Johannes Ring

Atopic eczema and other manifestations of atopy: results of a study in East and West Germany

Within an environmental health study, dermatologic examination of 1273 pre‐school‐age children (5–7 years old) was carried out in selected areas of East (n= 287) and West (n= 987) Germany in spring 1991. On the basis of comparable genetic background, the influence of a different exposure to air pollutants on the manifestation of atopic diseases was investigated. Halle an der Saale (East Germany) and Duisburg (North/South) as well as Essen (West Germany) were chosen as polluted study areas, whereas the countryside town of Borken (West Germany) served as a control region. Outdoor pollution with particles and SO2 was significantly higher in Halle an der Saale. Of the total study group. 12.9% suffered from atopic eczema at the time of examination. The prevalence was highest in East Germany (17.5%; adjusted odds ratio [OR] 1.39, confidence intervals [CI] 0.77–2.52, compared to Borken). The reported frequencies of hay fever and asthma in the total study population were 2% and 1.3%, respectively, without significant differences between study sites. Some 34.7% of the children showed at least one positive skin prick test reaction; significantly (P< 0.001) higher sensitization rates were obtained in western regions (Essen, Duisburg‐South) than in the control region (Borken) and East Germany. Multivariate analysis of the prevalence of atopic eczema showed associations with parental predisposition (OR 1.52, CI 1.03–2.25), sex (for boys, OR 0.63, CI 0.43–0.92), location (Duisburg‐South vs Borken OR 0.52, CI 0.30–0.96). month of investigation (May vs April, and March vs February OR 0.55, CI 0.37–0.81), contact with rabbits (for girls, OR 2.90, CI 1.36–6.19), animal fur in bedrooms (2.17, 1.01–4.67), indoor use of gas without hood (1.68, 1.11–2.56), and distance of homes from a busy road (<50 m 1.71, 1.07–2.73). Nonsignificant associations were observed for history of helminthic infections (OR 1.61, CI 0.98–2.64) and high parental education level (OR 1.83, CI 0.83–4.02). In East and West Germany, atopic eczema seems to follow a course different from that of respiratory allergic diseases and specific sensitization, a fact which underlines the need for a differentiated analysis.

The atopy patch test: an increased rate of reactivity in patients who have an air-exposed pattern of atopic eczema.

Summary In a subgroup of patients with atopic eczema (AE), eczematous skin lesions can he induced by epicutaneous testing with aeroallergens (the atopy patch test: APT). An increased frequency of positive APT has been found in AK patients showing a predictive lesional pattern affecting air‐exposed skin areas. This study investigates the dose‐response ofthe APT in two dilTerent patient groups with AE. Petrolatum preparations of house dust mite, cat dander and grass pollen allergens in four concentrations (500–10,000) protein nitrogen imits) were tested epicutaneously in 57 patients with AE. who were prospectively divided in two groups according to whether their AE pattern was with (group I) or without (group II) a predictive distribution. Sixty‐nine per cent of patients in group I. and 39% in group II. had positive APT reactions (P = 0.02). The reactions in group I were elicitable with lower allergen concentrations (P = 0.03). A clinically recognizable subgroup of patients with AE showed increased cutaneous sensitivity to aeroallergens.

Antiasthmatic Effects of Picrorhiza kurroa: Androsin Prevents Allergen- and PAF-induced Bronchial Obstruction in Guinea Pigs

In the Ayurvedic medicine, Picrorhiza kurroa Royle ex Benth. is used for the treatment of liver and lung diseases. Using different chemical and pharmacological methods, we could identify the phenol glycoside androsin as active compound preventing allergen and platelet-activating factor induced bronchial obstruction in guinea pigs in vivo (10 mg/kg p.o.; 1 h prior to the inhalation challenge). Histamine release from human polymorphonuclear leukocytes in vitro was inhibited by other compounds yet to be identified.

Autoradiographic mapping of beta-adrenoceptors in human skin

A high density of β2-adrenoceptors has been found in human skin. Using autoradiographic mapping we investigated the distribution of β1- β2-receptors in normal and diseased human skin. Cryostat sections of human skin obtained at biopsy were incubated with [125I]-iodocyanopindolol and nonspecific binding was identified by incubation of adjacent sections with 200 μM (-)-isoproterenol; β2-receptors were visualized using CGP 20712A and β1-receptors using ICI 118,551 as competing agents. The epidermis was densely labelled with an even distribution throughout all layers. Most of the β-receptors were of the β2-subtype with practically no β1-receptors. β-Receptors were also localized to eccrine sweat glands, dermal blood vessels, and perivascular inflammatory cells, but there was no labelling of sebaceous glands. Topical glucocorticoids caused an increase in the density of epidermal β-receptors. We conclude that keratinocytes and eccrine sweat glands express high densities of β2-receptors suggesting that they may have a physiological role in the regulation of these cells.

Histamine, Tryptase, Norepinephrine, Angiotensinogen, Angiotensin-Converting Enzyme, Angiotensin I and II in Plasma of Patients with Hymenoptera Venom Anaphylaxis

Markers of immediate-type hypersensitivity such as histamine and tryptase were measured in the plasma of nonallergic volunteers and patients with a history of hymenoptera venom anaphylaxis. No significant differences in histamine or tryptase were found between patients and controls. Norepinephrine, an important compound involved in the control of cardiovascular functions and blood pressure, was the same in patients and nonallergic volunteers. In addition, components of the renin-angiotensin system were determined. Patients with hymenoptera venom anaphylaxis showed significantly lower plasma angiotensinogen concentrations as compared to healthy nonallergic controls (p < 0.007), whereas plasma ACE activity was the same. Likewise, the plasma levels of angiotensin I and angiotensin II were significantly reduced in patients as compared to controls (p < 0.04 and p < 0.003, respectively). These findings suggest that the renin-angiotensin system may play an important role as a counteracting factor in hymenoptera venom anaphylaxis.

Contamination of heparin by histamine: measurement and characterization by high‐performance liquid chromatography and radioimmunoassay

Plasma samples which were collected in the presence of heparin contained 12.83 ± 0.34 ng/ml histamine‐immunoreactive material (n= 10). In contrast, histamine‐immunoreactive material in plasma samples which were collected in the presence of EDTA/phenanthroline contained 0.32 ± 0.01 ng/ml (n= 10). Histamine‐immunoreactive material was found as a contaminant in three different heparin formulations with unrelated batch numbers. The concentrations of the histamine‐like material were 32.82, 81.93, and 280.23 ng/ml, respectively. Octadecasilyl‐silica (ODS) cartridges were used to purify histamine from other constituents in the heparin preparations. The histamine‐immunoreactive material in the three preparations could be characterized as histamine with cation‐exchange high‐performance liquid chromatography (HPLC) on a TSK SP‐5 PW column with NaH2PO4, pH5.0, as a mobile phase and gradient elution. For the accurate measurement of histamine in plasma samples with heparin as an anticoagulant, one should be aware of a possible contamination of heparin formulations by histamine.

IN vivo modulation of the high affinity receptor for IgE (FcεRI) on human epidermal Langerhans cells

The presence of IgE-bearing epidermal Langerhans cells (LC) has been reported not only in patients with atopic eczema (AE) but also in patients with various inflammatory dermatoses unrelated to atopic

Dyshidrotic cutaneous T-cell lymphoma

In 1887 Kaposi 1 first reported vesiculobullous skin lesions in a patient with mycosis fungoides. Since then only few additional reports of this rare clinical variant have been published. 2-9 In most patients blisters occurred in areas of preexisting mycosis fungoides. Garb and Wise 2 coined the term mycosis fungoides bullosa for this clinical entity. We describe a patient with a dyshidrosis-like eruption on the palms and soles as the first clinical manifestation of a cutaneous T-cell lymphoma (CTCL).

Human Leukocytes Contain Angiotensin I, Angiotensin II and Angiotensin Metabolites

Angiotensin I (ANG I) and angiotensin II (ANG II) were measured radioimmunologically in human leukocytes extracted with a mixture of acetone, 1N HCl and water (40:1:10 vol). The analytical recoveries of 125I-ANG I and 125I-ANG II, which were added prior to extraction, were 92.00 +/- 3.10 and 99.19 +/- 0.91% (mean +/- SEM; n = 12). The concentration of ANG I- and ANG II-like material in leukocytes from healthy volunteers was 32.04 +/- 3.64 and 13.05 +/- 1.26 fmol/mg protein (n = 24). The immunoreactive material could be characterized on HPLC as Ile5-ANG I, Ile5-ANG II and angiotensin metabolites such as Ile4-ANG III, Ile3-ANG II hexapeptide, Ile2-ANG II pentapeptide and Ile1-ANG II tetrapeptide. From the ANG I-immunoreactive material determined in the extracts, 26% could be characterized on HPLC as Ile5-ANG I. The ANG II-immunoreactive material present in the extracts could be separated on HPLC into 44% Ile5-ANG II, 14% Ile4-ANG III, 7% Ile3-ANG II hexapeptide, 4% Ile2-ANG II pentapeptide and 8% Ile1-ANG II tetrapeptide. Patients with a history of anaphylactic reactions to bee or wasp venom showed significantly reduced ANG II concentrations in their leukocytes as compared to controls (6.76 +/- 0.76 fmol ANG II/mg protein, n = 22, vs. 13.05 +/- 1.26 fmol ANG II/mg protein, n = 24; p < 0.05). A significant correlation between the severity of clinical symptoms and the ANG II levels was found for grade I and II reactions (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Plasma concentrations of arginine vasopressin, oxytocin and angiotensin in patients with hymenoptera venom anaphylaxis

The plasma concentrations of arginine vasopressin, oxytocin, angiotensin I and II were studied in patients with hymenoptera venom anaphylaxis (n = 50) and healthy volunteers (n = 25). There was no difference in arginine vasopressin: 5.52 +/- 0.45 fmol/ml vs. 3.99 +/- 0.41 fmol/ml or oxytocin: 28.10 +/- 1.13 fmol/ml vs. 26.24 +/- 1.80 fmol/ml between patients and controls. No correlation between the severity of clinical symptoms and the plasma levels of arginine vasopressin and oxytocin was found in patients. However, patients with a history of hymenoptera venom anaphylaxis showed significantly reduced angiotensin I and angiotensin II plasma levels as compared to controls (ANG I: 9.51 +/- 0.61 fmol/ml vs. 22.91 +/- 1.73 fmol/ml; ANG II: 2.84 +/- 0.16 fmol/ml vs. 6.95 +/- 0.33 fmol/ml). A significant inverse correlation between the severity of clinical symptoms and the plasma levels of angiotensin I and angiotensin II was observed; the lower the concentrations the more severe the clinical symptoms. Oxytocin immunoreactivity eluted from the HPLC column as a single peak with the same retention time as synthetic oxytocin. The vasopressin immunoreactive material could be characterized on HPLC as arginine-vasopressin and two other peptides of unknown nature which crossreacted with the vasopressin antibody. These findings suggest a possible role of angiotensin I and angiotensin II in hymenoptera venom anaphylaxis while arginine vasopressin and oxytocin are most likely not involved.