing cholangitis). Conclusions: Diagnosis of a genetic immunodeficiency, especially an X-linked disease such as XHIGM syndrome, should prompt a survey of the entire family. Copyright © 2006 S. Karger AG.

KW - CD40 ligand gene

KW - Intravenous immunoglobulin therapy

KW - X-linked hyper-immunoglobulin M syndrome

KW - asparagine

KW - CD4 antigen

KW - CD40 ligand

KW - immunoglobulin

KW - immunoglobulin G

KW - immunoglobulin M

KW - tumor necrosis factor

KW - tyrosine

KW - adult

KW - antigen expression

KW - bronchiectasis

KW - cause of death

KW - Chinese

KW - clinical article

KW - clinical feature

KW - controlled study

KW - exon

KW - familial disease

KW - female

KW - follow up

KW - genetic analysis

KW - heterozygote

KW - human

KW - human cell

KW - human tissue

KW - hyperimmunoglobulinemia M

KW - immune deficiency

KW - immunoglobulin blood level

KW - immunotherapy

KW - infant

KW - laboratory test

KW - long term care

KW - lymphocyte activation

KW - lymphoma

KW - male

KW - medical record review

KW - molecular genetics

KW - mutagenesis

KW - mutational analysis

KW - priority journal

KW - protein domain

KW - review

KW - sclerosing cholangitis

KW - T lymphocyte

KW - treatment duration

KW - X chromosome linked disorder

KW - Adolescent

KW - Adult

KW - Amino Acid Substitution

KW - Asian Continental Ancestry Group

KW - CD40 Ligand

KW - Child

KW - Child, Preschool

KW - Common Variable Immunodeficiency

KW - DNA Mutational Analysis

KW - Female

KW - Follow-Up Studies

KW - Genetic Diseases, X-Linked

KW - Heterozygote Detection

KW - Humans

KW - Immunoglobulin G

KW - Immunoglobulin M

KW - Infant

KW - Male

KW - Pedigree

KW - Syndrome

U2 - 10.1159/000091744

DO - 10.1159/000091744

M3 - Article

VL - 140

SP - 1

EP - 8

JO - International Archives of Allergy and Immunology

JF - International Archives of Allergy and Immunology

SN - 1018-2438

IS - 1

ER -