British Journal of DermatologyVolume 147, Issue 1 p. 180-195 Atopic dermatitis and house dust mite control measures: reply from author C. Gutgesell, C. Gutgesell Departments of Dermatology andSearch for more papers by this authorS. Heise, S. Heise Departments of Dermatology andSearch for more papers by this authorS. Seubert, S. Seubert Departments of Dermatology andSearch for more papers by this authorA. Seubert, A. Seubert Departments of Dermatology andSearch for more papers by this authorS. Domhof, S. Domhof Medical Statistics, University of Göttingen, von-Siebold-Straße 3, D-37075 Göttingen, GermanyE-mail: cgutges@gwdg.deSearch for more papers by this authorE. Brunner, E. Brunner Medical Statistics, University of Göttingen, von-Siebold-Straße 3, D-37075 Göttingen, GermanyE-mail: cgutges@gwdg.deSearch for more papers by this authorC. Neumann, C. Neumann Departments of Dermatology andSearch for more papers by this author C. Gutgesell, C. Gutgesell Departments of Dermatology andSearch for more papers by this authorS. Heise, S. Heise Departments of Dermatology andSearch for more papers by this authorS. Seubert, S. Seubert Departments of Dermatology andSearch for more papers by this authorA. Seubert, A. Seubert Departments of Dermatology andSearch for more papers by this authorS. Domhof, S. Domhof Medical Statistics, University of Göttingen, von-Siebold-Straße 3, D-37075 Göttingen, GermanyE-mail: cgutges@gwdg.deSearch for more papers by this authorE. Brunner, E. Brunner Medical Statistics, University of Göttingen, von-Siebold-Straße 3, D-37075 Göttingen, GermanyE-mail: cgutges@gwdg.deSearch for more papers by this authorC. Neumann, C. Neumann Departments of Dermatology andSearch for more papers by this author First published: 03 July 2002 https://doi.org/10.1046/j.1365-2133.2002.480911.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume147, Issue1July 2002Pages 180-195 RelatedInformation

We read with great interest the paper of Holm et al. (1) in the February issue of this journal. The authors have performed a very thorough, placebo-controlled, prospective study on the effect of house-dust-mite (HDM) elimination in patients with atopic dermatitis (AD). We appreciate this laborious work over the period of a whole year, and, in fact, there was a need for this study because the studies published before did not focus on the population investigated by Holm et al., namely, only adult patients with AD. We have performed a similar investigation, and we did not observe a clinical effect of HDM control measures on the skin status of adult AD patients (2). Holm et al. observed improvement of the skin status of AD patients treated by occlusive bedding. However, the results did not differ significantly from the placebo group. Interestingly, patients not sensitized to HDM and not exposed to HDM allergens benefited equally from the use of the bedcovers. Analysis of the subgroup with sensitization to Pityrosporum orbiculare revealed a significantly greater eczema reduction in the active treatment group than the placebo group. In conclusion, the authors recommend the use of bedcovers as part of the treatment for AD. However, we do not agree with this conclusion since the main finding of this study is that, with respect to the skin status, there was no significant difference between the active and control groups. Therefore, the results of this investigation cannot be the basis for the recommendation of occlusive bedding as a part of AD treatment. A post hoc subgroup analysis, as performed here, regarding the sensitization to P. orbiculare is not warranted, according to the ICH E9 guideline (3). This guideline recommends that an analysis of subgroup effects be an integral part of the planned analysis, and hence be set out in the protocol; as a consequence, stratified randomization is required. Otherwise, such a post hoc analysis is considered to be an exploratory analysis that is unlikely to be accepted, especially as the mattress concentration of P. orbiculare has not been investigated. Another finding of the study is that patients not sensitized to HDM and not exposed to HDM allergens benefited equally from the use of the different bedcovers. The authors state that this result could be due to a reduction by mattress encasing of other important superantigens or irritants in the bed. Unfortunately, the authors have not investigated this hypothesis, which, we think, is rather unlikely, at least for staphylococci, since they directly colonize the skin (4) and thus cannot be removed by this method. The authors should have considered the possibility that a mere placebo effect was responsible for their results. The placebo effect can be dramatic in AD, as shown by another HDM study (4). We therefore conclude from the authors’ findings that there is no evidence for a clinical effect of occlusive bedding on the skin status of adult patients with AD, a conclusion which is in line with the results of our own study (2).

Background Avoidance of allergens has been shown to be of benefit in patients with atopic asthma sensitized to indoor allergens. In atopic dermatitis, there is so far little information about the effect of house dust mite elimination strategies.Objectives We therefore performed a randomized controlled study of house dust mite control in patients with this disease.Methods Twenty adult patients with moderate to severe atopic dermatitis were included. Inclusion criteria were a positive RAST to house dust mite antigen (CAP class > 3) and a concentration of > 2 mug g(-1) of the house dust mite antigen Der p1 in the patient's mattress dust. Patients were randomized to either the active treatment group (allergen-impermeable mattress encasing, acaricide spray containing tannic acid and benzylbenzoate) or a control group (allergen-permeable encasing, spray containing water and traces of ethanol). Severity of disease was estimated every 2 months by an established score (SCORAD), and eosinophil cationic protein (ECP) in the serum was determined by enzyme-linked immunosorbent assay. Furthermore, the use of topical steroids was quantified. Patients assessed daytime pruritus and pruritus-induced sleeplessness weekly on a visual analogue scale. The study lasted 1 year.Results At the end of the study, the active treatment group showed a statistically significant reduction in Der p1 exposure as compared with the control group. However, when comparing the change from the start to the end of the study, there was no statistically significant difference between active treatment and control groups as measured by the SCORAD score and by ECP levels in the serum. Some patients in the active treatment group reported less pruritus-induced sleeplessness, but there was no statistically significant difference between the two treatment groups.Conclusions For adult patients with atopic dermatitis it was shown that 1 year of house dust mite avoidance reduced the allergen exposure, but an improvement of overall disease activity was not demonstrated.

Background: The causes for sudden infant death (SID) remain unclear. As infants can become sensitized to NRL allergens by pacifiers and latex mattresses, we tried to establish whether there is a relationship between SID and natural rubber latex (NRL) allergy. Methods: We determined NRL–specific IgE concentrations in 112 unselected cases of SID by the CAP–FEIA method. Results: NRL–specific IgE could be detected only in 1 sample (0.64 kU/l; CAP class 1). Conclusions: We conclude that NRL allergy is not a cause of SID.

Twenty-six patients (21 females, five males) suspected of having a textile dermatitis from dyes or processing additives were tested epicutaneously between April 1992 and April 1994. Nine patients proved positive to one or more dyes, in three patients a positive reaction to processing additives was determined. In 18 of the patients, clothes were also tested and resulted in a positive reaction in five cases. However, according to our examinations, textile allergies are seldom. Especially with generalized eczematous reactions, one should remember this for differential diagnosis.

The porphyrinogenic action of 2,2',4,4',5,5'-hexabromobiphenyl and its toxicokinetics were studied in female Wistar rats that were treated every other day for 6 wk with oral doses of 112 mg/kg body weight. Subsequently, the animals were kept for a further period of 22.5 months but without supply of the brominated biphenyl. 10.5 months after cessation of treatment the compound reached a maximum concentration in the adipose tissue followed by a gradual decline of its content. In the liver the concentration of the substance started to decrease 3 months after cessation of treatment. In the excreta, hexabromobiphenylol and two pentabromobiphenyls were detected as metabolites. The rate of biotransformation amounted to about 5%. At the end of the dosing period no alterations in the content and profile of the hepatic porphyrins were observed. Urinary porphyrins and their precursors delta-aminolaevulinic acid and porphobilinogen were slightly elevated. The urinary porphyrin pattern and faecal porphyrin content and pattern did not differ from those of the controls. 15 and 18 months after cessation of treatment (16.5 and 19.5 months after the start of treatment) two animals were found to have marked alterations in the content and profile of hepatic porphyrins with uro- and heptacarboxyporphyrin predominating. It was concluded that there is an extreme delayed individual porphyric response to 2,2',4,4',5,5'-hexabromobiphenyl in female rats.

The toxicokinetics and biotransformation of 2,2′,3′,4,4′,5,5′-heptachlorobiphenyl, as well as its influence on the activity of microsomal and cytosolic enzymes and on the porphyrin pathway in the liver were studied in female rats following oral treatment with 7 mg/kg every other day for 3 months. One day after cessation of treatment the concentration of the compound in liver, spleen, CNS and blood was 100–500 times and in the trachea it was only 5 times less than in the adipose tissue. The daily excretion with the feces and urine amounted to 35 and 1.5 μg, respectively. In both excreta, heptachlorobiphenylol was identified as a metabolite. The biotransformation rate was estimated to be about 5%. Investigations of the liver revealed increases in the relative liver weight, total cytochrome P-450 content, O-deethylation of 7-ethoxycoumarin and in the activity of glutathione S-transferases. Disturbances of the hepatic porphyrin pathway were not detected. Only at the end of a post-dosing period of 12 months did the hepatic uroporphyrinogen decarboxylase show diminished activity. Only one of these animals with diminished enzyme activity showed drastically elevated porphyrins. In these animals, the fecal and urinary porphyrins did not differ from controls. At no time did heptachlorobiphenyl influence the urinary excretion of delta-aminolevulinic acid and porphobilinogen. The results indicate 1) that this congener shows expected toxicokinetics with the exception of being accumulated in the trachea and 2) that this congener induces disturbances of the hepatic porphyrin pathway several months after cessation of treatment.

In 59 patients showing clear clinical and biochemical signs of porphyria cutanea tarda (PCT), we tested 3 different modes of therapy: 20 patients received combined treatment with repeated bleeding and chloroquine, 24 patients were exclusively treated with oral chloroquine in low doses, and 15 patients underwent repeated phlebotomy only. On an average, the time necessary for remission amounted to 3.5, 10.2, and 12.5 months, respectively. So the combined therapy proved the quickest. In patients with the acquired form of PCT, the pattern of urinary porphyrin normalized; those suffering from hereditary PCT retained the typically high uro/copro ratio. The values of the plasma porphyrin count and the plasma porphyrin index (PPI), which had been greatly enhanced before, went down to normal after therapy.

We describe a clinical laboratory information system for the RAST laboratory based on personal computers. In developing this system, we paid special attention to easy handling which does not require any computer experience on the user's side. Data storage and retrieval are managed by a relational database system with fast data access. Aside from the usual functions of a laboratory information system, the laboratory work is facilitated by a clear distribution of samples, the possible on-line connection to various analyzers, as well as the provision of cumulative results and a fast access to archive data.

1. A 423-fold purified fraction of uroporphyrinogen decarboxylase (EC 4.1.1.37) showing a specific activity of 770 units/mg protein has been employed in order to study some properties in etiolated Euglena gracilis Z. 2. Uroporphyrinogen decarboxylase has a relative molecular mass of 54,000, an optimum pH of 7.2 and exhibits Michaelis-Menten kinetics, employing both uroporphyrinogen I and uroporphyrinogen III as substrates. 3. Anaerobic conditions seem not to be necessary for uroporphyrinogen decarboxylase activity. Neither EDTA nor cysteine affected enzyme activity, whereas dithiothreitol produced a remarkable activation of coproporphyrinogen formation. 4. Kinetic data employing both substrates showed an accumulation of porphyrinogen (i.e. hexa- and hepta-porphyrin) containing six or seven COOH groups, depending on the uroporphyrinogen concentration used. 5. An unusual elution profile of the intermediates on Sephacryl S-200 was found.

The influence of environmental pollutants on morphological and hepatic biochemical parameters of mature pike from the river Rhine and river Lahn was investigated.

A 33-year-old female dialysis patient suffered from osteomyelitis and luxation of the dens axis with cervical myelopathy. In the past she had had three attacks of anaphylaxis after treatment with dialyzers that had been sterilized with ethylene oxide. IgE-type antibodies directed against human serum albumin-ethylene oxide complexes could be demonstrated in the patient's serum by radioallergosorbent techniques. Immediately after an operation in which acrylic bone cement (Palacos-R) sterilized with ethylene oxide was implanted for stabilization of the cervical spine, the patient developed massive edema of the larynx, pharynx, and tongue, suggesting Quincke's edema. It is concluded that ethylene oxide present in acrylic bone cement may induce acute allergic reactions in sensitized patients. Dialysis patients may be at special risk, since the incidence of ethylene oxide allergy in this patient population is about 10%.

The elimination times of porphyrins and their precursors and of hexabromobenzene (HBB) itself were studied in female rats given 15 mg HBB by stomach tu

Porphyrin methyl esters and the isomers of uroporphyrin and heptacarboxylic porphyrin were separated by high-performance liquid chromatography. Isocoproporphyrin was also separated from coproporphyrin. By slight modifications to the solvent mixture, the separation of all biological polycarboxylic porphyrins was achieved. These separations were made possible through the high efficiency of 10- or 5-μm particle-size Radial-PAK cartridges, which have been used in the separation of porphyrins in various excreta and tissues in a number of porphyrias.