Atopy patch testing with aeroallergens in a large clinical population of dermatitis patients in Germany and Switzerland, 2000-2015: a retrospective multicentre study.

BACKGROUND: The diagnostic significance of the atopy patch test for the management of dermatitis possibly triggered by aeroallergens is still controversial. However, sufficiently large studies with routinely tested standardized aeroallergen patch test preparations in dermatitis patients are lacking. OBJECTIVE: To evaluate the reaction frequency and the reaction profiles of 10 until mid-2015 commercially available, standardized aeroallergen patch test preparations of the 'Stallerpatch' test series (Stallergenes, Antony Cedex, France) in a large multicentre patient cohort. METHODS: A retrospective data analysis of patients with suspected aeroallergen-dependent eczematous skin lesions was performed, who were patch tested in 15 Information Network of Departments of Dermatology-associated clinics between 2000 and 2015. Patients were stratified according to their atopic dermatitis (AD) status. RESULTS: The study group included 3676 patients (median age 41 years, 34.8% males, 54.5% AD). The most common aeroallergens causing positive patch test reactions were Dermatophagoides pteronyssinus (19.6%), Dermatophagoides farinae (16.9%), birch (6.2%), timothy grass (6.0%), cat dander (5.4%), mugwort (4.9%) and dog dander (4.6%). Reactions to other pollen allergen preparations, that is 5 grasses (3.2%), cocksfoot (2.1%) and plantain (1.6%), were less common. Positive patch test reactions to aeroallergens were consistently more frequent in patients with AD. These patients showed proportionally less dubious, follicular, irritant and weak positive reactions. Independent of AD status, a patient history of past or present allergic rhinitis was associated with an increased chance of a positive aeroallergen patch test reaction to pollen allergens. CONCLUSION: The aeroallergen patch test is a useful add-on tool in clinical routine, especially in patients with AD and/or respiratory allergy. A patch test series comprising Dermatophagoides pteronyssinus, Dermatophagoides farinae, birch, timothy grass, cat dander and mugwort seems to be suitable. Controlled studies with specific provocation and elimination procedures are required to further evaluate the diagnostic significance of the proposed screening series.

Fumaric acid ester-induced T-cell lymphopenia in the real-life treatment of psoriasis.

BACKGROUND: Fumaric acid esters (FAEs) are used to treat psoriasis and are known to cause lymphopenia in roughly 60% of the patients. Much remains to be elucidated about the biological effects of FAEs on lymphocytes. OBJECTIVE: To evaluate the influence of long-term FAE (Fumaderm® ) treatment on peripheral blood CD4+ and CD8+ T cells, CD19+ B cells and CD56+ natural killer (NK) cells in psoriasis. METHODS: In this single-centre retrospective observational subcohort study, we obtained leucocyte and lymphocyte subset counts before initiating FAE therapy in 371 psoriasis patients (mean age, 47.8 years; 63.3% males) and monitored them during treatment (mean treatment duration, 2.9 years). Multiparametric flow cytometry was used for immunophenotyping. RESULTS: FAEs significantly reduced the numbers of CD4+ T, CD8+ T, CD19+ B and CD56+ NK cells. Among lymphocyte subsets, the mean percentage reduction from baseline was always highest for CD8+ T cells, with a peak of 55.7% after 2 years of therapy. The risk of T-cell lymphopenia increased significantly with the age of the psoriasis patients at the time that FAE therapy was initiated. It was significantly decreased for the combination therapy with methotrexate and folic acid (vitamin B9) supplementation. Supporting evidence was found suggesting that T-cell lymphopenia enhances the effectiveness of FAE therapy. CONCLUSIONS: Monitoring distinct T-cell subsets rather than just absolute lymphocyte counts may provide more meaningful insights into both the FAE treatment safety and efficacy. We therefore suggest optimizing pharmacovigilance by additionally monitoring CD4+ and CD8+ T-cell counts at regular intervals, especially in patients of middle to older age. Thus, further prospective studies are needed to establish evidence-based recommendations to guide dermatologists in the management of psoriasis patients who are taking FAEs and who develop low absolute T-cell counts.

Auditory function in hereditary motor and sensory neuropathy (Charcot-Marie-Tooth disease).

Fourteen patients with hereditary motor and sensory neuropathy (HMSN), 12 of Type I and 2 of Type II, were assessed for auditory dysfunction. Five patients complained of hearing loss and all had pure-tone audiograms outside the normal range, while one patient who did not complain of hearing impairment also had an abnormal pure-tone audiogram. Assessment of loudness function, speech audiometry and brainstem auditory evoked potentials (BAEP) suggested that the hearing loss was the result of VIII nerve dysfunction, a conclusion supported by the abnormality of the electrocochleogram (ECochG) in one patient.

Peak-clipping in induction loop systems.

The decision to fit an induction loop system in many buildings is often dictated by cost, in particular that of the amplifier. In order to accommodate the peaks of speech the amplifier must be 4 times as powerful as that required for average speech. This often makes a profound difference to the cost and tips the balance against a loop being installed. Experience with two loops fitted for an audience of hard of hearing people where the peaks were clipped without any apparent loss of discrimination initiated this study. The findings showed that although high fidelity is to be preferred, peak clipping in loop systems can be tolerated without serious loss of intelligibility.

Auditory fusion: a critical interval test with implications in differential diagnosis.

Pulses of white noise each of uniform duration but adjustable in interpulse spacing were presented to subjects at a comfortable loudness level. Reduction of pulse spacing below a critical interval resulted in a subjective impression of continuous noise. Eighty-four per cent of patients with sensori-neural hearing loss had a longer critical interval than normal subjects. Tentative explanations for this phenomenon are put forward in terms of desynchronisation or impaired interaction between inner and outer hair cells. Longer critical intervals found predominately in neural cases are explicable in terms of a reduction in neural conduction velocities. Interesting similarities in respect of end organ and nerve fibre lesions are apparent between critical intervals and reported electrocochleographic responses.

Perception of everyday visual environments during saccadic eye movements.

Subjects were required to execute saccadic eye movements in the horizontal plane which passed through primary gaze. During the saccades, visual images were projected onto a screen which subtended 40 degrees horizontaloy and 26 degrees vertically and was centered on primary gaze. Content, contrast, and intensity of the stimulus patterns and level of illumination of the laboratory background were manipulated to maximise pattern recognition. Little or no detail of the projected images could be discerned under any conditions. Only horizontal laminations were perceived as blurs of appropriate colour. It is concluded that there is no useful perception of the everyday environment during saccades.

Instrument for the on-line measurement of the slow phase of nystagmus.

The on-line measurement of the slow-phase velocity of vestibular nystagmus, induced or spontaneous, has considerable practical advantages. An instrument for this purpose, developed around simple operational amplifiers, is described. Typical applications of the system are given in respect of nystagmus induced by optokinetic, rotational, and caloric stimuli.