Atopic dermatitis and impaired neutrophil chemotaxis in Job's syndrome

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Abstract
A 22 yr old white woman with Job''s syndrome had atopic dermatitis and impaired neutrophil chemotaxis in vitro. Major clinical features of Job''s syndrome included large, cold and recurrent staphylococcal abscesses, and intermittent bacterial and yeast infections. Evidence for atopic disease included infantile eczema progressing to flexural dermatitis, a family history of atopy, positive immediate hypersensitivity skin tests and hyperimmunoglobulinemia E. Defective erythema responses to histamine, methyl and methacholine (Mecholyl) chloride may explain the lack of redness, heat or pain signalling the development of abscesses (hence the term cold). Impaired chemotaxis was probably due to an intrinsic neutrophil defect since the patient''s serum generated normal amounts of chemotactic factors and did not contain an inhibitor of neutrophil chemotaxis. A delay in neutrophil exudation in vivo may explain the abscess formations. The atopic diathesis may explain the absence of clinical signs of inflammation that have been described in this and other patients with Job''s syndrome.