Search

Summary Basophil leucocyte-bound IgE has been investigated in patients with chronic urticaria by the method of reversed anaphylaxis. In this reaction basophil-bound IgE behaves as an antigen, the amount present being inversely proportional to the concentration of anti-IgE producing maximum histamine release. Dose-response curves in which histamine release was plotted against the concentration of anti-IgE failed to reveal any substantial difference in the optimum concentration of anti-IgE for maximum release from basophils of urticarial subjects compared with control subjects, thus suggesting there is no quantitative abnormality of basophil bound IgE in chronic urticaria. However, the magnitude of maximum histamine release by anti-IgE from basophils of urticarial subjects was reduced compared with controls and this was not related to serum IgE concentrations since the mean serum IgE concentration was slightly higher in the urticaria group. Studies of spontaneous and compound 48/80-evoked histamine release in the two groups did not reveal any differences in stability of histamine stores or in the biochemical histamine release mechanism over a wide range of concentrations of 48/80. These results raise the possibility of a qualitative abnormality of basophil bound IgE in chronic urticaria.

Serum levels of immunoglobulins G, A, and M were determined in 16 children with chronic wrticaria. The outstanding clinical feature of the group was recurrent upper respiratory infection. In 9 cases immunoglobulin levels were below the normal range for age for this laboratory. Four examples of multiple immunoglobulin deficiency and 5 examples of single immunoglobulin deficiency were noted, including a complete IgA deficiency. A statistical comparison of the entire urticaria group data with data from normal subjects revealed significantly (p =

1.1. Atarax gives relief in the majority of cases of chronic urticaria and dermographia. 2.2. Atarax is less effective in other allergic diseases. 3.3. Indirect evidence points to the possibility that there is a mediating mechanism in chronic urticaria besides the possible ones of histamine, acetylcholine, or serotonin. 4.4. Experimental studies in the guinea pig indicate that Atarax is a longacting, potent, antianaphylactic, antihistaminic, antiserotonin, and antiacetylcholine agent. For the most part, other tranquilizing or antihistaminic drugs have only part or none of these effects. 5.5. The antihistaminic activity of these drugs appears to be the most important feature determining its antianaphylactic action in guinea pigs.

慢性蕁麻疹における発症準備性について，種々の方面から検討した。それを要約すると，1)蕁麻疹の発症には多くの場合，真皮マスト細胞の変化と，その顆粒内のヒスタミンの遊離とが先行する。2)慢性蕁麻疹患者の真皮組織はマスト細胞に関しては質的および量的に特異性を有していない。3)本症患者の皮膚血管は正常人のそれにくらべてヒスタミンにたいする感受性が高い。また，本症患者の多くは自律神経系，とくに副交感神経系の緊張状態にある。4)本症患者においては，アレルギー疾患の家族的発現率が高いが，このことは上述の自律系の感受性にある程度影響をおよぼすと思われた。

We measured serum IgE in 264 patients seen in the course of an allergy practice during the summer of 1970. IgE values were elevated in 21 per cent of patients who had idiopathic asthma and 10 per cent of patients who had idiopathic rhinitis. The elevated IgE was of no immediate clinical help in this idiopathic group because we were unable to detect hidden allergenic factors on further review of the history and skin tests. The finding of such an elevation, however, will prompt us to a continuing search for an allergic etiology or other condition associated with elevation of IgE. In patients who had hypersensitivity to stinging insects, IgE was elevated in 9 of 29 (31 per cent), and in patients with asthma and aspirin intolerance it was elevated in one of 5. Results in small numbers of patients with several other conditions including cold urticaria, chronic urticaria, and drug allergy are also presented.

The serum level of immunoglobulin E (IgE) was found to be significantly greater than normal in a group of 23 out of 28 patients with atopic dermatitis. Each member of this group also showed several positive reactions to intradermal tests with 36 common antigens. The three atopic patients with the lowest IgE levels gave negative or, in one case, a single weak intradermal test. There was no correlation between the IgE level and the severity of clinical symptoms or a history of asthma or hay fever. IgE values were generally normal in a group of 34 patients with acute or chronic urticaria and in a larger group of patients with nonatopic dermatitis and various dermatological conditions.

1. The effect on the urinary histamine of histamine given by mouth or by intravenous infusion was studied in three men with chronic urticaria and found not to differ from that recorded in normal men. Two of these men who received histamine intravenously developed some hours later an urticarial reaction of unusual severity. 2. In two of the intravenous infusions no changes were detected in the histamine content of the plasma or cells obtained from the antecubital vein; no changes were detected in a single sample withdrawn from the femoral artery. The possible significance of this result is discussed. 3. The mean daily excretion of free histamine in a group of nine cases of urticaria differed significantly from the mean in a group of ten patients with other diseases and in a group of ten normal and convalescent subjects. The mean daily excretion of conjugated histamine did not differ significantly in the three groups. These results support the conception that histamine is either liberated or newly formed in urticaria.

Dermographism has always been defined in general terms. Quite often it has been difficult, in practice, to determine whether a response to a scratch was abnormal. The authors describe a device which produces a known pressure on the skin and present the results of their experience with this instrument in different groups. Dermographism is then defined in quantitative terms as the occurrence of a wheal of 3 mm. or more in diameter with the use of a force of 400 Gm. or less. With this definition 1.5 per cent of a normal group exhibited dermographism, as compared to 7.4 per cent in patients with chronic urticaria and 2.7 per cent in those with seasonal allergic rhinitis.

Background : The cutaneous manifestations of lupus erythematosus (LE) specific skin disease consists of acute cutaneous LE (ACLE), Subacute cutaneous (SCLE) and Chronic cutaneous (CCLE). Objective : To evaluate the spectrum of cutaneous manifestation in patients of LE. Methods : A case series of 41 clinically diagnosed cases of LE attending the outpatient department of Dermatology, BPKIHS were evaluated for the specific and non-specific skin changes. Results: All the patients enrolled in the study were female,with the age ranging from 14-64 years. ACLE was detected in 22/41(78.04%). Malar rash was the frequent skin lesion. CCLE was seen in 6/41 (14.63%) patients with classical discoid lesions (localized and generalized) in 4/6(66.66%) and 2/6(33.33%) respectively. Non specific skin lesions were found in 30/ 41(73.17%) of patients. Mucosal ulcers were seen in 23/41(56.09%), Facial telangiectasias 20/41(48.78%), Raynaunds phenomena 22/41(53.65%), Chronic urticaria 9/41(21.95%), Nail changes 12/41(29.26%) and non scarring alopecia was seen in 6/41(14.63%) patients. Eye involvement was seen in 3/41(7.3%), cutaneous vasculitis in 5/41(12.19%) and scaring alopecia in 3/41(7.3%) patients. Conclusion: The cutaneous manifestations of patients with lupus erythematosus (LE) are very frequent, show a great variety and can occur at any stage of the disease. DOI: http://dx.doi.org/10.3126/hren.v10i1.5999 HREN 2012; 10(1): 8-11

Fifty-two allergic patients were subjected to the Coca pulse acceleration method for determining specific food sensitivities. The entire testing procedure was carried out under what we considered ideal conditions, and, to insure accuracy, all pulse readings were taken by one of the investigators. Complete testing of all commonly eaten foods was done in 19 out of 52 patients and the effects of removing pulse accelerators from their diet evaluated. Of 13 asthmatics who completed the studies, 6 improved by removal of pulse-accelerating foods, 4 failed to benefit, and 3 showed no evidence of abnormal pulse increase after food ingestion. In 3 patients with chronic urticaria, one improved after elimination of the pulse-accelerating foods, one was unimproved, and the third patient had no pulse-accelerating foods. One of 2 patients with migraine was benefited and one patient with chronic allergic rhinitis failed to improve. The results of our studies would seem to verify the validity of Coca's claim that, in certain patients, foods can act as pulse-accelerators and that such an effect probably is on an allergic basis. Clinical application of the method is beset with certain drawbacks which greatly limit its usefulness in clinical practice. Its value as a method of diagnosis in food allergy will have to be determined by further investigation and clinical application.

One aspect of management of urticaria noteworthy for its lack of value is extensive scratch testing. Some 10 to 20 percent of cases of hives are thought to be emotional in origin. Recognized causes include drugs (chiefly penicillin and aspirin), foods, insect stings, inhalants, cold, heat, sunlight, pressure and water. Recent studies suggest that candidal organisms and food yeasts may be important in 20 percent of cases of chronic urticaria. Rarely, urticaria is inherited.

Unter 50 von uns gesehenen unausgesuchten Kranken mit einer chronischen Urticaria fanden sich bei Fallen neben der Dermatose noch weitere funktionelle bzw. chronisch rezidivierende korperliche Befindensstorungen wie auch phasisch verlaufende vitale Depressionen. Trotz der klinischen Mannigfaltigkeit dieser Krankheitsbilder besteht eine formale Gleichheit der einzelnen Krankheitsablaufe, d. h., sie stimmen uberein in ihrem periodischen, von Ausenfaktoren weitgehend unabhangigen Auftreten, ihrem phasenhaften umweltstabilen Verlauf und ihrer Richtungsprognose. Auch eine charakteristische lebensalterliche und gruppenspezifische Verteilung ist diesen Syndromen gemeinsam. Das Mit- oder Nacheinander korperlicher und psychischer Faktoren stellt somit im Langsschnitt ein echtes psychosomatisches Geschehen dar, das meist schon in der Aszendenz vorgepragt ist. Die Langsschnittbetrachtung eines Lebenslaufes und die Beziehungssetzung der Einzelerkrankungen auf diesen, wie auch der Feldwechsel korperlicher Syndrome untereinander oder deren Ablosung durch psychopathologische Symptomenverbande innerhalb einer abgegrenzten Krankheitsphase, sind unseres Erachtens unabhangig von exogenen pathogenetischen Faktoren, sondern rucken vielmehr endogen-rhythmische Vitalablaufe in den Vordergrund der atiologischen Betrachtungsweise.

The authors report their experiments with 100 cases of chronic urticaria or angioneurotic aedema. They point out especially the frequency of the allergic background (75% of the cases), the importance of the part played by Candida albicans and the results obtained by the treatment with nystatin (33%of good or very good results) or by desensitization to candidine (49% of good or very good results).It is quite certain that other infections or sensitizations can be responsible, their demonstration and the establishment of a specific treatment can similarly give good results.

This case report describes the features of chronic recurring angioedema of the face, arms, hands, and feet and generalized urticaria, provoked by antibiotics, maintained by food sensitivities and physical allergy, and complicated by malignant edema produced by the spore-bearing anthrax bacillus.

SUMMARY.— When a weal evoked as a cutaneous allergic response has disappeared, that area of skin, although appearing normal, shows factitious wealing: this tendency persists for 72–96 hr. The phenomenon is present after weals caused by positive intradermal prick tests from various substances, after weals from certain insect bites, and on the site of fading lesions of acute urticaria. Weals caused by intradermal histamine are not followed by this factitious wealing, nor is it present on skin which has been the site of a weal in chronic urticaria.

The histidine decarboxylase inhibitor brocresine, in doses from 600mg to 1800mg daily, failed to diminish skin histamine and histamine excretion in patients with chronic urticaria. A slight decrease in clinical symptoms was found, these data, however, are comparable to those found, when chronic urticaria patients are treated with placebo. No patient was cured after two weeks of treatment. Possible explanations of the lack of potent inhibition and discrepancies with observations of other workers are discussed.

Vitamin B 12 therapy using 1,000 μg. doses intramuscularly at weekly intervals was tried on 20 patients with asthma and 28 patients with chronic dermatoses. The number of patients treated with each type of chronic dermatitis is too small to draw any definite conclusions. However, it is felt that further trial of this therapy in chronic contact dermatitis and chronic urticaria is indicated. The response to B 12 by the patients with asthma was equivocal and in no case was spectacular.

SUMMARY Cheyletiella sp., with other mites, was isolated from the underclothes shakings of a woman with a papular rash and chronic urticaria. She had no contact with pets. Previously, Cheyletiella has been recognized only as an infestation derived from animals. The possible significance of this finding is discussed. The minute morphological differences between C. parasitivorax and C.yasguri are described.

SUMMARY Results are reported of Trasylol treatment of fifty-two patients with various forms of urticaria. 100,000 anti-kallikrein units were given intravenously every other day, with 15–20 injections per course. An excellent therapeutic effect was obtained in 44% (twenty-three patients), and another 37% (nineteen patients) were greatly improved. Additional evidence of the objective therapeutic benefit was obtained in a double-blind study (twenty patients).

Although the pathogenesis of acute urticaria may frequently involve an allergic mechanism, the etiology of chronic urticaria is a diagnostic dilemma in most patients. A recent study described 9 children with immunoglobulin deficiencies in a group of 16 children with chronic urticaria and recurrent upper respiratory tract infections. The purpose of this investigation was to quantitate the three major serum immunoglobulins, γG-, γA-, and γM-globulins, in adult patients with acute or chronic urticaria. None of these patients was subject to repeated upper respiratory tract or other infection. No deficiency of serum γG-, γA-, or γM-globulins was demonstrated in the 10 adult patients with acute urticaria or the 24 adult patients with chronic urticaria. In fact, when compared with normal adults, the patients with chronic urticaria had statistically significant increased serum γG-globulin concentrations. The clinical significance of this increased γG-globulin synthesis in adult patients with chronic urticaria has not been elucidated.

1.1. Antihistaminic drugs exhibit the property of inhibiting histamine- or antigen-induced wheals, but do not affect preformed wheals. 2.2. Sympathicomimetic drugs and aminophyllin both inhibit and cause resolution of histamine- or antigen-induced wheals. 3.3. Some mechanism other than "H" substance or histamine plays a role in many cases of chronic urticaria.

DERMOGRAPHISM is a term applied to wheals of various sizes and shapes produced on the skin by local physical or mechanical irritation, such as stroking, scratching, rubbing, and pinching. Synonomous terms are factitious urticaria (urticaria factitia), dermographic urticaria, autographism, mechanical urticaria, and dermographia. Dermographism is to be distinguished from "pressure" urticaria. 1 Dermographism is provoked within a few minutes by a relatively gentle superficial mechanical influence, such as stroking of the skin. Pressure urticaria appears only after a latent period varying from 2 to 24 hours and only at the sites of relatively great and persistent pressure, such as the soles, palms, and buttocks. Our interest in the relationship between dermographism and subacute or chronic urticaria was aroused when we noted many patients with dermographism were being referred for skin testing to the Allergy Section under the diagnosis of "chronic urticaria." On investigating the literature, we found marked differences of opinion as to the relationship of these entities. Walzer 2

Investigation of urticaria in a young woman disclosed a hypersensitivity to menthol. Innocent systemic or percutaneous exposure to this very common substance had also elicited "hot flashes" over several years, but recognition of the symptom as an urticarial equivalent required hindsight. Production of these clinical manifestations and of a histamine headache followed different provocative tests. This was associated with a diagnostic drop in the number of circulating basophil leukocytes.

Migraine has been known from the time of ancient Greco-Roman medicine. It has been studied by physicians throughout the ages, and many eminent physicians and scientists have themselves suffered from it.

To the Editor :—Six patients with chronic urticaria under treatment with Benadryl complained that the medication made them so sleepy that it was not practical for them to use it except at bedtime. All were instructed to take half of a 10 mg. tablet of amphetamine sulfate (Benzedrine) at the same time as the Benadryl. All except 1 patient reported complete relief of the annoying drowsiness, and this one was relieved by taking three-fourths of an amphetamine sulfate tablet. The undesirability of prolonged habitual use of amphetamine sulfate is recognized, but these patients required only one or two doses a day, which seems reasonably safe and at least preferable to the obvious alternatives.

A 21/2-year-old white girl developed an unusually delayed and prolonged toxic erythema and urticaria following the administration of live, attenuated measles virus vaccine. The significance of an associated IgA abnormality in relation to her symptoms is not clear.

Scent, whether organic or inorganic in origin, has a physicochemical basis and is propagated by minute particles. These odoriferous particles are termed osmyls and may act as inhalant allergens. The subject of allergy to scent or to osmyls has received but meager attention, if one is to judge from the few brief references in the literature. Among the authors who have advanced this etiologic conception are Feinberg and Aries, 1 Rappaport and Hoffman, 2 Urbach, 3 Sulzberger and Wolf 4 and Horesh. 5 That perfumes as contactants frequently cause dermatitis is well known. Downing, 6 Schwartz and Tulipan, 7 and Rattner and Pusey, 8 to mention but a few, have repeatedly called attention to the importance of scented cosmetics as a cause of dermatitis. The role of perfume, however, as an allergen causing chronic urticaria due to inhalation of osmyls has been seldom considered. A report, therefore

A case is reported in which chronic urticaria was thought to be the result of persistent dermatophytosis caused by Trichophyton rubrum . The evidence to support such a conclusion is briefly presented. The patient showed a response to the administration of griseofulvin with cessation of urticaria while taking the medication and resumption of urticaria upon discontinuation of therapy on several occasions. We suspect such an association may be more common than is at present appreciated and conclude that a therapeutic trial of griseofulvin may be indicated for selected individuals with chronic urticaria, who exhibit a focus of dermatophytosis, and in whom no other cause for chronic urticaria can be demonstrated.