Skin Prick Research Articles

Drug-Induced Anaphylaxis: Clinical Scope, Management, and Prevention

Drug-induced anaphylaxis (DIA) is a severe, life-threatening reaction occurring after drug exposure. It is an important cause of anaphylaxis and accounts for up to one third of drug hypersensitivity reactions. As in other anaphylaxis reactions, immunoglobulin E (IgE) has an important role in its mechanism, but other non-immunological reactions may also occur in DIA. Cutaneous and respiratory symptoms are present in a majority of patients, and cardiovascular events are more common in elderly patients. A complete work up is recommended not just to offer safe alternatives, but also to avoid incorrect labeling of patients as allergic to drugs. The investigation includes in vitro tests when available, followed by skin prick and intradermal tests. Although provocation tests are still considered the “gold standard” for the diagnosis of drug allergy, in DIA, the risk versus benefit ratio must be analyzed. Non-steroid anti-inflammatory drugs and antibiotics are the drug classes more frequently involved. Neuromuscular blocking agents, chemotherapeutic drugs, and biologics are commonly related to reactions in a hospital setting. Prevention measures include an individualized education plan, with recommendations to avoid the culprit drug and potential cross-reactive medications. In selected patients, desensitization can induce a temporary state of tolerance. Protocols are available and can be adapted for drugs used in different situations, from cancer treatment to enzyme replacement therapy.

Two galactose-α-1,3-galactose carrying peptidases from pork kidney mediate anaphylactogenic responses in delayed meat allergy.

Serum IgE antibodies directed at galactose-α-1,3-galactose (α-Gal) are associated with a novel form of delayed anaphylaxis occurring upon consumption of red meat or innards. Pork kidney is known as the most potent trigger of this syndrome, but the culprit allergens have not yet been identified. The aim of this study was the identification and characterization of pork kidney proteins mediating delayed anaphylactic reactions through specific IgE to α-Gal. A cohort of 59 patients with specific IgE to α-Gal was screened by immunoblot for IgE-reactive proteins in pork kidney. Proteins were identified by peptide mass fingerprinting. Isolated proteins were assayed in ELISA and ELISA inhibition, basophil activation and skin prick test. Several IgE-binding proteins of high molecular weight (100- >200 kDa) were detected in pork kidney extracts by immunoblot using patient sera and an anti-α-Gal antibody. Two major IgE-binding proteins were identified as porcine angiotensin-I-converting enzyme (ACE I) and aminopeptidase N (AP-N). Reactivity of patient sera and anti-α-Gal antibody to both proteins was abolished by carbohydrate oxidation. The α-Gal IgE epitopes were resistant to heat denaturation. Pork kidney extract, isolated ACE I, and AP-N were able to activate patient basophils and elicit positive responses in skin prick tests. Two cell-membrane proteins carrying α-Gal epitopes were identified in pork kidney. For the first time, isolated meat proteins were shown to induce basophil activation in patients with delayed anaphylaxis to red meat providing further confirmation for the clinical relevance of these α-Gal-carrying proteins.

Behcet’s Disease and Related Diseases -Immune Reactions to Oralstreptococci in Their Pathogenesis

Behçet’s disease (BD) is a systemic disorder characterized by the recurrent involvement in the muco-cutaneous, ocular, intestinal, vascular, and/or nervous system organs. The clinical muco-cutaneous manifestations including recurrent aphthous stomatitis (RAS), erythema nodosum (EN) –like eruption, genital ulceration, etc. of patients with BD were reviewed in their pathogenesis comparing with the similar symptoms seen in patients without BD (non-BD). Most of BD patients tend to have hypersensitivity against streptococci which might be acquired in the oral cavity through the innate immune mechanism. Generally, BD patients have the systemic symptoms following RAS symptom as an immune reaction. Then, the characteristics of hypersensitivity to oral streptococci may be utilized in order to make a diagnosis for BD. The skin prick with self-saliva including oral streptococci was much more sensitive than “Pathergy test” conventionally used for BD diagnosis. HLA-B51-restricted CD8+ T cell response is suspected to catch the target tissues expressing major histocompatibility complex class 1 chain-related gene A (MICA) by stress in active BD patients. Bes-1 gene and 65kD of heat shock protein (HSP-65) derived from Streptococcus sanguinis (S. sanguinis) are detectable in the lesions. The peptides of Bes-1 gene are highly homologous with the retinal protein Brn3b which might be connected with the eye involvement in BD patients. Also, the peptides seem to be homologous with HSP-65 in association with the human HSP-60 which reactively appeared in serum of the patients involved by S. sanguinis. Then, the pathogenesis of BD was conclusively discussed on the relationship between RAS and the systemic symptoms by the vascular reaction due to immune responses against antigens derived from S. sanguinis. Non-BD patients with RAS and/or Lipschutz genital ulceration were weekly sensitized by oral streptococci, except for patients with EN.

Acute urticaria with angioedema following sea hare ingestion

Seafood is one of the common causes of food allergies to adults. The sea hare Aplysia kurodai is a marine mollusk which belongs to invertebrate gastropod that has been consumed as a food in Korea. Cases of acute toxic hepatitis after ingestion of sea hares have been reported, but few cases of allergic reactions to sea hare have been reported in the literature. A 33-year-old man was referred to our Emergency Department due to urticaria and periorbital/perioral swelling after eating sea hares. Approximately 10 years ago, he experienced similar allergic reactions to it. Skin prick and intradermal tests showed strong positive responses to crude sea hare allergen extract. He was diagnosed with food allergy to sea hares. We herein report the first case of sea hare allergy after ingestion. (Allergy Asthma Respir Dis 2016;4:61-64)

Tranexamic Acid: An Exceedingly Rare Cause of Anaphylaxis during Anaesthesia.

Tranexamic acid (TXA) allergy is extremely rare. An 80-year-old woman without prior exposure to TXA underwent elective knee replacement. Shortly after induction of anaesthesia and intravenous TXA, she developed hypotension, tachycardia, and facial erythema accompanied by a raised serum tryptase. Later, skin prick and intradermal testing confirmed positive responses to TXA in high dilution and with negative results to the other drugs used. While neuromuscular blocking agents, opiates, and antibiotics remain the most frequent cause of anaphylaxis during anaesthesia, allergy to TXA should always be borne in mind and requires skin testing for confirmation as there are presently no blood tests available.

Interleukin-4 and interferon-γ are possible allergic markers in pediatric patients with β-lactam hypersensitivity

Background:β-lactam agents are known to elicit T-cell-mediated immune responses that play a central role in the onset of allergic reactions, but the involvement of specific type of cytokines in drug allergy remains largely unexplored in humans.Objectives:This study was undertaken to investigate the role of cytokines involvement in pediatric patients with β-lactam hypersensitivity and to determine whether involvement of cytokines in drug-mediated reactions are important for the perspective of allergic patient's management.Methods:β-lactam-induced hypersensitivity reactions in eighty pediatric patients were determined by clinical manifestations and skin prick or intradermal testing. Production of T-helper (Th) type-1 cytokine interferon (INF)-γ, Th-2 cytokine interleukin (IL)-4, regulatory T-cell cytokine IL-10, and other cytokines IL-6 and IL-12 were determined by sandwich ELISAs.Results:Diagnosis of β-lactam allergy was confirmed in 53 pediatric patients. IL-4 secretion in patients' sera was significantly higher as compared with healthy controls (P < 0.05). However, INF-γ level in patients' sera was significantly lower as compared with controls (P < 0.05). No significant alterations were found in the protein secretion of IL-10, IL-12, and IL-6 in allergic patients as compared with controls (P > 0.05).Conclusion:We conclude that IL-4 is specific marker for the diagnosis of β-lactam-induced hypersensitivity. Moreover, IL-4 in combination with INF-γ is more sensitive for the diagnosis of these reactions. This study also concludes that both IL-4 and INF-γ may play an active role in the onset of allergic reactions against β-lactam antibiotics.

Emulsification and antioxidation of biosurfactant extracts from Chinese medicinal herbs fermentation in vitro

Much attention has been paid to biosurfactants produced using microorganisms, but little direct evidence for the development of natural biosurfactants combined with Chinese medicinal herbs are available. We investigated the emulsification and antioxidation of biosurfactant extracts from Chinese medicinal herb fermentation (BECMHF) invitro and their application in water retention capacity and the skin prick and allergy test (SPAT) index for skin cells. The results showed that the water retention capacity of BECMHF was positively associated with the emulsification index. The SPAT index of 8 Chinese medicinal herbs was 0 at a 1% or 2% concentration, suggesting no sensitivity or adverse effects on the skin cells. Eight BECMHFs produced using Alcaligenes piechaudii CC-ESB2 exhibited antioxidant capabilities, including 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical and superoxide scavenging activity, and superoxide dismutase (SOD)-like activity at a concentration of 10mg/ml. The mechanism involved inhibitory effects on nitrite, inducible nitric oxide synthase (iNOS) expression, and reactive oxygen species (ROSs) generation. BECMHFs exhibit favorable antioxidative properties in health food and satisfactory emulsifying and moisturizing characteristics in cosmetic formulations, which have potential applications in the health food and cosmetic industries, respectively.

Severe asthma: Characteristics of patients in clinical practice

To provide clinical characteristics of severe asthma (SA) patients encountered in clinical practice. A cross-sectional cohort study was performed to cover 119 outpatients aged 22-82 years. SA was diagnosed according to the ERS/ATS criteria (2014). Spirometry and bronchodilator reversibility testing were carried out; fractional exhaled nitric oxide (FeNO) was measured; inhalant allergen hypersensitivity (skin prick and blood specific IgE testing) and peripheral blood eosinophil counts were estimated. Asthma control and asthma-related quality of life were assessed. 77% of the patients were found to have allergic asthma; in this case, house dust mites were leading allergens in the spectrum of sensitization. 82% of the patients were observed to have uncontrolled asthma and 76% had incompletely reversible bronchial obstruction. The airway eosinophilic inflammation markers (FeNO more than 25 ppb and eosinophil counts of more than 150 cells/µ) were elevated in 63% of the patients. Good compliance was noted in 61% of the patients. There were 27% of active smokers who had lower lung function and FeNO levels. The smokers showed a low compliance with inhaled glucocorticosteroid treatment. SA was concurrent with chronic obstructive pulmonary disease in 37% of the cases. SA is a heterogeneous disease. Traditional treatment is not always effective, as many patients, despite their treatment, have uncontrolled SA and continuously increased markers of airways eosinophilic inflammation. Monoclonal antibody therapy may promote success in treating this cohort of patients.

The potential utility of iodinated contrast media (ICM) skin testing in patients with ICM hypersensitivity.

Both immediate and delayed hypersensitivity reactions to iodinated contrast media (ICM) are relatively common. However, there are few data to determine the clinical utility of immunologic evaluation of ICM. To evaluate the utility of ICM skin testing in patients with ICM hypersensitivity, 23 patients (17 immediate and 6 delayed reactions) were enrolled from 3 university hospitals in Korea. With 6 commonly used ICM including iopromide, iohexol, ioversol, iomeprol, iopamidol and iodixanol, skin prick (SPT), intradermal (IDT) and patch tests were performed. Of 10 patients with anaphylaxis, 3 (30.0%) and 6 (60.0%) were positive respectively on SPTs and IDTs with the culprit ICM. Three of 6 patients with urticaria showed positive IDTs. In total, 11 (64.7%) had positive on either SPT or IDT. Three of 6 patients with delayed rashes had positive response to patch test and/or delayed IDT. Among 5 patients (3 anaphylaxis, 1 urticaria and 1 delayed rash) taken subsequent radiological examinations, 3 patients administered safe alternatives according to the results of skin testing had no adverse reaction. However, anaphylaxis developed in the other 2 patients administered the culprit ICM again. With 64.7% (11/17) and 50% (3/6) of the sensitivities of corresponding allergic skin tests with culprit ICM for immediate and delayed hypersensitivity reactions, the present study suggests that skin tests is useful for the diagnosis of ICM hypersensitivity and for selecting safe ICM and preventing a recurrence of anaphylaxis caused by the same ICM.

The Assessment Of The Risk Of Allergenicity Of ‘Sabina’ And ‘Debreceni Bötermö’ Sour Cherry Cvs (Prunus Cerasus L.) In A Guinea Pig Model

Abstract The allergic reactions to fruits are lesser known among food sensitivities. The most common fruits belonging to the Rosaceae family that might cause allergic reactions are apples, pears and peaches. However, little is known about the potential allergic reactions caused by another member of the Rosaceae, the cherry. The aim of this study was to assess the risk of any allergic reaction or food hypersensitivity resulting from topical application and chronic oral administration of cherry fruits. The cherry fruits ‘Sabina’ cv. were produced in the orchard in Dąbrowice according to the principles of integrated (IFP) and organic (OR) productions. Fruits of ‘Debreceni Bötermö’ cv. were produced in Dąbrowice (IFP), and in the orchard in Nowy Dwór (OR). The experiments were performed on 65 outbred young, adult, white albinotic guinea pigs (Dankin Hartley). Three procedures were applied: I. Guinea-Pig Maximization Test (GPMT); II. Chronic administration of fruits and III. Skin prick (Dreborg) test. The skin reactions based on GPMT or Dreborg tests revealed no differences between the two cherry cultivars ‘Sabina’ and ‘Debreceni’ obtained from integrated or organic production. Similarly, it was not observed of any effect of cultivars of cherries nor the type of fruits production on the guinea pig skin reaction as a result of chronic feeding with fruits.

충주지역 주민 피부 알레르기 반응율에 관한 연구

Objectives: The main purpose of this study is to produce background data which can be compared with several large-scale industrial complex regions. Methods: The framework of this study was designed to evaluate and monitor health effects associated with low-level and long-term exposure to environmental pollutants. In this study, 1,009 local residents were recruited in the city of Chungju using personal questionnaires, medical check-ups, and allergen skin-prick tests for 12 common allergens. The prevalence rate of skin allergens was reviewed together with that from large-scale industrial areas. Results: The diagnosis prevalence and medical treatment prevalence of asthma was 5.6% and 1.7%, respectively. Allergic rhinitis was 25.4% and 16.7%, allergic dermatitis was 16.6% and 9.9% and allergic conjunctivitis was 18.7% and 7.9%, respectively. These results were similar with those of industrial complexes. The prevalence of allergen skin-prick test was 16.4% and the most common allergen was dust mites (27.9-31.6%). This result was lower than those of the industrial complexes (22.5-39.9%) and Gangneung (18.2-24.7%). Conclusion: Further study is required to find the cause of the regional differences in skin prick prevalence.

The Editor takes a closer look at some of this month's articles

Clinical & Experimental AllergyVolume 44, Issue 11 p. 1295-1295 Editor's ChoiceFree Access The Editor takes a closer look at some of this month's articles First published: 21 October 2014 https://doi.org/10.1111/cea.12431AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Eosinophils and atopic dermatitis: a direct link with infection Eosinophilic inflammation is a hallmark of the Th2 responses that underpin allergic disease. There is increasing interest in the importance of the microbiota, particularly Staphylococcus aureus and its toxins in driving allergic inflammation. However, there is relatively little information on the mechanisms by which this might occur although a recent study demonstrated that the δ toxin induced mast cell degranulation 1. Fleminger and colleagues (pp. 1335–1346) help to fill this gap by demonstrating that S. aureus exotoxins can interact with eosinophils via CD48, a member of the CD2 family. Interactions via this receptor mediated eosinophil activation and signal transduction. The authors propose CD48 as a potential therapeutic target for atopic dermatitis. Francesca Levi-Schaffer (a) Confocal microscopy of human eosinophils incubated with SA fixed and stained with DAPI (x630; magnification, zoom 2, Zeiss). Bold arrows indicate SA adherent to the eosinophil surface. Thin arrows indicate the internalized bacteria. (b) Human eosinophils incubated with isotype Ab and FITC-labelled SA. (c) CD48 blocked human eosinophils incubated with FITC-labelled SA, exhibiting EETs. [see figure 2a, b, c, in Y. Minai-Fleminger et al. (pp.1335–1346)]. Resolution of airway inflammation: is it down to gamma-delta (γδ) T cells? The mechanisms involved in the resolution of allergic airway inflammation are relatively understudied compared with studies into the cause of the inflammatory response. γδT have previously been shown to downregulate acute inflammatory responses in the lung. In this issue, Murdoch and colleagues (pp. 1386–1398) have studied the role of γδT in remodelling caused by chronic inflammatory responses in mice in a house dust mite model of asthma. They demonstrated that blockade of γδT exacerbated the inflammatory response and led to a greater degree of remodelling changes. The next step is elucidation of the exact mechanism involved to see whether this can be manipulated for therapeutic gain. Jenna Murdoch Sirius red-stained lung sections demonstrating peribronchiolar collagen deposition from Alum and OVA-treated mice treated with either anti-γδTCR or the Ig control antibody, original magnification 40x. [see figure 2d in J. Murdoch et al. (pp. 1386–1398)]. Wheat allergy: distinguishing IgE sensitization from disease Wheat allergy is common, but as with all food allergies IgE sensitization either by skin prick or in vitro testing is relatively non-specific so that food challenge is often necessary to make a clear diagnosis. Mäkelä et al. (pp. 1420–1430) confirmed this observation by showing that while 93% of children suspected of wheat allergy who had an immediate reaction to eating wheat had specific IgE to wheat, so did 43% of children who had no reaction. They then explored in detail whether IgE against one or more of the many allergenic components of wheat would be more informative 2. They identified five components of wheat including alpha amylase inhibitors as giving greater specificity than whole wheat extract, but none of the components were sufficiently specific or sensitive to be useful diagnostically. The diagnosis of wheat allergy remains ‘challenging’. Mika Mäkelä A wheat field. [Photo credit: Bluemoose; Wikimedia Commons]. References 1Nakamura Y, Oscherwitz J, Cease KB et al. Staphylococcus delta-toxin induces allergic skin disease by activating mast cells. Nature 2013; 503: 397– 401. 2Pahr S, Constantin C, Mari A et al. Molecular characterization of wheat allergens specifically recognized by patients suffering from wheat-induced respiratory allergy. Clin Exp Allergy 2012; 42: 597– 609. Caption to cover illustration: The regulatory role of the airway epithelium. (See figure 2 of M. Loxham et al. pp. 1299–1313). This logo highlights the Editor's Choice articles on the cover and the first page of each of the articles. Volume44, Issue11November 2014Pages 1295-1295 ReferencesRelatedInformation

Drug‐induced skin reaction elicited by clindamycin and penicillin: one rash, but two culprits

Methods and results A 75-year old male suffering from erysipelas received simultaneous treatment with oral clindamycin and i.v. penicillin G, which later was switched to oral penicillin. After eight days of antibiotic therapy an erythematous maculopapular exanthema developed on his trunk and extremities. Treatment was changed to cefuroxime, topical steroids initiated and the skin rash slowly vanished during the following days. Skin prick and intracutaneous tests were negative for penicillin, aminopenicillines, cefuroxime and clindamycine. Patch test revealed delayed type hypersensitivity against penicillin, but not cefuroxime or clindamycin. Thus, an allergic skin reaction against penicillin was assumed. To confirm tolerance of cefuroxime and clindamycin oral challenge tests were performed. However, while cefuroxime (maximal single dose 250mg/d; maximal cumulative dose 750mg/ d) was well tolerated, on the third day of clindamycin application (maximal single dose 300mg/d; maximal cumulative dose 600mg/d) a maculopapular skin rash appeared, which was successfully treated with oral prednisolon. Since the positive patch test reaction could have simply resembled a penicillin sensitivity but not indicated a true allergic reaction, i.v. provocation with penicillin G was performed (maximal single dose 5 million IU/d; maximal cumulative dose 8 million IU/d). Interestingly, after two days a macuolpapular rash developed, which was again efficiently treated with oral prednisolon. Conclusion In summary, a delayed type drug reaction against both clindamycin and penicillin could be diagnosed, which became manifest as skin rash while both were taken at the same time. This case report underlines the value of provocation tests in diagnosing drug allergy, especially, when several drugs are potential culprits, and even if one drug has already been tested positive by skin tests.

Hypersensitivity to betalactam antibiotics: a three years characterization of an Immunoallergy Outpatients' Hospital

Methods Retrospective analysis of clinical files and results of skin testing and DPT (drug provocation tests) from January 2011 to December 2013. All patients were studied according to standardized diagnostic procedures of ENDA/EAACI: serum sIgE (specific IgE) (ImmunoCAP, ThermoFisher) to penicillin G/V, amoxicillin and ampicillin; skin prick and IDT (intradermal tests) to PPL/MD (DAP, Diater), penicillin G, amoxicillin and cefuroxime with immediate and delayed reading. Other penicillin derivatives/cephalosporins were tested if they were the culprit drug. DPT with culprit drug was performed if previous investigation was negative. In confirmed cases an alternative BL was tested.

Impact of sulfur and vitamin C on the allergenicity of Mal d 2 from apple (Malus domestica).

Mal d 2 is a minor allergen from apple which shows a high conformational stability due to its eight conserved disulfide bridges. Chemical reduction of disulfide bridges and linearization of Mal d 2 lead to enhanced IgE reactivity in vitro and indicate a higher potential for allergenicity. Since food preservatives such as sulfur and vitamin C are reducing and denaturing agents, their influence on Mal d 2 allergenicity was verified by simulated food processing conditions. The immunoreactivity of purified Mal d 2 was investigated after different treatments in vitro and in vivo using IgG/IgE Western blotting, mediator-releasing cell assay, and skin prick and oral smear tests. The conformational changes of Mal d 2 upon addition of 1% and 5% vitamin C were also monitored by attenuated total reflectance Fourier transform infrared spectroscopy. The results show no positive skin and oral smear test reactivity to native, heated, or vitamin C-treated purified Mal d 2. Furthermore, the results confirm that sulfur in combination with heat treatment can influence the structural integrity and thus the allergenicity of Mal d 2, while vitamin C is too weak as a reducing agent to change allergenicity.

Physician Specialty Influences Important Aspects of Pediatric Asthma Management

Physician training influences patient care. To compare asthma management and change in the percentage predicted FEV1 among pediatric physician specialties. A retrospective cohort of children 6 years of age or older, seen in a multidisciplinary asthma clinic between 2009 and 2010, and followed to 2012, was completed to examine differences in asthma outcomes by specialty (2 pediatricians, 3pediatric allergists, 5 pediatric respirologists). Univariate analyses compared investigation, including allergy testing (skin prick or RAST), comorbid conditions, and prescription by specialty. Multivariate regression, which controlled for random effect of the individual physician, examined specialty differences for prescribed inhaled corticosteroids (ICS) and changes in percentage predicted FEV1. More than 56% of the patients (309/548) were seen by pediatric respirologists, 26% by pediatric allergists, and 18% by pediatricians. Physician specialty influences investigation requested, comorbid diagnoses, treatment, and improvement in FEV1. Pediatric allergists' patients had more allergy tests, were more likely to be diagnosed with allergic rhinitis and, consequently, were more likely to be prescribed nasal steroids than pediatricians and pediatric respirologists. Pediatricians were less likely to prescribe ICS (odds ratio 0.39 [95% CI, 0.15-0.96]; P < .05) than pediatric allergists, with the greatest difference in ICS prescription among children with a percentage predicted FEV1 ≥80%. Improvement in FEV1 among children who received carewith pediatric allergists was higher than those seen by pediatricians (13%; P < .001) and pediatric respirologists (8%; P= .005). Patient management domains with the greatest room for discretion (investigations, comorbid diagnoses, and treatment with ICS among children with normal lung function) are most heavily influenced by physician specialty. These results have implications for asthma management at the patient level and in future practice guidelines.

Beliefs of People With Diabetes About Skin Prick During Ramadan Fasting

A large number of adult Muslims choose to fast during the month of Ramadan. The Ramadan fasting lasts 29–30 days, depending on the sighting of the moon. The duration of the fast can be 12–19 h, depending on the regional equatorial position. People with serious illness and long-distance travelers are exempted from fasting, but they have to fast after Ramadan to complete the missed days, except for those with serious disease (1). Most of the people with chronic diseases such as diabetes do not like to quit fasting. Studies show that individuals are exposed to risks if they do not modify their lifestyle and monitor their blood glucose during the Ramadan fasting (2–4). A retrospective observational study was planned to assess the existing beliefs and practices of people with diabetes about skin prick …

Diagnostic yield of allergy testing in Pediatric Eosinophilic Esophagitis: a 10 year experience at a tertiary care centre

Background Eosinophilic Esophagitis (EoE) is a disease in children characterized by esophageal dysfunction and eosinophilic infiltration [1]. Patients frequently present with an atopic history; therefore, allergy testing by both skin prick and food patch testing are often performed. However, the utility of allergy testing remains unclear [1,3]. Treatment with topical corticosteroids may be needed for clinical and histologic improvement if allergic triggers are not identified [1,2]. However, the natural history of EoE suggests that this condition is chronic and may recur when corticosteroids are withdrawn [2]. Therefore, treatment with dietary/aeroallergen avoidance is preferable to reduce the need for oral corticosteroids, while preventing exacerbation of EoE [3]. This study aims to describe the atopic characteristics of a pediatric cohort with EoE over a 10 year period at a tertiary care center.

Considerations concerning the epidemiology of occupational dermatoses.

Considerations concerning the epidemiology of occupational dermatoses.

A New Diagnostic Way for Behcet's Disease: Skin Prick with Self-Saliva.

Behcet's disease (BD) is a mysterious multisystemic disorder characterized by recurrent involvement of mucocutaneous (including recurrent aphthous stomatitis; RAS), ocular, intestinal, vascular, and/or nervous system organs. Previously, the positivity of “pathergy test”, which is one of the diagnostic examinations, was reported to be related to the possession of HLA-B51 gene in BD patients, even though the positivity is low and different from the countries. Here, instead of the ordinal pathergy test, we would like to propose the prick with self-saliva as a new diagnostic way for patients with RAS of BD based on the genetic intrinsic factors including HLA-B51 and extrinsic triggering factors. BD patients are considered to acquire the hypersensitivity against oral streptococci through the innate immune mechanism in the oral cavity. Bes-1 gene and 65 kD of heat shock protein (HSP-65) derived from oral S. sanguinis are supposed to play important roles as extrinsic factors in BD pathogenesis. Although the prick positivity was not related to the possession of HLA-B51 gene, the method is suggested to be a significant way for BD diagnosis. The results also suggest that BD symptoms are due to the vascular immune responses by monocytes expressed oral streptococcal agents of the patients.