Bettina Wedi

Correlation of IL-31 serum levels with severity of atopic dermatitis

wheat-sensitized patients appears not to be helpful. However, our study suggests that for some patients with suspected wheat allergy without increased wheat-specific IgE levels, the determination of v-5 gliadin–specific IgE levels might be helpful in detecting sensitization to water-insoluble wheat proteins. Importantly, additional studies are necessary to identify the major allergens involved in food allergy to wheat proteins. Kirsten Beyer, MD Danna Chung, MD Gabriele Schulz Michelle Mishoe Bodo Niggemann, MD Ulrich Wahn, MD Hugh A. Sampson, MD From the Department of Pediatric Pneumology and Immunology, University Children’s Hospital Charité, Berlin, Germany; and the Division of Pediatric Allergy and Immunology and the Jaffe Food Allergy Research Institute, Mount Sinai School of Medicine, New York, NY. E-mail: kirsten.beyer@charite.de. Supported by institutional funding. Reagents and ImmunoCAPs were provided by Phadia (Freiburg, Germany, and Uppsala, Sweden). Disclosure of potential conflict of interest: K. Beyer has received research support from the European Union, the Food Allergy and Anaphylaxis Network, Phadia, and the Paul Ehrlich Institute. H. A. Sampson has received research support from Phadia.

Urticaria and infections

Urticaria is a group of diseases that share a distinct skin reaction pattern. Triggering of urticaria by infections has been discussed for many years but the exact role and pathogenesis of mast cell activation by infectious processes is unclear. In spontaneous acute urticaria there is no doubt for a causal relationship to infections and all chronic urticaria must have started as acute. Whereas in physical or distinct urticaria subtypes the evidence for infections is sparse, remission of annoying spontaneous chronic urticaria has been reported after successful treatment of persistent infections. Current summarizing available studies that evaluated the course of the chronic urticaria after proven Helicobacter eradication demonstrate a statistically significant benefit compared to untreated patients or Helicobacter-negative controls without urticaria (p < 0.001). Since infections can be easily treated some diagnostic procedures should be included in the routine work-up, especially the search for Helicobacter pylori. This review will update the reader regarding the role of infections in different urticaria subtypes.

Circulating levels of brain‐derived neurotrophic factor correlate with disease severity in the intrinsic type of atopic dermatitis

Background:  Recent studies have shed light on the complex regulation of genetic, environmental, immunologic and pharmacologic factors, which contribute to the development of atopic dermatitis (AD). However, it is still unclear to which extent neuroimmune mediators have a role in AD.

Effective treatment of refractory severe heat urticaria with omalizumab

and lactose. The total IgE level was 46 kU/l (<100 kU/l) (Pharmacia ImmunoCAP, Phadia, Sweden). Specific IgE to common seasonal or perennial allergens, to maize and latex was not detected. The skin prick test for major food allergens was negative. We then performed prick to prick testing of the tablets she was working with. Positive reaction was found for ASA tablets from her and a competing drug company. Excipients were identical for both tablets. Testing of 10% pure ASA in 20 g glycerin was negative. An allergy to the tablet coingredients was then suspected, especially to its maize components. A type I sensitization to maize bran was detected by skin prick test, then by intracutaneous tests for maize bran and flour. Spirometry showed a light obstructive syndrome, and metacholin provocation confirmed a bronchial hyperreactivity at 4 mg/ml of metacholin. Nasal provocation test with maize bran revealed a strong positive reaction with sneezing, conjunctival injection and pruritus of the nose and eyes after 6 min. Moreover, the nasal flow diminished from 70 to 35 l/min after 10 min. Western blot of maize flour incubated with patient serum showed a marked band at 50 kDa (Fig. 1) possibly matching the reduced soluble protein allergen of the maize endosperm (3). These findings suggest that our patient developed her maize allergy during occupational exposure by airway and cutaneous contact to the allergen. Although maize starch consists almost exclusively of carbohydrates it may contain 0.3–1% protein, whereas flour contains about 7–13% protein. As maize starch particles measure 5–10 lm in diameter, they can easily be inhaled. Allergic respiratory reactions to inhaled maize dust in exposed workers and anaphylactoid reactions with contact urticaria because of maize starch in exam or surgical gloves have been described previously (4, 5). To our knowledge, this is the first report of maize as an occupational allergen in tablet manufacturing. Our data suggest that patients working in tablet manufacturing and presenting occupational allergy symptoms should be tested for sensitization to drug excipients in particular maize starch.

Increased levels of serum IL-31 in chronic spontaneous urticaria*

Please cite this paper as: Increased levels of serum IL‐31 in chronic spontaneous urticaria. Experimental Dermatology 2010; 19: 464–466.

Differential up-regulation of neurotrophin receptors and functional activity of neurotrophins on peripheral blood eosinophils of patients with allergic rhinitis, atopic dermatitis and nonatopic subjects.

Background Recent studies suggest that neurotrophins have a pivotal role in neuroimmune interactions. Indeed, in contrast to nonatopic subjects (NA), neurotrophins have been shown to be increased in atopic diseases such as allergic rhinitis (AR) and atopic dermatitis (AD).

Modulation of intercellular adhesion molecule 1 (ICAM-1) expression on the human mast-cell line (HMC)-1 by inflammatory mediators

The effect of inflammatory mediators on the expression of several surface adhesion molecules on the human mast‐cell line (HMC)‐1 was studied. By flow cytometry, it could be shown that among several surface adhesion molecules (ICAM‐UCDS4, VLA‐4/CD49d, Mac‐UCD11b, LFA‐1/CD11a, LFA‐2/CD2, LFA‐3/CDS8, VCAM‐1), only the constitutively expressed immunoglobulin family member intercellular adhesion molecule‐1 (ICAM‐1) is modulated by proinflammatory cytokines on HMC‐1 mast cells. Stimulation with tumor necrosis factor‐a (TNF‐α) and interferon‐γ (IFN‐γ) resulted, in addition to interleukin‐(lL‐)4, in selective upregulation of ICAM‐1 expression. Costimulation of either IL‐4 or IFN‐γ with TNF‐α further increased the ICAM‐1 expression as compared to the stimuli alone. In contrast, stem‐cell factor (SCF), granulocyte/macrophage colonystimulating factor (GM‐CSF), IL‐10, IL‐8, monocyte chemotactic and activating factor (MCAF), and the complement split product C5a failed to modulate the expression of any adhesion molecule examined. The levels of cytoplasmic free calcium in HMC‐1 mast cells were not altered by cross‐linking surface ICAM‐1, suggesting linkage of other intracellular signaling pathways. This cytokine‐induced upregulation of ICAM‐1 expression might reveal a putative regulatory mechanism of mast‐cell interaction with effector cells bearing the counterparts of ICAM‐1 (CD54), the molecules Mac‐1 (CD11b/CD18) and leukosialin (CD43), and the principal ligand LFA‐1 (CD11a/CD18).

Allergic contact dermatitis to acid blue 158 in suture material

A 38-year-old woman presented with three episodes of inflammatory reactions, including healing difficulties, after skin suturing. The first occurrence was in childhood after an operation on her left forearm. A second episode occurred in 2005, 7 days after suturing required after the insertion of an intramedullary nail due to a lower leg fracture. Two years later, the intramedullary nail was removed. Again, 6 days after suturing, healing problems occurred with inflammation around the stitches. Seralon blue thread (Serag Wiessner, Naila, Germany) was the suture material used in 2005 and 2007. Patch testing with Seralon blue thread (Serag Wiessner) that was cut into small pieces and applied to the upper back under occlusion for 2 days produced a þþ reaction after 3 and 4 days (not shown). There were no reactions to Vicryl , Vicryl plus , Monocryl unstained , Monocryl purple , Mersilene , Prolene blue thread [which is coloured with phthalocyanine blue, colour index (C.I.) 74160] (all Johnson & Johnson Medical GmbH, Norderstedt, Germany), or the baseline series, medicaments, leather and textile colours (including p-phenylenediamine), resins, and adhesives of the German Contact Dermatitis Research Group. The allergens (Johnson & Johnson; Serag Wiessner; and Hermal, Reinbeck, Germany and Chemotechnique Diagnostics, Malmö, Sweden) were applied in Finn Chambers on Fixomull stretch (Bayersdorf Medical GmbH, Hamburg, Germany) to the upper back for 2 days. Readings were made onD2, D3, andD4. Further testing of Seralon thread components produced a þþ positive reaction to the azo dye C.I. acid blue 158 in a dilution of 1% in pet. after 2 days, a þþþ positive reaction on D3 (Fig. 1), and a þþþ positive reaction onD4. Patch testingwith phthalocyanine blue C.I. 74160 (1% pet.), epsilon-caprolactam, and Seralon unstained thread produced no positive reactions.Tohelp excludenon-specific, cutaneous hyper-reactivity, we also included patch testing with sodium lauryl sulfate (0.25% in aqua), which was negative.

The basophil activation test is a helpful diagnostic tool in anaphylaxis to sesame with false-negative specific IgE and negative skin test

83 (1.7%) were withdrawn and 1120 (22.3%) were not presented. Nonpresentation rates varied from 18.3% to 28.0% (Table 1). Nonpresenting authors came from 75 different countries. Among countries with >10 accepted abstracts, posters from North Africa, Middle East, Eastern Europe and the former Soviet Union were much less likely to be presented than those from Western Europe, North America (including Mexico), Japan or Australia. Honourable exceptions to these broad generalizations include Czech Republic and Slovenia (nonpresentation rates 1.7% and 3.4% respectively). No-show rates were higher for clinical than basic science abstracts (P < 0.001). Nonpresentation was clearly associated with distance from the author’s institution to the congress. Nonpresented posters were more likely from countries with lower gross national domestic products. The other factor associated with nonpresentation was single authorship (OR 3.0 vs multiple authors, CI 2.3–3.9). A total of 124 authors failed to present at more than one congress: most of these had more than one abstract accepted each year, suggesting a systematic pattern of behaviour. It may be inevitable that authors from remote and economically less developed countries are less likely to attend congresses. Congress organizers understand there is an unavoidable risk of nonattendance: ideally those not attending should inform organizers so display arrangements can be appropriately adjusted. A Cochrane review of 97 papers on scientific meeting abstracts and highlighted that <50% of studies presented at professional meetings are ever published in peer-reviewed journals, leading to publication bias in systematic reviews (1). To reduce rates of nonpresentation, conference organizers should monitor whether posters are presented and consider restricting abstract acceptance from authors who have previously failed to present. For conferences that publish abstracts in citable media, publication policy could be altered to deter researchers from submitting abstracts without any intention of presenting, e.g. only publishing abstracts that are actually presented. Alternative outlets including digital posters (2, 3) and online conferencing should be considered for researchers who want to publicize their work but cannot attend conferences in person. HS conceived the study and surveyed the posters; MR and AF assisted with the data analysis; all three authors helped write the paper. HS & MR have no conflicts of interest. AF is an ex-president of EAACI and an associate editor of Allergy.

Human HMC-1 mast cells exclusively express the FcγRII subtype of IgG receptor

Because of their localization at the interface of the internal and external environment mast cells play a crucial role in the immune response and in inflammatory reactions. Effects may be mediated not only by the high-affinity IgE receptor, but also by IgG receptors. Since in rodent mast cells signal transduction via the Fcγ receptor family has been shown, we analysed the expression of surface receptors for IgG on the human mast cell line HMC-1. It was shown by flow cytometric analysis that HMC-1 constitutively expressed the FcγRII/CD32 subtype whereas FcγRI/CD64 and FcγRIII/CD16 were not expressed. This exclusive expression of the FcγRII subtype of IgG receptor is similar to the expression pattern of basophils, although concerning cell surface molecules HMC-1 rather seem to resemble monocytes. In contrast to monocytes the expression profile on HMC-1 did not change upon stimulation with IL-4, TNFα, IFNγ, PMA or salbutamol. Moreover, the mast cell-activating cytokine SCF and the calcium ionophore A23187 did not modulate the FcγR profile in this study. To assess the importance of the exclusive FcγRII expression on HMC-1, we investigated whether the production of the cytokine TNFα is modulated via FcγRII activation or if an increase in intracellular calcium could be observed. No significant modulation of TNFα release or of intracellular free calcium after crosslinking of FcγRII by heat-aggregated IgG or by a second antibody was observed. It remains to be clarified whether this low-affinity subtype for the IgG receptor is involved in antigen-dependent sensitization of human tissue mast cells resulting in secretion of immunoregulatory cytokines. This mechanism may be important for disease states associated with circulating or tissue-bound immune complexes.