The vicious circle effect: stress as effect and cause in patients with psoriasis.

Psoriasis is a common immune-mediated, chronic inflammatory disease, causing adverse effects on patients' quality of life and disease burden. In psychodermatology, psoriasis is included both in the group of dermatological diseases, in which the psychophysiological background plays a key role, and in dermatoses being a potential source of emotional disturbances or being a trigger for the development of secondary mental disorders. A comprehensive view of the patient with psoriasis, not only from the point of view of skin disease, but also as a result of a wide impact of stress, including low self-esteem and inappropriate social perception may have a key influence on improvement of quality of life of these patients.

The Effect of Biological Treatment on Stress Parameters Determined in Saliva in Patients with Severe Psoriasis.

Background and objectives: In psoriatic patients, stress is the most common aggravating factor. Despite the use of quality-of-life assessment questionnaires, diagnosing stress in psoriatic patients is not a flawless procedure. This study aimed to assess the usefulness of potential stress biomarkers in saliva for monitoring the treatment of psoriasis. Materials and methods: A total of 104 adult patients with severe psoriasis were included and randomly treated via biological treatment or symptomatic therapy: 84 received biological treatment, with 20 formed a control group receiving symptomatic therapy. The administered biological treatment was adalimumab, whilst in controls calcipotriol/betamethasone dipropionate topical gel and emollients were used. Patients were monitored monthly with a dermatological examination and the dispensing of a biological drug. During each of the four visits, the severity of the disease was assessed (PASI, BSA, and DLQI), and a sample of the patient's saliva was taken. In all the participants, the saliva concentrations of immunoglobulin A (sIgA), α-amylase (sAA), and chromogranin A (CgA) were measured. Results: The majority of patients in both the study and control groups achieved clinical improvement, though favoring the group receiving biological treatment. The concentration of sIgA in the saliva was constantly increasing in the study group during subsequent visits (Fr = 27.26; p < 0.001). Meanwhile, there were no statistically significant changes in the control group during the same follow-up period (Fr = 6.66; p = 0.084). Levels of sAA underwent statistically significant changes in both groups (Fr = 58.02; p < 0.001-study group and Fr = 13.74; p = 0.003-control group). In the study group, a steady, statistically significant increase in sAA was observed from the first to the third visit. In the study group, a downward trend in CgA concentration was observed. In the control group, no significant differences in the level of CgA were obtained. Conclusions: sIgA, sAA, and CgA are potential markers of the severity of psoriasis and the associated stress reaction. Based on the presented observations, only sIgA and CgA seem to be valuable biomarkers for monitoring the effectiveness of the systemic treatment of psoriasis.

Examples of adverse effects after biological therapy.

Psoriasis is one of the most common, chronic skin diseases of as yet unexplained etiopathogenesis. In the recent years it has been proven that an immunological factor plays an important role in the dermatosis onset. This has led to introduction of biological drugs to the disease treatment regimen, which include, inter alia, adalimumab and ustekinumab. New therapy has become an alternative for patients with psoriasis resistant to standard treatment methods as well as an alternative form of treatment in case of occurrence of severe adverse drug reactions after administration of standard treatment. Despite good treatment results the administration of these drugs is associated with the occurrence of adverse reactions. This article presents cases of 4 patients who have been administered biological treatment and in whom there have been observed, inter alia, the occurrence of hypersensitivity reactions in the form of acute urticaria as well as skin lesions of erythema multiforme nature or positive antinuclear antibodies titre. The symptoms experienced by the presented patients posed no direct threat to life and the benefits of the drugs' administration had a significant therapeutic importance.

Different Development Forms of Local Allergic Rhinitis towards Birch.

BACKGROUND: Efficacy of allergen immunotherapy (AIT) in local allergic rhinitis (LAR) is a new subject of research. The presence of asthmatic symptoms in patients with LAR in the context of AIT is unexplored. OBJECTIVE: The efficacy and safety of AIT in patients with LAR towards birch pollen were investigated. The possibility of concomitant local allergic asthma in studied patients and the impact of AIT on it were examined. METHODS: 36 patients with LAR towards birch were included in three years of AIT in a double-blind, placebo-control study. Primary outcome measurement was the mean changes in the combined symptom and medication scores (CSMSs) after AIT, and the second is the changes in the quality of life (QoL). Skin prick tests, serum, nasal allergen-specific IgE to birch, nasal and bronchial provocation challenge tests with birch allergen, methacholine tests, and spirometry were carried out at baseline and after AIT. RESULTS: Mean CSMSs of three years of AIT were significantly decreased in the active group from 5.88 (range: 4.11-9.01) to 1.98 (range: 1.22-4.51; p < 0.05). After three years of AIT, there was a significant increase of toleration for birch allergen from the mean concentration of 6250 ± 1200 SQ-U/ml up to 45000 ± 2500 SQ-U/ml (p = 0.02) during repeated nasal challenges. 16 patients with LAR had the positive results of methacholine tests, and 11 of them had a positive bronchial challenge to birch allergen. After AIT, the significant decrease of bronchial responsiveness to birch allergen in 5 from 7 patients was confirmed (p = 0.03). QoL assessed by the use of the RQLQ score was improved after AIT from 1.84 (95% CI: 1.53-1.97) to 1.45 (95% CI: 1.32-1.62) score in the active group after three years of AIT therapy (p = 0.03). CONCLUSION: AIT to birch can be useful and safe in a patient with local allergic rhinitis and also with concomitant asthmatic symptoms. Further studies are needed.

Can atopy have a protective effect against cancer?

BACKGROUND: An increased prevalence of allergies and an increased incidence of breast cancer have been observed. The hypothesis that atopy may have a protective effect against the risk of different types of breast cancer was evaluated. METHODS: In this study, 11,101 patients (11,101 women with a mean age of 55.2±14.7 years) with different types of breast cancer were tested for allergies. Allergies were confirmed based on the retrospective analysis of allergy diagnostic procedures in patients who had been previously diagnosed with breast cancer. The retrospective prevalence rates of active allergic diseases, including allergic rhinitis, bronchial asthma and atopic dermatitis, were assessed. All patients were also analyzed for bronchial asthma and allergic rhinitis according to the relevant guidelines. A group of healthy control patients was used for the comparisons. RESULTS: The women with breast cancer had a significantly lower incidence of IgE-mediated allergic diseases than the controls. The odds ratios (ORs) for allergic rhinitis, atopic dermatitis, and bronchial asthma were 0.61 (95% CI: 0.57-0.73), 0.17 (95% CI: 0.11-0.44), and 0.73 (95% CI: 0.65-0.83), respectively. The mean serum concentrations of total IgE were significantly lower in the study population of women with breast cancer than in the patients of the control group (39.2 ± 26.2 kU/L vs. 108.5 ± 38.5 kU/L; p = 0.002). CONCLUSION: Our results suggest that the overall incidence of allergies, especially allergic rhinitis, is lower in patients with certain types of cancer than in individuals who did not have cancer. Further studies are needed to confirm our findings.

Fall episodes in elderly patients with asthma and COPD - A pilot study.

OBJECTIVE: Evidence of an increased risk of falls in patients with chronic obstructive pulmonary disease (COPD) exists; however, this has not been studied in elderly asthmatic patients. The aim of the study was to determine the incidence of falls in elderly patients who were diagnosed with bronchial asthma compared to subjects with COPD. METHODS: A 12-month prospective observational study in elderly outpatients with diagnosis of either asthma or COPD was conducted. All of the participants were monitored on the following parameters: falls, comorbidities, drug therapy, and The Berg Balance Scale. The rate of falls was shown as an incidence ratio. Cluster analysis for subgroups with similar features was performed on all patients included in the study. Two clusters of frequent fallers were determined. RESULTS: The fall incidence rate in falls per person per year was 1.41 (95% CI: 0.86-1.96) in asthmatic patients and 1.49 (95% CI: 1.05-2.11) in the COPD group. Frequent fallers were more prevalent in the COPD group, with 32% in this group compared to 28% in the groups of patients with asthma. In cluster analysis, frequent fallers were grouped into two models characterized by polytherapy, depression symptoms, hospitalizations, coronary disease, dementia, and diagnosis of COPD or asthma. CONCLUSION: Elderly asthmatic patients presented a high rate of falls, which is comparable to that of patients with COPD.

The prevalence and characteristics of local allergic rhinitis in Poland.

BACKGROUND: Local allergic rhinitis (LAR) is found in some patients with typical symptoms but who have negative skin prick tests and negative IgE to aeroallergens while presenting with positive nasal provocation tests for proper allergens. Little information about the clinical characteristics and prevalence of LAR has been published. The aim of this study was to determine the prevalence and characteristics of LAR in patients with symptoms of chronic rhinitis. METHODS: In total, 680 patients out of 3400 pre-screened subjects with chronic rhinitis who were at least 5 years old were included from 17 sites in Poland in the study protocol. The following medical history and diagnostic procedures were performed with aeroallergens: skin prick tests, allergen specific serum IgE and nasal provocation tests. In addition to LAR, allergic rhinitis (AR) and non-allergic (NAR) rhinitis were explored and compared. RESULTS: In total, 621 patients were examined. LAR was diagnosed in 109 (17.6%) patients; AR was diagnosed in 251 (40.4%) patients; and NAR was diagnosed in 261 (42%) patients. In the LAR group, younger, non-smoker patients with allergies to D. pteronyssinus or grass pollen were predominant. Polysensitization was more prevalent in AR patients than in LAR patients. Bronchial asthma was at a similar level in patients diagnosed with AR (38%) and LAR (35%) but was significantly less prevalent in patients diagnosed with NAR (16%). The mean age of disease onset was similar between patients with AR and LAR (17.6 plus or minus 4.8 yrs), and it was significantly lower than that in patients with NAR (24.5 plus or minus 6.9 yrs, p less than 0.05). CONCLUSIONS: LAR is a significantly understudied problem in patients of various ages with chronic nasal symptoms. Patients with LAR and AR have similar clinical phenotypes.

Prolonged effect of allergen sublingual immunotherapy to grass pollen.

Background: The prolonged effect of allergen immunotherapy is unknown, especially in older patients. Objective: The three-year effect of sublingual allergen-specific immunotherapy (AIT) to grass pollen on elderly patients with allergic rhinitis was analyzed. Methods: Thirty-eight elderly patients (63.18 ± 3.12 yrs.) underwent AIT to grass pollen, were monitored for three years and were compared to a placebo group. AIT was performed with the use of an oral Staloral 300 SR grass extract (Stallergens Greer, London, UK) or a placebo. Symptoms and medication scores, represented by the average adjusted symptom score (AAdSS), the serum level of IgG4 to Phl p5 and the quality of life were assessed immediately after AIT and three years later. Results: After AIT, the AAdSS was significantly decreased and remained lower than in the placebo group during the three years after AIT. Serum-specific IgG4 against Phl p5 increased during the AIT trial in the study group. For the three years of observation after AIT, there were no significant changes in specific IgG4 levels against the analyzed allergens in comparison to the results immediately after AIT. The quality of life, based on the Rhinoconjunctivitis Quality of Life Questionnaire, was significantly decreased in patients who received AIT, from 1.83 (95%CI: 1.45-1.96) to 0.74 (95%CI: 0.39-1.92) (p < 0.05) to 0.82 (95%CI: 0.45- 1.04) three years after AIT. Conclusion: A prolonged positive effect after AIT to grass pollen was observed in elderly patients with allergic rhinitis. Further trials are needed to confirm this effect.

Efficacy and safety of birch pollen immunotherapy for local allergic rhinitis.

BACKGROUND: Local allergic rhinitis (LAR) is a relatively new disease. OBJECTIVE: To ascertain the effects of allergen-specific immunotherapy in LAR. METHODS: A randomized, double-blind, placebo-controlled trial of birch subcutaneous allergen immunotherapy (AIT) for LAR was performed in 28 patients. The therapy was performed for 24 months in 15 patients with AIT and 13 patients given placebo. The primary end point was decrease in symptom medication score (SMS). In addition, we monitored serum-specific immunoglobulin E (IgE), serum-specific immunoglobulin G4, nasal-specific IgE to Bet v 1, and safety and quality-of-life parameters. RESULTS: After 24 months of treatment, there was a significant decrease in the median area under the curve for SMS of the active group vs the placebo group: 2.14 (range, 1.22-4.51) vs 6.21 (range, 5.12-7.89), at the P < .05 level. During AIT, the active group showed a significant decrease in SMS of up to 65% vs baseline. A significant increase in immunoglobulin G4 and decrease in nasal-specific IgE were observed in the active group during AIT compared with the placebo group. AIT was well-tolerated and without systemic reactions. CONCLUSION: This study demonstrates that AIT for birch pollen in patients with LAR was clinically effective and exhibited good tolerance. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03157505.

Tissue hemostasis is shifted toward thrombogenesis in the psoriatic plaques.

BACKGROUND: Psoriasis is a common autoimmune disease of unknown etiology. Recently, much attention has been paid to evidence that a local hypercoagulable state is an important contributing factor to the development of inflammatory skin diseases. Thus, the aim of this study was to characterize the local hemostasis in the affected skin of patients with psoriasis. METHODS: Skin biopsies of psoriatic plaques were obtained from 73 consecutive patients (48M, 25F, average age 45 years) with at least a one year history of the disease. The studied patients had not received any specific systemic treatment for at least 4 weeks before the biopsy was done. As a control, normal skin biopsies were obtained from 16 healthy subjects. For immunohistological study, the En-Vision method (DAKO EnVision Kit ®/Alkaline Phosphatase detection system), and monoclonal antibodies anti-tissue factor (TF), anti-thrombomodulin (TM) and anti-von Willebrand Factor (vWF) were used. All these molecules were assessed semi-quantitatively in the frozen sections. RESULTS: Clinically, the Body Surface Area index ranged between 1-90% and the Psoriasis Area Severity Index score ranged from 1.6 to 47. Immunohistochemistry revealed redistribution of TF antigens from the upper to lower layers of the epidermis as compared to the control. It was collaborated with the number of TF-positive cells in the psoriatic skin sections (78.3%) as compared with the healthy subjects (34.4%; P<0.001). In addition, TF was uniformly and moderately expressed on capillary endothelial cells of the plaque sections in 43 out of 73 patients (58.9%). As far as the thrombomodulin is concerned, TM was clearly down-regulated and localized mainly in the upper layers of the psoriatic epidermis. It was collaborated with the number of TM positive cells in the psoriatic skin sections (38.9%) as compared with the healthy subjects (66.7%; P<0.001). All capillary vessels found in the biopsy sections were positive for TM and vWF staining, with similar expression (≥2+) in both groups. In the current study, no relationship was found between the TF, TM and vWF expression and the PASI and BAS (NS). CONCLUSIONS: A local procoagulable state found in psoriatic plaques suggests a significant role of local tissue hemostasis in pathogenesis of the disease. These findings indicate another potential target for a therapeutic approach in patients with psoriasis, although further research would help elucidate the exact mechanisms.

Local Allergic Rhinitis in Adult Patients with Chronic Nasal Symptoms.

BACKGROUND: Local allergic rhinitis (LAR) remains an underdiagnosed condition characterized by the local production of IgE antibodies during the natural exposure to aeroallergens. The prevalence of LAR in adult patients with a previous diagnosis of non-AR was assessed. MATERIAL AND METHODS: Eighty-four patients with perennial nasal allergy symptoms but a negative skin prick test and specific IgE antibodies against common inhalant allergens were included in the study. Nasal provocation tests were performed with the inhalant allergens Dermatophagoides pteronyssinus, Alternaria, and cat allergen, followed by the detection of nasal-specific IgE antibodies in the lavage during the challenge. RESULTS: LAR was confirmed in 21 (25%) study patients. In the remaining 63 (75%) patients, non-AR was diagnosed. In addition, LAR was found following exposure to D. pteronyssinus in 19 (22.6%) patients, Alternaria in 3 (3.6%) patients, and the cat allergen in 1 (1.2%) patient. In 2 patients, concomitant allergies to D. pteronyssinus and Alternaria were observed. CONCLUSION: LAR can be a form of chronic perennial rhinitis that has previously been considered to be non-AR.

Prolonged effect of allergen sublingual immunotherapy for house dust mites in elderly patients.

BACKGROUND: The prolonged effect of allergen immunotherapy is unknown, especially in older patients. OBJECTIVE: To analyze the 3-year effect of sublingual allergen-specific immunotherapy (SLIT) to house dust mites in elderly patients with allergic rhinitis. METHODS: Forty-seven elderly patients (65.78 ± 4.89 years old) underwent SLIT to house dust mites and were monitored for 3 years and compared with a placebo group. SLIT was performed with the use of oral Staloral 300 SR Der p and Der f 50/50% extract (Stallergens Greer, London, United Kingdom) or placebo. Symptoms and medication score, represented by the average adjusted symptom score (AAdSS), serum level of immunoglobulin (Ig) G4 to Dermatophagoides pteronyssinus, Dermatophagoides farinae, Der p 1, and Der p 2, and quality of life, were assessed immediately after SLIT and 3 years later. RESULTS: The AAdSS was significantly decreased after SLIT, and the level remained low during the 3 years after SLIT compared with placebo. Serum-specific IgG4 against D pteronyssinus, D farinae, Der p 1, and Der p 2 increased during the SLIT trial in the study group. For the 3 years of observation after SLIT, there were no significant changes of specific IgG4 levels against the analyzed allergens compared with results just after SLIT. Quality of life based on the Rhinoconjunctivitis Quality of Life Questionnaire score was significantly decreased in patients who received SLIT, from 1.48 (95% confidence interval 1.33-1.79) to 0.98 (95% confidence interval 0.67-1.07; P < .05) compared with 0.94 (95% confidence interval 0.55-1.04) 3 years after SLIT. CONCLUSION: The prolonged positive effect after SLIT to house dust mites was observed in elderly patients with allergic rhinitis. Further trials are needed to confirm this effect. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01605760.

Twenty years' observation of subcutaneous pollen allergoid immunotherapy efficacy in adults.

INTRODUCTION: It is valuable to determine the long-term efficacy of allergen-specific immunotherapy (SIT) and whether it can cure allergy. AIM: For this study, patients were prospectively observed for 20 years after completion of SIT to determine its effectiveness. MATERIAL AND METHODS: A total of 1006 patients who underwent SIT for pollen allergy were observed for 20 years to assess the efficacy of SIT. The rhinitis symptom score (RSS) and asthma symptom score (ASS) were measured after SIT completion. The possibility of allergy cure was estimated based on three sets of criteria: group A - neither symptoms nor intake of medication during the analysis period, group B - no symptoms during the analysis period (but possible medication intake), and group C - at most one mild symptom during the analysis period. RESULTS: After SIT, approximately 25% of patients showed complete relief of allergy symptoms and had no need for symptomatic drug treatment during the pollen season. The level of effectiveness of SIT was similar throughout the treatment period. During the observation period after SIT, RSS ranged from 1.51 to 1.82, and ASS ranged from 1.22 to 1.29. The treatment effect at 10 and 20 years after SIT was comparable, regardless of whether criterion A or B was used. However, the effect of SIT using criterion C was lower than those using criteria A and B for the analyzed time points. CONCLUSIONS: For this study cohort, SIT had a long-term effect that did not depend significantly on the duration of immunotherapy against pollen.

Allergic rhinitis, bronchial asthma and other allergies in patients with Alzheimer's disease: unnoticed issue.

INTRODUCTION: Allergic diseases are becoming more prevalent in elderly patients. Allergic diseases have been observed in patients with Alzheimer's disease (AD). The prevalence of atopic bronchial asthma, allergic rhinitis and atopic dermatitis was analyzed in such elderly Polish population. AIM: Analysis of the presence of allergic diseases in the patients with AD in Poland, including asthma, allergic rhinoconjunctivitis and atopic dermatitis. MATERIAL AND METHODS: The recruitment of subjects with AD was conducted at 6 sites representative of Polish rural and urban areas, and 1060 subjects with a mean age of 69.2 ±5.1 years were screened. Medical examinations, an original questionnaire, skin prick testing for common aeroallergens and appropriate serum-specific IgE assays were performed. RESULTS: Probable atopy was diagnosed in 234 (22.1%) analyzed patients, including 127 women (21.5% of women) and 234 men (22.8% of men). The average prevalence associated with age and sex in this population for bronchial asthma was 2.9%, atopic dermatitis/eczema was 0.6%, seasonal allergic rhinitis was 6.6%, perennial allergic rhinitis was 11.1% and polymorphous atopic disease was 4.4%. The most frequent positive results were recorded for the following allergens: mixed grass, Dermatophagoides pteronyssinus, Dermatophagoides farinae and Alternaria. CONCLUSIONS: One-fifth of diagnosed patients with AD have allergic disease requiring treatment.

Association between cancer and allergies.

BACKGROUND: The prevalence of allergies and the incidence of cancer are both increasing worldwide. It has been hypothesized that atopy may affect the risk of some cancers. METHODS: In this study, 1525 patients (754 women and 771 men with a mean age of 52.7 ± 11.9 years) with different types of cancer were examined for the presence of allergies. Allergies were confirmed based on retrospective analysis of allergy diagnostic procedures in patients previously diagnosed with cancer. All patients were also analyzed for bronchial asthma and allergic rhinitis according to relevant guidelines. A control group of patients without cancer diagnoses was used for comparison. RESULTS: Patients with cancer had significantly fewer IgE-mediated allergic diseases than the control population. For the oncological group compared to the non-cancer patients, the odds ratios (ORs) for allergic rhinitis, atopic dermatitis, and bronchial asthma were 0.67 (95 % CI 0.52-0.81), 0.89 (95 % CI 0.78-0.99), and 1.03 (95 % CI 0.91-1.13), respectively. The mean serum concentrations of total IgE were significantly lower in the study population of patients with cancer than in the patients in the control group (45.98 ± 14.9 vs. 83.2 ± 40.1 IU/l; p < 0.05). There were no significant correlations between the type of cancer diagnosed and the form of allergy. CONCLUSION: Our results indicate that the overall incidence of allergies, particularly allergic rhinitis, was lower in patients with some types of cancer. Further studies are needed to confirm our findings.

The effect of allergen-specific immunotherapy on offspring.

BACKGROUND: The incidence of allergic diseases has increased worldwide. Thus, there is a need for effective primary prevention of allergies. OBJECTIVE: The aim of the present study was to examine how allergen-specific immunotherapy (ASIT) affects the development of allergies in the generation of children whose parents were subjected to this method of treatment. METHODS: A total of 194 children with at least one parent with allergy subjected to ASIT were enrolled. These patients were compared with control individuals without ASIT. Their risk of allergy, based on medical history, examination, allergy skin-prick tests, serum total immunoglobulin E and specific immunoglobulin E concentrations was assessed. RESULTS: The children of parents subjected to immunotherapy showed significantly reduced clinical symptoms of allergic disease. The odds ratios (OR) of any allergic disease and asthma were significantly lower in children with one or both parents with allergy after ASIT compared with the children with parents with allergy and without ASIT: OR 0.73 (95% confidence interval [CI], 0.59-0.86) versus OR 1.85 (95% CI, 1.73-2.2) for any allergic disease and OR 0.63 (95% CI, 0.53-0.79) versus OR 1.36 (95% CI, 1.22-1.67) for asthma. CONCLUSION: The phenomenon of reducing the risk of allergies in children whose parents were desensitized might be important in the primary prevention of allergies.

The clinical differences of asthma in patients with molds allergy.

INTRODUCTION: Bronchial asthma is an increasing problem worldwide. The course of bronchial asthma is dependent on the type of inducing allergens. The differences between the clinical features of asthma in patients with monovalent allergies to molds and with other allergies were explored. MATERIAL AND METHODS: Randomly selected 1910 patients (924 women and 986 men) between 18-86 years in age were analyzed according to type of allergy and asthma. The diagnosis of asthma was confirmed on the basis of GINA criteria, physical examination and spirometry. Allergy diagnosis was confirmed on the basis of medical history, a positive skin prick test and the measurement of serum-specific IgE to inhalant allergens, using an extended profile of mold allergens. RESULTS: Patients with monovalent allergies to molds (4% of analyzed group) had significantly more frequent diagnoses of asthma than patients in the other group (53% vs. 27.1-32.4%, p < 0.05). Patients with allergies to Alternaria alternata had an odds ratio of 2.11 (95%CI: 1.86-2.32) for receiving a diagnosis of bronchial asthma. They had less control over their asthma, which was more severe compared to patients with other allergies. Patients with asthma and allergies to mold had significantly more frequent exacerbation of asthma requiring systemic corticosteroids and/or hospitalization. They used a significantly greater mean daily dose of inhaled steroids compared to other patients. CONCLUSION: Patients with monovalent IgE allergies to molds are at a higher risk for asthma than patients with other allergies. Their asthma is often more intense and less controlled compared to that of patients with other types of allergies.

Analysis of selected allergic reactions among psoriatic patients.

INTRODUCTION: Psoriasis is a chronic and recurrent inflammatory skin disease. The aetiology is still unknown in spite of numerous scientific researches. There is very little evidence which does not provide enough knowledge about allergic reactions in psoriatic patients. Based on the fact that the epidermal barrier damage allows different allergen types to penetrate into deep layers of epidermis and skin, we can assume that it may lead to immunological reactions. AIM: To investigate the allergic reaction indicators and hypersensitivity assessment about contact, inhalant and food allergens. The results were analysed with regard to clinical disease indicators and progression stage of dermal lesions. MATERIAL AND METHODS: Eighty patients with psoriasis were examined. The concentration of total IgE antibodies and allergen specific IgE antibodies (asIgE) were analysed. Standard epidermal tests and atopy patch tests were performed. All the patients were estimated for their dermatological condition based on the PASI scale. The control group consisted of 50 patients without psoriasis and allergic history. RESULTS: Significantly higher concentration of total E immunoglobulin has been stated in the patients with psoriasis. Higher concentrations of specific allergic IgE antibodies were more often observed in the examined group but the most frequently observed values were present in 1-3 class. The most common airborne allergens were birch, artemisia, timothy and rye pollens. There have not been any significant statistical differences in the case of positive epidermal test results. CONCLUSIONS: There is slightly expressed hypersensitivity in psoriatic patients. This hypersensitivity degree correlates with the intensification of symptoms.

The frequency of polymorphic variants of filaggrin gene and clinical atopic dermatitis.

INTRODUCTION: As far as pathogenesis of the atopic dermatitis (AD) is concerned, the roles of an impaired epidermal barrier and cornified cell envelope are widely emphasized. AIM: The assessment of mutations of the filaggrin gene and their connection with the clinical picture of AD as well as selected allergological and environmental indicators. MATERIAL AND METHODS: 105 patients with diagnosed AD on the basis of diagnostic criteria were included. For every patient of the examined group, quantitative determination of the total concentration of IgE and the concentration of IgE antibodies to selected allergens were examined. For all patients, studies were performed by means of analysis of two genomic gene variants of profilaggrin (FLG) - R501X and 2282del4. RESULTS: Loss-of-function mutations in the filaggrin gene were shown in 12 (11.4%) patients in the examined group. All patients in the study group who developed one of the tested loss-of-function mutations in the filaggrin gene demonstrated an extrinsic, allergic form of atopic dermatitis. A significant association (p = 0.0002) between the presence of one of the tested loss-of-function mutations in the filaggrin gene and elevated levels of total concentration of immunoglobulin E was shown. CONCLUSIONS: Patients with AD of null mutations in the filaggrin gene demonstrate a relationship with the total and specific concentration of immunoglobulin E, specifically higher concentrations of IgE against aeroallergens and alimentary allergens as well as elevated levels of total immunoglobulin E.