Hyper IgE syndrome: review and future directions.

Hyper IgE syndrome, or Job's syndrome, is an immunodeficiency syndrome characterized by eczema, recurrent infections and elevated serum immunoglobulin E levels. Individuals tend to have frequent staphylococcal abscesses and pneumonias early in life, often developing pneumatocoeles that predispose them to later fungal and Gram-negative bacterial infections. In addition to the immunologic abnormalities, hyper IgE syndrome is now recognized as a multisystem disorder with skeletal and morphologic features such as characteristic facies, osteopenia, scoliosis, fractures and retention of the primary teeth. Therapy of hyper IgE syndrome involves careful skin care, antimicrobial prophylaxis and aggressive treatment of infections, as well as treatment of some of the complicating abnormalities, such as scoliosis. The genetic etiology of hyper IgE syndrome remains unknown, however, it continues to be investigated. Identification of the genetic etiology or etiologies of this syndrome will allow for targeted therapies as well as great advances in understanding the connections between immunologic function and connective tissue.