Standardization of a new photodiagnosis method based on LEDs for patients with solar urticaria sensitive to visible light

Standard methods for photodiagnosis of solar urticaria are based in exposure of patient skin to different polychromatic UV and visible sources where minimal urticarial doses for different spectral bands (UVB and UVA) are established. Classical photodiagnosis devices are based in solar simulation and use of UVB and UVA enhanced fluorescent lamps. In case of visible US photodiagnosis, US patient skin is exposed for 15 min to a slight projector, provided with halogen lamp, at a distance of 15 cms and presence of erythema and/or wheals is determined as positive reaction. Slights projector is from several years almost out of market due to use of new projection digital technologies and new visible light emerging technologies are good candidates for their substitution as photodiagnosis tool. The objective of the present work is to analyze photodiagnosis of visible light solar urticaria with using a LED device in comparison to normal slight projector exposure protocol. A total of twenty patients, from 7 different photodiagnosis units have participated in the study. Patients, with SU positive to visible light (with or without to UV radiation) following the standard photodiagnosis protocols were included in the study. Slight projector used in all photodiagnosis units were of similar characteristics and irradiance at 15 cm distance, as well as total dose of visible light after 15 min were calculated for each halogen lamp device. LED exposure was performed in parallel in a closed zone of the back of the patients. For LED photodiagnosis a prototype from University of Málaga (Spain) has been developed consisting in a black box provided with 4 holes of 12 mm diameter in which each hole white warm of a LED of 1 W is emitted. Thus, each LEDs dose is controlled independently and the device allows establishing, as well as for UVB and UVA normal protocols a MUD also under visible light. In that case, maximal visible light dose is reached in less than 5 min compared to 15 min under exposure to slight projector. All patients were positive to LED warm visible light with presence of erythema and / or wheals in parallel to the exposure to the slight projector. A MUD to visible light has been established with significant variations between patients which reveals different grade to visible light sensibilization. In conclusion, a new technology of illumination based in LEDs can be used in photodiagnosis of SU.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Standardization of a new photodiagnosis method based on LEDs for patients with solar urticaria

Standard methods for photodiagnosis of solar urticaria are based in exposure of patient skin to different polychromatic UV and visible sources where minimal urticarial doses for different spectral bands (UVB and UVA) are established. Classical photodiagnosis devices are based in solar simulation and use of UVB and UVA enhanced fluorescent lamps. In case of visible US photodiagnosis, US patient skin is exposed for 15 min to a slight projector, provided with halogen lamp, at a distance of 15 cms and presence of erythema and/or wheals is determined as positive reaction. Slights projector is from several years almost out of market due to use of new projection digital technologies and new visible light emerging technologies are good candidates for their substitution as photodiagnosis tool. The objective of the present work is to analyze photodiagnosis of visible light solar urticaria with using a LED device in comparison to normal slight projector exposure protocol. A total of 30patients, from 8 different photodiagnosis units have participated in the study. Patients, with SU positive to visible light (with or without to UV radiation) following the standard photodiagnosis protocols were included in the study. Slight projector used in all photodiagnosis units were of similar characteristics and irradiance at 15 cm distance, as well as total dose of visible light after 15 min were calculated for each halogen lamp device. LED exposure was performed in parallel in a closed zone of the back of the patients. For LED photodiagnosis a prototype from University of Málaga (Spain) has been developed consisting in a black box provided with 4 holes of 12 mm diameter in which each hole white warm of a LEDof 1 W is emitted. Thus, each LEDs dose is controlled independently and the device allows establishing, as well as for UVB and UVA normal protocols a MUD also under visible light. In that case, maximal visible light dose is reached in less than 5 min compared to 15 min under exposure to slight projector. All patients were positive to LED warm visible light with presence of erythema and / or wheals in parallel to the exposure to the slight projector. A MUD to visible light has been established with significant variations between patients which reveals different grade to visible light sensibilization. In conclusion, a new technology of illumination based in LEDs can be used in photodiagnosis of SU.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

A genome-wide association study suggests the HLA Class II region as the major susceptibility locus for IgA vasculitis.

The genetic component of Immunoglobulin-A (IgA) vasculitis is still far to be elucidated. To increase the current knowledge on the genetic component of this vasculitis we performed the first genome-wide association study (GWAS) on this condition. 308 IgA vasculitis patients and 1,018 healthy controls from Spain were genotyped by Illumina HumanCore BeadChips. Imputation of GWAS data was performed using the 1000 Genomes Project Phase III dataset as reference panel. After quality control filters and GWAS imputation, 285 patients and 1,006 controls remained in the datasets and were included in further analysis. Additionally, the human leukocyte antigen (HLA) region was comprehensively studied by imputing classical alleles and polymorphic amino acid positions. A linkage disequilibrium block of polymorphisms located in the HLA class II region surpassed the genome-wide level of significance (OR = 0.56, 95% CI = 0.46-0.68). Although no polymorphic amino acid positions were associated at the genome-wide level of significance, P-values of potential relevance were observed for the positions 13 and 11 of HLA-DRB1 (P = 6.67E-05, P = 1.88E-05, respectively). Outside the HLA, potential associations were detected, but none of them were close to the statistical significance. In conclusion, our study suggests that IgA vasculitis is an archetypal HLA class II disease

Role of the IL33 and IL1RL1 pathway in the pathogenesis of Immunoglobulin A vasculitis

Cytokines signalling pathway genes are crucial factors of the genetic network underlying the pathogenesis of Immunoglobulin-A vasculitis (IgAV), an inflammatory vascular condition. An influence of the interleukin (IL)33- IL1 receptor like (IL1RL)1 signalling pathway on the increased risk of several immune-mediated diseases has been described. Accordingly, we assessed whether the IL33-IL1RL1 pathway represents a novel genetic risk factor for IgAV. Three tag polymorphisms within IL33 (rs3939286, rs7025417 and rs7044343) and three within IL1RL1 (rs2310173, rs13015714 and rs2058660), that also were previously associated with several inflammatory diseases, were genotyped in 380 Caucasian IgAV patients and 845 matched healthy controls. No genotypes or alleles differences were observed between IgAV patients and controls when IL33 and IL1RL1 variants were analysed independently. Likewise, no statistically significant differences were found in IL33 or IL1RL1 genotype and allele frequencies when IgAV patients were stratified according to the age at disease onset or to the presence/absence of gastrointestinal (GI) or renal manifestations. Similar results were disclosed when IL33 and IL1RL1 haplotypes were compared between IgAV patients and controls and between IgAV patients stratified according to the clinical characteristics mentioned above. Our results suggest that the IL33-IL1RL1 signalling pathway does not contribute to the genetic network underlying IgAV.Acknowledgements: We are indebted to the patients and healthy controls for their essential collaboration to this study. We also thank the National DNA Bank Repository (Salamanca) for supplying part of the control samples. This study was supported by European Union FEDER funds and `Fondo de Investigaciones Sanitarias´ (Grant PI18/00042) from ‘Instituto de Salud Carlos III’ (ISCIII, Health Ministry, Spain). DP-P is a recipient of a Río Hortega programme fellowship from the ISCIII, co-funded by the European Social Fund (ESF, `Investing in your future´) (Grant Number CM20/00006). SR-M is supported by funds of the RETICS Program (RD16/0012/0009) (ISCIII, cofunded by the European Regional Development Fund (ERDF)). VP-C is supported by a pre-doctoral grant from IDIVAL (PREVAL 18/01). BA-M is a recipient of a `López Albo´ Post-Residency Programme funded by Servicio Cántabro de Salud. LL-G is supported by funds from IDIVAL (INNVAL20/06). OG is staff personnel of Xunta de Galicia (Servizo Galego de Saude (SERGAS)) through a research-staff stabilization contract (ISCIII/SERGAS) and his work is funded by ISCIII and the European Union FEDER fund (Grant Numbers RD16/0012/0014 (RIER) and PI17/00409). He is beneficiary of project funds from the Research Executive Agency (REA) of the European Union in the framework of MSCA-RISE Action of the H2020 Programme, project 734899—Olive-Net. RL-M is a recipient of a Miguel Servet type I programme fellowship from the ISCIII, co-funded by ESF (`Investing in your future´) (Grant Number CP16/00033)

Urticaria solar: epidemiología y fenotipos clínicos en una serie española de 224 pacientes

Antecedentes: La urticaria solar es una urticaria crónica inducible física clasificada también como fotodermatosis idiopática. El objetivo de este trabajo es definir las características fenotípicas y valorar la incidencia de US. Material y Método: Estudio multicéntrico retrospectivo en el que recogen datos epidemiológicos, características clínicas, fotobiológicas, analíticas y terapéuticas. Resultados: Se han incluido 224 pacientes procedentes de 9 Unidades de Fotobiología. La distribución por sexos correspondió a 141 mujeres y 83 varones con una edad media al diagnóstico de 37,9 años (rango 3-73). El 26,7% presentaba antecedentes de atopia, siendo la rinitis alérgica la manifestación más frecuente (16,5%) Un 75.9% de los pacientes refería clínica solo en zonas fotoexpuestas. El espectro implicado con más frecuencia fue la luz visible aisladamente (31,7%). En el 21% la urticaria solar solo fue posible desencadenarla con luz natural. El tratamiento más empleado por los expertos fueron los anti histamínicos por vía oral (65,46%) seguido por diferentes modalidades de fototerapia (34%). La resolución completa se observó con mayor frecuencia en urticaria solar desencadenada exclusivamente, por luz visible o luz natural con diferencias estadísticamente significativas (p<0,05) con respecto a otras longitudes de onda. No se observa un incremento de la incidencia anual. Conclusiones: Presentamos la serie de urticaria solar más larga hasta ahora publicada. Las características epidemiológicas, clínicas y fotobiológicas confirman los datos ya conocidos, aunque en nuestra serie 3 destaca un alto índice de fototest negativos. La reactividad exclusiva a luz visible o luz natural se asocia a mayores probabilidades de resolución. No se observa una tendencia al aumento en la incidencia anual.BACKGROUND: Solar urticaria is a chronic inducible urticaria also classified as an idiopathic dermatosis. The objective of this paper is to define the phenotypic characteristics of solar urticaria and to evaluate its incidence. MATERIAL AND METHOD: This was a retrospective multicenter study in which data were gathered on the epidemiology and clinical, photobiologic, laboratory, and therapeutic characteristics of solar urticaria. RESULTS: A total of 224 patients (141 women and 83 men) were included from 9 photobiology units. The mean age of the patients was 37.9 years (range, 3-73 years). A history of atopy was detected in 26.7%, and the most common presentation was allergic rhinitis (16.5%). Clinical signs were limited to sun-exposed areas in 75.9% of patients. The light spectrum most commonly implicated was visible light only (31.7%), and in 21% of cases it was only possible to trigger solar urticaria with natural light. The treatments most widely used by photobiology experts were oral antihistamines (65.46%), followed by different forms of phototherapy (34%). Complete resolution was observed most often in patients with solar urticaria triggered exclusively by visible or natural light, with statistically significant differences with respect to other wavelengths (P<.05). No increase in the annual incidence of solar urticaria was observed. CONCLUSIONS: We have presented the largest series of solar urticaria published to date. The epidemiological, clinical, and photobiologic findings confirm previously reported data, although there was a particularly high rate of negative phototests in our series. Reactivity exclusively to visible or natural light was associated with a higher probability of resolution. No increasing trend was observed in the annual incidence