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Notes: Severity scoring of atopic dermatitis (SCORAD) was introduced as a standard tool but has not been used in a population-based epidemiological study; the objective of the present study was to determine the practicability of this instrument in this setting. We assessed the distribution of the severity of atopic eczema in the community and investigated differences between east and west Germany. A factor analysis was then carried out to characterize the variables of this scoring system and to analyse possible relationships within them. A multicentre cross-sectional study was carried out in five east German and two west German locations in 1994; pre-school children (5–6 years old) were investigated and cases of atopic eczema identified by a dermatological examination. The SCORAD was used to determine the severity of atopic eczema and the results assessed using analysis of variance and principal component analysis (varimax rotation). In all, 1511 (76·2%) of the children originally contacted participated and 11·3% were diagnosed with atopic eczema at the time of examination. The median severity score was 21·4 (interquartile range 13·5) and there was a tendency to higher scores in west Germany for the mean overall score, the intensity score and the extent. ‘Erythema’ (1·30 vs. 1·06; P= 0·006) and ‘excoriation’ (0·77 vs. 0·36; P= 0·002) were significantly more prominent in children with eczema from west Germany (adjusted for observer). Interobserver variabilities of the SCORAD parameters were calculated, adjusted for location and were in accordance with earlier findings. Principal component analysis identified three independent factors accounting for 54·1% of the total variance. A severity factor, characterized by ‘extent’, ‘lichenification’, ‘excoriation’ and ‘pruritus’, was separated from a factor with an acute eczema-type profile (‘erythema’, ‘oedema’, ‘oozing’) and a factor whose major characteristics were ‘extent’, ‘dryness’, and ‘sleep loss’. We conclude that atopic eczema is frequent in pre-school children. The SCORAD proved to be readily applicable and useful in epidemiological studies, but further validation is needed.

Notes: A 51-year-old white male suffering from metastatic malignant melanoma of the skin presented with lymph node metastases and paraneoplastic retinopathy 4 years after resection of the primary tumour. There were no cerebral metastases. Ocular symptoms consisting of night blindness and sensations of ‘shimmering lights’ persisted after total resection of the inguinal lymph node metastases and administration of dacarbazine and prednisone. Perimetry of both eyes was abnormal with concentric restriction. Electroretinography showed significantly reduced amplitudes in both eyes. Only 11 patients with melanoma-associated retinopathy (MAR) have been described. High titres of autoantibodies against whole retina extract were detected by enzyme-linked immunosorbent assay (ELISA) reactions. Indirect immunohistochemistry showed strong autoantibody activity against retinal bipolar cells.

Notes: After contact with grass pollen, seasonal exacerbations of eczematous skin lesions have been described in a subgroup of patients with atopic eczema (AE). Epicutaneous patch testing with aeroallergens (atopy patch test, APT) has been used to investigate these patients. We performed comparative APT in 79 patients with AE and 20 control subjects (14 non-atopic volunteers and six patients with grass pollen allergic rhinoconjunctivitis). Subjects were tested with grass pollen allergen extract in petrolatum and with unprocessed native dry pollen of Dactylis glomerata. Results after 48 h were compared with the patient's history, corresponding skin prick test and specific IgE. Fifteen of the 79 AE patients showed clear-cut eczematous reactions to unprocessed D. glomerata pollen; 14 of these had an elevated serum IgE to D. glomerata and 13 had a positive skin prick test. Twenty patients had a positive APT reaction to grass pollen allergen extract, including 12 of the D. glomerata reactive subjects (P 〈 0.001). Positive patch test reactions to D. glomerata were seen in 66.7% of cases with and 10.5% of patients without a predictive history of exacerbations during the pollen season. For the standardized extract, these percentages were 75% vs. 16.4% (P 〈 0.001). No side-effects were observed. Control subjects showed no positive reactions. We conclude that grass pollen preparations may be used to investigate trigger factors for eczematous skin lesions in a subgroup of patients with AE.

Notes: Cytokines have been proposed as histamine-independent itch mediators. To investigate this hypothesis, single doses of interleukin-2 (IL-2, 10MU/mL) and tumour necrosis factor α (TNF-α, 10 μg/mL) were delivered to the epidermis of 10 healthy volunteers with a controlled skin-prick model; 1% histamine and solvent controls were included in a double-blind, randomized crossover design. Itch ratings (computerized visual analogue scale) were obtained every 20s for 15 min and cutaneous reactions (weal, flare and temperature) were measured. Reactions were also recorded after 2, 24 and 48 h. The mean itch ratings were: histamine 35·5, IL-2 3·3 (both P〈0·01 compared with control), TNF-α 1.6 and solvent control 1.75 (not significant). Weal and flare occurred only with histamine. In two volunteers, an inflammatory papule with transient pruritus developed 12–18 h after applying IL-2. In conclusion, IL-2 showed a rapid, low pruritogenic effect, which may be followed by an inflammatory response. TNF-α induced no itching in this setting. Skin-prick testing with appropriate doses of potential pruritogens provides a safe and sensitive model for further chemoreceptor studies.

Notes: 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.

Notes: The first months of life may be an important period for allergic sensitization. Several studies suggest a relationship between the month of birth (MB) and the development of skin sensitivity to aeroallergens or the manifestation of an atopic disease. In 1988 and 1989 we investigated a population of 1066 Bavarian preschool children aged 5–6 years. Skin prick tests were performed with common aeroallergens (grass pollen, birch pollen, house-dust mite, eat epithelia). The personal history of atopic disease (atopic eczema, allergic rhinitis, bronchial asthma) was recorded by a questionnaire, and the presence of overt atopic disease was documented by a personal examination. Positive prick test reactions to the above-mentioned aeroallergens were found in 15.4%, 9.2%, 12.2%, and 10.4% of the subjects, respectively; lifetime prevalence of manifest atopic disease was 22.2% for atopic eczema, 11.7% for allergic rhinitis, and 4.5% for asthma. The MB distributions of children reacting to aeroallergens or of those with atopic diseases were compared with those of subjects with corresponding negative findings. Chi-square tests were performed for each aeroallergen and each of the atopic diseases separately. No significant differences among the MB distributions were found (P〉0.3). Thus, in this coherent group. MB correlated neither to allergic sensitization nor to manifest atopic disease.

Notes: In a total of 525 patients with hypersensitivity reactions to hymenoptera stings diagnostic parameters of hymenoptera venom (HV) allergy (severity of reactions, skin test threshold and RAST for bee and vespid venoms) were investigated for their relationship to the following indicators of atopy: positive history of atopic diseases, elevated (≤ 100 kU/1) total scrum IgE and positive prick test reactions to common inhalant allergens (CIA) (grass pollen, cat epithelium, house dust mite). There was a conclusive history of atopic disease in 25%, a total serum IgE ≥ 100 kU/1 in 48%, and at least one positive reaction to CIA in 53%. Total IgE ≥ 100 kU/l correlated with a higher frequency of RAST classes ≥ 2 (P 〈 0.01) and with less severe reactions to hymenoptera stings (P 〈 0.05). In the presence of at least one positive reaction to CIA, there were more frequently skin test thresholds ≤ 10 μg/ml (P 〈 0.05) and RAST classes ≥ 2 (P 〈 0.01) for HV than in CIA prick test negative individuals. There was no significant relationship between the other pairs of parameters evaluated. Thus, reactivity to HV in diagnostic tests is increased in the presence of certain indicators of atopy. This has to be considered in the interpretation of skin test and RAST results obtained with HV.

Notes: During rush venom immunotherapy (VIT), about 65% of patients develop large local reactions (LLR) at the application site that last for at least 24 h. However, LLR subside during long-term treatment. To learn more about the provenance of infiltrating cells in late, local skin reactions during VIT, we analyzed the skin infiltrates of 23 Hymenoptera venom (HV)-allergic patients. Punch biopsies were obtained 24 h after s.c. injection of HV allergens from 23 HV-allergic patients and five nonallergic controls. Seven patients did not show LLR at the beginning of VIT. Ten patients had LLR when the dose of HV allergens was increased. Six patients showed reduced LLR after long-term treatment. Immunoenzymatic labeling of the cryostat sections with a panel of monoclonal antibodies was performed by the APAAP method. S.c. application of HV allergens induced a perivascular and periadnexial cutaneous mononuclear cell infiltrate consisting mainly of CD4+, CD45RO+, and HLA-DR+ cells in patients without clinically apparent LLR. In contrast, LLR were associated with a significant increase in total cells, CD4+ cells, CD8+ cells, CD11c+ cells, EG2+ cells, NP57+cells, HLA-DR+ cells, CD45RO+ cells, CD45RA+ cells, CD23+ cells, and CD25+ cells (P 〈 0.001). Decreased LLR after long-term VIT was correlated with a significantly reduced recruitment of CD4+ cells, EG2+ cells, and CD23+ cells as compared to LLR in the course of dose increases (P〈0.05), whereas the number of CD8+ cells, CD11c+ cells, NP57+ cells, and CD25+ cells remained high. Our data suggest that s.c. injections of HV allergens attract CD4+ helper T cells, of both the naive (CD45RA+) and memory (CD45RO+) phenotypes, to the allergen application site. LLR represent delayed allergic rather than toxic reactions to HV components and might be relevant to the development of clinical protection during VIT.