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Notizen: Background:  As the literature has only controversial data on the role of nonallergen-specific antibodies in atopic eczema dermatitis syndrome, the authors investigated the link between the occurrence of the antiphospholipid [anticardiolipin (ACL), anti-β2-glycoprotein I] and allergen-specific immunoglobulin E (IgE) antibodies in 72 children with atopic eczema/dermatitis syndrome (AEDS).Methods:  The measurement of antiphospholipid antibodies was carried out by enzyme-linked immunosorbent assay (ELISA), serum total IgE by nephelometry, and allergen-specific IgE by immunoblotting assay. The statistical analysis was carried out by Fisher's exact test and odds ratio was calculated.Results:  Thirteen of 72 children with AEDS (mean age 8.3 years) had elevated serum levels of ACL, and eight anti-β2-glycoprotein I antibodies. The presence of allergen-specific IgE against inhalant allergens and nutritive allergens was among eight of 13 and three of eight in the cases with elevated ACL. The ratio of patients with highly increased severity scoring of atopic dermatitis (SCORAD) index (〉75) was significantly higher in the group with elevated (4/13) than in those with the normal ACL levels (2/59). There was a significant association between the appearance of mite (Dermatophagoides pteronyssinus, D. farinae)-specific IgE and ACL IgM antibodies (6/13).Conclusion:  These findings show that there are significant linkage and association between the appearance of ACL IgM or the production of allergen-specific IgE against inhalant (mainly mite) allergens in children with atopic eczema/dermatitis syndrome.

Notizen: Background Diabetes mellitus (DM) affects an estimated 175 million people world-wide. Approximately one-third of patients with DM have toenail onychomycosis. Objectives To determine the efficacy and safety of terbinafine treatment of toenail onychomycosis in patients with DM receiving insulin and/or oral antidiabetic agents. Special interest was focused on potential drug interactions with oral hypoglycaemic substances. Methods In a multicentre trial, patients suffering from insulin-dependent DM (IDDM) or non- insulin-dependent DM (NIDDM) with toenail onychomycosis were treated for 12 weeks with oral terbinafine 250 mg daily and followed up to 48 weeks. In addition to clinical, mycological and laboratory investigations, blood glucose levels were monitored. Results At the end of the trial (week 48), a mycological cure rate of 73% was achieved. The rates of␣clinical cure and complete cure (mycological cure plus clinical cure) were 57% and 48%, respectively. There was no statistically significant difference between the NIDDM and IDDM groups with respect to the cure rates (P 〉 0·05). No hypoglycaemic episode was reported and none of the patients had hypoglycaemia during the treatment phase. Conclusions With excellent cure rates and a good tolerability profile, terbinafine should continue to be a drug of choice for the treatment of toenail onychomycosis in the rising number of NIDDM patients receiving multiple medication.

Notizen: Four thousand, three hundred and ninety-two lymphocyte transformation tests with seventy-nine different drugs were performed in 1723 patients because of the clinical suspicion of drug hypersensitivity. The optimal stimulating concentration and the lowest cytotoxic concentration were determined for every drug, and transformation tests were carried out only with those drugs whose optimal stimulating concentration was lower than its lowest cytotoxic concentration.The transformation tests gave positive results in 557 of the 1723 patients (32%); hypersensitivity to one drug could be confirmed in 410 cases (24%), and to two or more drugs in 147 cases (9%). It is considered that the test is a valuable in vitro method in the diagnosis of drug allergy, and that its application can lead to a substantial decrease in the number of patients who must be subjected to the possible risk of in vivo tests for the determination of the sensitizing drug.

Notizen: It is generally accepted that keratinocyte migration plays a critical role in the process of wound healing. A study was therefore made of the migratory response of freshly separated and cultured human keratinocytes to factors with chemotactic properties for a variety of cells. Interleukin-lα (IL-lα), interferon-γ (IFN-γ), interleukin-8 (IL-8), and tumour necrosis factor α (TNF-α) were tested for their chemotactic effectiveness in a modified Boydcn chamber assay. IFN-γ, IL-lα and IL-8 were demonstrated to serve as chemoattractants for freshly separated keratinocytes. For cultured cells, however, only IFN-γ was found to display chemotactic properties. The findings demonstrate that there is significant difference between the chemotactic behaviour of freshly separated and cultured cells.

Notizen: Background  The autoimmune subclass of chronic idiopathic urticaria (CU) has been characterized by the occurrence of biologically relevant IgG antibodies against the IgE molecule or the α chain of the high-affinity Fcɛ receptor (FcɛRIα) on basophils and mast cells. These antibodies are usually detected by autologous serum skin testing and confirmed by histamine release studies, immunoblotting, or enzyme-linked immunosorbent assay, but not always.Objectives  To detect autoantibodies to the FcɛRIα in sera of CU patients by a modified serum-induced basophil activation test measured by flow cytometry (FCM) and to evaluate the relationship between the in vitro functional test, the autologous serum skin test (ASST), and the serum levels of IgE, eosinophil cationic protein (ECP) and antithyroid antibodies.Methods  Sera of 30 patients with CU and 26 patients with systemic autoimmune diseases (systemic lupus erythematosus, dermatomyositis) were tested for CD63 activation marker expression on basophils by FCM. Leucocytes from two highly sensitized atopic donors (DA1, DA2) and one non-atopic donor (DNA) were incubated with patients' sera and double-labelled with anti-IgE and anti-CD63 antibodies. Subsequently, the percentage of CD63-expressing basophils was determined by using FCM. In all CU patients an ASST was carried out and the serum IgE, and ECP levels and antithyroid antibodies were evaluated.Results  Twelve patients had a positive ASST and 14 patients a positive CD63 expression assay. There was a strong correlation between the ASST and CD63 assay. Sera from patients with systemic autoimmune diseases did not raise positive CD63 expression on basophils. There was a moderate negative correlation between the occurrence of atopic serum markers (IgE, ECP) and the ability of sera to induce CD63 expression on basophil cells of DA2 (P 〈 0·05). The female sex was preponderant and antithyroid antibodies were more frequent.Conclusions  Our new technical observation demonstrates that basophils of highly sensitized atopic donors can be successfully used without priming with IL-3 for the in-vitro flow cytofluorimetric diagnosis of CU. With this investigation the characterization of the autoimmune origin of CU is based on an objective in vitro technique.

Notizen: Summary Background  A number of studies exist demonstrating the increased expression of type 2 cytokines and decreased capacity to produce interferon-γ (IFN-γ) in peripheral blood mononuclear cells (PBMCs) of patients with atopic dermatitis (AD). Objectives  To clarify the results of recent studies concerning the role of interleukin (IL)-4 and IL-13 in PBMCs of AD patients, we analysed the activation status of lymphocyte subpopulations. Methods  We measured the intracellular expression and serum levels of certain type 1 and type 2 cytokines, using cell surface and intracellular cytokine staining, flow cytometry and enzyme-linked immunosorbent assay techniques. Results  The frequency of IL-10 and IL-13 producing CD4+ and CD8+ T cells was significantly higher in patients with AD, while the frequency of IFN-γ secreting helper and cytotoxic T cells was significantly lower in patients with AD than in control subjects. The serum levels of IL-10 and IL-13 were also significantly increased. There were no significant differences observed between the experimental groups in the frequency of IL-4 producing CD4+ and CD8+ cells. Conclusions  This study demonstrates a type 2 cytokine production in the CD4+ and CD8+ T cells of AD patients, which is characterized by an elevated IL-13, but not by IL-4 secretion, and by an increased level of the immunoregulatory IL-10, which can contribute to a decrease in IFN-γ expression.