Atopic Dermatitis (AD) is a common chronic relapsing inflammatory skin disease affecting 15 - 20% of children and 2 - 10% of adults worldwide, with significant morbidity. A hallmark of AD is disruption of the critical barrier function of upper epidermal layers, causatively linked to environmental stimuli, genetics and infections. Another typical feature of AD is skin infections, especially from Staphylococcus aureus (S. aureus), which closely relates with the disease severity. Although not a normal flora, S. aureus is found on 75-100% of AD lesions (< 30% on healthy skin). S. aureus secrete a range of virulence factors, including extracellular toxins and proteases which contribute to disease pathogenesis. S. aureus serine protease A (SspA/V8) is a well-characterised extracellular protease widely expressed among different S. aureus strains. The pathogenic effect of V8 protease has been demonstrated in vivo, damaging murine skin integrity via effects on the stratum corneum (SC), but the targets for this V8-mediated damage remains unclear. The capacity of proteases to induce barrier dysfunction has been proposed as a key driving force in the initiation and exacerbation of AD. Thus, understanding the host factors that maintain barrier function is a priority in developing novel therapeutic approaches. This thesis therefore aimed at detecting host factors which can combat the barrier dysfunction caused by pathogenic proteases, assessing their relevance in vitro and ex vivo and elucidating the underlying mechanisms. Firstly, an in vitro skin barrier integrity model was developed, using both immortalized and primary keratinocytes, to evaluate the barrier damage mediated by pathogenic proteases. The results revealed that S. aureus protease SspA/V8 is the dominant secreted factor (in laboratory and AD clinical strains of S. aureus) inducing barrier integrity impairment. In addition, studies demonstrated that V8 protease itself was sufficient to induce barrier disruption, and this phenotype was not dependent on cell death, but rather on breaking down of cell-cell junctions. Key tight junction proteins including claudin-1 and occludin were found to be degraded by V8 protease. Next, a wide range of host and bacterial factors were investigated to determine whether they could promote protection of keratinocytes against V8 damage. Several factors, including IL-1β, TNF-α, heat-killed Staphylococcus epidermidis (which is the main skin normal flora), were found to induce protection against V8 protease, with IL-1β having the strongest effect. In addition, data indicated that this IL-1β-mediated protection was independent of effects on claudin-1 but occurred via secretion of a transferrable host factor. Induction of keratinocyte expression of the antimicrobial/host defence peptide human beta-defensin 2 (hBD2) was found to be the mechanism underpinning this IL-1β- induced protective effect. Endogenous hBD2 expression was required and sufficient for protection against V8 protease-mediated integrity damage, and exogenous application of hBD2 was also protective. An ex vivo model using human skin tissue was also established to address this novel function of hBD2, and preliminary data indicated that exogenous hBD2 protected against V8-mediated damage in this system. Overall, my data reveal a novel function for the antimicrobial/host defence peptide hBD2. This modulatory property of hBD2, independent of its antibacterial effects, gives new significance to the defective induction of hBD2 in the barrier-defective skin lesions of AD and indicates therapeutic potential to prevent S. aureus-mediated aggravation of skin barrier dysfunction in AD.

Lam Man Ching. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (leaves 101-114). / Abstracts in English and Chinese; appendices also in Chinese. / Chapter Chapter 1 --- Introduction and Literature Review / Chapter 1.1 --- General introduction of atopic dermatitis --- p.1 / Chapter 1.1.1 --- Definition and its nature --- p.1 / Chapter 1.1.2 --- Epidemiology and prevalence of atopic dermatitis --- p.1 / Chapter 1.1.3 --- Factors and triggers related to high risk of atopic dermatitis --- p.3 / Chapter 1.2 --- Pathogenesis of atopic dermatitis --- p.5 / Chapter 1.2.1 --- Nature of complexity of pathogenesis --- p.5 / Chapter 1.2.2 --- Role of T-helper cell in atopic dermatitis and its paradigm model --- p.5 / Chapter 1.2.3 --- Nature of immunoglobulin-E and its role in atopic dermatitis --- p.6 / Chapter 1.2.4 --- Chemokines in pathogenesis of atopic dermatitis: CTACK and TARC --- p.7 / Chapter 1.2.5 --- Role of antimicrobial peptides and innate immunity --- p.8 / Chapter 1.3 --- Measurements of atopic dermatitis severity and related quality of life impairment --- p.9 / Chapter 1.3.1 --- Scoring of atopic dermatitis severity and the SCO Ring Atopic Dermatitis Index --- p.9 / Chapter 1.3.2 --- Quality of life measurement --- p.9 / Chapter 1.3.3 --- The Children's Dermatology Life Quality Index (CDLQI) --- p.10 / Chapter 1.4 --- Pruritus in atopic dermatitis and its underlying mechanisms --- p.11 / Chapter 1.4.1 --- Introduction to pruritus --- p.11 / Chapter 1.4.2 --- Difference between pruritus and pain --- p.11 / Chapter 1.4.3 --- Pathogenesis and neuronal pathways of pruritus --- p.12 / Chapter 1.4.4 --- Neurogenic itch --- p.13 / Chapter 1.4.5 --- Role of histamines in pruritus of AD --- p.14 / Chapter 1.4.6 --- Substance-P --- p.14 / Chapter 1.4.7 --- Brain-derived neurotrophic factor and other recent mediators in pruritus --- p.15 / Chapter 1.5 --- "Scratching, nocturnal scratching and sleeping behavior in atopic dermatitis subjects and related research progress" --- p.16 / Chapter 1.5.1 --- Overview --- p.16 / Chapter 1.5.2 --- "Interrelationship between pruritus, scratching and sleep disturbance" --- p.17 / Chapter 1.5.3 --- Current methodologies in nocturnal scratching and sleep quality measurement --- p.18 / Chapter Chapter 2 --- Objectives --- p.25 / Chapter Chapter 3 --- Methodologies and Materials / Chapter 3.1 --- Validation of a new methodology /device --- p.27 / Chapter 3.1.1. --- Device selection --- p.27 / Chapter 3.1.2 --- Study design --- p.27 / Chapter 3.1.3 --- Validation of the Digitrac with laboratory markers --- p.29 / Chapter 3.1.4 --- Factor and statistical analysis --- p.31 / Chapter 3.2 --- Application of Digitrac in traditional Chinese herbal medication (TCHM / TCM) clinical trial --- p.32 / Chapter 3.2.1 --- Current AD treatment using corticosteroids and their drawbacks --- p.32 / Chapter 3.2.2 --- Recent trend on TCM treatment --- p.32 / Chapter 3.2.3 --- Study plan --- p.33 / Chapter 3.2.4 --- "Validation with laboratory markers, Staphylococcus aureus infection and statistical analysis" --- p.35 / Chapter 3.3 --- Application of Digitrac in a trial of 0.1% tacrolimus ointment in treatment of atopic dermatitis --- p.37 / Chapter 3.3.1 --- Topical immunomodulators as a treatment approach of AD --- p.37 / Chapter 3.3.2 --- Mechanism of tacrolimus in suppressing AD and pruritus --- p.37 / Chapter 3.3.3 --- Study plan --- p.39 / Chapter 3.4 --- Further application of Digitrac in pruritus of other medical fields --- p.41 / Chapter Chapter 4 --- Results and Discussions / Chapter 4.1 --- Digitrac validation --- p.52 / Chapter 4.1.1 --- General demographic background data --- p.52 / Chapter 4.1.2 --- Wrist activities --- p.53 / Chapter 4.1.3 --- Laboratory markers and factor analysis --- p.54 / Chapter 4.1.4 --- Interpretation of results --- p.55 / Chapter 4.1.5 --- Drawbacks of the validation --- p.58 / Chapter 4.1.6 --- Summary --- p.59 / Chapter 4.2 --- Digitrac in traditional Chinese herbal medication clinical trial --- p.68 / Chapter 4.2.1 --- General information --- p.68 / Chapter 4.2.2 --- "SCORAD, wrist activities and CDLQI" --- p.69 / Chapter 4.2.3 --- Laboratory findings --- p.70 / Chapter 4.2.4 --- Interpretation of results --- p.71 / Chapter 4.2.5 --- Safety of TCM use --- p.73 / Chapter 4.2.6 --- Summary --- p.74 / Chapter 4.3 --- Tacrolimus clinical trial --- p.81 / Chapter 4.4 --- Application of Digitrac in other areas of study --- p.90 / Chapter 4.4.1 --- Pemphigoid gestationis case study --- p.90 / Chapter 4.4.2 --- T-cell lymphoma case study --- p.92 / Chapter Chapter 5 --- Further Discussions and Conclusion --- p.98 / References --- p.101 / Appendices --- p.116

Allergier ökar i västvärlden. Påverkan på livssituationen hos barn med atopiskt eksem (AE) och deras familjer är jämförbar med andra kroniska sjukdomar hos barn och deras familjer. Förebyggande behandling genom utbildning anses viktigt då det inte finns något botemedel mot AE. Det behövs ökad kunskap inom området för att kunna ge bra stöd och utbildning till dessa familjer i förhoppning om att skapa en bättre livssituation. Syftet med studien var att beskriva faktorer som påverkar familjens livssituation när barnet har AE. En litteraturstudie har gjort där nio artiklar bearbetades enligt kvalitativ innehållsanalys. Resultat visar att AE hos barn påverkar livssituationen i familjen på många olika sätt. I resultatet framkom sex kategorier som påverkade livssituationen. Dessa var klådans påverkan på familjens livssituation, omgivningens påverkan på familjens livssituation, föräldrarnas skuld och oro, ökad belastning i vardagen, utbildningens påverkan på familjens livssituation och klimatets påverkan på livssituationen. Det framkom tydligt i resultatet att klåda var huvudsymtomet hos barn med AE och hade störst påverkan på familjens livssituation. För att få en ökad förståelse för familjer som har barn med AE är det viktigt som distriktssköterska att sätta sig in i deras situation och på så sätt skapa en god relation och ett ömsesidigt förtroende. / <p>Program: Specialistsjuksköterskeutbildning med inriktning mot distriktssköterska</p><p>Uppsatsnivå: D</p>

INTRODUÇÃO: A dermatite atópica é uma doença inflamatória crônica da pele que possui alta prevalência e etiopatogenia multifatorial. Os ácaros são alguns dos desencadeadores das crises desta enfermidade. OBJETIVO: avaliar a freqüência de positividade ao teste de contato, utilizando extratos do ácaro Aleuroglyphus ovatus em doentes com dermatite atópica, comparando-a à dos doentes portadores de alergia respiratória e à dos indivíduos sem atopia. MÉTODOS: Cento e vinte e quatro indivíduos (48 doentes com dermatite atópica, 47 com alergia respiratória e 29 sem atopia) foram avaliados através do teste de contato contendo extrato de Aleuroglyphus ovatus nas concentrações de 0,1%, 0,5%, 1,0%, 1,5%, 2,0%. O teste de puntura com leitura imediata (“prick test”) e a dosagem da IgE sérica também foram avaliados. RESULTADOS: seis doentes com dermatite atópica, 4 com alergia respiratória e 1 indivíduo sem atopia responderam positivamente ao teste de contato alérgico com Aleuroglyphus ovatus. Não houve diferença estatística significativa entre os grupos estudados. CONCLUSÃO: O Aleuroglyphus ovatus possui papel relativo na elicitação das crises de dermatite atópica, podendo o teste de contato alérgico com Aleuroglyphus ovatus ser usado em caso de dúvida no diagnóstico etiológico. / INTRODUCTION: Atopic dermatitis is a chronic, inflammatory disease of the skin with high prevalence and complex etiopathogenesis. Mites are known to cause flares of this disease. OBJECTIVE: Evaluation of the epicutaneous test response with Aleuroglyphus ovatus antigen in patients with atopic dermatitis. METHODS: One hundred and twenty four subjects were patch tested with Aleuroglyphus ovatus antigen in concentrations of 0.1%, 0.5%, 1.0%, 1.5%, 2.0%. Forty eight patients with atopic dermatitis, 47 with respiratory allergy and 29 healthy subjects were studied. Prick test and total serum IgE were also evaluated. RESULTS: six patients with atopic dermatitis, 4 with respiratory allergy and 1 healthy subject had positive responses to Aleuroglyphus ovatus atopy patch test. No statistical differences among the studied groups were found. CONCLUSION: This mite must have a relative role in the atopic dermatitis flares and Aleuroglyphus ovatus atopy patch test should be reserved for etiopathogenic uncertainties cases.

A qualidade de vida tem sido objeto de muito interesse nos últimos tempos. A Qualidade de Vida Relacionada à Saúde é considerada como um indicador de saúde, que aborda aspectos físicos, mentais e sociais relativos à saúde. Para sua mensuração necessita-se de instrumentos válidos e confiáveis desenvolvidos ou adaptados para a cultura alvo. Condições crônicas dermatológicas têm sido associadas ao declínio da qualidade de vida dos indivíduos acometidos por estas. O objetivo deste estudo foi adaptar culturalmente para o Brasil e obter as características psicométricas iniciais do instrumento DISABKIDS®-MDA para avaliação da qualidade de vida relacionada à saúde de crianças/adolescentes com Dermatite Atópica e seus pais/cuidadores, instrumento que possui 12 itens e duas dimensões, impacto e estigma. A pesquisa consistiu de uma investigação metodológica quantitativa, que incluiu uma amostra de 70 crianças/adolescentes brasileiros com Dermatite Atópica, na faixa etária de 8 a 18 anos, e seus responsáveis, recrutados no Serviço de Dermatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, na cidade de São Paulo, entre os meses de abril e setembro de 2009. O processo abrangeu as fases de tradução-retrotradução, validação semântica e teste piloto, por meio de análise estatística apropriada. A validação semântica mostrou boa aceitação do instrumento pelos participantes, o qual foi considerado como muito bom e composto por itens de fácil compreensão. A confiabilidade de consistência interna foi satisfatória, com coeficiente Alfa de Cronbach aceitáveis para as dimensões constantes no instrumento (0,7024/0,8124 e 0,7239/0,8604). A análise MAP para validade convergente mostrou valores maiores que 0,30 para todos os itens. Quanto à validade discriminante, a análise revelou resultados satisfatórios. A concordância entre as versões self e proxy foi acessada pelo coeficiente de Correlação Intra-Classe, com valores de 0,8173 para impacto e 0,7629 para estigma. Diante dos resultados encontrados neste estudo considera-se que o instrumento DISABKIDS®-MDA possa vir a ser utilizado por pesquisadores brasileiros depois de finalizado seu processo de validação no país, por seus resultados iniciais apontarem ser um instrumento válido e confiável. / Quality of Life has been object of many interesting nowadays. Health Related Quality of Life is considered as a health indicator, which approaches physical, mental and social aspects. Its measurement involves instruments with validity and reliability developed or adapted to a specific culture. Dermatologic chronic conditions has been associated with patients quality of life decrease. The aim of this study was to do the cultural adaptation to Brazil and to obtain DISABKIDS®-MDAs preliminary psychometric properties to measurement of health related quality of life of children/adolescents with Atopic Dermatitis and their parents/caregivers. The instrument has 12 items and two dimensions, impact and stigma. The research consisted of a quantitative methodological investigation, that included a sample of 70 Brazilian children/adolescents with Atopic Dermatitis, aged 8 to 18, and their parents/caregivers, recruited at Dermatology Service from Clinic Hospital from College of Medicine from University of Sao Paulo, at Sao Paulo, between April and September of 2009. The procedure comprised translation, back-translation, linguistic validation and pilot test, with appropriate statistic analysis. On the linguistic validation the instrument was well accepted by the participants, and it was considered very good and has comprehensible items. Reliability of internal consistency was adequate, with Cronbachs Alpha acceptable to instruments dimensions (0,7024/0,8124 and 0,7239/0,8604). The MAP analysis to convergent validation displayed values higher than 0,30 for all items. In relation to discriminant validation, the analysis presented acceptable outcomes. The agreement between self and proxy versions was accessed by ICC, with values of 0,8173 to impact and 0,7629 to stigma. By the outcomes from this research, DISABKIDS®-MDA, after its complete validation procedure at the country, may be used by Brazilian researchers, once its initial outcomes appoint to be a valid and reliable instrument.

Made available in DSpace on 2016-04-28T20:15:24Z (GMT). No. of bitstreams: 1 2006- Victor do Espirito Santo Cunha.pdf: 1132781 bytes, checksum: 5edd69d626ede6488b658d61c07e111b (MD5) Previous issue date: 2006-02-22 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / The objective of this case-control study was to evaluate whether allergenic extracts from five species of house dust mites standardized for humans may be taken into account in the diagnosis of the canine atopic dermatitis. Extracts of Dermatophagoides pteronyssinus, D. farinae, Blomia tropicalis, Lepidoglyphus destructor and Tyrophagus putrescentiae have been evaluated through intradermal testing on 45 dogs, from which 20 belonged to the control group and 25 suffered from allergic dermatitis. There was a significant difference on the response pattern between the two groups (p<0,05). Only one dog (5%) from the control group has reacted to the intradermal test, whereas from the allergic group, 14 dogs (56%) have presented at least one positive reaction (odds ratio = 24,2). Most of the positive reactions observed in the allergic group were to the extracts of T. putrescentiae or L. destructor, each one inducing reactions on ten dogs (40%). The D. farinae, D. pteronyssinus e B. tropicalis extracts were responsible for positive reactions on 7 (28%), 3 (12%) and 3 (12%) dogs, respectively. The intradermal testing sensitivity and specificity were 56% and 95%, respectively, and the positive predictive value and the negative predictive value were 93% and 63%, respectively. / O presente estudo do tipo caso-controle teve como objetivo avaliar se extratos alerg?nicos de cinco esp?cies de ?caros da poeira domiciliar padronizados para humanos podem ser utilizados no diagn?stico da dermatite at?pica canina. Extratos de Dermatophagoides pteronyssinus, D. farinae, Blomia tropicalis, Lepidoglyphus destructor e Tyrophagus putrescentiae foram avaliados atrav?s de testes intrad?rmicos em 45 c?es, dos quais 20 controles e 25 com dermatite al?rgica. Uma diferen?a significativa foi observada no padr?o de respostas entre os dois grupos (p<0,05). Apenas um animal (5%) do grupo controle reagiu ao teste cut?neo, enquanto que no grupo dos al?rgicos 14 c?es (56%) apresentaram pelo menos uma rea??o positiva (odds ratio = 24,2). As maiores freq??ncias de rea??es positivas observadas no grupo dos al?rgicos foram aos extratos de T. putrescentiae ou L. destructor, cada um induzindo rea??es em 10 (40%) c?es. Os extratos de D. farinae, D. pteronyssinus e B. tropicalis foram respons?veis por rea??es positivas em 7 (28%), 3 (12%) e 3 (12%) c?es, respectivamente. A sensibilidade e a especificidade dos testes intrad?rmicos foram de 56% e 95%, respectivamente e, o valor preditivo positivo e valor preditivo negativo de 93% e 63%, respectivamente. .

A atopia ou dermatite atópica é uma doença inflamatória pruriginosa, crônica e recorrente reconhecida como a segunda alergopatia mais comum, estando aquém apenas da dermatite alérgica à picada de pulgas. Esta doença é caracterizada pela presença exacerbada de prurido corpóreo, infringindo sofrimento ao paciente e desalentando seu proprietário. A busca a uma boa \"qualidade de vida\" está sendo cada vez mais demandada pelos proprietários de animais alergopatas ou portadores de outras doenças crônicas. Por se tratar de uma doença de longo decurso, o tratamento com glicocorticóides pode causar diversos efeitos colaterais, além de doenças mais graves como diabetes melitus e hiperadrenocorticismo iatrogênico. Como alternativa ao tratamento de cães atópicos, a ciclosporina (CsA) acaba tornando-se uma boa opção terapêutica. A CsA inibe as funções das células que iniciam a resposta imunológica (células de Langerhans e linfócitos) e das células que efetuam a resposta alérgica (mastócitos e eosinófilos) e, também, diminui a liberação de histamina e de várias citocinas. Os objetivos do presente estudo incluíram: análise da eficácia da CsA na redução de lesões corpóreas e do prurido com auxílio do CADESI-03 (Olivry et al.,2007) e de duas escalas de prurido corpóreo; detecção de ocorrência de eventuais efeitos adversos (tegumentares ou sistêmicos) decorrentes da terapia imunomodulatória através da realização de hemograma, função renal, função hepática e mensuração da pressão arterial; avaliação e monitoramento da qualidade de vida de 21 animais atópicos tratados com ciclosporina (5 mg/Kg, SID durante 60 dias) com auxílio de uma escala validada para cães. A CsA mostrou-se eficaz no tratamento da dermatite atópica canina pois reduziu as lesões corpóreas em 70% após 60 dias de terapia. Nesse mesmo período ocorreu redução da intensidade do prurido corpóreo em 52,6%, avaliado através da escala numérica verbal; e observou-se redução significativa na escala qualitativa de prurido corpóreo (Hill, 2002; modificada), uma vez que os níveis máximos de prurido (\"três\" e \"quatro\") quase não foram observados após a terapia imunomodulatória. Os efeitos adversos observados foram relacionados a distúrbios gastrintestinais e, ocorreram com maior freqüência nos primeiros 15 dias de tratamento. Alterações laboratoriais não foram observadas. Os animais portadores de dermatite atópica apresentaram melhora no escore de qualidade de vida em 32%. A CsA mostrou-se eficaz no tratamento da dermatite atópica canina. / Atopic dermatitis (AD) is an inflammatory, pruritic and chronic allergic skin disease. It´s recognized as the second most common allergic skin disease of dogs after flea allergy. Pruritus is the predominant sign of canine AD affecting a variety of areas of the body, leading to intense suffering to the animal and its owner. \"Quality of life\" (QL) is being much more requested from owner of animals with allergic skin diseases or with any kind of chronic disease. The long-term use of glucocorticoids therapy can be devastating because of its inumerous adverse effects and secondary diseases like diabetes mellitus and iatrogenic hiperadrenocorticism. Cyclosporine (CsA) has been considered a good therapeutic option in the treatment of canine atopic dermatitis. It inhibits the activation of cells that initiate cutaneous immune response (Langerhans\' cells and lymphocytes) and cells that mediate allergic reactions (mast cell and eosinophils). It also decreases histamine and other citocines release. The objectives of this study included: analysis of the efficacy of CsA in reducing skin lesions and pruritus of 21 atopic dogs using CADESI-03 (Olivry ey al., 2007) and two scales to quantify levels of body itching; detection of any possible adverse effects (dermatologic or systemic) secondary to immunomodulatory therapy, by performing complete blood count, renal and hepatic function and measurement of blood pressure; evaluation and monitoring QL from dogs treated with CsA (5 mg/Kg, SID during 60 days) with a validated scale; This immunomodulatory therapy was considered an effective treatment for atopic dogs because it reduced skin lesions in 70% after 60 days of therapy. During that period there was a reduction of body itching in 52,6% by verbal numeric scale, and there was significant reduction on qualitative scale of body itching (Hill, 2002; modified), since maximum levels of pruritus (\"three\" and \"four\") were hardly observed after immunomodulatory therapy. Gastrointestinal disorders were observed and appeared most often in the first 15 days of therapy. Laboratory abnormalities were not detected. The quality of life of these atopic dogs treated with CsA for 60 days was improved by 32%. CsA was effective and safe in the treatment of canine atopic dermatitis.

Exposure to a strong T-helper 2 (Th2)-like environment during fetal development may promote allergy development. Increased cord blood (CB) levels of the Th2-associated chemokine CCL22 were associated with allergy development during the first 2 y of life. The aim of the present study was to determine whether CB Th1- and Th2-associated chemokine levels are associated with allergy development during the first 6 y of life, allowing assessment of respiratory allergic symptoms usually developing in this period. The CB levels of cytokines, chemokines, and total IgE were determined in 56 children of 20 women with allergic symptoms and 36 women without allergic symptoms. Total IgE and allergen-specific IgE antibody levels were quantified at 6, 12, 24 mo, and 6 y of age. Increased CB CCL22 levels were associated with development of allergic sensitization and asthma and increased CCL17 levels with development of allergic symptoms, including asthma. Sensitized children with allergic symptoms showed higher CB CCL17 and CCL22 levels and higher ratios between these Th2-associated chemokines and the Th1-associated chemokine CXCL10 than nonsensitized children without allergic symptoms. A pronounced Th2 deviation at birth, reflected by increased CB CCL17 and CCL22 levels, and increased CCL22/CXCL10 and CCL17/CXCL10 ratios might promote allergy development later in life.

Background: Birch pollen is an important outdoor allergen able to aggravate symptoms in atopic dermatitis (AD). Specific immunotherapy (SIT), an established procedure for allergic airway diseases, might also represent an attractive therapeutic option for the causal treatment of allergen-triggered cutaneous symptoms in these patients. Studies with house dust mite SIT have already shown beneficial effects in AD patients, whereas the safety and efficacy of SIT with birch pollen extract in AD patients have not been studied so far. The aim of this study was to evaluate for the first time the safety and efficacy of SIT with a depigmented polymerized birch pollen extract in AD patients. Methods: Fifty-five adult patients with moderate-to-severe AD and clinically relevant sensitization to birch pollen received SIT for 12 weeks. SIT was continued during birch pollen season. The assessment of safety, the total SCORAD value, and the Dermatology Life Quality Index (DLQI) were evaluated. Results: The median total SCORAD value was reduced by 34% (p < 0.001) during the course of treatment and the mean DLQI improved by 49% (p < 0.001) despite strong simultaneous birch pollen exposure. Eight patients (14.5%) developed systemic reactions and 19 patients (34.5%) developed local reactions which were of mild intensity in most cases. No patient discontinued the study prematurely due to adverse drug reactions. Coseasonal treatment was well tolerated. Conclusion: SIT with a depigmented polymerized birch pollen extract leads to significant improvement of the SCORAD value and the DLQI in patients suffering from moderate-to-severe AD sensitized to birch pollen. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Teste intradérmico avalia reação de hipersensibilidade a diversos agentes que possam apresentar poder reacional alérgico e são comumente utilizados para complementar o diagnóstico da dermatite atópica canina (DAC). Ainda não existe consenso sobre as concentrações de histamina e extratos alergênicos a serem utilizadas. Para determinar a concentração ideal de histamina, como controle positivo, e do limiar irritativo de extratos alergênicos em teste intradérmico é necessário que diversas concentrações sejam avaliadas em uma população bem numerosa de cães hígidos. O objetivo desta pesquisa foi avaliar em 160 cães sadios submetidos a teste intradérmico, quais seriam as concentrações de histamina e de extratos alergênicos consideradas ideais. A solução contendo 0,1 mg/mL de histamina foi considerada como parâmetro ideal, provocando reações cutâneas com diâmetro médio, mediana e desvio padrão, de 15,18 mm, 14,97 mm e 2,07 mm, respectivamente. A partir do estabelecimento da concentração de histamina, foram determinadas as concentrações ótimas dos extratos alergênicos, expressas em PNU/mL: 1.000 para Dermatophagoides pteronyssinus, 500 para D. farinae, 125 para Blomia tropicalis e 2.000 para Malassezia pachydermatis. Futuros estudos devem ser conduzidos em cães atópicos para verificação da acurácia dos testes intradérmicos realizados com essas concentrações. / Intradermal testing evaluates hipersensitivity reaction to different agents that can present allergic reactivity power. It is commonly used to complement canine atopic dermatitis diagnosis. There is still no consensus about histamine concentrations and allergen extracts to be used. The determination of the histamine ideal concentration as positive control and the irritant threshold of allergen extracts for intradermal testing, requires evaluation of different concentrations on a large population of healthy dogs. The purpose of this research was to evaluate the ideal histamine and allergen extracts concentrations on 160 healthy dogs submitted to intradermal testing. A histamine solution 0,1 mg/mL was considered the ideal parameter. It caused cutaneous reactions with average diameter, median measure and standard deviation of 15.18 mm, 14.97 mm and 2.07 mm, respectively. From the histamine concentration establishment, the optimum allergen extracts concentrations were determined, expressed by PNU/mL: 1.000 for Dermatophagoides pteronyssinus, 500 for D. farinae, 125 for Blomia tropicalis and 2.000 for Malassezia pachydermatis. Future studies have to be conducted on atopic dogs to verify the accuracy of the intradermal testing with these concentrations.