ヒスタミンまたはVEGFによる組織因子の発現および血管内皮細胞間隙の開大は、LPS、TNF- α、IL-33またはIL-1βによって相乗的に増強される

広島大学(Hiroshima University)博士(医学)Doctor of Philosophy in Medical Sciencedoctora

Changes in patient‐perceived aggravating factors during the course of atopic dermatitis

Abstract Objective This study aimed to clarify how patient‐perceived aggravating factors change during the course of AD. Methods This study involved a questionnaire‐based survey administered to 115 patients with AD at our hospital. The changes in patient‐perceived aggravating factors were examined as treatment progressed by readministering the questionnaire to 36 patients 6 months later. Results The most frequent aggravating factors at the first visit were sweating, emotional stress, and house dust. The number of patients who identified food, dust mites, house dust, pollen, and pets as aggravating factors decreased during the course of the disease. However, the number of patients who identified sweating, environmental factors, emotional stress, and lack of sleep as aggravating factors did not differ from those at the first visit; this included those who newly identified these as aggravating factors. Conclusion Many patients with AD are concerned about the aggravating factors, and it may be possible to reduce aggravating factor‐related anxiety by informing patients that certain aggravating factors may change during treatment. Hence, it is necessary to ask patients about the aggravating factors at the first visit and fixed intervals and resolve them immediately

Different hypersensitivities against homologous proteins of MGL_1304 in patients with atopic dermatitis

Background: Atopic dermatitis (AD) is exacerbated by sweating, and the skin of most patients with AD are resided by Malassezia (M.) fungi. Recently, MGL_1304 produced by Malassezia globosa was identified as the major histamine releasing antigen in human sweat. Methods: The full length cDNA of the counterpart of MGL_1304 in Malassezia restricta (Mala r 8), was cloned by degenerate PCR and rapid identification of cDNA ends (RACE). Recombinant MGL_1304, and its counterparts, Mala s 8 (produced by Malassezia sympodialis) and Mala r 8 were prepared, and compared in their allergenicities by dot blot analysis and histamine release tests with sera and basophils of patients with AD. Results: The identities between MGL_1304 and Mala s 8, MGL_1304 and Mala r 8, and Mala s 8 and Mala r 8 were 68%, 78%, and 76%, respectively, in protein sequences. Dot blot analysis revealed that the level of IgE binding to Mala s 8 was higher than that of MGL_1304. However, histamine release tests revealed that MGL_1304 and Mala r 8 possessed higher activity than Mala s 8. In addition, the crude lysate of M. globosa showed higher histamine release ability than that of M. sympodialis. Conclusions: Patients with AD showed hypersensitivities against MGL_1304 and its homologs. However, the allergenicities of the homologs are variable and the histamine release activities may be different from the solid-phase binding activities for IgE. Sweat allergy should be carefully evaluated with biological activities of MGL_1304 and its homologs of other Malassezia fungi residing on the skin

The Benefit of Complete Response to Treatment in Patients With Chronic Spontaneous Urticaria—CURE Results

Background and Objective: Chronic spontaneous urticaria (CSU) is a distressing disease. We report real-world data from the global Chronic Urticaria Registry (CURE) about associations between various CSU states and sleep impairment, plus important health-related quality-of-life (HRQoL) outcomes and compared different methods to assess CSU states. Methods: CURE data were collected at baseline and 6-monthly follow-ups (FU). Assessments included CSU states using the Urticaria Control Test (UCT), weekly Urticaria Activity Score (UAS7), and Physician Global Assessment (PhyGA) of treatment response. Complete response to treatment (CR, UAS7 = 0), complete control of disease (CC, UCT = 16), and PhyGA = CR were assessed, plus the Dermatology Life Quality Index and the Chronic Urticaria Quality-of-Life Questionnaire (CU-Q2oL) sleep domain. Results: Overall, 2078 patients were included. At baseline, 9.8%, 17.9%, and 42.3% of patients had UCT = 16, UAS7 = 0, or PhyGA = CR, respectively, which increased at FU1 and FU2. Patients with higher UCT scores had better sleep and HRQoL. The presence of angioedema without wheals, episodic disease, omalizumab treatment, and male sex were associated with CC (P <.05). Among 469 patients who achieved CC or CR, 16.4% (n = 77) showed CC or CR with all 3 instruments. Agreement between UCT = 16 and UAS7 = 0 measurements was moderate (κ = 0.581), but poor between UCT = 16 and PhyGA = CR (κ = 0.208). Conclusions: Few patients had CR/CC of their CSU at baseline entry. Disease control strongly related to good sleep and better HRQoL; therefore, it is important to aim for CR in CSU treatment. Patient-reported UCT and UAS7 assessments demonstrated a more accurate measurement of CSU state versus physician assessments