Toshiyuki Aoki

Acute Urticaria: History and Natural Course of 50 Cases

Fifty patients with acute urticaria who visited within a week after the onset were interviewed and the history around the onset of urticaria was carefully taken. It was known that the majority of the patients had experienced some symptoms suggestive of infection. The patients were followed up for a year to determine the last efflorescence. It was disclosed that 43 cases were cured within two weeks and 5 other cases were cured between 2 weeks and 3 months. The remaining 2 cases persisted over a year.

Studies on Carrier Substances of DNCB Contact Allergy

To elucidate the sensitization mechanism of allergic contact dermatitis isolation of carrier substances from DNCB-treated epidermis was attempted. The homogenate of the epidermis was found to contain immunogenic substances. One of its subcellular fractions could elicit intense contact hypersensitivity although it contained less amounts of haptenic groups than other fractions. Electron microscopy revealed it to be the microsomal fraction of epidermal cells. Treatment of the fraction with deoxycholic acid caused slight reduction of its immunizing ability.

English version of the interim report published in 1998 by the members of the Advisory Committee on Atopic Dermatitis Severity Classification Criteria of the Japanese Dermatological Association

The Japanese Dermatological Association established an advisory committee in 1995 to set up severity scoring systems for atopic dermatitis (AD). Its interim report was published in Japanese in the Japanese Journal of Dermatology (108: 1491–1496, 1998) by Chairman Hikotaro Yoshida. Because of the strong demand for an English version, we have decided to publish the report in English. This prospective study was designed to evaluate the status of 259 AD patients using Method 1, which involves a simple global evaluation of disease severity; Method 2, which involves global evaluation by summing severity scores obtained from five body regions (i.e. the head and neck, anterior and posterior trunks, and upper and lower limbs); Method 3, which consists of both assessment of the extent of involved areas at each of the five body regions and that of the severity scores of each eruption component observed in the most severely affected body region; and Method 4, which consists of the evaluation of only subjective components (daytime pruritus and sleep disturbance). Employing the results obtained with Method 1 as a tentative benchmark, we analyzed its correlation with those of Methods 2, 3 and 4 to statistically assess the validity and reliability of these methods. Method 2, Method 3 and the portion of Method 4 involving evaluation of only the subjective symptom of daytime pruritus but not the sleep disturbance were considered useful in evaluating AD severity.

Type I wheat ingestion allergy: a model of masked allergy.

Type I wheat ingestion allergy is a special type of food allergy because the patient usually is not aware of his allergy. The unawareness comes from two reasons; one is that the clinical symptom appears not immediately after ingestion of wheat products but occurs sometime (30-60 min) later, and the other is that it may not appear if the patient does not exercise at this particular time. Therefore, the reaction does not always follow wheat ingestion. The study of enzymatically digested gluten antigens in the patients disclosed that the allergenicity to wheat was reinforced by peptic digestion but abolished by further tryptic digestion, indicating that allergen activity was most potent in the stomach. Anaphylaxis may occur in some patients after wheat ingestion and exercise. Therefore, in exercise-induced anaphylaxis without apparent allergy, one should consider wheat allergy.

INDUCTION OF CONTACT SENSITIVITY BY EPIDERMAL MICROSOMES DINITROPHENYLATED IN VITRO

Epidermal microsomes were dinitrophenylated in various concentrations to obtain the optimum ratio of hapten to microsome for induction of contact sensitivity. The epidermal microsomes with 494 μg of dinitrophenyl residue produced sensitization, whereas the sensitizing ability of those with less than 114 μg of dinitrophenyl residue was incomplete or lacking. The optimum amount of dinitrophenyl residue for sensitization of all animals tested was much higher than that in the epidermal microsomes extracted from DNCB treated animals.

Atopy-related skin rash in a normal population of infants: Distribution and rates for 50 separate skin regions: Cohort study from 4 months to 3.5 years

Analysis of the rash in a normal population of infants may give new information that is different from clinical observation of atopic dermatitis (AD). For this purpose, a cohort study was undertaken on infants at 4 months, 10 months and 3.5 years. Infants who attended the local health center for health check were the subjects. Rash related to AD, dryness, scaling, erythema, papules, exudation and crusts was recorded in 50 skin regions and divided into three degrees. Examination was performed twice a month for a year at each age. The 777 infants who attended all three examinations were analyzed in this report. Rash‐positive regions were 14.7% on average at 4 months and decreased with age. Prevalence of rash‐positive infants was 93.6% at 4 months and also decreased with age. The main findings are as follows. First, rash was more frequent and more severe in younger infants. This seems to suggest that AD in early infancy is initiated and developed by immune immaturity, and is resolved by its maturation. Second, rash involved preferentially air‐exposed and air‐closed skin in younger infants. This seems to be evidence that the epidermis of young infants is easily responsive to both dryness and wetness. Third, some regions did not show age‐dependent reduction of rash rate in younger infants. Those regions are probably irritated by saliva and urine or rubbing and scratching.

English version of the concluding report published in 2001 by the Advisory Committee on Atopic Dermatitis Severity Classification Criteria of the Japanese Dermatological Association

The Japanese Dermatological Association established an advisory committee in 1995 to develop a severity scoring system for atopic dermatitis (AD). Its interim and concluding reports were published in Japanese in the Japanese Journal of Dermatology (108: 1491–1496, 1998 and 111: 2023–2033, 2001). Because of the strong demand for an English version, we have decided to publish the reports in English. This manuscript is the English version of the concluding report. The interim report suggested that eruption components such as erythema, papule, erosion, crust, excoriation and lichenification with extent of involved areas in five body regions, including the head and neck, anterior and posterior trunks, and upper and lower limbs, were important items for assessing AD severity. Additionally, it was recommended that streamlining of eruption components was mandatory for improving the statistical validity and reliability. The committee members subsequently concentrated their efforts on this task, and finally proposed an Atopic Dermatitis Severity Classification Criteria of the Japanese Dermatological Association.