Kazuko Sugai

Acute Allergic Reaction due to Milk Proteins Contaminating Lactose Added to Corticosteroid for Injection

We encountered two patients with severe cows milk allergy who reacted strongly to an injection of methylprednisolone sodium succinate (Sol-Medrol 40 mg Pfizer, Japan). They came to our hospital because of an asthmatic attack or urticaria and were treated with Sol-Medrol 40 mg. After the injection, the allergic reaction was immediate. Skin prick tests demonstrated that the beta-lactoglobulin contaminating the lactose of the drug preparation caused the immediate allergic reaction.

Severity of respiratory signs and symptoms and virus profiles in Japanese children with acute respiratory illness

Associations between the severity of respiratory signs and symptoms and the respiratory viruses identified in 214 Japanese children with acute respiratory illness (ARI) enrolled between January and December 2012 were studied. Respiratory rate, wheezing, cyanosis, and the use of accessory muscles were used as indices of respiratory severity and phylogenetic analysis of the viruses identified in these children was performed. Respiratory viruses such as respiratory syncytial virus (RSV), human rhinovirus (HRV), human parainfluenza virus (HPIV), and human metapneumovirus (HMPV) were prevalent, being detected in approximately 70% of the patients (151/214 patients). Co‐detection of viruses occurred in about 9% of patients. RSV was identified more frequently in cases scored as moderate/severe than in those scored as mild (P < 0.05). Severity scores of patients with RSV were significantly higher than those of cases with HPIV. Moreover, severity scores in patients with mild disease and co‐detections were higher than in those in whom only HPIV or adenovirus was detected. Phylogenetic analysis showed that many genotypes of HRV‐A and ‐C with wide genetic divergence were associated with acute respiratory illness (ARI). On the other hand, only a limited number of genotypes of RSV were associated with ARI. HPIV and HMPV were associated with ARI at similar frequencies. These results suggest that different respiratory viruses with unique genetic characteristics can be found in patients with mild to severe ARI.

Identification of biomarkers for predicting the response to cyclosporine A therapy in patients with chronic spontaneous urticaria

Cyclosporine A (CsA) is recommended as a third-line treatment for patients with chronic urticaria (CU) in the guideline of the European Academy of Allergy and Clinical Immunology (EAACI), the Global Allergy and Asthma European Network (GA2 LEN), the European Dermatology Forum (EDF), and theWorld Allergy Organization (WAO); i.e., CsA is recommended for use in patients with severe disease refractory to treatment with not only antihistamines, but also omalizumab.1 However, no useful biomarkers for predicting the therapeutic response to CsA in patients with chronic spontaneous urticaria (CSU) presently exist. This letter describes efforts to identify biomarkers for predicting the response to CsA therapy in patients with CSU. Thirty-four patients with CSU whose symptoms could not be controlled with second-generation H1-antihistamines at a dose of up to 2-fold of the recommended dose were treated with 3 mg/kg/day of CsA2 for 4 weeks in the Department of Dermatology, Nihon University School of Medicine, Japan. Their median age was 47 years (range, 18e82 years), and the median duration of their CSU was 18 months (range, 2e480 months, Table 1). Subjects were excluded if steroids had been used within 3 weeks. Blood tests, which included the serum IgE level, basophil counts, IgG anti-nuclear Abs, IgG anti-thyroglobulin Abs, and IgG antithyroid microsomal Abs, were performed. IgG autoantibodies (AAbs) to FcεRI a-chain (FcεRIa) and IgE were measured using ELISAs (see Supplementary Methods). The autologous serum skin test (ASST) was performed as described previously3 (see Supplementary Methods). The UAS7 is used to quantify the severity of pruritus and the number of hives appearing during a 1-week period.4 Five CSU health states were defined according to the UAS7: urticaria-free (UAS7 1⁄4 0); well-controlled urticaria (UAS7 1⁄4 1e6); mild urticaria (UAS7 1⁄4 7e15); moderate urticaria (UAS7 1⁄4 16e27); severe urticaria (UAS7 1⁄4 28e42).5 This study was approved by the Ethics Committee of the Nihon University School of Medicine, Japan. All the subjects provided written informed consent in accordance with the Helsinki Declaration of the World Medical Association. To identify variables associated with the response to CsA, we compared continuous variables between patients with a positive ASST and those with a negative ASST and between patients whose UAS7 was 6 and those whose UAS7 was >6 after treatment with CsA for 4 weeks using the Mann-Whitney-U test; to compare categorical variables, a 2-