Pollen grains induce a rapid and biphasic eczematous immune response in atopic eczema patients

Introduction: Eczematous reactions to type I allergy-inducing antigens are documented in a subgroup of patients with atopic eczema. Yet, the underlying immunological mechanisms are not well understood. Material and Methods: To delineate the effect of native pollen grains on human skin of healthy and atopic individuals we performed patch tests (atopy patch test with native pollen grains, PPT). Nickel patch tests (NPT) served as an established model of contact dermatitis. Skin site biopsies were taken 6 - 96 h after allergen application and investigated immunohistochemically. Results: Histology of positive patch tests showed an influx of mononuclear cells (predominantly CD4+, CD25+, CD45RO+). This influx was detected earlier in the PPT reaction than in the immune response to nickel. A biphasic cytokine response could be detected in the PPT: IL-5 dominated in the early, IFN-gamma in the late phase. The NPT was continuously dominated by IFN-gamma. Dendritic cell subpopulations imitated the earlier kinetics of the mononuclear infiltrate. Discussion: Thus, pollen grains induce eczematous reactions in susceptible individuals. This reaction appears clinically and immunohistochemically similar to the contact hypersensitivity reaction to nickel but follows a faster kinetic and a biphasic course: Th2 and IgE in the early (24 h) and Th1 predominance in the late (96 h) phase. Copyright (c) 2007 S. Karger AG, Basel

Relationship Between Atopy Patch Test with Foods and SCORAD

Background and Design: The relationship between food and atopic dermatitis (AD) is controversial. Atopy patch test (APT) gained prominence due to low specificity of “fresh prick tests” (FPT) with foods, commonly late occurrence of lesions in AD and, thus, the inconsistencies in anamneses, and being the provocative tests time consuming and risky, as well as due to the role of T lymphocytes in the pathophysiology of the disease. In this study, we investigated the relationship of APT and FPT made with food with SCORAD index assessing the disease severity.Materials and Methods: Forty-five children (21 males and 24 females) aged between 2-15 years who were diagnosed with AD in our outpatient clinic between May 2006 and May 2007 were included in the study. FPT and APT with eggs, milk and wheat flour were performed in all patients. The severity of illness was assessed using the SCORAD index. Statistical analysis was performed using SPSS version 11.0 for Windows. A p value of less than 0.05 was considered statistically significant

Human and computational models of atopic dermatitis:A review and perspectives by an expert panel of the International Eczema Council

Atopic dermatitis (AD) is a prevalent disease worldwide and is associated with systemic comorbidities representing a significant burden on patients, their families, and society. Therapeutic options for AD remain limited, in part because of a lack of well-characterized animal models. There has been increasing interest in developing experimental approaches to study the pathogenesis of human AD in vivo, in vitro, and in silico to better define pathophysiologic mechanisms and identify novel therapeutic targets and biomarkers that predict therapeutic response. This review critically appraises a range of models, including genetic mutations relevant to AD, experimental challenge of human skin in vivo, tissue culture models, integration of “omics” data sets, and development of predictive computational models. Although no one individual model recapitulates the complex AD pathophysiology, our review highlights insights gained into key elements of cutaneous biology, molecular pathways, and therapeutic target identification through each approach. Recent developments in computational analysis, including application of machine learning and a systems approach to data integration and predictive modeling, highlight the applicability of these methods to AD subclassification (endotyping), therapy development, and precision medicine. Such predictive modeling will highlight knowledge gaps, further inform refinement of biological models, and support new experimental and systems approaches to AD

Latex Allergy In Health Care Workers

Background and Design: We aimed to determine the frequency of latex allergy in our hospital and to to evaluate the clinical and demographical features of the cases.Materials and Methods: A detailed questionnaire was administered to healthcare workers by a physician. Skin prick test with latex and patch test with rubber chemicals and a piece of latex glove were performed for all healthcare workers. Latex-specific IgE was measured in serum.Results: The study sample consisted of 36 nurses, 14 doctors, and 50 healthcare workers. While 46 subjects had symptoms, 54 subjects had no symptoms. The relationship of clinical disease with working duration, exposure duration (hour/day), history of atopy, and drug/food allergies was statistically significant. Five nurses and 1 healthcare worker had positive skin prick test. Two of them had positive latex-specific IgE. Positive skin prick test statistically significantly correlated with occupation, working duration, exposure duration (hour/day) and positive latex-specific IgE. Two nurses and 2 healthcare workers had positive latex-specific IgE. Two of them had positive skin prick test. Positive latexspecific IgE statistically significantly correlated with working duration, exposure duration, and positive skin prick test. Patch test with a piece of latex glove was negative in all subjects. Three healthcare workers had positive patch test with thiuram-mix, one of them had also positive patch test with mercaptobenzothiazole.Discussion: One of the risk factors for latex allergy is occupations involving frequent exposure to latex products. Latex allergy should be taken into consideration if type I hypersensitivity reactions occur in occupational groups at risk for anaphylactic reaction

Atopy patch test are useful to predict oral tolerance in children with gastrointestinal symptoms related to non-IgE-mediated cow's milk allergy.

Atopy patch tests (APTs) have been proposed for the diagnostic approach in children with non-IgE-mediated cow's milk allergy and gastrointestinal symptoms. We aimed to investigate the benefit of APTs in predicting oral tolerance in these patients. We prospectively evaluated 172 subjects with a sure diagnosis of non-IgE-mediated CMA and gastrointestinal symptoms (97 boys, 56.4%; age, 6.37 m; range, 212 m). At diagnosis, 113/172 (65.7%) children had positive APTs to cow's milk proteins (CMP). After 12 months of exclusion, diet APTs were repeated immediately before OFC. APTs significantly correlated (P < 0.001) with the OFC outcome (r 0.579). Diagnostic accuracy was sensitivity of 67.95%, specificity of 88.3%, PPV of 82.81%, NPV of 76.85%, and a +LR of 5.80. APTs are a valuable tool in the follow-up of children with non-IgE-mediated CMA-related gastrointestinal symptoms by contributing in determining whether an OFC can safely be undertaken

Debates in allergy medicine: Specific immunotherapy in children with atopic dermatitis, the "con" view.

Atopic dermatitis (AD) is a common chronic skin condition in children that has a proven association with other atopic conditions and allergies. These associations, like the general pathophysiology of AD, are complex and not fully understood. While there is evidence for the efficacy of specific immunotherapy (SIT) in pediatric asthma and allergic rhinitis (AR), there is a lack of strong data to support its use in AD. IgE has been shown to be elevated in many patients with AD, but it is an unreliable biomarker due to variability and great fluctuation over time, poor positive predictive value for clinically relevant allergy, and poor correlation with disease state. In spite of this, almost all studies of SIT use either positive skin prick testing (SPT) or serum specific IgE levels to guide therapy. Allergen avoidance, with some exceptions, is generally not effective at controlling AD in children. The few studies that have investigated the efficacy of SIT in children with AD have produced conflicting results, and a lack of reproducibility with a standard treatment protocol. Limited studies have shown clinical improvement in mild to moderate AD cases, but no effect on more severe patients. Uncontrolled studies are difficult to interpret, due to the natural history of remission or "outgrowing" of AD over time in many patients without specific interventions. Drawbacks to SIT include the length of treatment, poor compliance, cost, and potential side effect profile. The potential for misdirection of time and energy away from skin directed therapy could negatively impact on AD outcomes

A new formulation of oral viscous budesonide in treating of paediatric eosinophilic oesophagitis: a pilot study

OBJECTIVES: Oral viscous budesonide is a recent therapeutic option for eosinophilic oesophagitis (EoE) compared with dietary restriction and inhaled steroids. This single-centre, open-label, not blinded study aims to evaluate the efficacy and safety of a new, preprepared oral viscous budesonide suspension (PVB) in children and adolescents with EoE. METHODS: We treated 36 children with PVB (29 boys; median age 12 years) with EoE diagnosed according to European Society for Paediatric Gastroenterology Hepatology and Nutrition guidelines. Patients <150 and >150 cm height received 2 and 4 mg PVB daily, respectively, for 12 weeks. Upper gastrointestinal endoscopy was performed at baseline, after 12 weeks of therapy and 24 weeks after the end of therapy. Baseline and post-treatment scores were calculated for symptoms, endoscopy, and histology. Serum cortisol was performed at baseline, 12, and 36 weeks. RESULTS: At the end of PVB trial, endoscopy showed macroscopic remission in 32 patients (88.9%), whereas at histology median pre- and post-treatment peak eosinophil count/high power field (HPF) markedly decreased from 42.2 (range: 15-100) to 2.9 (range: 0-30); moreover, mean symptom and histology scores impressively improved compared with baseline (P < 0.01). At 24 weeks after the end of PVB therapy, endoscopy showed oesophageal relapse in 21 patients (58.3%), whereas 15 (41.7%) were still in remission. Seven children (19.4%) with positive multichannel intraluminal impedance-pH were treated also with proton pump inhibitors. No significant difference between pre-/post-treatment morning cortisol levels occurred. CONCLUSIONS: The new PVB suspension presented in the present study is effective and safe for treating children with proven EoE. Larger placebo-controlled clinical trials would provide more information about dosing, efficacy, and long-term safety of this formulation, specifically designed for the oesophagus

Procjena atopije i kontaktne senzibilizacije tijekom prethodnih pregleda u prevenciji alergijskih bolesti

The aim of this study was to determine the prevalence of markers of atopy and contact sensitisation in asymptomatic young adults and to assess their role in pre-employment screening. The study included 351 subjects, of whom 166 women (mean age 28.0±6.4 years) and 185 men (mean age 26.3±5.4 years). The pre-employment examination commissioned by a pharmaceutical company included a questionnaire, the patch test with the European standard series of contact allergens, prick test with common inhalatory allergens, and the serum-specific IgE measurement. According to the medical history 115/166 (69.3%) women and 142/185 (76.8%) men were asymptomatic, but 28 (24.3%) asymptomatic women and 40 (28.2%) asymptomatic men showed atopy and/or contact sensitisation. Pre-employment allergy examination can be considered a reliable detection procedure for the majority of asymptomatic persons with atopy and contact sensitisation. The knowledge of these conditions gives the opportunity for secondary prevention and better diagnostic validation of occupational allergic diseases.Cilj ovog rada bio je utvrditi učestalost pokazatelja atopije i kontaktne senzibilizacije u asimptomatske mlade odrasle populacije tijekom prethodnih pregleda te procijeniti njihovo značenje u otkrivanju rizičnih osoba za razvoj alergijskih bolesti prije zapošljavanja. Ispitivanje je obuhvatilo 351 ispitanika, od toga 166 žena (srednja dob 28,0±6,4 godine) i 185 muškaraca (srednja dob 26,3±5,4 godine). Svi ispitanici ispitani su tijekom prethodnih pregleda za farmaceutsku industriju koja se smatra rizičnom za razvoj dišnih i kožnih bolesti. Za sve ispitanike ispunjen je alergološki upitnik, učinjeno je epikutano testiranje s europskom standardnom serijom kontaktnih alergena (Epipharm-ALK), prick-testiranje s najčešćim inhalacijskim alergenima (Imunološki zavod, Zagreb) i mjerenje serumskoga specifičnog IgE (UNICAP 100, Pharmacia). Ispitanici bez dišnih i/ili kožnih simptoma u anamnezi smatrani su asimptomatskima. Atopičarima su smatrani ispitanici s pozitivnim prick-testom i povišenim specifičnim IgE na jedan ili više inhalacijskih alergena. Ispitanici s pozitivnim epikutanim testom na jedan ili više kontaktnih alergena smatrani su osobama s kontaktnom senzibilizacijom. S obzirom na anamnestičke podatke, 115/166 (69,3%) žena i 142/185 (76,8%) muškaraca bili su asimptomatski. U 28 (24,3%) asimptomatskih žena i 40 (28,2%) asimptomatskih muškaraca utvrðeno je postojanje atopije i/ili kontaktne senzibilizacije. Prethodni alergološki pregledi mogu se smatrati pouzdanom metodom za otkrivanje većine asimptomatskih osoba s atopijom i kontaktnom senzibilizacijom. Znanje o postojanju ovih stanja kod radnika omogućuje provoðenje sekundarne prevencije i bolju dijagnostičku procjenu profesionalnih alergijskih bolesti

What's the best approach to diagnosing food allergies in infants?

A well-designed oral food challenge (OFC) is the most reliable diagnostic test for infants whose clinical history and physical examination suggest a specific food allergy (strength of recommendation [SOR]: C, consensus guidelines)