Hymenoptera-venom-induced upregulation of the basophil activation marker ecto-nucleotide pyrophosphatase/phosphodiesterase 3 in sensitized individuals.

BACKGROUND: Bee and wasp venoms are potent allergens capable of inducing severe clinical reactions. To detect immediate-type hypersensitivity to these allergens, a rapid in vitro test was developed that relies on the upregulation of ecto-nucleotide pyrophosphatase/phosphodiesterase 3 (E-NPP3) on activated basophils. METHODS: Blood basophils of 13 healthy donors and 22 patients allergic to bee or wasp venom were analyzed for E-NPP3 (CD203c) expression using monoclonal antibody 97A6. Basophils were analyzed by flow cytometry after activation with anti-IgE antibody or allergen. Venom-induced E-NPP3 upregulation on basophils was compared with diagnostic parameters, including skin tests and assessment of specific IgE. In selected samples, the increase in E-NPP3 expression on activated basophils was compared with histamine release and CD63 upregulation. RESULTS: In 20/22 patients sensitized to wasp or bee venom, E-NPP3 expression on basophils was upregulated in response to activation by allergen or anti-IgE. The maximum increase in E-NPP3 expression (above ten times of baseline) was achieved after 15 min of stimulation with 1 microg/ml of allergen or anti-IgE antibody. Sensitized individuals who failed to upregulate E-NPP3 in response to IgE receptor cross-linking also failed to induce histamine release and CD63 upregulation. CONCLUSIONS: Flow cytometric determination of hymenoptera-venom-induced upregulation of E-NPP3 is a novel in vitro test to identify sensitized individuals.

Reduction of minimal erythema dose by sweating.

BACKGROUND/AIMS: Solar ultraviolet (UV) radiation is the most important environmental risk factor for melanoma and non-melanoma skin cancer. It is known that tap water and saltwater baths have a photosensitizing capacity in subsequent UV irradiation of the skin. The aim of the present study was to determine the influence of sweating from heat or from physical activity on the photosensitivity of the skin. METHODS: Minimal erythema dose to ultraviolet B (MED/UVB) was determined on the inner forearms of 22 healthy volunteers with a Saalmann Multi-tester. Sweating had been provoked by heat (sauna for 10 min) and, on another occasion, physical exercise (jogging for 15 min) followed by MED/UVB testing in a similar way. RESULTS: Compared to baseline MED/UVB there was a highly significant decrease in MED/UVB of up to 31.6% (median 15.8%, mean 15.9% +/- 10.0) after 10 min in the sauna and up to 40.9% (median 16.3%, mean 17.2% +/- 12.5) after 15 min jogging (P < 0.0001). CONCLUSION: Sweat influences the hydration of the horny layer of the skin, resulting in a decrease in reflection and dispersion of UV light. Moderate physical activities such as jogging and/or heat may facilitate erythema reaction. By sweating, outdoor workers and people practicing outdoor sports who are exposed to considerable amounts of solar UV radiation further increase their risk of sunburn.

[Subcutaneous panniculitic T-cell lymphoma]. / Subkutanes pannikulitisches T-Zell-Lymphom.

Subcutaneous panniculitic T-cell lymphoma is categorized as a subtype of peripheral T-cell lymphoma. Patients typically present with nontender subcutaneous nodules. The characteristic histologic features include the presence of atypical lymphocytes and benign macrophages that infiltrate between the adipocytes of the subcutis mimicking panniculitis. We report a 75-year old patient with a three week history of asymptomatic subcutaneous nodules. The diagnosis of subcutaneous T-cell lymphoma was confirmed by immunohistological and molecular biological studies. Chemotherapy had to be interrupted due to a rapid worsening of the patient's general condition. She died few weeks after confirmation of diagnosis.

Granulomatous mycosis fungoides: report of a case with some histopathologic features of granulomatous slack skin.

We describe a case of granulomatous mycosis fungoides, tumor stage, mimicking sarcoidosis in an 82-year-old man with a 2-year history of skin disease. The final diagnosis was established after one of seven biopsy specimens showed a nongranulomatous histologic picture of patch-stage mycosis fungoides. Monoclonality was proven for the lymphocytic population by T-cell-receptor rearrangement studies. The unusually extensive granulomatous inflammation with huge giant cells surrounded by CD1a-positive cells in the other six biopsy specimens was suggestive of the histopathology of granulomatous slack skin, another rare granulomatous cutaneous T-cell lymphoma. Because both a clinical and histologic overlap between granulomatous mycosis fungoides and granulomatous slack skin have been reported in the literature, we conclude that they may belong to the spectrum of a single disease.

Treatment of acute graft-versus-host disease with PUVA (psoralen and ultraviolet irradiation): results of a pilot study.

Acute graft-versus-host disease (aGVHD) is a frequent and major complication after allogeneic stem cell transplantation. For many years psoralen and ultraviolet (UV)-A light have been used in the treatment of chronic cutaneous graft-versus-host disease, but few patients have received PUVA therapy for aGVHD. We assessed 20 patients who received PUVA therapy for acute cutaneous GVHD (grade 2-4). Seven patients showed additional organ manifestations (liver, gut). To better quantify the cutaneous lesions, a new scoring system was introduced: intensity of erythema (0-3) x %body surface + size of bullae (4-5) x %body surface affected. All patients received prednisolone and PUVA for treatment of aGVHD. Fifteen patients (75%), 12 with manifestations restricted to the skin, responded by score classification (average time to a 50% score reduction: 39 days) and reduction of the dosage of prednisolone (average time to a 50% prednisolone reduction: 35 days). PUVA treatment was well tolerated and might play a role in the therapy of acute cutaneous GVHD.

[Edematous swelling of the eyelids caused by contact allergy]. / Odematöse Schwellung der Augenlider durch Kontaktallergie.

Cosmetics and ophthalmological topical preparations are the main causes of allergic contact eczema about the eye. In most cases, clinical signs are conjunctival injection, blepharitis, periorbital dermatitis and edema of lids, often combined with itching. Pure edematous swelling of the eyelids should not immediately be blamed on a contact allergy, but sufficiently evaluated to exclude a benign or malignant process of the eyelids, orbita, lacrimal duct and paranasal sinus. We present a patient with pure edematous swelling of the eyelids due to a contact allergy by the sympathicomimetic phenylephrine hydrochloride, an uncommon allergen.

Anaphylactic reaction to bovine serum albumin after embryo transfer.

OBJECTIVE: To increase the awareness of bovine serum albumin (BSA) sensitivity as a potentially lethal complication during ET. DESIGN: Case report. SETTING: Routine ET in university hospital. PATIENT(S): A 26-year-old woman who was undergoing her first ET. INTERVENTION(S): ET with BSA containing standard fluid medium. MAIN OUTCOME MEASURE(S): Specific immunoglobulin (Ig) E antibodies and skin tests. RESULT(S): The patient demonstrated increased levels of specific IgE antibodies to BSA and a clearly positive scratch test for BSA. CONCLUSION(S): Anaphylactic reactions to BSA can occur during ET. The risk can be reduced substantially if a detailed medical history is obtained.

National rates and regional differences in sensitization to allergens of the standard series. Population-adjusted frequencies of sensitization (PAFS) in 40,000 patients from a multicenter study (IVDK).

Sensitization rates to contact allergens vary between centers and are influenced by sex and age. Eliminating the latter 2 factors by standardization of data by age and sex, the present analysis addresses possible differences between centers remaining after elimination of these confounders, and analyzes other factors which might influence rates, e.g., the MOAHL index. Overall standardized rates were well within the range reported in previous studies and may be regarded as representing the rates of the "patch test population" in Central Europe (e.g., nickel sulfate 12.9%, fragrance mix 10.5%, balsam of Peru 7.3%, thimerosal 5.6%). For this analysis, data of those departments which contributed more than 2000 patients, or of those with extreme proportions concerning sex, age and occupational cases were selected. Patients from these 10 departments differed considerably with regard to the items of the MOAHL index and with regard to standardized rates. The items of the MOAHL index proved to be suitable for describing different patch test populations and for explaining some differences between centers. Only 'atopic dermatitis' seems to have little influence on (standardized) rates. Face dermatitis is not yet represented in the MOAHL index, but should be included, together with age > 40 years, in an extended index (acronym: MOAHLFA). Regional allergen exposure (with striking differences between East Germany, West Germany and, to a lesser extent, Austria) seems to have a great influence on the sensitization pattern observed in a department. In addition, sociological factors may influence sensitization rates, which is exemplified by high rates of nickel allergy in a socially defined subgroup. Future studies should focus on these factors, as well as on factors concerning patch test practices and quality control.

Langerhans' cells in skin tumors.

DESIGN: We studied 58 skin specimens of normal skin (NS), basal cell epithelioma, squamous cell carcinoma, seborrheic keratosis, and malignant melanoma for the presence of Langerhans' cells (LCs) in and above the tumor. Anti-CD1 was used as a marker for LCs. All specimens were also incubated with anti-CD4, which also labels a certain number of LCs. RESULTS: All tumors contained LCs in the tumor and overlying epidermis. The number of LCs over basal cell carcinoma, squamous cell carcinoma, and malignant melanoma was significantly lower than in normal skin and seborrheic keratosis. These results are presented in detail and are compared with former studies discussing the different methodological approaches. CONCLUSIONS: Langerhans' cells were present in the epidermis of all the examined tumors. A certain percentage of LCs express CD4 surface antigen. This percentage varies from tumor to tumor.

Reproducibility of patch tests. A multicenter study of synchronous left-versus right-sided patch tests by the German Contact Dermatitis Research Group.

BACKGROUND: The efficiency and reproducibility of patch tests remain controversial. OBJECTIVE: Our purpose was to determine the efficiency and reproducibility of patch tests and to identify factors influencing these features. METHODS: We double-tested 1285 patients concomitantly with 10 standard allergens by manually filled test chambers. Additional information was obtained from all patients with a standardized protocol. RESULTS: Patch test efficiency was good (> or = 0.94) with all 10 allergens. In contrast, nonreproducibility of patch tests was strongly allergen dependent, ranging from 0.2 for nickel sulfate to 0.6 for formaldehyde. The likelihood of nonreproducible allergic reactions increased when more than four positive reactions were seen at the same time, and with another positive reaction located in close proximity to an allergic reaction. Sex and age of patients, atopy, dermatitis at distant sites, sleeping habits, and the time of allergen exposure (24 or 48 hours) did not affect the rate of nonreproducible results. CONCLUSION: To increase patch test reproducibility, specific preparations of patch test allergens need to be improved. Furthermore, amplification effects by synchronous neighboring positive reactions should be excluded.

[Benzalkonium chloride--a relevant contact allergen or irritant? Results of a multicenter study of the German Contact Allergy Group]. / Benzalkoniumchlorid--relevantes Kontaktallergen oder Irritans? Ergebnisse einer Multicenter-Studie der Deutschen Kontaktallergiegruppe.

At eight dermatological clinics, a total of 2146 patients were tested between May 1990 and December 1991 to determine the significance of the preservative benzalkonium chloride in inducing allergic contact dermatitis and to evaluate recommendations for patch testing. In 225 cases an allergic reaction was proven, with 258 irritant reactions in addition. Only 12 cases were clinically relevant. Therefore, benzalkonium chloride is considered a weak allergen. A doubtful (erythema) or an incipient positive (with occasional papules) reaction may be regarded as an irritant reaction. In isolated cases a "repeated open application test" (ROAT) should be applied to determine clinical relevance. Our recommendation for patch testing is 0.1% benzalkonium chloride in vaseline, and also in water for special cases.

[Anaphylactic reaction to human insulin. Successful desensitization]. / Anaphylaktische Reaktion auf Humaninsulin. Erfolgreiche Hyposensibilisierung.

A 48-year-old woman with diabetes mellitus (type IIb) had to be treated with insulin because of poor blood-sugar control. Infiltrates at the sight of injection occurred with two different porcine insulin preparations, necessitating a switch to human insulin. After the third injection of the latter an anaphylactic reaction developed within minutes. During a pregnancy in 1968 the patient had briefly received bovine insulin. Tests now revealed an immediate-type allergy against all three available species insulins, which was successfully treated by hyposensitisation.

Collaborative clinical assay of the biological potency of allergen skin-test extracts.

A multicentre collaborative clinical trial has been made at one centre in each of six countries to decide if the potency of allergen extracts can be determined satisfactorily by skin-prick tests in man. Although there was considerable variation in potency of antigen when determined in different patients, if a sufficiently large group (n = 54) of persons were tested, it was shown to be feasible to compare potencies of sequential batches of the same specificity, and also of antigens of different specificities. It was shown that batches of mite extract were weaker than that of a grass pollen, but it proved to be a simple matter to adjust the concentration to give the same biological potency.

[Benzoyl peroxide for the treatment of badly healing leg ulcers. A double-blind study (author's transl)]. / Benzoylpeoxyd zur Therapie schlecht heilender Ulcera cruris. Eine Doppelblindstudie.

According to reports in the literature and the results of our own double-blind trial benzoyl peroxide at a 20% concentration in an oil-in-water emulsion (Benoxyl 20) is a very effective medication especially in problem ulcers. The benefit probably outweighs the considerable dangers of application in the indication mentioned which may consist of a selection of certain gram-negative organisms and an epicutaneous sensitization.