Relationship between skin prick and atopic patch test reactivity to aeroallergens and disease severity in children with atopic dermatitis.

BACKGROUND: The immunological mechanism in aetiology of atopic dermatitis (AD) shows significant differences from other allergic diseases. Allergen inhalation exacerbates AD lesions and AD patients' complaints decrease in house dust mite (HDM) low level environments, which reveals the importance of inhalant allergens. OBJECTIVE: We evaluated the skin prick test (SPT) and atopy patch test (APT) positivity rates with aeroallergens and studied the effect of test results, and aimed to determine the value of allergic test reactivity on the clinical characteristics of children with AD. METHODS: Forty-five children aged 2-15 years with AD were included to study between May 2006 and May 2007 in GATA Haydarpasa Teaching Hospital, Allergy Department. The reactivity to inhalant allergens using SPT and APT was evaluated. The severity of AD, which was assessed with SCORAD, was compared with aeroallergen hypersensitivity. RESULTS: The highest positivity of APT was seen against HDM (48.9%). HDM SPT positivity and subjective symptoms score were statistically correlated (P<0.05). Patients with strong SPT positivity to HDM had a higher total SCORAD score (P<0.05). Although there was no statistical correlation between HDM APT and SCORAD parameters, APT positive patients had generally higher SCORAD parameters. The statistical significance was only shown between the extent of the disease and strong APT positive reactions to Dermatophagoides pteronyssinus. CONCLUSION: HDM allergens play an important role in determining the clinical severity of AD and strong APT positivity could be more meaningful clinically.

Evaluation of autologous serum skin test results in patients with chronic idiopathic urticaria, allergic/non-allergic asthma or rhinitis and healthy people.

BACKGROUND: Recent data indicate that the autologous serum skin test (ASST) shows a high rate of reactivity not only in chronic idiopathic urticaria (CIU) but also in cases with non-allergic asthma and rhinitis (NAAR), multiple drug allergy syndrome (MDAS) and even in some healthy people. Aim. To evaluate ASST reactivity in patients with CIU, allergic/non-allergic asthma or rhinitis and in healthy controls. METHODS: We studied 80 patients with CIU, 40 non-atopic patients with NAAR, 57 patients with allergic rhinitis (AR) and allergic bronchial asthma (ABA), and 45 healthy controls. ASST was performed in all patients and controls, and it was considered positive when a serum-induced weal with a diameter 1.5 mm greater than the negative (saline) control, surrounded by erythema, was present. RESULTS: In total, 42 patients with CIU showed ASST reactivity (52.5%). ASST was found to be positive in 8 of 40 patients with NAAR (20%). The rate was similar (17.5%) in the AR/ABA patient group. However, 25 healthy controls (55.5%) also had positive ASST. The highest rate was in female controls and in individuals in the 18-30-year-old age group. CONCLUSION: The data indicate that ASST positivity might be a nonspecific phenomenon, influenced by many factors. In the light of the results of this study, we suggest that the significance of ASST reactivity should be re-evaluated in CIU. In addition, the importance of ASST reactivity in patients with AR/ABA and in patients with NAAR remains unclear, and further controlled studies are needed.

Does atopy affect the radiological extent of pulmonary tuberculosis?

BACKGROUND: Th1 cytokines, IL-2 and IFN-gamma , have critical importance in the CD4 cell driven antimycobacterial activity. Th2 type immune response is a characteristic feature of atopic disorders. Th1 and Th2 cells have been reported to negatively cross-regulate each other in vitro and in experimental animals. Our aim in the present study is to determine whether the atopy affects radiological extent of pulmonary tuberculosis (TB) and disease severity. MATERIALS AND METHODS: A total of 82 male patients with pulmonary TB were prospectively enrolled in the study between March 2005 and March 2006. All patients were evaluated for atopic symptoms and TB related systemic symptoms. Radiological dissemination was scored and cavitation was noted. The skin prick test (SPT) was performed and serum total IgE level was measured. RESULTS: The SPTs were positive in 28 of 82 (34.1 %) patients. There was no distinction between SPT-positive and negative patients in terms of pulmonary cavitation and radiological dissemination. The median IgE level of moderate-severe radiologically disseminated TB patients was significantly higher than that of mild radiologically disseminated TB patients (130 IU/ml vs. 58 IU/ml). Cavitary TB patients had also significantly higher median IgE levels (78 IU/ml vs. 46 IU/ml) (p < 0.05) CONCLUSION: This study suggests that SPT-positivity and atopic respiratory phenotype do not affect the formation of cavitation, radiological dissemination and systemic symptoms of pulmonary TB. The high level of IgE in patients with cavitary and radiologically disseminated TB may be a consequence of a dysregulated immune response to infection or reflect disease activity.

Effect of active tuberculosis on skin prick allergy tests and serum IgE levels.

OBJECTIVE: Mycobacterium tuberculosis has been shown to suppress allergic airway disease driven by type 2 helper T cells in animal models. In this study, we investigated the effect of active tuberculosis on skin prick test (SPT) positivity and serum immunoglobulin (Ig) E levels of atopic patients with and without tuberculosis infection. MATERIALS AND METHODS: Seventeen atopic HIV-negative men with pulmonary tuberculosis and 18 atopic healthy male controls at our military hospital were studied prospectively between March 2005 and March 2006. The sums of all SPT positive tests and positivity to house dust mite alone were calculated before initiation of treatment and after 6 months. Measurement of total serum IgE levels was also performed at the same moments. RESULTS: The mean (SD) initial serum total IgE concentrations were significantly higher in the tuberculosis patients than in the healthy controls (324.1 [317.67] U/mL vs. 146.7 [75.29] U/mL, respectively; P < .05), The total serum IgE concentrations after 6 months of treatment were also higher in the patients than in the controls. The mean sum of SPT positivity was higher in the tuberculosis patients than in the controls at both testing times. CONCLUSION: Our study does not support the hypothesis that M tuberculosis suppresses atopy and atopic disorders, but large, prospective experimental studies are needed before excluding the possibility of a relationship.

Does the atopic phenotype prevent development of active tuberculosis infection?

This study investigated the relationship between the atopic phenotype and the development of active tuberculosis. A total of 82 human immunodeficiency virus negative males with active pulmonary tuberculosis and 88 healthy controls were enrolled into this prospective study. Serum immunoglobulin E (IgE) levels were measured and skin prick tests performed before initiation of treatment. Skin prick tests were positive in 34.1% of the tuberculosis patients and 39.8% of the controls. Allergic respiratory symptoms were significantly less frequent in skin prick test positive tuberculosis patients (21.4%) compared with skin prick test positive controls (62.9%). Median IgE levels in atopic tuberculosis patients were significantly higher than in atopic controls. The low rate of atopic respiratory complaints seen in the tuberculosis patients, despite having similar allergic skin prick test sensitivities to the controls, could be attributed to a weak T-helper (Th) 2 immune reaction and its effects on Th1-Th2 interaction.

Evaluation of patients with symptomatic dermographism.

BACKGROUND: Dermographism or 'simple' dermographism, which has been noted in about 1.5% to 5% of healthy individuals, is regarded as a normal physiological phenomenon. However, in symptomatic dermographism (SD), even light pressure or rubbing from clothes may provoke widespread weal-and-flare reactions with itching and burning. It is one of the dermatologic diseases that negatively impacts quality of life. OBJECTIVE: We aimed to reveal triggering factors and/or associated clinical conditions in patients with SD. METHODS: Forty patients (28 women and 12 men) with SD whose ages varied between 7 and 65 (30.3 +/- 10.7) participated in the study. Patients having chronic idiopathic urticaria, other types of physical urticaria and cutaneous/systemic mastocytosis were excluded. The diagnosis of SD was confirmed by stroking the skin of the back with a tongue blade. This procedure elicited within minutes a linear weal with a flare and severe itching. In light of the history, physical examination, skin prick test (SPT) with aeroallergens and laboratory results, a possible relationship of certain triggering factors and/or associated diseases (psychic factors, atopy, thyroid diseases, diabetes, menopause, infectious, systemic or malignant diseases, history of scabies, and history of drug reaction) to SD were investigated. RESULTS: The duration of SD varied between 10 days and 10 years (mean: 20.8 months). Psychic factors were found to play the initial triggering role in 12 patients (30%). Five patients (12.50%) were atopic, and they had SPT reactivity to house dust mites. Three female patients (7.50%) defined that their complaints began following drug-induced urticarial rash. Two patients (5%) had hyperthyroidism, and one of the patients with SD of 1-month duration had type-II diabetes mellitus. A female patient defined that her complaints began during the onset of menopausal period. SD was observed with scabies in one patient; and after poststreptococcal glomerulonephritis in a 7-year-old girl. No autoimmune, malignant or other systemic diseases were found in patients with SD. CONCLUSIONS: Contrary to commonly held opinion, SD may be associated with some diseases and/or triggered by some conditions. In this study, a close temporal relationship between the appearance of SD and psychic factors, drug reactions and scabies was documented. The relation between SD and atopy, hyperthyroidism, diabetes mellitus, menopause and glomerulonephritis seemed unclear.

Latex allergy among operating room personnel in Turkey.

This study was performed to evaluate the prevalence of latex allergy among health care workers in Turkey, as well as to compare the medical histories with the skin test results and investigate the risk factors. Using a 1/100 weight/volume commercial skin prick test (SPT), we investigated latex sensitization in 206 health care workers who regularly use latex products. One hundred atopic and 100 nonatopic patients without occupational latex exposure were also examined as control groups. Latex SPTs were positive in 10 health care workers (9.22%), whereas none of the control patients was found to have positive SPT to latex. Health care workers were divided into two groups based on the latex SPT results. There was no significant difference between the latex SPT-positive and -negative health care worker groups according to age, sex and total exposure time to latex. In the latex SPT positive group, daily exposure time and daily glove use were significantly higher (p <0.05). The symptoms related to latex products were limited to hands and itching was present in all, however, erythema was found in 68.4%, and contact urticaria in 52.6% in the latex SPT positive group. These symptoms in the latex SPT negative health care group were 21.4%, 14.4%, and 1.6%, respectively (p <0.0001). History of allergic rhinitis, bronchial asthma and conjunctivitis were also higher in the SPT-positive group (p <0.05). Additionally, we found sensitivity to house dust mites and/or grass pollens in seven cases of latex allergy. Patch tests with rubber additives were positive in five out of 42 medical care workers. Two surgeons were found to have both type-I hypersensitivity to latex and type-IV hypersensitivity to rubber additives. Our results suggest that the frequency of latex allergy is higher in the atopic health care workers with a high exposure to latex, and that SPT is a sensitive, safe, cheap and easy method of testing the diagnosis of latex hypersensitivity.

A case of coumarin necrosis with penile and pedal involvement.

A 57-year-old male patient with advanced adenocarcinoma of the lung, who was administered oral anticoagulant therapy because of pulmonary embolism, developed coumarin necrosis confined to the penis and feet. To our knowledge, this patient showing acral involvement is the seventh case of coumarin-induced penile necrosis reported to date.