Identification of a Dau c PRPlike protein (Dau c 1.03) as a new allergenic isoform in carrots (cultivar Rodelika).

BACKGROUND: Up to 25% of food allergic subjects in central Europe suffer from carrot allergy. Until now, two isoforms of the major carrot (Daucus carota) allergen Dau c 1 have been described: Dau c 1.01, comprising five variants (Dau c 1.0101-Dau c 1.0105) and Dau c 1.02. OBJECTIVE: To investigate potential allergenic properties of a Dau c PRPlike protein, a novel isoform of the PR-10 protein family in carrot. METHODS: Dau c PRPlike cDNA from carrot roots (cv Rodelika) was cloned after RT-PCR and 5'RACE. Dau c PRPlike protein was expressed in E. coli, purified under native conditions by Ni-NTA chromatography and analysed by CD spectroscopy. Immuno-reactivity of the rDau c PRPlike protein was compared with rDau c 1.0104 and rDau c 1.0201 in terms of IgE binding (immunoblotting, ImmunoCAP), IgE cross-reactivity (ELISA inhibition) and in vitro mediator release with sera from carrot allergic patients. mRNA expression of Dau c PRPlike protein in wild-type and transgenic carrot roots was analysed by qRT-PCR. RESULTS: The Dau c PRPlike protein was identified as a new allergenic isoform, Dau c 1.03, in carrot roots. 68% of carrot allergic patients were sensitized to rDau c 1.03. The IgE-reactivity of rDau c 1.03 strongly correlated with reactivity to rDau c 1.0104, but not to rDau c 1.0201. The extent of IgE cross-reactivity and allergenic potency of Dau c 1 isoforms varied between the individual sera tested. Dau c 1.03 mRNA transcripts were up-regulated in Dau c 1.01 and Dau c 1.02 gene-silenced carrot roots. CONCLUSION AND CLINICAL RELEVANCE: Dau c 1 isoforms display distinct IgE epitope heterogeneity. Dau c 1.03 appears to contribute to the allergenicity of carrots and the manifestation of carrot allergy. The epitope diversity of different Dau c 1 isoforms should be considered for component-resolved diagnosis and gene silencing of carrot allergens.

Trichoid basal cell carcinoma found in a dilated pore on the nose.

A pore of Winer is a common, benign epidermal appendageal tumor arising from a hair follicle. We present a case where routine removal of a pore of Winer revealed the presence of a trichoid basal cell carcinoma. We describe the history of these lesions, discuss clinical and histologic differential diagnoses, and propose an explanation for the presence of these tumor cells. No prior report of basal cell carcinoma within a pore of Winer has been documented in the literature.

Microscopic features of lichen sclerosus et atrophicus in acrochordons: a clue to the cause of lichen sclerosus et atrophicus?

BACKGROUND: The cause of lichen sclerosus et atrophicus (LSA) is unknown, but on the penis it is associated with chronic occlusion, that is, phimosis. Microscopic changes of LSA were seen unexpectedly in two acrochordons. OBJECTIVE: Our purpose was to further characterize this phenomenon. METHODS: A total of 449 acrochordons examined in our histopathologic laboratory in the past 2 years were studied for changes of LSA, and clinical data were collected. RESULTS: Eight additional cases were found. All of the acrochordons exceeded 0.5 cm, and three were 1 cm or larger. At least six were under chronic occlusion or pressure. The dermal changes of LSA predominated over the epidermal changes. All showed collagenous homogenization, sclerosis, and inflammation. Elastic fibers were characteristically decreased. CONCLUSION: These observations strengthen the evidence that LSA in flaccid skin may be caused by chronic occlusion.

Basal cell carcinoma and melanocytic nevus in the same lesion.

We report a case of basal cell carcinoma and intradermal melanocytic nevus in the same lesion. A review of the literature indicates that the simultaneous occurrence of two or more neoplasms in one specimen is a relatively infrequent finding. The pathogenesis of simultaneously occurring neoplasms remains the subject of speculation. Based on currently available evidence, we believe that the coexistence of lesions in this particular patient is most likely coincidental.

Cutaneous immunofluorescence.

Immunofluorescence, especially direct immunofluorescence of skin, has been widely used for diagnosis of connective tissue diseases. It is principally of value for LE and may be used also as a prognostic test for SLE. It is of relatively little value for diagnosis of other connective tissue diseases and appears not to predict the outcome of undifferentiated connective tissue disease. Cutaneous immunofluorescence is widely available and has an established place in the field of dermatopathology. As with other microscopic interpretations, substantial experience, along with an understanding of basic immunopathologic principles, is necessary for reliable results. Antibodies to certain ultrastructural components of the basement membrane zone are now available. These are being evaluated for further diagnostic applications to LE and other diseases that involve the epidermal basement membrane zone.

Direct immunofluorescence in bullous pemphigoid: effects of extent and location of lesions.

We have reevaluated the previously reported conclusion that direct immunofluorescence in bullous pemphigoid is often negative in biopsy specimens from the legs. Duplicate tests from the trunk and legs were generally of equal intensity in a prospectively evaluated series of eight patients with generalized bullous pemphigoid. Also, in 36 patients evaluated retrospectively, the intensity of the direct immunofluorescence reaction correlated roughly with extent of disease, rather than with specific anatomic region. Localized disease predictably required less vigorous treatment to achieve control, but the intensity of the immunofluorescence reaction was not similarly predictive. Direct immunofluorescence is a less useful diagnostic test in localized bullous pemphigoid than in generalized bullous pemphigoid.

Late circumcision and lichen sclerosus et atrophicus of the penis.

We retrieved the records of 20 cases of lichen sclerosus et atrophicus of the penis from pathology service files at five metropolitan hospitals. Histologic sections were available for study in 16 cases. All patient records were available. All cases except one (that of a 14-year-old boy) occurred in men aged 34 to 77 years. Most of the patients (14) were circumcised for phimosis, often with meatal stenosis, and the diagnosis was made on the foreskin specimen. The remaining six patients had already been circumcised, at ages 32 to 54 years, and had lichen sclerosus et atrophicus of the glans penis. Therefore in this series of patients, the condition occurred only in patients circumcised late in life. This must be considered when a decision about neonatal circumcision is made.

Anesthesia in alopecia mucinosa.

A 23-year-old woman was noted to have a hypoesthetic patch over the right mandible. A biopsy specimen revealed alopecia mucinosa. Anesthesia in the involved area has been reported rarely in the literature.

Lupus band test: anatomic regional variations in discoid lupus erythematosus.

Seventy-one patients with discoid lupus erythematosus were studied for anatomic regional variations in the lupus band test. The test was positive in 82% of biopsies from the scalp, face, neck, and upper extremity. Only three out of fourteen biopsies (21%) from the trunk were positive. Discoid lupus erythematosus could be confirmed or strongly suspected in the light microscopic sections from all cases. Truncal lesions should not be selected for the lupus band test in discoid lupus erythematosus if there are other choices.

Effect of anatomic region on immunofluorescence diagnosis of bullous pemphigoid.

Forty-six patients with clinical and histologic criteria of bullous pemphigoid, and on whom direct immunofluorescence testing had been done, were analyzed by anatomic region of the lesions and by the region from which the immunofluorescence biopsy specimens were taken. One third of immunofluorescence tests from the lower extremities were negative, compared with only 3% from all other areas. The possible reasons for this result are discussed. The lower extremity should probably be avoided as a biopsy site for immunofluorescence in bullous pemphigoid.