Heliotherapy improves vitamin D balance and atopic dermatitis.

BACKGROUND: Vitamin D insufficiency during winter is common in the Nordic countries. Heliotherapy (HT) may heal atopic dermatitis (AD) but its effect on vitamin D balance has not been examined. OBJECTIVES: To study the effect of HT on serum calcidiol (25-hydroxyvitamin D) concentration and on healing of AD. METHODS: Twenty-three adult patients with AD received a 2-week course of HT in the Canary Islands in either January or March 2005. Daily solar ultraviolet (UV) radiation was measured and personal UV exposure calculated as standard erythema doses (SED). Blood samples were taken during HT and during a 1-2 month follow-up. Serum calcidiol concentration was measured by radioimmunoassay. Healing of AD was examined by SCORAD index. RESULTS: Before HT 17 (74%) AD patients had vitamin D insufficiency (calcidiol < 50 nmol L(-1)) and four patients high (> 80 nmol L(-1)) serum calcidiol values. The median personal UV dose during the 2-week HT course was 60 SED in the January group and 109 SED in the March group. Serum calcidiol concentration increased significantly in both groups, by 13.4 and 24.0 nmol/L(-1), respectively, and after HT only four (17%) patients had vitamin D insufficiency. SCORAD improved from 34 to 9 in the January HT group and from 30 to 9 in the March group. CONCLUSIONS: A 2-week course of HT significantly improved vitamin D balance by increasing serum calcidiol concentration, and caused a marked healing of AD. These parallel positive responses should be taken into account when the benefits of HT are considered.

Positive skin and oral challenge responses to potato and occurrence of immunoglobulin E antibodies to patatin (Sol t 1) in infants with atopic dermatitis.

The clinical significance and molecular specificity of hypersensitivity reactions to raw and cooked potatoes remain ambiguous. We therefore investigated the clinical hypersensitivity to raw and cooked potato in infants suspected to have potato allergy and compared the findings with the occurrence of immunoglobulin E (IgE) antibodies to patatin (Sol t 1), characterized as the primary allergen of potato. Twelve infants (10 to 24 months of age) suffering from atopic dermatitis (AD) and suspected to have adverse reactions to potato, were examined. As a skin exposure test we used rubbing with both raw and cooked potato, and used open oral challenge with cooked potato for 7 days. A special eczema scoring system (SCORAD) was used to assess the severity of symptoms and signs of AD. Skin-prick tests (SPTs) were performed with raw potato and natural Sol t 1, and serological studies included measurement of total serum IgE and IgE antibodies to Sol t 1, and potato radioallergosorbent testing (RAST). The skin-rubbing test with raw potato was positive in seven (58%) and the oral challenge positive in eight (67%) infants. One infant presented with an immediate reaction and seven with a delayed reaction, i.e. exacerbation of AD, after oral challenge responses to cooked potato. Nine (75%) infants had IgE antibodies to Sol t 1 in enzyme-linked immunosorbent assay (ELISA), and SPT to natural Sol t 1 was positive in six (50%) potato-allergic infants. In conclusion, we observed positive challenge responses to both raw and cooked potato in food-allergic atopic infants. The presence of IgE antibodies and concomitant positive SPTs to the heat-stable potato allergen, Sol t 1, suggest that cooked potato can be an allergenic food for infants suffering from AD.

Identification of four novel potato (Solanum tuberosum) allergens belonging to the family of soybean trypsin inhibitors.

BACKGROUND: We have previously identified patatin (Sol t 1) of potato tubers as a major food allergen among atopic children. In addition to Sol t 1, concomitant IgE binding to other, then unidentified, potato proteins was observed. METHODS: Purification and identification of the putative allergens were done by both standard and advanced methods of protein chemistry. The patient series comprised 39 children with positive skin prick test (SPT) to raw potato. Immunoblotting and ELISA were used to examine IgE-binding ability and skin prick testing to assess in vivo reactivity of the purified potato proteins. RESULTS: Four IgE-binding potato proteins with molecular masses ranging from 16 to 20 kDa were purified and identified as cathepsin D-, cysteine-, and aspartic protease inhibitors belonging to the family of soybean trypsin inhibitors (Kunitz type). The proteins were designated Sol t 2, Sol t 3.0101, Sol t 3.0102, and Sol t 4. In ELISA, 51% of the sera of the 39 atopic children showed specific IgE to Sol t 2, 43% to Sol t 3.0101, 58% to Sol t 3.0102, and 67% to Sol t 4, respectively. All these four allergens were able to produce positive wheal-and-flare responses in SPT. CONCLUSION: In addition to Sol t 1, potato tubers contain several proteins belonging to the family of soybean trypsin inhibitors against which atopic children with positive SPT responses to raw potato have in vitro and in vivo reactive IgE antibodies.

IgE reactivity to patatin-like latex allergen, Hev b 7, and to patatin of potato tuber, Sol t 1, in adults and children allergic to natural rubber latex.

BACKGROUND: Patients allergic to natural rubber latex (NRL) frequently show positive skin prick tests (SPT) and hypersensitivity reactions to various fruits, such as avocado, banana, and kiwi, as well as to vegetables such as potato. METHODS: Hev b 7 was purified from NRL "C-serum" and Sol t 1 from potato extract, and they were detected by immunoblotting. IgE antibodies to Hev b 7 and Sol t 1 were measured with ELISA in sera from 35 adults and 35 children allergic to NRL. ELISA inhibition and immunoblotting were used to study allergen cross-reactivity. The in vivo reactivity of Hev b 7 and Sol t 1 were demonstrated in the SPT. RESULTS: Seventeen (49%) of the 35 NRL-allergic adults had IgE antibodies to Hev b 7, in contrast to only one of the 35 NRL-allergic children. Fifteen (43%) of the NRL-allergic adults and 29 (83%) of the NRL-allergic children had IgE antibodies to Sol t 1. Ten (29%) of the adult sera showed IgE binding to both Sol t 1 and Hev b 7, and crosswise inhibition tests with pooled sera revealed marked cross-reactivity. In the SPT, both natural Hev b 7 and Sol t 1 were able to produce a wheal and flare reaction. CONCLUSIONS: One-half of the NRL-allergic adults, but only one of the NRL-allergic children, had IgE antibodies to natural Hev b 7. These results suggest that Hev b 7 is an important NRL allergen for adults, but not for children. Elucidation of the clinical importance of the observed cross-reactivity between Hev b 7 and Sol t 1 requires further studies.

Expression of p53 protein before and after PUVA treatment in psoriasis.

We investigated the effect of the potentially carcinogenic psoralen plus UVA radiation (PUVA) therapy on the expression of p53 in skin of psoriatic patients. p53 antibodies DO7 and Pab240, antibodies against PCNA and Ki67 and the avidin-biotin immunoperoxidase complex method were used in the immunohistochemical staining of biopsy samples from non-lesional and lesional skin of 23 patients who received either trioxsalen bath PUVA or oral 8-methoxypsoralen PUVA. Biopsies were taken before and after a PUVA course. A modest expression of p53 was seen in psoriatic lesions in 17/21 patients before any treatment, probably as a physiological reaction to the hyperproliferation. Both p53 and the proliferation markers Ki67 and PCNA followed the same pattern, being more frequent in psoriatic lesions than in non-lesional skin. Exposure to PUVA induced an increase in p53 expression in non-lesional skin in 14/19 patients, putatively as a response to DNA damage caused by PUVA. In psoriatic lesions about half of the patients showed increased and half decreased expression of p53. The latter finding might be explained by decreased proliferation activity of the healing epidermis. In conclusion, p53 nuclear positivity in non-lesional skin after PUVA treatment is likely to be induced by DNA damage caused by PUVA, while in psoriatic lesions it could be a result of the combined effect of decreasing epidermal proliferation and DNA-damage.

Identification of patatin as a novel allergen for children with positive skin prick test responses to raw potato.

BACKGROUND: Peeling of raw potatoes may cause allergic symptoms, such as sneezing, wheezing, and contact urticaria, for adults. For children, potatoes as food may cause various allergic reactions. However, the identity and molecular structure of the putative allergens in potato have remained unknown. OBJECTIVE: The aim of our study was to identify possible major allergens in potato by using sera of atopic children suspected of having food allergy and having positive skin prick test responses to raw potato. METHODS: Potato proteins were purified by standard methods of protein chemistry and characterized with amino-terminal sequencing and mass spectrometry. The IgE-binding ability of the purified proteins was verified by immunoblotting and ELISA with IgE antibodies from the sera of atopic children having positive skin prick test responses to raw potato. RESULTS: Immunoblotting showed strong IgE binding to a 43-kd protein, identified as patatin, the main storage protein of potato tubers. In ELISA, 20 of 27 (74%) children with positive skin prick test responses to potato and none of the control subjects showed specific binding of IgE antibodies to purified patatin. A positive wheal-and-flare reaction was seen in 8 of 14 children prick tested with purified patatin. CONCLUSION: These results show that patatin in potatoes is a significant, previously unrecognized,IgE-binding protein for children with a positive skin prick test response to raw potato. Further studies are needed to confirm the clinical importance of potatoes, and especially patatin, as a food allergen.

Cross-reacting allergens in natural rubber latex and avocado.

BACKGROUND: An association between allergy to latex and avocado has been reported but the responsible cross-reacting allergens have not been identified or characterized. METHODS: Immunoblotting, immunoblot inhibition, and RAST inhibition methods were used to study cross-reactive proteins between natural rubber latex (NRL) and avocado. Sera from 18 patients with previously verified latex allergy were used as the source of IgE antibodies, and 11 of the patients underwent skin prick testing with fresh avocado. RESULTS: Fourteen of the 18 sera (78%) had IgE antibodies that bound to a total of 17 avocado proteins with apparent molecular weights ranging from 16 to 91 kd. Ten most strongly reacting sera were used for immunoblot inhibition studies. When NRL proteins were used as soluble inhibitors, binding of IgE antibodies to solid-phase avocado proteins was inhibited in a dose-dependent manner: 100 micrograms of NRL proteins inhibited IgE binding to 15 of the 17 avocado proteins, and 10 micrograms caused inhibition to 13 protein bands. Comparably, soluble avocado proteins were able to inhibit IgE binding to solid-phase NRL. Corresponding RAST inhibitions were performed with two patient sera; in both, avocado inhibited IgE binding to NRL and in one NRL proteins inhibited IgE binding to avocado. Skin prick test responses to fresh avocado were positive in seven of the 11 patients with latex allergy who were tested. CONCLUSIONS: The large number of inhibitable proteins in immunoblot experiments and clinical observations from skin prick tests suggest considerable immunologic cross-reactivity between NRL and avocado. The observed cross-reacting protein components may be responsible for the recently reported type I hypersensitivity reactions to NRL and avocado in patients with a preexisting allergy to either allergen.

Immediate and delayed hypersensitivity reactions to birch pollen in patients with atopic dermatitis.

We investigated immediate and delayed hypersensitivity to birch pollen in 10 patients with atopic dermatitis (AD) who had experienced a worsening of their eczema during the birch pollen season. The patients were prick- and patch-tested and antigen-induced basophil histamine release and lymphocyte proliferation were measured. 9/10 birch pollen-allergic patients proved positive in the histamine release test and the results correlated with specific IgE levels measured by RAST. Birch pollen antigen induced lymphocyte proliferation in 6/10 patients, but a positive patch test result was obtained in only one case. Both peripheral blood monocytes and purified epidermal Langerhans' cells were able to present birch pollen antigen to T cells, although Langerhans' s cells seemed to function less efficiently in this respect.

Effect of long-term PUVA treatment of psoriasis on the collagen and elastin gene expression and growth of skin fibroblasts in vitro.

The proliferation rate, collagen metabolism and collagen and elastin messenger-RNA levels were studied in fibroblasts derived from patients who had received many courses of either systemic 8-methoxypsoralen or topical trioxsalen PUVA treatment. The proliferation rate of fibroblasts as measured by the incorporation of 3H-thymidine or by cellular division was decreased in those obtained from patients who had PUVA treatment as compared with controls. Collagen synthesis was slightly increased in the cells from PUVA-treated patients, but the relative collagen synthesis and the ratio between types I and III collagen were unchanged. The levels of collagen and elastin mRNAs were increased in fibroblasts derived from the PUVA-treated patients. No significant differences in histology or immunochemistry could be found in the biopsies taken from topical and systemic PUVA-treated patients.

Alcohol intake: a risk factor for psoriasis in young and middle aged men?

OBJECTIVE: To clarify the nature of the association between alcohol intake and psoriasis. DESIGN: Case-control study of men aged 19-50 with onset of skin disease in 1976 or later. SETTING: Outpatient clinics of the departments of dermatology of the university central hospitals in Helsinki, Oulu, and Tampere from September 1987 to April 1989. SUBJECTS: 144 Patients with psoriasis and 285 unmatched controls with other skin diseases. MAIN OUTCOME MEASURES: Results of clinical examination and self administered questionnaire assessing lifestyle and alcohol intake during two specified periods--namely, 12 months before the onset of skin disease and 12 months before the date of examination. RESULTS: Recalled mean alcohol intake before the onset of skin diseases was 42.9 g/day among the patients with psoriasis and 21.0 g/day among the controls. In logistic regression analysis psoriasis was associated with alcohol intake but not with coffee consumption, smoking, age, marital state, or social group. The odds ratio for psoriasis at an alcohol intake of 100 g/day compared with no intake was 2.2 (95% confidence interval 1.3 to 3.9). The controls decreased their alcohol intake after the onset of the disease but the group with psoriasis did not. Analysis of serum enzyme values showed that gamma-glutamyltransferase activity was significantly correlated with alcohol intake (r = 0.35), the mean activity being 75.0 U/l among patients with psoriasis and 41.9 U/l among controls. CONCLUSIONS: Alcohol is a risk factor for psoriasis in young and middle aged men, and psoriasis may sustain drinking.

Comparison of trioxsalen bath and oral methoxsalen PUVA in psoriasis.

Fifty patients with chronic plaque psoriasis were treated with trioxsalen bath PUVA and 43 patients with oral methoxsalen PUVA. The two treatment regimens gave similar results; 75% and 77% of the patients had excellent or good clearing and a follow-up of one year revealed relapses in 61% and 58% of the patients, respectively. The cumulative UVA dose remained significantly lower in bath PUVA (mean 23.5 J/cm2) than in oral PUVA (mean 131 J/cm2). Nausea and headache occurred in 21% of the patients receiving oral PUVA but in none in the bath PUVA group. Local side-effects were found in 30% of the patients receiving bath PUVA and in 17% of the patients in the oral PUVA group.

PUVA treatment and skin cancer: A follow-up study.

Altogether 525 PUVA-treated psoriatics were re-examined. The mean follow-up period since the beginning of PUVA therapy was 2.1 years (range 1-3.6 years). In 107 cases (20%) the total UVA dose was below 100 J/cm2 and in 20 (4%) over 1000 J/cm2. During PUVA treatment or at re-examination of 14 of the 525 patients (3%) were found to have skin lesions suspected of being malignant. A total of 23 biopsies were taken and in one case a basal-cell carcinoma was histologically verified. This had almost certainly been present before the beginning of the PUVA therapy. Two other patients, both previously treated with methotrexate, had reversible lesions with Bowenoid histology. Both these patients had received a total UVA dose of more than 1000 J/cm2. The incidence of skin carcinomas in the present PUVA treated series was lower than that in hospitalized psoriatics treated with regimens other than PUVA and was not higher than the incidence in the age-matched general population in Finland.