Analysis of primary treatment and prognosis of spontaneous urticaria.

BACKGROUND: The prognosis of spontaneous urticaria in association with early treatment remains unclear. In this study, we retrospectively studied the prognosis of acute spontaneous urticaria in relation to age and treatments in a local clinic of dermatology. METHODS: Out of 5000 patients who visited an office dermatology clinic, clinical records of patients with spontaneous urticaria were extracted. Their prognosis and the relation to age and treatments were analyzed by the Kaplan-Meier method and generalized Wilcoxon test. RESULTS: Among 386 patients diagnosed with spontaneous urticaria, 284 patients (73.6%) began treatments within a week after the onset. Their non-remission rates after one week, four weeks and one year from the onset were 26.8%, 15.0% and 6.7%, respectively. The non-remission rates of patients who were 20-years-old or younger by one year after the onset of urticaria, were significantly lower than those of patients older than 20-years-old. No apparent relationship between remission rates and sex or the use of steroids was detected. However, the non-remission rates of urticaria treated with a standard dose of antihistamine were lower than that treated with additional medications. CONCLUSIONS: Most patients who began treatments within one week from the onset remitted quickly. However approximately 7% of them continued to suffer from symptoms for more than a year. Such prolongation tended to be seen among patients who required other medications in addition to a standard dose of antihistamine.

Highly Oriented J-Aggregates of Nitroazo Dye and Its Surface-Induced Chromism.

Highly oriented J-aggregates of a nitroazo dye were obtained in solid thin films on aligned poly(tetrafluoroethylene) surfaces. During film deposition on a friction-transferred poly(tetrafluoroethylene) layer, a sharp peak grew in the polarized absorption spectra around 613 nm, which was red-shifted 117 nm from the peak in dilute dichloromethane solution. The peak showed remarkable optical anisotropy: dichroic ratios D of up to 22 were observed, and the intrinsic D value should substantially exceed this value. These results indicate that the peak is attributable to highly oriented J-aggregates. On glass, however, H-like aggregates grew, exhibiting an absorption peak at 410 nm. Hence, the substrate surface induced the remarkable chromism observed as a 203 nm red shift.

[ANALYSIS OF PRIMARY TREATMENT AND PROGNOSIS OF SPONTANEOUS URTICARIA IN A LOCAL CLINIC OF OFFICE DERMATOLOGY].

BACKGROUND: Prognosis of spontaneous urticaria in association with early treatment remained unclear. In this study, we retrospectively studied the prognosis of acute spontaneous urticaria in relation to age and treatments in a local clinic of dermatology. METHODS: Out of 5000 patients who visited an office dermatology clinic, clinical records of patients with spontaneous urticaria were extracted. Their prognosis and the relation to age and treatments were analyzed by the Kaplan-Meier method and generalized Wilcoxon test. RESULTS: Among 386 patients diagnosed as spontaneous urticaria, 284 patients (73.6%) had begun treatments within a week after the onset. The non-remission rates of them after one week, four week and one year from the onset were 26.8%, 15.0% and 6.7%, respectively. The non-remission rate of patients who were 20-years-old or younger by one year after the onset of urticaria, was significantly lower than that of patients older than 20-years-old. No apparent relations between the remission rate and sex or the use of steroids was detected. However, the non-remission rate of urticaria that was treated with a standard dose of antihistamine was lower than that treated with additional medications. CONCLUSION: Most patients who began treatments within one week from the onset remitted shortly. However approximately 7% of them continued to suffer from symptoms for more than a year. Such prolongation tends to be seen among patients who required other medications in addition to standard dose of antihistamine.

Diamond-rich crystalline nanosheets seeded with a Langmuir monolayer of arachidic acid on water.

The enigmatic self-assembling ability of nanodiamond (ND) particles has been discovered herein. Diamond-rich crystalline nanosheets with thickness of approximately ∼25 nm were grown from a Langmuir monolayer of arachidic acid (AA) at the interface between air and a dilute aqueous ND solution. Their fine rectangular shapes with uniform uniaxial birefringence indicate appreciable crystallinity, thus supporting that they are hydrated colloidal crystals of homogeneous ND particles.

A survey on subtypes and clinical characteristics of 1061 patients with urticaria in the primary care institutes in Japan.

The prevalence of urticaria has been reported mostly in Europe and North America. However, precise information regarding its subtypes and clinical characteristics in primary care practice, especially in Asian countries, are scant. Patients with urticaria and/or angioedema who visited nine primary clinics of accredited dermatologists and allergologists in Japan were recruited from October to November 2020. The information of age, sex, disease duration, urticaria control test (UCT), and concomitant urticaria subtypes were collected. A total of 1061 patients participated. The number of patients was high in the 20 to 50 age groups with a peak in the 40s. The most frequent urticaria subtype was chronic spontaneous urticaria (CSU) followed by dermographism, acute spontaneous urticaria (ASU), angioedema, and cholinergic urticaria (CholU) (66.8%, 22.7%, 18.9%, 14.1% and 5.7% in all patients with urticaria). CSU development increased with age from the 20s to 50s, especially in females. Dermographism had a peak in the 40s. ASU had bimodal peaks in childhood and in the 30s. CholU was common in males in the 10-20s. Most angioedema patients were female with an increase in their 30s. Angioedema was solely present in 14 of 1061 participants (1.3%), while 136 (12.8%) had angioedema concomitant with urticaria. UCT showed poorly controlled urticaria with lower scores in patients with concomitant CSU and other subtypes than in those with CSU alone. Urticaria tends to develop in young to middle-aged females. The most common urticaria subtype is CSU, while the number of patients with CholU is high and that of angioedema is low in Japan.

[Efficacy of sweat-antigen-inactivating skin care products on itching of patients with atopic dermatitis].

BACKGROUND: Many patients with atopic dermatitis showed immediate-type hypersensitivity against sweat antigen. Therefore, to deal with sweating is important to prevent itching and aggravations of dermatitis of patient with atopic dermatitis. We had searched a substance that inactivated sweat antigen adopting histamine release test. And we found that tannic acid which selected by screening various natural products inactivated sweat antigen. METHODS: We evaluate skin care products (spray, after-bathing water and aerosol-spray) containing tannic acid for patients with atopic dermatitis. We administered in a tannic acid-containing spray and after-bathing water on 17 patients with atopic dermatitis. RESULTS: After treatment, total clinical assessment score and itching in the afternoon had significantly decreased from that on day 0. To evaluate the effect of tannic acid containing-aerosol spray on itching of patients with AD, we assessed symptoms of atopic dermatitis patients who used a tannic acid containing-aerosol spray every day for 4 weeks in a cross-over, double-blind study. Clinical severity of atopic dermatitis and degrees of itching in daily life of patients were evaluated by physicians and patients themselves, respectively. Degrees of itching in morning and those at night were significantly more largely improved by the use of tannic acid-containing aerosol spray than those by the use of placebo control aerosol spray. The overall efficacy of tannic acid-containing aerosol sprays was also significantly higher than those of tannic acid free spray. CONCLUSION: Sweat antigen inactivating skin care products may be effective to reduce itching of patients with atopic dermatitis.

[Taking showers at school is beneficial for children with severer atopic dermatitis].

BACKGROUND: Sweat(ing) is a common aggravating factor of atopic dermatitis (AD), and many school children with AD experience the exacerbation of their disease in summer. OBJECTIVE: We evaluated the usefulness of taking shower at the school for the management of AD in summer. METHODS: Fifty-eight school children with moderate or severer atopic dermatitis were enrolled in the study. Subjects were allocated to one of following groups, group A: no shower (n=15), group B: 4-weeks shower (n=22), group C1: 2-weeks shower in the first half (n=11), or group C2: 2-weeks shower in the latter half (n=10), and took (or did not take) shower at the school from the beginning of September. Disease severity was evaluated on day 0, 2 weeks later and 4 weeks later using SCORAD scoring system. RESULTS: Significant improvements in SCORAD scores after 4 weeks were observed only in groups B and C1. When the subjects were sub-divided by the severity of the disease, the significant effect of shower was limited to the patients with severe and most severe disease. Similar results were obtained with a modified SCORAD score in which subjective symptoms were excluded. CONCLUSION: It is useful to take showers at the school for the management of AD for the children with severer disease.

Community validation of the U.K. diagnostic criteria for atopic dermatitis in Japanese elementary schoolchildren.

BACKGROUND: A simple list of diagnostic criteria for atopic dermatitis for use in epidemiological studies was developed by a U.K. working party. This list served well for both hospital patients with skin diseases and in general population within the U.K. OBJECTIVES: To validate the U.K. diagnostic criteria in Japanese elementary schoolchildren, we collected the questionnaires on regular health checkups, which had been completed by parents of schoolchildren in 2001/2002 and 2004/2005. METHODS: Elementary schoolchildren were examined by dermatologists in eight areas (16,152 children) in 2001/2002 and in three areas (3849 children) in 2004/2005. The questionnaire was distributed to the parents 2 weeks before the skin examination, completed by the parents and collected after the survey. RESULTS: In 2002/2002 comparing the U.K. diagnostic criteria with the findings on clinical examination used as the reference standard, the U.K. criteria (1-year prevalence measure) showed a sensitivity of 71.8%, specificity of 89.3% and positive predictive value of 44.7%. In 2004/2005 we confirmed that the U.K. criteria for a point prevalence measure showed a higher positive predictive value (59.9%) compared with that for 1-year prevalence measure (49.3%). CONCLUSION: Now that we know the sensitivity and specificity of the U.K. criteria in the population examined in this study, we will be able in the near future to estimate the prevalence of atopic dermatitis in a similar population with reverse operation by questionnaires alone using these criteria without examination by dermatologists. Therefore, the validation study of U.K. criteria could be useful for future epidemiologic surveys.

[Cholinergic urticaria successfully treated by immunotherapy with partially purified sweat antigen].

A 24-years-old man was referred to our University Hospital because of one and a half-year history of disabling symptoms related to physical exertion. Multiple small round-shaped wheals with severe itch were induced by exercise, warmth and psychological stress. These symptoms were resistant to histamine H1-receptor antagonists. Similar eruptions were induced by sauna-bathing, and skin test with autologous sweat showed a flare and wheal reaction. Incubation of his peripheral-blood leukocytes with partially purified sweat antigen evoked marked histamine release, indicating that he has been IgE-sensitized to an antigen(s) in human sweat. Specific immunotherapy using partially purified sweat antigen was performed every other week. Both pruritus and wheals improved gradually, and the reactivity of his peripheral blood leukocytes against sweat antigen decreased as immunotherapy was proceeded. Specific immunotherapy using sweat antigen may be valuable for patients with cholinergic urticaria with type I hypersensitivity to sweat antigen(s).

[Analysis of the prevalence of subtypes of urticaria and angioedema].

BACKGROUND: The prevalence of various subtypes of urticaria in Japan has not been analyzed. METHODS: We have classified 260 (105 males and 155 females) out patients with urticaria based on the classification in Guidelines for the diagnosis and treatment of urticaria and angioedema" prepared by the Japanese Dermatological Association with slight modification. RESULTS: The urticaria in 200 out of 260 (76.9%) patients was idiopathic, and 101 (38.8%) patients showed more than one type of urticaria or angioedema. Among 146 patients with chronic urticaria, 90 (61.6%) were complicated by other types of urticaria; 59 (40.4%) by factitia, 29 (19.9%) by angioedema, and 12 (8.2%) by other types of urticaria. Deep pressure urticaria has been assumed as a rare type of urticaria in Japan, but was diagnosed in 5 patients with other types of urticaria. CONCLUSION: Most of the subtypes of urticaria could be diagnosed mainly by history and physical examinations. Correct diagnosis of the subtypes of urticaria should be the basis of better understanding and the treatment of this disease.

The effectiveness of montelukast for the treatment of anti-histamine-resistant chronic urticaria.

Many patients with chronic idiopathic urticaria are not sufficiently controlled with histamine H(1)-receptor antagonists. Leukotriene receptor antagonists have been reported to be effective for certain cases of urticaria, although their proper application remains to be established. To study the effectiveness of montelukast, a leukotriene receptor antagonist, for the treatment of chronic urticaria that was not controlled by histamine H(1)-receptor antagonists. Twenty-five patients with chronic idiopathic urticaria were treated with 10 mg of montelukast for one week or more, without changing any precedent treatment that they were using before the study including histamine H(1)-receptor antagonists. The effectiveness of montelukast for each patient was evaluated and compared with clinical features and/or backgrounds of the patients. Twelve patients, including six who had been treated with corticosteroids, were evaluated as "markedly improved" or "improved" following treatment with montelukast. There was no statistically significant relation of the effectiveness to the complications with non-steroidal anti-inflammatory drugs (NSAIDs) intolerance, mechanical urticaria, or reactions to autologous serum skin test. However, the patients for whom montelukast was effective were younger (33.2+/-16.3 years, mean +/- SD)(P<0.05, Mann-Whitney test) and their duration of illness shorter (15.9+/-18.3 months) (P<0.005, Mann-Whitney test) than those of patients for whom montelukast was ineffective (45.9+/-15.0 years, 89.6+/-71.7 months). Montelukast may be worth trying for patients with chronic idiopathic urticaria, when the condition is not sufficiently controlled with histamine H(1)-receptor antagonists.

Pelodera strongyloides infestation presenting as pruritic dermatitis.

Pelodera strongyloides is a free-living soil nematode of the order Rhabditida. We report an 18-year-old man with P strongyloides skin infestation. In this case, pruritic follicular papulopustules developed on the buttocks, then the right flank. Skin scrapings revealed many live rhabditiform larvae that were cultured adult worms and hatched ova, identified as P strongyloides . The eruption was treated effectively with topical 1% gamma-hexachlorocyclohexane ointment.

Type I Chiari malformation presenting central sleep apnea.

Sleep apnea is a rare but a well-known clinical feature of type I Chiari malformation. It may be obstructive or central in nature. Sleep apnea in patients with type I Chiari malformation rarely presents without accompanying neurological signs or symptoms. We here report a case of a 10-year-old girl who presented with central sleep apnea without any other neurological signs but was ultimately diagnosed with type I Chiari malformation. The patient initially showed mild improvement in symptoms after administration of an acetazolamide. Finally, posterior fossa decompression dramatically improved her respiratory status during sleep, both clinically and on polysomnography. This case suggests that type I Chiari malformation should be considered in the differential diagnoses of central apneas in children, even if there are no other neurological signs and symptoms. Furthermore, sagittal craniocervical magnetic resonance imaging may be necessary for a definitive diagnosis.

Onsite medical rounds and fact-finding activities conducted by Nippon Medical School in Miyagi prefecture after the Great East Japan Earthquake 2011.

This report describes our onsite medical rounds and fact-finding activities conducted in the acute phase and medical relief work conducted in the subacute phase in Miyagi prefecture following the Great East Japan Earthquake and subsequent tsunami that occurred off northeastern Honshu on March 11, 2011. As part of the All-Japan Hospital Association medical team deployed to the disaster area, a Nippon Medical School team conducted fact-finding and onsite medical rounds and evaluated basic life and medical needs in the affected areas of Shiogama and Tagajo. We performed triage for more than 2,000 casualties, but in our medical rounds of hospitals, clinics, and nursing homes, we found no severely injured person but did find 1 case of hyperglycemia. We conducted medical rounds at evacuation shelters in Kesennuma City during the subacute phase of the disaster, from March 17 through June 1, as part of the Tokyo Medical Association medical teams deployed. Sixty-seven staff members (17 teams), including 46 physicians, 11 nurses, 3 pharmacists, and 1 clinical psychotherapist, joined this mission. Most patients complained of a worsening of symptoms of preexisting conditions, such as hypertension, respiratory problems, and diabetes, rather than of medical problems specifically related to the tsunami. In the acute phase of the disaster, the information infrastructure was decimated and we could not obtain enough information about conditions in the affected areas, such as how many persons were severely injured, how severely lifeline services had been damaged, and what was lacking. To start obtaining this information, we conducted medical rounds. This proved to be a good decision, as we found many injured persons in evacuation shelters without medication, communication devices, or transportation. Also, basic necessities for life, such as water and food, were lacking. We were able to evaluate these basic needs and inform local disaster headquarters of them. In Kesennuma City, we found that some evacuation shelters could not contact others even after 1 week after the earthquake. We realized from our experiences that, unlike our activities following more localized earthquake disasters, the first task following such large-scale disasters is to acquire information on basic life needs, including medication needs, and the number of persons requiring assistance. We must provide medical relief according to the unique characteristics of the disaster-affected areas as well as the specific nature of the disaster, in this case, a tsunami.

Anaphylactic shock caused by exposure to sea anemones.

BACKGROUND: Since the first report of a dog that developed severe systemic symptoms in response to a second injection of sea anemone toxin by Richet and Portier in 1902, no clear human cases of anaphylaxis related to exposure to sea anemones has been reported in the literature. METHODS: A 24-year-old man with an episode of local urticaria on his first contact with a sea anemone (Stichodactyla haddoni), developed dyspnea, severe urticaria and hypotension on exposure to water containing the dead bodies of the organism. To study whether this reaction was mediated by antigen-specific IgE, we performed a histamine release test with blood, Western blotting with serum and lymphocyte proliferating test with peripheral blood mononuclear cells of the patient, for the homogenate of sea anemones. RESULTS: The homogenate of sea anemones induced histamine release from the blood of the patient, but it also induced histamine release from the blood of control subjects. Moreover, it also caused hemolysis of blood of all donors. However, Western-blotting demonstrated the presence of an 86 kd protein-specific IgE in the serum of the patient. CONCLUSIONS: Protein antigen(s) in sea anemones may cause anaphylactic shock under the influence of the cytolytic effects and/or lymphocyte-stimulating activity elicited by the toxin of sea anemones.

Photoluminescence properties of vapor deposited films of a bisazomethine dye.

Steady-state and time-resolved photoluminescence (PL) measurements on vapor deposited films of a non-ionic bisazomethine dye have been performed. In the films, it is possible to control the ratio between J-aggregate and crystalline phases of the dye by means of exposure to chloroform vapour, and thus the origin of PL can be determined from comparison between several films. In the films, PL was emitted exclusively from the crystalline phase. Although the origin of PL was not from the J-aggregate phase, some features of the observed PL were very similar to those reported for J-aggregates of ionic dyes. We also found that these features in the vapor deposited films were caused by a competition between free excitons and excitons trapped at defect sites.

OCA4: evidence for a founder effect for the p.D157N mutation of the MATP gene in Japanese and Korean.

Oculocutaneous albinism type 4 (OCA4) was identified as a rare form of human OCA among a group of autosomal recessive hypopigmentary disorders. Little is known about the prevailing distribution of patients of OCA4 with mutations of the MATP gene, although one Turkish, five German, one Korean, and 18 Japanese patients have been reported so far. The p.D157N mutation was previously reported to be the most frequent (0.389; 14/36) in Japanese patients and was also found in a Korean patient. On the other hand, this mutation has not been found in Turkish and German patients. We therefore investigated haplotypes of the patients who have the p.D157N mutation. The results showed that OCA4 is prevalent in East Asia including Japan and Korea likely as a result of a founder effect for the p.D157N mutation. Furthermore, it is suspected that the p.D157N mutation might have occurred on an ancestral chromosome after the divergence of Orientals and Caucasians.

IgE-mediated hypersensitivity against human sweat antigen in patients with atopic dermatitis.

Sweating aggravates itch in atopic dermatitis, but the mechanism is unclear. In this study, we examined the involvement of type I hypersensitivity in the aggravation of atopic dermatitis by sweating. Skin tests with autologous sweat were positive in 56 of 66 patients (84.4%) with atopic dermatitis, but only in 3 of 27 healthy volunteers (11.1%). Sweat samples from both patients and healthy volunteers induced varying degrees of histamine release from basophils of patients with atopic dermatitis. However, the histamine release was impaired by removal of IgE on the basophils. Incubation of basophils with myeloma IgE before sensitization with serum of patients blocked the ability to release histamine-induced sweat. IgE antibody against antigen(s) in sweat may be present in serum of patients with atopic dermatitis. Key words:

Carbamylated hemoglobin as a therapeutic marker in hemodialysis.

Carbamylation requires isocyanic acid derived from urea. Carbamylation of hemoglobin (Hb) produces carbamylated Hb (carbHb), which could serve as a marker of posttranslational protein modification possibly associated with such uremic complications as atherosclerosis. Since relative carbHb levels are determined by mean urea concentration and duration of exposure, they could be used to assess the adequacy of a patient's hemodialysis (HD) regimen. We therefore determined the relationship between carbHb and urea kinetics in patients with chronic renal failure (CRF) undergoing maintenance HD. In pre-HD determinations as well as in nondialyzed subjects including healthy subjects and CRF patients without dialysis, carbHb correlated well with blood urea nitrogen (BUN) concentrations, especially with BUN averaged for the preceding 1-3 months. In HD patients, carbHb correlated significantly with urea kinetics (time-averaged concentration of urea, or TAC(urea), K(t)/V and urea reduction rate). The estimated mean urea concentration in HD patients calculated from the relationship between carbHb and averaged BUN over 3 months in the nondialyzed groups was lower than TAC(urea), suggesting that TAC(urea) may be an overestimate. Pre-HD BUN is not a good nutritional index since detrimental decreases in urea elimination from the body can elevate pre-HD BUN independently of nutrition. We therefore devised a new nutritional index, BUN/carbHb, which correlated significantly with serum albumin as well as the normalized protein catabolic rate. These results demonstrate that carbHb accurately reflects uremic control and the BUN/carbHb ratio could serve as an index of nutritional state in HD patients.

Using an air-pad sensor for the diagnosis of sleep apnea: a trial study.

An air-pad sensor (APS) was developed to record respiratory effort non-invasively. The APS is placed under the subjects' bodies and acoustic signals received by the pad are analysed. Nine patients with obstructive sleep apnea (OSA) and two healthy subjects were examined using an APS and daytime polysomnography, including intraesophageal pressure (Peso), simultaneously. The agreement ratio in terms of the central apnea time between the APS and the Peso was 93.4%, although the ratio between the Peso and an abdominal strain gauge was 40.7%. The agreement ratio in terms of respiratory rate among the Peso, APS, and abdominal strain gauge in patients with OSA was high; but the agreement ratio was low (74.4%) between the Peso and the strain gauge in mixed apnea.