Is food allergy testing reliable in pediatric atopic dermatitis? A population-based study.
Authors: Keck LE, Simpson EL, Berry TM, Hanifin JM
Abstract
We sought to assess the value and reliability of serologic testing for predicting clinical food allergy in a population-based cohort of infants with atopic dermatitis (AD). Infants 3-18 months of age, recruited from the general population, were followed quarterly for 3 years and carefully evaluated for evidence of immediate reactions to foods. Specific serum IgE levels for six foods were assayed at 3-5 years. Parents were interviewed at each visit regarding past/current immediate food-specific reactions involving skin, gut or respiratory systems. ...
Source: Chemical Immunology and Allergy - December 2, 2014 Category: Allergy & Immunology Tags: Chem Immunol Allergy Source Type: research
New strategies for dealing with Staphylococcus aureus colonization and the emerging methicillin-resistant Staphylococcus aureus epidemic in atopic dermatitis.
Authors: Boguniewicz M
Abstract
Atopic dermatitis is a common inflammatory skin disease and a global health problem. Patients are often colonized or infected by Staphylococcus aureus, usually by toxin-producing strains. Methicillin-resistant S. aureus (MRSA) has emerged as an important pathogen. Community-acquired MRSA, a frequent cause of skin and soft tissue infections has become epidemic. Basic skin care measures emphasizing repair and protection of the skin barrier reduce microbial colonization and decrease the need for specific antimicrobial therapy even in patients colonized by MRSA. Novel approaches...
Source: Chemical Immunology and Allergy - December 2, 2014 Category: Allergy & Immunology Tags: Chem Immunol Allergy Source Type: research
Anti-IL-4 as a new strategy in allergy.
Authors: Schmidt-Weber CB
Abstract
Allergic diseases are characterized by an overreaction characterized by Th2-type cell response, and as a consequence, an IgE-switched B cell immunity. Obviously, type-2 cytokines (IL-4, IL-5, IL-9, IL-13) and particularly IL-4 have been identified as potential targets for allergy treatment. While initial experiences using anti-IL-4 principles in asthma were rather ambiguous, more recent studies using an IL-4 mute in blocking the IL-4 and IL-13 receptor have shown promising results. Furthermore, our understanding of IL-4 biology is more specific and may promote more target...
Source: Chemical Immunology and Allergy - December 2, 2014 Category: Allergy & Immunology Tags: Chem Immunol Allergy Source Type: research
New drug targets in atopic dermatitis.
Authors: Simon D, Simon HU
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disorder characterized by eczematous skin lesions, pruritus and typical histopathological features. T cells are thought to play a key role, but B cells might also participate in the pathogenesis of AD. In two investigator-initiated pilot studies, we studied the effects of B cell depletion by monoclonal anti-CD20 antibody therapy or a reduction of activated T cells by LFA3-IgG fusion protein on moderate-to-severe AD. All patients treated with either rituximab or alefacept showed an improvement of their skin symptoms wi...
Source: Chemical Immunology and Allergy - December 2, 2014 Category: Allergy & Immunology Tags: Chem Immunol Allergy Source Type: research
Latest approaches to treating atopic dermatitis.
Authors: Paller AS
Abstract
Recent investigations have shown atopic dermatitis (AD) results from the interplay of epidermal barrier defects, immune dysfunction and environmental triggers. These discoveries teach the importance of addressing all of these factors in treating patients. The barrier issues remind us of the need for moisturizers, especially after bathing, to replenish lipids and decrease water loss. Addition of dilute sodium hypochlorite (bleach) to bathwater often improves the dermatitis of children with moderate-to-severe dermatitis, especially with a history of staphylococcal infection. Oral ...
Source: Chemical Immunology and Allergy - December 2, 2014 Category: Allergy & Immunology Tags: Chem Immunol Allergy Source Type: research
Epidemiology of cutaneous adverse drug reactions.
Authors: Mockenhaupt M
Abstract
Epidemiologic investigations of cutaneous adverse drug reactions (cADR) are important to evaluate their impact in dermatology and health care in general as well as their burden for affected patients. Few epidemiologic studies have been performed on frequent non-life-threatening cADR including reactions of both delayed and immediate hypersensitivity, such as maculopapular exanthema, fixed drug eruption and urticaria. Concerning rare but life-threatening severe cutaneous adverse reactions, e.g. toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS), acute generalized...
Source: Chemical Immunology and Allergy - December 2, 2014 Category: Allergy & Immunology Tags: Chem Immunol Allergy Source Type: research
Genetics and the potential for predictive tests in adverse drug reactions.
Authors: Pirmohamed M
Abstract
Drug hypersensitivity reactions are an immune-mediated reaction to otherwise innocuous antigens derived from drugs. These reactions can affect many different organs, with the skin being the commonest. Skin involvement can range in severity with hypersensitivity syndrome (or DRESS) and the blistering reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis), also termed serious cutaneous adverse drug reactions, being the most severe and most feared. There is increasing evidence for the role of the immune system in the pathogenesis of these reactions, with drug-specific ...
Source: Chemical Immunology and Allergy - December 2, 2014 Category: Allergy & Immunology Tags: Chem Immunol Allergy Source Type: research
Etiology and pathogenesis of adverse drug reactions.
Authors: Hausmann O, Schnyder B, Pichler WJ
Abstract
In clinical routine, adverse drug reactions (ADR) are common, and they should be included in the differential diagnosis in all patients undergoing drug treatment. Only part of those ADR are immune-mediated hypersensitivity reactions and thus true drug allergies. Far more common are non-immune-mediated ADR, e.g. due to the pharmacological properties of the drug or to the individual predisposition of the patient (enzymopathies, cytokine dysbalance, mast cell hyperreactivity). In true drug allergiesT cell- and immunoglobulin E (lgE)-mediated reactions domin...
Source: Chemical Immunology and Allergy - December 2, 2014 Category: Allergy & Immunology Tags: Chem Immunol Allergy Source Type: research
Diagnostic approach to drug allergy.
Authors: Harr T
Abstract
The approach to drug hypersensitivity always comprises a clinical and a diagnostic workup. About 15% of drug side effects are due to hypersensitivity reactions. All types of immunological reactions can be induced by drugs, but type I and type IV reactions are seen most often. The initial judgment of the skin symptoms is therefore one of the key factors besides a stringent history of drug intake for a further diagnostic workup. The goal of a diagnostic workup is not only to identify the culprit drug, but also to defer the patient from similar drugs in order to prevent a second episo...
Source: Chemical Immunology and Allergy - December 2, 2014 Category: Allergy & Immunology Tags: Chem Immunol Allergy Source Type: research
Histopathological patterns indicative of distinct adverse drug reactions.
Authors: Kerl K
Abstract
Histologically, drug eruptions may present virtually all patterns of inflammation in the skin, including spongiotic, lichenoid and psoriasiform dermatitis as well as vasculitis or panniculitis. Drug reactions may mimic specific skin diseases such as lupus erythematosus, lichen planus or lymphoma. While a single drug may cause a wide range of reaction patterns, no reaction pattern is specific for a certain drug. Nevertheless, some reactions are quite characteristic for certain drugs as for example psoriasiform dermatitis for anti-TNF agents or folliculitis for epidermal growth facto...
Source: Chemical Immunology and Allergy - December 2, 2014 Category: Allergy & Immunology Tags: Chem Immunol Allergy Source Type: research
Uncomplicated drug-induced disseminated exanthemas.
Authors: Bircher AJ
Abstract
Exanthematous reactions with various morphological and localization patterns are the most frequently encountered adverse drug reactions involving the skin. The time course of benign exanthemas typically encompasses a few days to some weeks. They are not complicated by severe systemic symptoms or internal organ involvement. They manifest themselves in a polymorphous manner with primary efflorescences including macules, papules, and more rarely limited pustules, vesicles or bullae, followed by secondary lesions such as scales, and more rarely erosions and hemorrhage. Due to the l...
Source: Chemical Immunology and Allergy - December 2, 2014 Category: Allergy & Immunology Tags: Chem Immunol Allergy Source Type: research
Drug-induced angioedema.
Authors: Lerch M
Abstract
Angioedema (AE) is the end result of deep dermal, subcutaneous and/or submucosal swelling, and represents a major criterion in the definition of anaphylaxis. Drug-induced AE, like other cutaneous drug reactions, is most frequently elicited by betalactam antibiotics and nonsteroidal antiinflammatory drugs. However, differences exist in their underlying pathophysiology (IgE mediated vs. pseudoallergic). Blockers of the renin-angiotensin-aldosterone system are the most common class of medications associated with isolated AE and are most probably related to elevated bradykinin levels....
Source: Chemical Immunology and Allergy - December 2, 2014 Category: Allergy & Immunology Tags: Chem Immunol Allergy Source Type: research
Fixed drug eruption: the dark side of activation of intraepidermal CD8+ T cells uniquely specialized to mediate protective immunity.
Authors: Shiohara T, Mizukawa Y
Abstract
Fixed drug eruption (FDE) is generally regarded as representing the mild end of drug-induced dermatitis, but the clinical importance of recognizing this disease as an abortive, localized variant of toxic epidermal necrolysis has received increasing attention in recent years. FDE often presents with a wide spectrum of clinical manifestations indistinguishable from those of other skin diseases, such as erythema multiforme, Stevens-Johnson syndrome /toxic epidermal necrolysis, cellulitis, paronychia, lichen planus, and parapsoriasis en plaques. These unusual forms of F...
Source: Chemical Immunology and Allergy - December 2, 2014 Category: Allergy & Immunology Tags: Chem Immunol Allergy Source Type: research
Drug-induced hypersensitivity syndrome: recent advances in the diagnosis, pathogenesis and management.
Authors: Shiohara T, Kano Y, Takahashi R, Ishida T, Mizukawa Y
Abstract
Drug-induced hypersensitivity syndrome (DIHS), also referred to as drug reaction with eosinophilia with systemic symptoms, is a life-threatening multiorgan system reaction caused by a limited number of drugs such as anticonvulsants. This syndrome is characterized by fever, rash, lymphadenopathy, hepatitis, and leukocytosis with eosinophilia. DIHS has several unique features that include the delayed onset, paradoxical deterioration of clinical symptoms after withdrawal of the causative drug and unexplained cross-reactivity to multiple d...
Source: Chemical Immunology and Allergy - December 2, 2014 Category: Allergy & Immunology Tags: Chem Immunol Allergy Source Type: research
Acute generalized exanthematous pustulosis.
Authors: Sidoroff A
Abstract
The key clinical features of acute generalized exanthematous pustulosis (AGEP) are the acute occurrence of numerous pinhead-sized nonfollicular sterile pustules on an edematous erythema accompanied by fever and leukocytosis. Histology shows mainly spongiform subcorneal and/or intraepidermal pustules, frequently a marked edema of the papillary dermis, neutrophils, and often eosinophils. AGEP is a reaction pattern mostly caused by drugs, the ones with the highest risk being antibacterial agents like ampicillin/amoxicillin, and quinolones, pristinamycin, anti-infective sulfonamide...
Source: Chemical Immunology and Allergy - December 2, 2014 Category: Allergy & Immunology Tags: Chem Immunol Allergy Source Type: research
