Control of atopic eczema with pimecrolimus cream 1% under daily practice conditions: results of a > 2000 patient study.

BACKGROUND: Pimecrolimus cream 1% has been shown to effectively control atopic eczema (AE) when applied twice daily from the first signs or symptoms of AE until clearance. Moreover, pimecrolimus cream 1% has a favourable safety profile, lacking topical corticosteroid-related side-effects such as skin atrophy, making it particularly useful to treat delicate body regions (e.g. the face). OBJECTIVE: The objective of this naturalistic study was to monitor the safety, tolerability and efficacy of pimecrolimus when used in the long-term management of AE in a real-life setting. METHODS: A multicentre, open-label study was conducted in 2034 patients aged >or= 3 months with mild to moderate AE for up to 12 months' duration. Patients applied pimecrolimus cream twice daily, initiating treatment at first signs or symptoms of AE, continuing until clearance. RESULTS: Patients (n= 1847; 91%) completed 3 months of the study. Treatment success (clear or almost clear AE) after 3 months of treatment was observed on the whole body in 59% of patients and on the face in 81% of patients. Disease improvement of whole body and face was seen in 77% and 63% of patients, respectively. Pruritus was absent or mild in 79% of patients. Pimecrolimus cream was well tolerated throughout the study. CONCLUSION: In a daily practice setting, pimecrolimus cream 1% effectively and safely controls AE.

Pyoderma gangrenosum as a complication of coronary artery bypass grafting.

A 60-year-old male patient developed progressive wound ulcerations, simulating wound sepsis after coronary bypass operation. The condition did not respond to intensive antibiotic therapy. Based on clinical signs and biopsy, the diagnosis of pyoderma gangrenosum was made and successfully treated with cyclosporin A. Pyoderma gangrenosum, although extremely rare, must be considered as a possible diagnosis in wound complications unresponsive to traditional therapy.

Allergy to hen's egg white in atopic dermatitis.

Clinical parameters of 84 egg-allergic children were recorded. The individual allergens in hen's egg white were studied by means of crossed radio-immunoelectrophoresis (CRIE). Thirteen of the proteins in the egg white were found to have given rise to IgE-antibody production in the egg-allergic children. The major allergens were identified as ovalbumin, ovomucoid and ovotransferrin. Pruritus and exacerbation of atopic dermatitis were the symptoms of egg allergy most frequently recorded. A clear association was found between egg allergy and atopic dermatitis and can be explained on basis of the relationship that seems to exist between atopic dermatitis and high levels of total IgE in serum. This relationship is discussed.

Grading of the severity of atopic dermatitis.

A simple system for baseline grading the severity of atopic dermatitis in clinical work, is presented. The grading, which may be carried out on the basis of one single consultation, permits distinction between mild, moderate and severe atopic dermatitis by means of a score summation using the following parameters: 1) extent (by "rule of nine"), 2) course (via history) and 3) intensity (disturbance of night's sleep by itching).

Studies of atopic patch tests.

35 patients were patch-tested for 72 h with house dust mite, timothy- and birch-pollen, Cladosporium herbarum and hen's egg white allergens, prepared in a cream in concentrations up to 1,000 times the concentration used for skin prick testing. 6 patients developed a total of 10 positive reactions. All the strong positive patch-test reactions occurred in patients with a strong positive skin prick test to the same allergen. Immunohistochemical studies of biopsied positive patch-test reactions demonstrated a mononuclear cell-infiltrate in the upper part of dermis, consisting mainly of T-cells, with a slight predominance of T-helper-cells as compared to T-suppressor cells, and about 10% CD1 positive cells. No significant responses were obtained in peripheral blood mononuclear cell-cultures stimulated with the various allergens. A positive patch-test reaction to birch-pollen was successfully transferred passively to a non-allergic-recipient, suggesting that the positive reaction may depend upon sensitizing factor(s) in the serum.

Feasibility of strain and strain rate imaging for the assessment of regional left atrial deformation: a study in normal subjects.

AIMS: There are no data on the use of Myocardial Velocity Imaging (MVI) to study the left atrium (LA) wall deformation. The aims of this study were to assess the feasibility of measuring regional longitudinal strain/strain rate (epsilon/SR) profiles in the LA wall, to define the normal values and to validate these measurements. METHODS AND RESULTS: MVI data were recorded in 40 healthy young individuals using a GE Vivid7 for the lateral, anterior and inferior LA walls. The peak epsilon/SR values and total epsilon values during the contractile, reservoir and conduit LA phases were measured. For the LA lateral wall, the total epsilon values were correlated with the LA volumetric indicators (LA active emptying fraction: LA AEF; LA expansion index: LA EI; and LA passive emptying fraction: LA PEF). The correlations were significant for all three periods: contractile (total epsilon vs. LA AEF, r=-0.78, P<0.001), reservoir (total epsilon vs. LA EI, r=0.43, P<0.01) and conduit (total epsilon vs. LA PEF, r=-0.46, P<0.005). CONCLUSION: SR/epsilon imaging for the quantification of longitudinal myocardial LA deformation was shown to be feasible and the normal values were reported and validated. These data may improve the understanding of the LA pathophysiology.

Childhood cicatricial pemphigoid with linear IgA deposits: a case report.

A 16-year-old boy with a bullous eruption from the age of thirteen, also presented symptoms of scarring conjunctivitis and involvement of oral mucosal membranes. Linear IgA deposits were demonstrated in the basement membrane zone in skin and conjunctiva. The eruptions improved during therapy with aldesulfonsodium, but complete remission was not obtained. Gluten-free diet did not significantly influence the activity of the disease. The described patient seems to fit in a recently described entity of chronic bullous diseases.

A clinical and immunological study of allergy to hen's egg white. III. Allergens in hen's egg white studied by crossed radio-immunoelectrophoresis (CRIE).

Allergens in hen's egg white were studied in crossed radio-immunoelectrophoresis (CRIE). Specific IgE-antibodies against different proteins in the egg white were examined in sera from 70 atopic patients with clinical hypersensitivity, and RAST greater than or equal to 2 to egg white. Ovalbumin, ovomucoid and an unidentified protein, antigen 22, were classified as major allergens. Specific IgE-antibodies against 10 more proteins in hen's egg white were detected. IgE-antibodies against lysozyme could not be detected.

A clinical and immunological study of allergy to hen's egg white. VI. Occurrence of proteins cross-reacting with allergens in hen's egg white as studied in egg white from turkey, duck, goose, seagull, and in hen egg yolk, and hen and chicken sera and flesh.

The occurrence of proteins cross-reacting with allergens in hen's egg white was studied in turkey, duck, goose and seagull egg whites, in hen egg yolk, and in hen and chicken sera and flesh. The study was based upon quantitative immunoelectrophoretic techniques. The different egg whites were all found to contain proteins cross-reacting with most of the allergens in hen's egg white, but the degree of cross-reactivity varied considerably among the various egg whites. All egg whites contained proteins able to bind human IgE-antibody in the sera of patients with allergy to hen's egg white. Several proteins cross-reacting with allergens in hen's egg white were also detected in egg yolk and in hen and chicken sera and flesh. Clinical implications of the results are discussed.

A clinical and immunological study of allergy to hen's egg white. IV. Specific IGE-antibodies to individual allergens in hen's egg white related to clinical and immunological parameters in egg-allergic patients.

Different subgroups of egg-allergic patients were established according to differences in allergic symptoms provoked by hen's egg white, total IgE-level, RAST (radioallergosorbent test) results to egg white, and age. In each group the pattern of specific IgE-antibodies to individual allergens in the egg white, determined by means of crossed radioimmunoelectrophoresis (CRIE), was compared with the pattern in a control group. The RAST value to egg white was found to exert the strongest influence on the CRIE results. A few statistically significant differences in CRIE results to certain allergens were also observed in other pairs of subgroups of egg-allergic patients. Possible explanations for this are discussed. It was concluded that CRIE studies of allergens in mixed protein solutions, using a series of sera from allergic patients, will most probably give the same results and the same classification of the allergens independent of the characteristics of the patients from which the sera were collected. However, it should be emphasized that the CRIE series must include a sufficient number of patients with high RAST values to the allergen in question. Otherwise some allergens may be missed and the classification of the allergens may be different.

A clinical and immunological study of allergy to hen's egg white. I. A clinical study of egg allergy.

Various clinical features of eighty-four atopic patients, with clinical hypersensitivity to egg and positive RAST to egg white, were studied. Some of the clinical data were compared with data from a control group of atopic patients without egg allergy. Atopic diseases and certain food allergies in the families of the egg-allergic patients and atopic controls were also studied. This was done in order to investigate the extent to which differences between the egg allergy group and the atopic control group were reflected in their respective families.

[Skin-prick tests in atopic dermatitis]. / Prikktest ved atopisk dermatitt.

The usefulness of skin prick tests in the management of atopic dermatitis is discussed on the basis of results from testing 100 patients, mean age 23 years. Skin prick tests may be useful when allergies to food are suspected, and also when it is suspected that the dermatitis is aggravated due to reactions to airborne allergens. Testing with a series of common inhalant allergens may provide information about the tendency to respond with IgE-synthesis. From a practical and economical point of view, a skin prick test may be a good alternative to other techniques for allergy testing.

A clinical and immunological study of allergy to hen's egg white. V. Purification and identification of a major allergen (antigen 22) in hen's egg white.

Antigen 22 (ag-22) in hen's egg white, previously shown to be one of the major allergens in the egg white, was partially purified by combining biochemical separation techniques and quantitative immunoelectrophoretic methods. The molecular weight of ag-22 was found to be approximately 78,000 using analytical ultracentrifugation and pI was determined to be 6.1, which is appropriate with the values of ovotransferrin. It was concluded that ag-22 is identical with ovotransferrin. The ability of ovotransferrin to react in the human IgE-system was demonstrated in vivo and in vitro, by means of skin prick tests and crossed radioimmunoelectrophoresis.

Unique antigenic determinants (idiotypes) used as markers in a patient with macroglobulinemia and urticaria. Similar idiotypes demonstrated in the skin and on peripheral blood lymphocytes.

An antiserum was raised against a monoclonal IgMk macroglobulin isolated from serum of a patient with recurrent urticaria. The antiserum was made idiotype-specific through adequate absorptions. The anti-idiotype antiserum reacted only with the immunizing protein and its Fab fragments and not with other monoclonal proteins of IgM and IgA class or pooled IgG as assayed in an enzyme-linked immunosorbent assay. IgM antibodies with the same idiotype as the monoclonal IgM protein were detected in the dermal/epidermal junction area of diseased skin. The similar idiotypic determinants could also be demonstrated on membrane-bound molecules of peripheral blood B and T lymphocytes using the immunofluorescence methods.

Psoriasis induced by interferon-alpha.

Recombinant human interferon-alpha has been used in the treatment of several cancers, but there have been several reports that it may exacerbate psoriasis or trigger off its onset. We report four patients, three of whom first developed psoriasis and one who had an aggravation of the condition during treatment with interferon-alpha. Three of the patients had the carcinoid syndrome and one a renal carcinoma, and all were treated with interferon-alpha 2b or 2a (IFN-alpha 2b, 2a) with doses ranging from 1.5 x 10(6) U daily to 18 x 10(6) U three times weekly. In two of the patients there appeared to be a correlation between the severity of the psoriasis and the dosage of interferon.

Therapeutic effect of loratadine on pruritus in patients with atopic dermatitis. A multi-crossover-designed study.

The aim of the study was to assess the therapeutic efficacy of loratadine on pruritus in patients with atopic dermatitis, considering the patients' sensation of itch. Sixteen patients, mean age 24.8 years, with moderate or severe atopic dermatitis were included in a double-blind and placebo-controlled study with a six-period, multi-crossover design. The patients were given 10 mg loratadine or placebo every day, alternating between loratadine and placebo every 2 weeks. The degree of pruritus during the day and during the night was recorded by the patients every morning and every evening, respectively, on a 10-cm visual analog scale. The study detected a significant effect of loratadine, as compared with placebo, on pruritus during the day, pruritus during the night, and severity of rash. At least nine of the 16 patients included were classified as responders and only one as a nonresponder to loratadine treatment. It is concluded that loratadine may be tried as an adjuvant therapy in the management of severe and moderate atopic dermatitis, in patients complaining of pruritus.

Comparison of cyclosporin and UVAB phototherapy for intermittent one-year treatment of atopic dermatitis.

Although cyclosporin is effective for the treatment of severe atopic dermatitis, phototherapy is the standard second-line treatment for this disease. An open, randomized, controlled, parallel-group study was conducted to compare the efficacy, influence on quality of life and safety of cyclosporin and UVAB phototherapy during 1 year of intermittent treatment of atopic dermatitis in adult patients. The main endpoints of the study were the number of days in remission and the influence on quality of life. Seventy-two patients were treated, 36 in each group. Cyclosporin produced significantly more days in remission than UVAB phototherapy during the 1-year study period. At the end of the study no difference between the 2 groups was noted in terms of quality of life. A significant increase in serum creatinine occurred in 2 patients and 7 patients developed mild or moderate hypertension during cyclosporin treatment. It can be concluded that intermittent cyclosporin seems to be more effective than UVAB and is reasonably safe for the treatment of atopic dermatitis over a 1-year treatment period.

Cutaneous complications in heart transplant recipients in Norway 1983-1993.

All Norweigian heart transplant recipients with more than one year's survival (n = 140) were investigated for dermatological disorders. Observation time after transplantation was 1-10 years (mean 5.0 years). Patients alive at the end of 1993 (n = 122) were examined clinically, and medical records for all patients were reviewed. The histopathological diagnoses of excised skin specimens were reevaluated. Malignant skin tumours (i.e. basal cell carcinoma, squamous cell carcinoma and malignant melanoma) and/or premalignant skin tumours (i.e. morbus Bowen (carcinoma in situ), solar keratosis and keratoacanthoma) were found in 34 patients (24.3%), of which 18 patients (12.9%) had malignant skin tumours. Seventeen lesions diagnosed as keratoacanthoma and two lesions diagnosed as morbus Bowen had primarily been diagnosed as squamous cell carcinoma. Five patients (3.6%) had multiple keratoacanthomas. Other frequent dermatological diagnoses included hypertrichosis (86.9%), steroid-induced skin features (59.8%), common warts (42.6%) and seborrheic skin disorders (20.5%). This study demonstrates the importance of dermatological surveillance in the follow-up of heart transplant recipients.

Adverse reaction to food: assessment by double-blind placebo-controlled food challenge and clinical, psychosomatic and immunologic analysis.

Double-blind placebo-controlled food challenge (DBPCFC) with food items applied in capsules was performed in a prospective study of 17 selected patients and 34 age- and sex-matched healthy controls in the interdisciplinary clinical setting. Protein immunoblotting showed no differences in antigenicity between foods in the capsules and the corresponding fresh foods. All patients reacted to one or more food substances during DBPCFC, with a doubtful reaction to placebo in 2 patients. Agreement between diet history and provocation was seen in 53 of 85 individual food challenges, 36 being positive with both examinations. In 22 (38%) of the 58 positive provocations, the reactions were not expected from the patients' histories. No reaction to food or placebo occurred in the control group. Related to diet history, sensitivity and specificity of provocation were 62 and 63%, respectively, with a positive predictive value of 78%. Allergy, previous gastroenterologic and infectious diseases among first-degree relatives, immunologic abnormalities and elevation of total IgE were significantly more common for the patients than controls. A positive skin prick test correlated well with diet history, but both prick test and food antibodies correlated poorly with DBPCFC. Assessment by the General Health Questionnaire showed a significant difference towards the controls. After 3-4 months of follow-up on an individually based diet, 11 of 15 patients reported general improvement of their condition. DBPCFC may be a valuable diagnostic test in addition to dietary history as a basis for elimination diet on food-intolerant patients. The effect of the elimination diet on the symptoms may also suggest a therapeutic effect or provocation.(ABSTRACT TRUNCATED AT 250 WORDS)