Food-dependent exercise-induced anaphylaxis: influence of concurrent aspirin administration on skin testing and provocation

BACKGROUND: Provocation tests in patients with food-dependent exercise-induced anaphylaxis (FDEIA) are often negative, even after a sufficient quantity of the implicated food and exercise have been taken. OBJECTIVES: To investigate the effect of aspirin in provocation tests and in skin prick testing (SPT) of patients with FDEIA. Gluten as a major allergen in wheat-dependent FDEIA was also investigated. METHODS: Provocation tests and SPT with suspected foods were performed in 12 patients with FDEIA. Provocation tests were performed with combinations of foods, exercise and aspirin. Detection of gluten-specific IgE was also performed by the CAP System FEIA radioallergosorbent test, SPT and a histamine release test. RESULTS: The SPT reaction was enhanced by pretreatment with oral aspirin in five of eight (62.5) patients. Aspirin facilitated provocation in five of seven (71%) patients tested. Ingestion of wheat and aspirin without exercise provoked symptoms in two patients. Aspirin provoked symptoms even with a small amount of wheat and exercise in one patient. Only the combination of aspirin, wheat and exercise provoked anaphylaxis in one patient. Specific IgE, SPT and/or the histamine release test with gluten were positive in nine of 11 patients with wheat-dependent FDEIA. CONCLUSIONS: Aspirin enhances symptoms of FDEIA, and prior ingestion of aspirin under controlled conditions can be used to confirm FDEIA. In practice, such patients should avoid aspirin ingestion. Gluten appears to be the major allergen in these patients with wheat-dependent FDEIA.     

Skin protection programmes

Educational programmes, including evidence-based recommendations on skin protection (skin protection programmes), have been proposed for the prevention of irritant contact dermatitis in occupations with a high frequency of this disease. Recent intervention studies directed at wet-work employees showed a positive influence on wet-work behaviour and on clinical skin symptoms. The structure and implementation of skin protection programmes are discussed.     

Intrinsic aging vs. photoaging: a comparative histopathological,immunohistochemical, and ultrastructural study of skin

Cutaneous aging is a complex biological phenomenon affecting the different constituents of the skin. To compare the effects of intrinsic and extrinsic aging processes, a total of 83 biopsies were collected from sun-exposed and protected skin of healthy volunteers representing decades from the 1st to the 9th (6-84 years of age). Routine histopathology coupled with computer-assisted image analysis was used to assess epidermal changes. Immunoperoxidase techniques with antibodies against type I and type III collagens and elastin were used to quantitatively evaluate changes in collagen and elastic fibers and their ultrastructure was examined by transmission electron microscopy. Epidermal thickness was found to be constant in different decades in both sun-exposed and protected skin; however, it was significantly greater in sun-exposed skin (P = 0.0001). In protected skin, type I and III collagen staining was altered only after the 8th decade, while in sun-exposed skin the relative staining intensity significantly decreased from 82.5% and 80.4% in the 1st decade to 53.2% and 44.1% in the 9th decade, respectively (P = 0.0004 and 0.0008). In facial skin the collagen fiber architecture appeared disorganized after the 4th decade. The staining intensity of elastin in protected skin significantly decreased from 49.2% in the 1st decade to 30.4% in the 9th decade (P = 0.05), whereas in sun-exposed skin the intensity gradually increased from 56.5% in the 1st decade to 75.2% in the 9th decade (P = 0.001). The accumulated elastin in facial skin was morphologically abnormal and appeared to occupy the areas of lost collagen. Collectively, the aging processes, whether intrinsic or extrinsic, have both quantitative and qualitative effects on collagen and elastic fibers in the skin.     

Skin cancer and ultraviolet-B radiation under the Antarctic ozone hole: southern Chile, 1987-2000

BACKGROUND: Punta Arenas, Chile, the southernmost city in the world (53 degrees S), with a population of 154,000, is located near the Antarctic ozone hole (AOH) and has been regularly affected by high levels of ultraviolet-B (UV-B) radiation each spring for the last 20 years. Large increases in UV-B associated with the AOH have been measured with increases in UV-B at 297 nm of up to 38 times those of similar days with normal ozone. Recently we reported significant increases in sunburns during the spring of 1999 on days with low ozone because of the AOH. METHODS: A surveillance of skin cancers occurring from 1987 to 2000 was performed. Age, sex, location, type of skin cancer and skin phototype were recorded. A Brewer Spectrophotometer was used in order to obtain in situ measurements of ozone and UV-B. Total Ozone Mapping Spectrometer (TOMS) data from National Aeronautics and Space Administration (NASA) was used in order to establish pre-ozone hole climatology. RESULTS: Ozone levels as low as 145 DU (Dobson Units) were recorded, a 56% decrease in ozone, and UV-B levels up to 4.947 J/m2. These levels are close to summertime levels at mid latitudes. For the 14-year period--from 1987 to 2000--173 cases of skin cancer were diagnosed, 65 during the first 7 years, 108 during the second, an increase of 66%. Cutaneous malignant melanoma (CMM), 19% of the cases, increased by 56%, raising the rate from 1.22 to 1.91 per 100,000. Non-melanoma skin cancer (NMSC), 81% of the total, increased the rate from 5.43 to 7.94 per 100 000 (P < 0.05), a 46% increase. Patients with CMM and NMSC had skin phototypes I-II in 59% and 54% of cases, respectively. Days with more than 25% ozone loss occurred in 143 days during the last 20 springs. Significant increases of UV-B were observed under ozone hole conditions, especially around 300 nm, the most carcinogenic wavelengths. CONCLUSIONS: Highly unusual ozone loss and UV-B increases have occurred in the Punta Arenas area over the past two decades resulting in the non-photoadapted population being repeatedly exposed to an altered solar UV spectrum with a greater effectiveness for erythema and photocarcinogenesis. This phenomenon has not previously been reported over other populated areas and an additional increase in the skin cancer rate attributable to the AOH may be occurring. Research on the clinical and subclinical impact of these abnormalities is urgently needed.     

The co-expression of ASIC3 with calcitonin gene-related peptide and parvalbumin in the rat trigeminal ganglion

The co-expression of ASIC3 with calcitonin gene-related peptide (CGRP) or parvalbumin (PV) was examined in the trigeminal ganglion (TG) by a double immunofluorescence method. ASIC3-immunoreactivity (IR) was detected in 23% of TG neurons. These neurons were of various sizes (range= 43-1768 microm(2), mean+/-S.D.=651+/-356 microm(2)); 26% and 14% of ASIC3-immunoreactive (IR) neurons co-expressed CGRP- and PV-immunoreactivity (IR), respectively; 33% and 13% of the TG neurons retrogradely labeled from the tooth pulp and facial skin, respectively, exhibited ASIC3-IR; 36% of CGRP-IR TG neurons which innervate these tissues co-expressed ASIC3-IR. Only 4% of ASIC3-IR cutaneous TG neurons showed PV-IR, while 25% of ASIC3-IR tooth pulp neurons were also immunoreactive for PV. The present study suggests that ASIC3-IR TG neurons supply the tooth pulp and facial skin with unmyelinated or finely myelinated axons. ASIC3-IR neurons which have large myelinated axons may be common in the tooth pulp but not the facial skin. The axonal morphology of ASIC3-IR TG neurons may depend on the variety of their receptive fields.     

Thoracic sympatholysis with epidural blockade assessed by quantitative measurement of cutaneous blood flow

BACKGROUND: Quantifying sympathetic activity is difficult. Direct measurement is possible and superior to indirect techniques, but nerves to internal organs are not accessible in humans. Recently, we validated a quantitative technique for measurement of cutaneous blood flow using heat as an indicator. The aim of the study was to investigate whether sympatholysis during thoracic epidural blockade (TEA) may be documented by changes in regional cutaneous blood flow. A secondary aim was to assess whether, during TEA, local heating itself enhances regional blood flow. METHODS: Six patients scheduled for elective coronary artery bypass grafting (CABG) were studied. An epidural catheter was inserted at the T2-3 interspace. Measurements were performed with an electrode, which can measure the local temperature of the skin. The probe is covered with a thermostatically controlled cap to avoid a thermic gradient to air. As a result of the cap, a change in temperature of the central disc depends almost solely on the blood flow in the underlying tissue. Regional cutaneous blood flow rates were measured before and after epidural anesthesia with and without local heating. RESULTS AND COMMENTS: All patients had a sensory blockade covering at least T1-5. Cutaneous blood flow increased in all six patients after blockade (13.6 ml/min/100 g, range 10.6-14.6 vs. 18.4 ml/min/100 g, range 13.9-24.5; P<0.05). Local heating did not further enhance blood flow. CONCLUSION: High TEA is associated with a uniform increase in thoracic cutaneous blood flow, and is suggestive of regional sympatholysis. Quantitative measurements of skin blood flow appear promising for documenting regional sympatholysis during TEA.     

Initial experience with cultured epithelial autografts in massively burnt patients

Background: Prognosis in patients with severe burns is improved by early debridement and coverage with skin. The limiting factor in these patients is the lack of unburnt skin for harvesting. Cultured epithelial autograft (CEA) sheets provide an alternative means of covering debrided skin. This is a report on an initial experience with using CEA sheets. Methods: The two patients in this study had their medical records examined retrospectively. Results: The effective take of the CEA sheets was zero in both patients. One of the patients died approximately 6 weeks after admission. Conclusions: Because of the poor graft take seen in the patients in the present study, the use of CEA sheets only as a form of temporary biological dressing is recommended.     

菱壳中挥发性成分的研究

目的:分析菱壳粉末中挥发性成分。方法:采用水蒸气蒸馏法从菱壳中提取挥发油,用气相色谱-质谱法对化学成分进行鉴定,用面积归一化法测定其相对百分含量。结果:共检出58种化合物,鉴定出56种化合物,占总检出物的96.5%。结论:菱壳挥发油成分中莳萝脑、N-乙酰基-N,N-′1,2-二乙基乙酰胺、邻苯二甲酸二异丁酯、十六酸和油酸为主要成分。     

Parotid lymph‐node metastases from cutaneous squamous‐cell carcinomas: Treatment outcome and prognostic factors following surgery and adjuvant radiotherapy

Australia has the highest incidence of cutaneous squamous cell carcinoma (SCC) in the world. The majority of lesions occur in the head and neck, and regional lymph‐node metastases from cutaneous SCCs, though uncommon, reflect an aggressive manifestation. Surgery and adjuvant radiotherapy are currently considered best practice. Fifty‐two eligible patients during 1980–1997 were identified in a retrospective review of patients treated within the department of Radiation Oncology, Westmead Hospital, Sydney. Relevant data were extracted from the files, referring clinicians and the New South Wales Cancer Council. The median age at diagnosis was 63 years and the majority were men (87%). Unfavourable pathological features were present in many of the patients. Only extranodal spread (P = 0.02) was identified as an independent predictor for locoregional recurrence on multivariate analysis. The cumulative locoregional recurrence rates were 28 and 45% at 2 and 5 years, respectively. The 5‐year cause‐specific survival rate in this study was 65%. We conclude that parotid lymph‐node metastases from cutaneous SCCs of the head and neck are associated with a high rate of locoregional recurrence and cause‐specific mortality despite surgery and adjuvant radiotherapy. The role of altered fractionation after surgery as a means to further enhance locoregional control warrants further investigation.