Targeting IgE in Severe Atopic Dermatitis with a Combination of Immunoadsorption and Omalizumab.

Patients with atopic dermatitis (AD) tend to have greatly elevated levels of serum immunoglobulin E (IgE). However, the role of IgE in the pathogenesis of AD is debated. This investigator-initiated open-label pilot study evaluates an anti-IgE-treatment approach by combining extracorporeal immunoadsorption and anti-IgE antibody omalizumab in 10 patients with severe, therapy-refractory AD. IgE levels decreased after immunoadsorption and decreased continuously in all patients during anti-IgE therapy. The reverse trend was observed during 6 months follow-up without treatment. In parallel with these observations, an improvement in AD was observed during the treatment period, with aggravation during follow-up. Further research is needed, based on the principle of reducing IgE levels in order to improve clinical symptoms, using a combination anti-IgE treatment approach, adjusted according to IgE levels.

Superficial radiation therapy in peyronie's disease: An effective and well-tolerated therapy.

PURPOSE: This study aimed to assess the safety, efficacy, and patient satisfaction of superficial radiation therapy in the treatment of Peyronie's disease (PD) in a retrospective analysis. METHODS AND MATERIALS: We performed a retrospective analysis of 83 patients who underwent radiation therapy between 1999 and 2008 with 8 fractions of 4 Gy over a period of 6 months. With a mean follow-up time of 52 months, patients responded to a comprehensive questionnaire that covered patient characteristics, disease duration before radiation therapy, course of disease, treatment response, side effects, and patient satisfaction. RESULTS: After a mean follow-up time of 52 months, 78% of the treated patients reported that PD progression had stopped. Furthermore 47% of patients had a symptom regression. Only 7% of patients reported PD progression. The penile curvature was improved in 49% of patients, and plaque induration could be reduced in 42% of patients. Moreover, 71% of patients reported substantial pain relief, as measured by a visual analogue scale (1 = not satisfied; 10 = very satisfied). Treatment satisfaction was rated with a median of 8 in a visual analogue scale out of 10. Side effects included transient erythema in 38.6% of patients and 9.6% reported of transient or chronic dryness. No severe side effects were observed. CONCLUSIONS: Radiation therapy for PD in the disease's early stages proved to be a safe and well-tolerated method with good results in pain relief, especially in patients aged <62 years. No serious adverse events or malign transformations are expected using doses up to 32 Gy.

Reduced skin reactivity to vasoconstrictor and vasodilator substances in atopic eczema.

UNLABELLED: Atopic eczema is a common chronic inflammatory disease with itchy skin and altered skin reactions to acetylcholine and nicotinic acid compared to healthy non-atopic individuals. AIM: The aim of this study was to evaluate skin reactivity to 11 vasoactive substances and peptides by skin prick and intradermal tests in 20 patients with atopic eczema and 20 healthy controls. METHODS: Skin reactions, blanching, wheal and flare areas were measured by planimetry, 15 minutes after provocation. RESULTS: Patients with atopic eczema had significantly smaller reactions at certain concentrations of the vasodilators acetylcholine, bradykinin, calcitonin gene-related peptide, substance P and vasoactive intestinal peptide for flare, and of substance P and vasoactive intestinal peptide for wheals, in intradermal testing and/or in skin prick testing. Testing of the vasoconstrictors angiotensin-II, arginine-vasopressin, endothelin-1 and noradrenaline in atopic eczema resulted in significantly smaller reactions at certain concentrations for blanching in intradermal testing and/or skin prick testing. Significantly smaller reactions were seen with arginine-vasopressin for wheals and with arginine-vasopressin and noradrenaline for flares in intradermal testing and/or skin prick testing at certain concentrations. Significantly larger wheals were seen with angiotensin-II and endothelin-1 in intradermal testing and/or skin prick testing at certain concentrations. No significant differences were found for prostaglandin E2. CONCLUSION: These results demonstrate not only a reduced responsiveness to vasodilators but also to vasoconstrictor substances and peptides in patients with atopic eczema, which may be considered a general feature of atopic eczema skin.