Else Svejgaard

Immune reactions to Pityrosporum ovale in adult patients with atopic and seborrheic dermatitis

Pityrosporum ovale is a lipophilic yeast commonly present in the seborrheic areas of the skin of adults. Fifty-five young adult patients with atopic dermatitis, 19 patients with seborrheic dermatitis, and 19 healthy control subjects were examined for immune reactions to P. ovale, including tests for specific IgE antibodies (prick test, histamine release), IgG antibodies and epicutaneous testing. IgE antibodies against P. ovale were found in two thirds of the patients with atopic dermatitis and were more frequent in patients with lesions predominantly in the seborrheic areas. In addition, some atopic patients had positive reactions to epicutaneous tests, which suggest that delayed allergic reactions to P. ovale may also be important. In patients with seborrheic dermatitis, no evidence of immediate or delayed hypersensitivity to P. ovale was found. IgG antibody levels were low in all groups.

HL-A in psoriasis vulgaris and in pustular psoriasis--population and family studies.

A collaborative study of HL‐A typing was done on 156 unrelated patients with psoriasis vulgaris and thirty‐one patients with pustular psoriasis. Highly significant increases of HL‐A13 and HL‐A17 were found in psoriasis vulgaris: about half of the patients carried either of these antigens as compared to about 12% of the controls. The effect of HL‐A13 and 17 is confined almost exclusively to psoriasis with onset before the age of 35 years. In contrast, none of these antigens was increased in pustular psoriasis, indicating that pustular and common psoriasis are different aetiological entities. Family studies in psoriasis vulgaris showed that psoriasis can develop in relatives lacking the HL‐A haplotype following psoriasis in the other family members. Hence, it seems most likely that HL‐A represents only part of the genetic basis of psoriasis vulgaris. This disease is probably of a polygenic threshold character, and HL‐A13 and 17 decreases the threshold making the expression of psoriasis more likely in individuals carrying these determinants in addition to other probably non‐HL‐A linked psoriasis determinants. This concept is supported by the observation of a higher incidence of a positive family history in HL‐A13 and/or 17 positive patients than in patients lacking these antigens. Studies of antistreptolysin O and antistreptococcal hyaluronidase titres and of triggering streptococcal infections yielded no clue as to the pathogenetic effect of HL‐A. The frequencies of HL‐A13 and 17 were not significantly increased in twenty‐one patients with psoriatic arthritis, but HL‐A27 may be increased in these patients. This study shows the importance of HL‐A in the subdivision of diseases and stresses the importance of family studies for clarifying the associations between HL‐A and disease.

IgE-sensitization to cellular and culture filtrates of fungal extracts in patients with atopic dermatitis

BACKGROUND Patients with atopic dermatitis may experience exacerbations of eczema triggered by various inflammatory stimuli. One mechanism may be IgE-mediated reactions to dermatophytes since these patients are more likely to acquire skin infections with dermatophytes and may become sensitized. OBJECTIVE This study investigates IgE-sensitization to fungi in patients with atopic dermatitis and compares the biologic activity of culture filtrates and cellular fungal extracts. The following allergen extracts were provided as culture filtrates and cellular extracts: Candida albicans, Fusarium moniliforme, and Penicillium notatum. In addition, Pityrosporum ovale and Trichophyton rubrum cultures were included in the test panel. METHODS Fifteen patients with clinical findings suggesting dermatophytosis and 11 controls were selected. Each subject was tested by leukocyte histamine release and skin prick test to each fungal extract. The extracts were separated and reduced by sodium dodecylsulfate polyacrylamide gel electrophoresis and analyzed by IgE-immunoblotting with sera from all study subjects. RESULTS Fourteen patients (93%) reacted to one or several fungal extracts by releasing histamine when challenged in vitro. By immunoblotting experiments, patient sera showed binding to a wide range of components in all extracts. Patient sera recognized allergenic components shared by culture filtrates and cellular extracts but with higher frequent and greater intensity in culture filtrates. Although culture filtrates generated more frequent and potent IgE-reactions than the cellular extracts, the difference was not statistically significant. Biologic potency was similar when evaluated by skin prick tests and leukocyte histamine release. CONCLUSION Patients with atopic dermatitis may develop specific IgE-antibodies to a number of fungi as demonstrated by IgE-immunoblotting. In selected patients, fungi may trigger an IgE-mediated reaction that may contribute to the exacerbation of eczema. Approximately, one-half of the patients, however, produced IgE-antibodies to fungal (glyco)proteins without a significant histamine release or skin test response possibly because of nonspecific interaction with carbohydrate moieties on IgE and poor biologic activity of IgE antibodies directed to cross-reactive carbohydrate determinants of fungal glycoproteins. This warrants caution when interpreting clinical relevance of serologic measurements of fungal IgE-antibodies.

Lymphocyte transformation in patients with cobalt dermatitis.

A lymphocyte transformation test with cobalt chloride was performed in 14 patients who had positive cobalt patch tests and eczema compatible with a cobalt induced contact dermatitis and in 9 controls. Eight of the patients had strongly positive patch tests, while 6 had weakly positive patch tests. Patients and controls showed equivalent responses to the mitogens, phytohaemagglutinin, pokeweed mitogen, and concanavalin A, as well as to the recall antigens, purified protein derivative and Candida albicans. A 1:5000 dilution in RPMI‐1640 medium of a 1% aqueous solution of cobalt chloride proved optimal in distinguishing patients from controls. With this dilution, a significantly higher lymphocyte transformation was found in patients with strongly positive cobalt patch tests than in the controls. No significant difference was detected when the results for patients with weakly positive patch tests were compared with those of the controls.

Tinea pedis and erythrasma in Danish recruits

Prior to military service, 665 recruits were examined clinically and microbiologically for tinea pedis and erythrasma and 546 of these were reexamined at the end of military service. The prevalence of clinical signs, erythrasma, and dermatophyte infection at the first investigation was 58.8%, 51.3%, and 6.2%, respectively, and at the second investigation, 81.1%, 77.1%, and 7.0%, respectively. The incidence of tinea pedis was 4.2% during the 9 months of military service. Of those infected at the first visit 41% had persistent infection mainly due to Trichophyton rubrum, whereas new infections were largely caused by Trichophyton mentagrophytes. Some of those persistently infected had signs of chronicity at the follow-up visit, indicating that chronic dermatophytosis may become established in the early twenties. The prevalence of atopy was 15.0% in all the recruits but was almost 50% in those with persistent tinea pedis.

Antibodies against nickel‐albumin in rabbits and man

Five albino rabbits were immunized every 2 weeks by intradermal injections of a nickel rabbit‐albumin complex and during alternate weeks by occluded cutaneous applications of 5% nickel sulphate in petrolatum. After 6 weeks of immunization, passive immunodiffusion disclosed precipitating antibodies against the nickel‐albumin complex in the serum of all the rabbits. The specificity of these antibodies was substantiated by the precipitation of anti‐albumin antibodies with rabbit albumin prior to immunodiffusion.

Tinea pedis and onychomycosis in Danish soldiers before and after service in ex-Yugoslavia.

Seventy‐three 1‐year‐experienced Danish soldiers were examined for tinea pedis as well as onychomycoses before and after a duty period of 6 months in ex‐Yugoslavia. The incidence of fungal infections was 16.4% before and 32.3% after their duty period abroad. At first investigation Trichophyton rubrum and T. mentagrophytes were dominant but onychomycosis and tinea pedis were found as well. In contrast, Candida albicans was the predominant pathogen in the second investigation. We explain this by means of the more aggressive nature that yeasts can show when host–parasite relations are disturbed or compromised. Twelve soldiers with positive mycology were offered treatment and the final investigation showed a cure rate of 50%. This result is satisfactory in view of the difficult sanitary conditions.

T and B lymphocytes in contact and atopic dermatitis

Twenty patients with contact dermatitis, eighteen with atopic dermatitis, two with mixed dermatitis, and 20 controls were examined for the number of T and B lymphocytes, and serum concentrations of IgD and IgE. Significantly higher counts of B lymphocytes bearing IgE and high serum IgE values were found in the atopic group. No other significant differences were found. In particular, we found a normal frequency of IgD bearing lymphocytes in contact dermatitis, and normal T lymphocyte counts in both groups of patients.

The Occurrence of Tinea of the Feet in 15-year-old School Children/Über die Häufigkeit der Tinea pedis unter 15jährigen Schulkindern

Summary: The prevalence of tinea pedis in 347 15‐year‐old school children in the County of Copenhagen was studied. Abnormal toe clefts were observed in 96 (27.7%), the majority being boys. Dermatophytes were demonstrated in 13 cases (3.7%), 9 boys and 4 girls. Corynebacterium minutissimum, the cause of erythrasma, was revealed in clinical symptomatic toe clefts of 17 boys and 0 girls. Six children with tinea pedis had hay‐fever, atopic dermatitis or a family history of atopy, while seven had not This difference is significant (p < 0.05) giving a relative risk of 3.1 for contracting tinea pedis when being an atopic or having an atopic family history.

Hereditary angioneurotic edema and HLA types in two Danish families

SummaryHLA types were determined in 19 patients and 9 healthy members of 2 Danish families with hereditary angioneurotic edema. The study revealed no connections between hereditary angioneurotic edema and the HLA system.