Cynthia C. McCaskill

Food hypersensitivity and atopic dermatitis." Evaluation of 113 patients

One hundred thirteen patients with severe atopic dermatitis were evaluated for food hypersensitivity with double-blind placebo-controlled oral food challenges. Sixty-three (56%) children experienced 101 positive food challenges; skin symptoms developed in 85 (84%) challenges, gastrointestinal symptoms in 53 (52%), and respiratory symptoms in 32 (32%). Egg, peanut, and milk accounted for 72% of the hypersensitivity reactions induced. History and laboratory data were of marginal value in predicting which patients were likely to have food allergy. When patients were given appropriate restrictive diets based on oral food challenge results, approximately 40% of the 40 patients re-evaluated lost their hypersensitivity after 1 or 2 years, and most showed significant improvement in their clinical course compared with patients in whom no food allergy was documented. These studies demonstrate that food hypersensitivity plays a pathogenic role in some children with atopic dermatitis and that appropriate diagnosis and exclusionary diets can lead to significant improvement in their skin symptoms.

Depressed mood is a factor in glycemic control in type 1 diabetes.

Objective The diabetes literature contains conflicting evidence on the relationship between depression and glycemic control. This may be due, in part, to the fact that past studies failed to distinguish between patients with type 1 and type 2 diabetes. Because these are actually completely different diseases that are often treated differently and consequently make different demands on patients, the relationship between glycemic control and depressed mood in type 1 and type 2 diabetes was examined separately. Methods The relationship between Beck Depression Inventory (BDI) scores and HbA1c, as an index of long-term glycemic control, was measured in samples of 30 patients with type 1 and 34 patients with type 2 diabetes. Results Groups of patients with type 1 and type 2 diabetes did not differ in mean BDI score or HbA1c level. Correlation analysis revealed a significant positive relationship between BDI scores and HbA1c in the type 1 group (r = .44, p < .02) but not in the type 2 group (r = −0.06, p > .05). This relationship was evident throughout the entire range of BDI scores and was not restricted to scores indicative of clinical depression. Patients with type 1 diabetes who had higher HbA1c and BDI scores reported a lower frequency of home blood glucose monitoring. Conclusions Variations in depressive mood, below the level of clinical depression, are associated with meaningful differences in glycemic control in type 1 but not type 2 diabetes. Preliminary data analysis suggests that this effect may be mediated, at least in part, by decreased self-care behaviors in patients with more depressed mood.

The relation of stress and family environment to atopic dermatitis symptoms in children.

The relation of stress and family environment to symptom severity in children with atopic dermatitis (AD) was examined. Forty-four children with severe AD and their families completed questionnaires measuring life events, chronic everyday problems and family environment. Measures of symptom severity were collected during medical evaluation and included an estimate of body surface affected by AD, course of AD symptoms over time, medication usage, and scratching intensity during the day and night. Regression analyses indicated that the measures of stress and family environment were important predictors of symptom severity even after controlling for demographic and medical status variables such as age and serum IgE level. These results have important implications for health care professionals working with children who have AD. Future research directions in the area of stress and AD are discussed.

Relaxation Training for NIDDM: Predicting who may benefit

OBJECTIVE To examine the benefits of relaxation training for patients with NIDDM and to investigate individual differences that could predict a positive response to relaxation training. RESEARCH DESIGN AND METHODS Thirty-eight subjects with NIDDM were treated with intensive conventional diabetes therapy after an initial metabolic evaluation and psychological and pharmacological testing. Half were assigned to also receive biofeedback-assisted relaxation training. Treatment effects on GHb levels and glucose tolerance were evaluated after 8 wk. RESULTS Subjects demonstrated significant improvements in GHb level, but not in glucose tolerance, after 8 wk of intensive conventional treatment. These improvements persisted throughout the follow-up period. However, the group provided with relaxation training did not experience greater improvements on either measure than the group given conventional diabetes treatment only. Within the group that received relaxation training, correlations occurred between the improvements in glucose tolerance after treatment and individual differences in trait anxiety and in the effect of alprazolam on glucose tolerance. Differences in the effects of EPI on glucose tolerance and personality measures of neuroticism and perceived locus of control also appeared to be related to improvements in glucose tolerance after training. CONCLUSIONS Relaxation training did not confer added benefit over and above that provided by conventional diabetes treatment for patients with NIDDM. Additional research is needed to determine whether the administration of relaxation training to selected patients, especially those who are most responsive to stress, would provide benefits for glucose control that are not achieved by conventional treatment.

Examination of the Neuroticism-Symptom Reporting Relationship in Individuals with Type 2 Diabetes:

The current study utilized a within-subject, experience sampling methodology (ESM) to examine the relationship between neuroticism (N) and physical symptom reports. Individuals with type 2 diabetes monitored diabetes-related symptoms, rated negative and positive affect (NA and PA), estimated their blood glucose (BG) levels, and tested their actual BG levels with a glucometer four times per day for 7 days. Multilevel modeling analyses indicated that N, NA, and PA were related to reported symptom frequency. Neuroticism moderated the relation between PA and symptom reports: Lower PA was more strongly related to symptom reports among high-N individuals. In addition, there was evidence that symptoms mediated the relationship between N and state NA. Finally, N was related to overestimation of BG, beyond that accounted for by state NA. Results are discussed with respect to potential effects of N on the processing of negative self-relevant information and on self-regulatory behavior in health contexts.

Personality predictors of mood related to dieting

The clinical utility of a model of normal emotional functioning (vs. psychopathology) and the moderating effects of neuroticism (N) and extraversion (E) on mood were examined during a 6-week weight-loss trial. Participants were 40 obese women who completed measures of negative affect (NA) and positive affect (PA) weekly during the diet and measures of anxiety and depression (Beck Depression Inventory [BDI]) at pre-, mid-, and postdiet. Results indicated that (a) average NA and PA were each uniquely related to postdiet BDI scores, (b) N was significantly related to NA during the diet and postdiet BDI scores, and (c) N and E interacted to predict PA during the diet. The results suggest that assessment of personality and normal mood variation may be useful additions to weight-loss intervention and research.

Direct observation of scratching behavior in children with atopic dermatitis

This study examines scratching behavior in children with atopic dermatitis (AD). Thirty children with severe AD and one parent of each child were observed for a 10-minute observation period during a five-minute structured and five-minute unstructured task. Observers coded child and parent behaviors. Data analyses revealed that children engaged in more scratching behavior during the unstructured than structured task. Furthermore, regression analyses indicated that parent responses to scratching behavior in children were important predictors of scratching behavior even after controlling for demographic and medical status variables, such as serum IgE level and percentage of body area affected by AD. These results have important implications for health care professionals working with children who have AD. Suggestions for future behavioral treatment studies are discussed.

Plasma levels of beta-endorphin and adrenocorticotropic hormone in IDDM and NIDDM.

There has been considerable discussion regarding the role of CNS in the etiology and control of noninsulin-dependent diabetes mellitus (NIDDM; 1,2). One particular area of study has been the possible contribution of endogenous opiates to disordered carbohydrate metabolism (3-5). Vermes et al. (6) found that patients with NIDDM had significantly higher levels of peripherally circulating immunoreactive (3-endorphin and adrenocorticotropic hormone (ACTH) than patients with insulin-dependent diabetes mellitus (IDDM) and control subjects. As part of our investigation of the role of CNS in carbohydrate metabolism, we repeated these measurements on a group of our own patients, with different results. Diabetic patients visiting the Duke University diabetes clinic for routine appointments gave informed consent, and a single venipuncture was performed between 900 and 1130. Subjects consisted of four men and eight women with IDDM (mean ± SD age 36.5 ± 7.3 yr, duration of diabetes 17.4 ± 11.8 yr, % ideal body wt 105.5 ± 9.8%) and