Overview of atopic dermatitis

Current Review  Open Access

|    Asia Pac Allergy. 2013 Apr;3(2):79-87. English. Published online 2013 April 26.  http://dx.doi.org/10.5415/apallergy.2013.3.2.79  Copyright © 2013. Asia Pacific Association of Allergy, Asthma and Clinical Immunology. Overview of atopic dermatitis Kyu Han Kim Department of Dermatology, Seoul National University Hospital, Seoul 110-744, Korea.  Correspondence: Kyu Han Kim. Department of Dermatology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 110-744, Korea. Tel: +82-2-2072-3643, Fax: +82-2-747-0611, Email: kyuhkim@snu.ac.kr  Received March 27, 2013; Accepted March 31, 2013. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Atopic dermatitis (AD) is a very common chronic disease that reportedly affects 10%-20% of the general population. The prevalence of AD appears to be steadily increasing, at least in developing countries. Two pathogenetic mechanisms have been mentioned. Traditionally immunological aberrations are thought to be a primary event in the initial development of AD ("inside-to-outside hypothesis"). Another hypothesis assumes that there is an intrinsic defect in epidermal barrier. Due to this barrier defect, allergens or irritants can easily penetrate the epidermal barrier, and induce immunologic reaction secondarily ("outside-to-inside hypothesis"). These days the epidermal barrier defect seems to gain more support as a primary event than immunological aberrations in the early changes of AD since the filaggrin mutation was reported in AD patients. Clinically AD initially affects face, and with age, flexural areas are typically involved. AD has many different clinical features. Diagnostic criteria for AD in each country may be a little different, although based on the criteria proposed by Hanifin and Rajka. AD can be controlled effectively with topical and/or systemic treatments and fortunately spontaneously disappears with age. However, in some cases very resistant to conventional therapies, additional treatments such as immunosuppressive agents are needed. Keywords: Atopic dermatitis, Prevalence, Immunological aberrations, Epidermal barrier defect, Filaggrin mutation.      |

Original research

Differences in IgE mediated basophil degranulation induced by proteic fractions from whole flea body extract in patients with papular urticaria by flea bite and healthy controls

Omar Dominguez-Amorocho, Silvia Duarte, Elizabeth Garcia, Evelyne Halpert, Adriana Cuellar and Adriana Rodriguez

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World Allergy Organization Journal 2013, 6:10 doi:10.1186/1939-4551-6-10

Published: 16 May 2013

Abstract (provisional)

Background

Papular urticaria by flea bite is a chronic inflammatory disease in children. The aim of this study was to assess the functional activity of IgE to protein fractions from flea body extract, through basophil degranulation in PUFB patients and controls.

Methods

Basophil degranulation, measured by overexpression of CD63 surface molecules, was evaluated by flow cytometry in samples from patients and controls. Cell stimulation was performed with three fractions with different molecular weight from flea body extract using a Basotest(R) modified protocol. Mann-Whitney U-test was used for comparisons.

Results

Specific IgE from PUFB patients and healthy controls induced basophil degranulation to flea body extract with no significant differences between them (16.2 +/- 3.1% vs 13.6 +/- 2.8% p = 0.77). However, when flea extract was analyzed in fractions with proteins ranging different molecular weights, significant differences were observed on the response from patients compared with controls to <50 1.6="" 2.1="" 2.8="" 3.2="" 5.1="" 50-100="" 9.7="" and="" fractions="" kd="" p="0.0021).</p" proteic="" vs="">

Conclusion

In this study, was established that the differential response by IgE, in PUFB, depends from the molecular weight of the antigens contained in the flea extract. These antigens may be related to 30-35 kD proteins previously described as major allergens.

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Jornal de Pediatria

Available online 26 April 2013

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Review article

Specific instruments to assess quality of life in children and adolescents with asthma ^☆

Instrumentos específicos para avaliar a qualidade de vida em crianças e adolescentes com asma ^☆

• Cristian Roncada^a, , , 
• Rita Mattiello^b, 
• Paulo M. Pitrez^b, 
• Edgar E. Sarria^b

• ^a MSc Doctoral student, Programa de Pós-Graduação em Pediatria e Saúde da Criança, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
• ^b PhD Centro Infant - Instituto de Pesquisas Biomédicas, Programa de Pós-Graduação em Pediatria e Saúde da Criança, PUCRS, Porto Alegre, RS, Brazil

• http://dx.doi.org/10.1016/j.jped.2012.11.010, How to Cite or Link Using DOI

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Abstract

Objective

To identify and describe specific instruments to assess health-related quality of life (HRQoL) in children and adolescents with asthma.

Data source

Searches were performed in the PubMed, Ovid, and LILACS databases using different combinations of key words (MeSH terms), selecting original articles on the development of specific HRQoL questionnaires, published in English, Portuguese, or Spanish, between 1990 and 2012.

Data synthesis

A total of 15 instruments that met the inclusion criteria were identified. Most studies assessed reliability through internal consistency, reproducibility, and/or sensitivity to changes. Validity was assessed by comparison with healthy controls (discordant validity) or factorial analysis.

Conclusions

Of the 15 instruments, three are the most frequently used: Pediatric Asthma Quality of Life Questionnaire (PAQLQ), Pediatric Quality of Life Inventory 4.0 (PedsQL-Asthma), and Disability Kids (DISABKIDS). In general, these three tools have adequate psychometric characteristics and are practical to implement, but only PAQLQ has been culturally adapted to Brazil.

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Original research article

Prevalence of tracheobronchomalacia and excessive dynamic airway collapse in bronchial asthma of different severity

Roberto W Dal Negro, Silvia Tognella, Massimo Guerriero and Claudio Micheletto

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Multidisciplinary Respiratory Medicine 2013, 8:32 doi:10.1186/2049-6958-8-32

Published: 14 May 2013

Abstract (provisional)

Background

Tracheobronchomalacia (TBM) is a pathologic condition in which softening of tracheal and bronchial cartilage causes the dynamic narrowing of transverse or sagittal diameters of tracheobronchial lumen; an excessive dynamic airway collapse (EDAC) may also be associated, with a substantial invagination of the posterior membrane of trachebronchial tree.

The aim of this study was to assess the prevalence of both TBM and EDAC in a population of asthmatics with different degrees of disease severity compared to a reference group of subjects without any bronchial obstruction.

Methods

A cohort of 202 asthmatics was investigated by means of a dynamic flexible videobronchoscopy: 74 mild persistent (MPA - age 18--68 ys; 35 males; mean FEV1 = 88.6% pred. +/- 8.3 sd); 63 moderate (MA - age 21--71 ys; 30 males; mean FEV1 = 71.3% pred. +/- 9.1 sd), 65 severe asthmatics (SA - age 33--70 ys; 25 males; mean FEV1 = 48.5% pred. +/- 7.6 sd), and 62 non obstructed subjects (NO - age 18--71 ys; 38 males; mean FEV1 98.6% pred. +/- 2.7 sd). TBM and EDAC were classified according to FEMOS classification.

Results

TBM and EDAC were observed in only 1/62 subjects (both 1.61%) of NO group, while their prevalence was 2.70% and 6.75% in MPA group; 7.93% and 19.04% in MA group; 18.46% and 69.23% in SA group, respectively. The crude prevalence of thyroid disorders in the population was 12.9%. In particular, the prevalence of thyroid disorders was significantly higher in females than in men, but 54-fold higher in females than in men in the presence of EDAC.

Conclusions

1) The prevalence of both TBM and EDAC is directly related to age, gender (females), and asthma severity; 2) EDAC is much more frequent than TBM in all asthma patients; 3) both tracheal abnormalities proved to be more represented in asthmatics with thyroid disorders, and particularly in female asthmatics with EDAC.

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Case report

Food protein induced enterocolitis syndrome caused by rice beverage

Lucia Caminiti, Giuseppina Salzano, Giuseppe Crisafulli, Federica Porcaro and Giovanni Battista Pajno

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Italian Journal of Pediatrics 2013, 39:31 doi:10.1186/1824-7288-39-31

Published: 14 May 2013

Abstract (provisional)

Food protein-induced enterocolitis syndrome (FPIES) is an uncommon and potentially severe non IgE-mediated gastrointestinal food allergy. It is usually caused by cow?s milk or soy proteins, but may also be triggered by ingestion of solid foods. The diagnosis is made on the basis of clinical history and symptoms. Management of acute phase requires fluid resuscitation and intravenous steroids administration, but avoidance of offending foods is the only effective therapeutic option. Infant with FPIES presented to our emergency department with vomiting, watery stools, hypothension and metabolic acidosis after ingestion of rice beverage. Intravenous fluids and steroids were administered with good clinical response. Subsequently, a double blind placebo control food challenge (DBPCFC) was performed using rice beverage and hydrolyzed formula (eHF) as placebo. The ?rice based formula? induced emesis, diarrhoea and lethargy. Laboratory investigations reveal an increase of absolute count of neutrophils and the presence of faecal eosinophils. The patient was treated with both intravenous hydration and steroids. According to Powell criteria, oral food challenge was considered positive and diagnosis of FPIES induced by rice beverage was made. Patient was discharged at home with the indication to avoid rice and any rice beverage as well as to reintroduce hydrolyzed formula. A case of FPIES induced by rice beverage has never been reported. The present case clearly shows that also beverage containing rice proteins can be responsible of FPIES. For this reason, the use of rice beverage as cow?s milk substitute for the treatment of non IgE-mediated food allergy should be avoided.

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Drug-induced Thrombotic Thrombocytopenic Purpura Successfully Treated with Recombinant Human Soluble Thrombomodulin

Internal Medicine
Vol. 52 (2013) No. 10 p. 1111-1114

Language:      English     Japanese   

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http://dx.doi.org/10.2169/internalmedicine.52.9180

 

DN/JST.JSTAGE/internalmedicine/52.9180

CASE REPORTS

Drug-induced Thrombotic Thrombocytopenic Purpura Successfully Treated with Recombinant Human Soluble Thrombomodulin

Yu Nishijima^{1) 2)}, Haruhiko Hirata¹⁾, Aiko Himeno²⁾, Hiroshi Kida¹⁾, Masanori Matsumoto³⁾, Ryo Takahashi¹⁾, Yasushi Otani¹⁾, Kouji Inoue¹⁾,Izumi Nagatomo¹⁾, Yoshito Takeda¹⁾, Takashi Kijima¹⁾, Isao Tachibana¹⁾, Yoshihiro Fujimura³⁾, Atsushi Kumanogoh¹⁾

1) Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, Japan 2) Postgraduate Medical Training Center, Osaka University Hospital, Japan 3) Department of Blood Transfusion Medicine, Nara Medical University, Japan

 Released on J-STAGE 20130515  

Keywords: thrombotic thrombocytopenic purpura, gemcitabine, bevacizumab, recombinant human soluble thrombomodulin

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Clinical Characteristics and Outcomes of Patients Undergoing Drug Provocation Tests (DPTs)

 Original Article

Clinical Characteristics and Outcomes of Patients Undergoing Drug Provocation Tests (DPTs) 

Meera Thalayasingam, Lucy J Davies, Genevieve V Llanora, Irvin F Gerez, Hugo P Van Bever, Lynette PC Shek

• Acta Otorhinolaryngol Ital >
• v.33(1); Feb 2013 >
• PMC3631816

Acta Otorhinolaryngol Ital. 2013 February; 33(1): 36–42.

PMCID: PMC3631816

Computational fluid dynamics: a suitable assessment tool for demonstrating the antiobstructive effect of drugs in the therapy of allergic rhinitis

N. ACHILLES,¹ N. PASCH,² A. LINTERMANN,³ W. SCHRÖDER,³ and R. MÖSGES¹

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SUMMARY

This systematic review aims first to summarize the previous areas of application of computational fluid dynamics (CFD) and then to demonstrate that CFD is also a suitable instrument for generating three-dimensional images that depict drug effects on nasal mucosa. Special emphasis is placed on the three-dimensional visualization of the antiobstructive effect of nasal steroids and antihistamines in the treatment of allergic rhinitis. In the beginning, CFD technology was only used to demonstrate physiological and pathophysiological airflow conditions in the nose and to aid in preoperative planning and postoperative monitoring of surgical outcome in the field of rhinosurgery. The first studies using CFD examined nasal respiratory physiology, important functions of the nose, such as conditioning and warming of inspired air, and the influence of pathophysiological changes on nasal breathing. Also, postoperative outcome of surgical procedures could be "predicted" using the nasal airflow model. Later studies focused on the three-dimensional visualization of the effect of nasal sprays in healthy subjects and postoperative patients. A completely new approach, however, was the use of CFD in the area of allergic rhinitis and the treatment of its cardinal symptom of nasal obstruction. In two clinical trials, a suitable patient with a positive history of allergic rhinitis was enrolled during a symptom-free period after the pollen season. The patient developed typical allergic rhinitis symptoms after provocation with birch pollen. The 3-D visualization showed that the antiallergic treatment successfully counteracted the effects of nasal allergen provocation on nasal airflow. These observations were attributed to the antiobstructive effect of a nasal steroid (mometasone furoate) and a systemic antihistamine (levocetirizine), respectively. CFD therefore constitutes a non-invasive, precise, reliable and objective examination procedure for generating three-dimensional images that depict the effects of drugs used in the treatment of allergic rhinitis.

KEY WORDS: Computational fluid dynamics (CFD), Nasal airflow simulation, Allergic rhinitis, Nasal obstruction, Nasal steroid, Mometasone furoate nasal spray (MFNS), Antihistamine, Levocetirizine

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