Gerd Michaëlsson

Urticaria induced by preservatives and dye additives in food and drugs

Fifty‐two patients with recurrent urticaria or angio‐oedema and thirty‐three controls have been provoked with five different food dyes and the preservatives sodium benzoate and 4‐hydroxy‐benzoic acid, as well as aspirin, sulphanilic acid and a placebo. The reaction was judged as positive in thirty‐nine patients who developed urticaria within 14 h. Of these, thirty‐five reacted to aspirin, twenty‐seven to benzoic acid compounds and twenty‐seven to azo dyes. The four patients who did not have urticaria after aspirin, reacted with urticaria to benzoic acid compounds, and three of them to azo dyes. No definite pattern for the reaction to the different azo dyes was seen. None had an urticarial reaction from sulphanilic acid, Patent Blue (a non‐azo dye) or placebo. The doses of additives used in the provocation tests are easily exceeded in daily life by the consumption of foods and drugs. Recurrences of urticaria could be prevented through the avoidance of food and drugs containing azo dyes and preservatives.

Urticaria and asthma induced by food-and-drug additives in patients with aspirin hypersensitivity

Abstract Seven of 8 recently investigated aspirin-sensitive patients reacted with asthma, urticaria, or both after 1 to 2 mg. of the azobenzene dye, tartrazine. Tartrazine is commonly used as a food and drug color and a daily intake of several milligrams is possible. The patients also reacted to some benzoic acid derivatives. All of these food-and-drug additives may be difficult to avoid. It is important, therefore, that they are properly identified since they are dangerous for certain patients with asthma and urticaria. Administration of these drugs to patients with a history of reactivity is a procedure of considerable danger that should be done only with extreme caution and informed consent.

Psoriasis patients with antibodies to gliadin can be improved by a gluten‐free diet

In a previous screening study, 16% of patients with psoriasis had IgA and/or IgG antibodies to gliadin (AGA). The aim of the present study was to evaluate the effect of a gluten‐free diet (GFD) in 33 AGA‐positive and six AGA‐negative psoriasis patients. Of the 33 AGA‐positive patients, two had IgA antibodies to endomysium (EmA) and 15 an increased number of lymphocytes in the duodenal epithelium, but in some this increase was slight. Two patients had villous atrophy. A 3‐month period on a GFD was followed by 3 months on the patient’s ordinary diet. The severity of psoriasis was evaluated with the psoriasis area and severity index (PASI). The examining dermatologists were unaware of the EmA and duodenal biopsy results throughout the study. Thirty of the 33 patients with AGA completed the GFD period, after which they showed a highly significant decrease in mean PASI. This included a significant decrease in the 16 AGA‐positive patients with normal routine histology in duodenal biopsy specimens. The AGA‐negative patients were not improved. After GFD, the AGA values were lower in 82% of those who improved. There was a highly significant decrease in serum eosinophil cationic protein in patients with elevated AGA. When the ordinary diet was resumed, the psoriasis deteriorated in 18 of the 30 patients with AGA who had completed the GFD period. In conclusion, psoriasis patients with raised AGA might improve on a GFD even if they have no EmA or if the increase in duodenal intraepithelial lymphocytes is slight or seemingly absent.

Palmoplantar pustulosis: a clinical and immunohistological study.

Pustulosis palmoplantaris (PPP) is a common chronic skin disease, which is very resistant to treatment. It is not known why the lesions are located in the palms and soles. There are few studies of the disease and in particular studies of the histology. Fifty‐nine patients with PPP answered a questionnaire concerning their medical history and 39 of them were clinically examined. Biopsy specimens were taken from involved skin in 22 of the 39 patients and studied immunohistologically for tryptase+ mast cells, EG2+ eosinophils, lipocalin+ neutrophils and CD3+ T lymphocytes. The sweat gland and sweat duct were visualized with AE1/AE3 antibody (cytokeratins 1–8, 10, 14/15, 16, 19). In addition to neutrophils in the pustule and lymphocytes in the upper dermis, there were also large numbers of mast cells and eosinophils in the subpustular area. Numerous eosinophils were present in the pustule. The epidermal part of the eccrine duct was not detectable in any of the specimens from patients with PPP but was present in all of the nine control persons (including two smokers). The results indicate that the acrosyringium is involved in the inflammation and also that mast cells and eosinophils participate in a hitherto unknown way. Of the 39 patients clinically examined, two had previously diagnosed thyroid disease and two had gluten hypersensitivity. Seventeen had one or several abnormal serum concentrations of thyroid‐stimulating hormone, thyroxin, antibodies against thyroglobulin or thyroperoxidase and 10 had immunoglobulin (Ig) A antibodies to gliadin. The mean ± SD for serum IgA and for eosinophil cationic protein was increased. From the questionnaire the most notable finding was that 56 of the 59 patients had been or still were smokers, all of whom had started smoking before the first signs of PPP. We hypothesize that the acrosyringium might be the target for the inflammation and that PPP is linked to autoimmune thyroid disease and smoking.

A follow-up study of patients with recurrent urticaria and hypersensitivity to aspirin, benzoates and azo dyes

We have studied seventy‐five patients with recurrent urticaria and angio‐oedema of more than 4 months duration and with positive provocation tests to aspirin, azo dyes, and/or benzoates. Crossreactions between the test compounds were common. The patients were recommended to be on a diet free from salicylates, benzoates, and azo dyes. They were then followed for 6–24 months. At the follow‐up, 24% were free from symptoms, 57% considered themselves much better and 19% stated that they were slightly better or unchanged. All patients had followed the diet for at least 1–3 months. Most of those who became totally free of symptoms did not continue with the diet, while most of the patients who considered themselves much better found that it was necessary to continue on the recommended diet. They usually developed symptoms as soon as they ingested something containing azo dyes or benzoates. To be able to maintain such a diet, it is important that the content of additives in food and drugs be properly declared.

Infliximab can precipitate as well as worsen palmoplantar pustulosis : possible linkage to the expression of tumour necrosis factor-alpha in the normal palmar eccrine sweat duct?

Infliximab can precipitate as well as worsen palmoplantar pustulosis : possible linkage to the expression of tumour necrosis factor-alpha in the normal palmar eccrine sweat duct?

Patients with psoriasis often have increased serum levels of IgA antibodies to gliadin.

It was recently observed that in six patients with psoriasis and one with palmoplantar pustulosis. with newly discovered gluten intolerance, a gluten‐free diet had a remarkable effect on the skin lesions. This prompted us to undertake a screening investigation to discover whether increased levels of serum antibodies to gliadin are more common in patients with psoriasis than in healthy persons. IgA and IgG antibodies to gliadin (IgA AGA and IgG AGA) were quantified by a micro‐ELISA method.

Expression of nicotinic receptors in the skin of patients with palmoplantar pustulosis.

Summary Background A suggested role for nicotine in the pathogenesis of palmoplantar pustulosis (PPP) has been discussed. The target for the inflammation in PPP is the acrosyringium. Nicotine acts as an agonist on nicotinic acetylcholine receptors (nAChRs) and can influence a variety of cellular functions.

Serum zinc and retinol‐binding protein in acne

The serum levels of zinc and retinol‐binding protein (RBP) have been determined in 173 patients with acne and compared with those of a control group. The RBP is a specific transport protein and its level in plasma reflects the amount of vitamin A available to the tissues. Patients with severe acne were found to have lower levels of RBP than either patients with mild acne or healthy subjects ofthe same age. In the case of males with severe acne, the mean serum zinc level was significantly lower than that of the control group. No such difference was observed for girls. The observed condition of low levels of zinc and vitamin A in the serum of patients with severe acne may provide a rationale for the clinically good effect of oral zinc treatment.

Increased chemotactic activity of neutrophil leukocytes in psoriasis

The random and active migration of neutrophil leukocytes in agarose was studied in sixty‐one patients with psoriasis and in healthy controls. E. coli filtrate was used as chemoattractant. The random as well as the active migration was increased in psoriasis. The increase was most pronounced in those cases with widespread psoriasis. In twenty patients who were followed for 1–3 years, the neutrophil chemotactic activity remained essentially unchanged.