Nonallergic anaphylaxis to pantoprazole.
Consider reactions to proton pump blockers in suspected food hypersensitivity
Biomedical subjects
Publications and source records attributed to C Hipler.
Consider reactions to proton pump blockers in suspected food hypersensitivity
There are very few case reports on allergic reactions to lychee in the literature - so far only in adults. We report on a 12-year-old girl who developed swelling of lips, pruritus, generalized urticaria and dyspnea 30 min after eating a raw lychee. A second event occurred after eating a piece of cake covered with a fruit cocktail. All other foods were well tolerated. In infancy the girl had suffered from atopic dermatitis, which disappeared in childhood; for the previous 2 yr she had presented with seasonal allergic rhinoconjunctivitis. Upon oral provocation, she developed restlessness, flush, generalized urticaria and inspiratory stridor 50 min after eating half a lychee. The diagnostic work up showed a clear positive skin prick test to raw lychee and specific immunoglobulin E (IgE) in serum to latex but not to lychee. In the cellular antigen stimulation test (CAST) carried out with lychee extracts in several concentrations, the same positive results could be found confirming an allergic reaction. Cross-reactivity of lychee to latex was shown by inhibition experiments using the UniCAP 100-system. In conclusion, it seems worthwhile considering the rare allergy to lychee in the case of unclear food-allergic reactions and lychee should be added to the list of foods cross-reacting with latex.
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The present study describes lectin and immunoreactivity in the pilosebaceous unit of porcine skin. Complex carbohydrates of mucin and biantennary Man/Gluc types were distributed among hair follicle epithelia (hair root sheaths, cuticula, shaft, and shaft matrix). Sebaceous glands expressed biantennary Man/Gluc carbohydrates and GalNAc residues. The expression of simple-type and epidermis-like keratins was confirmed by immunohistochemistry with monoclonal antibodies. Filaggrin-positive cells were found in the keratinizing zone of Henle's layer in anagen follicles. The innermost layer of the outer hair root sheath was stained with antibodies against the epidermal growth factor-receptor, keratin 10 and Ki67 antigen. The differences to humans were remarkably small.
In the present study, a porcine model for controlled skin expansion was investigated to improve our understanding of epidermal and vascular responses following stretching. The model is of outstanding importance not only for the clinical use of tissue expansion but provides interesting data for skin physiology and oncology, too. Thirteen out of 15 animals, who underwent silicone tissue expander implantation showed good clinical results. In all of them, skin biopsies were taken at the end of a controlled tissue expansion procedure (final expander volumes 350 or 500 ccm): one tissue specimen was obtained from the centre of the expanded skin area and a second from the neighbouring but nonexpanded skin. The tissue specimens were immediately frozen in liquid nitrogen and processed to 4 microns thick acetone-fixed frozen sections. Lectin histochemistry and immunohistology were performed using the following techniques: direct and indirect immunofluorescence technique (DIFT, IIFT), immunoperoxidase technique (POX) with either 3,3'-diamino-benzidine (DAB) or 3-amino-9-ethyl-carbazole (AEC). The histochemical findings were supplemented by measurements of the number of vital epidermal cell layers, the epidermal thickness (microns), and the papillary vascular count per visual field. There was a significant diminuation of the vascular count (mean +/- S.D. = 55.0% +/- 12.5%; U-test: p less than 5%). By immunohistochemistry, a loss of the basal cell reactivity for the following antibodies was noted: ACAM (against calmodulin), K 8.12 (against keratins 13 +/- 16) and A51-B/H4 (against keratins 8, 14, 18). There was a remarkable increase of filaggrin expression in the uppermost spinal cell layers in expanded skin, which was most pronounced in those specimens with the shortest interval to the last fluid injection into the expander. We gained no evidence for alterations of the expression of suprabasal epidermal keratins, lectin binding sites (UEA I, PNA, ConA, WGA), and vascular lectin- and immunoreactivity due to tissue expansion. The subdermal capsule, which had formed around the silicone expander, was strongly vimentin-reactive. In conclusion, controlled tissue expansion is capable to change the basal cell phenotype--a feature which is shared with a number of conditions with increased proliferative activity and with the epidermis covering different skin tumours. The regular expression of suprabasal keratins and epidermal lectin binding sites provides evidence for a normal epidermal cell differentiation. Furthermore, the porcine skin is a reliable model for studying physiology and pathophysiology of human skin.
An uncommon case of unilateral systemic linear porokeratosis in a women aged 22 years is reported in this paper. The results obtained from frozen-section investigations into lectin binding were indicative of reduced epidermal fucosylation and sialinization beneath the cornoid lamella. The basal stratum failed to react with a polyclonal antibody against calmodulin. Epidermal reaction, with AS-6 staining against urokinase, was of higher intensity. The above findings, as a whole, are likely to suggest accelerated keratinocyte migration to the stratum corneum in cases of linear porokeratosis and and should actually support assignment of the latter to the group of dermatoses with transepidermal elimination.
Histogenesis of eccrine sweat glands is incompletely understood. Histochemistry of the human eccrine sweat gland of adult skin by the use of lectins as well as antibodies to neuroglandular antigen (NGA) and urokinase was in favour of a relative independent differentiation from interfollicular epidermis. Expression of NGA by sweat glands is a feature unique among skin appendages. The possible impact of our findings for sweat gland histogenesis is briefly discussed.
Seborrheic keratoses were investigated by means of histo- and biochemical techniques in order to define the epidermal differentiation and proliferation of this most common epithelial tumor in adults. The following markers have been used in our study: cytokeratins, epidermal proteins binding zinc, insulin receptors, tissue plasminogen activator (tPA), as well as calmodulin (immunohistochemical and quantitative evaluation). Immunohistochemical investigation of seborrheic keratoses revealed a decreased tPA expression; their epidermal concentration of calmodulin was doubled. The differentiation markers failed to show any significant deviation from normal skin. Thus, seborrheic keratoses are associated with normal epidermal differentiation in spite of morphogenic alterations. Pathogenetically, we have to consider epidermaldermal interactions.
Histochemical investigations were performed in normal and psoriatic epidermis to evaluate possible differences in the acrosyringial reactivity. Luminal (abundant in glycoconjugates, immunoreactive) and outer (almost nonreactive) epithelial cells could be distinguished. Psoriasis did not affect the staining pattern. The findings argue against a primary involvement of acrosyringial keratinocytes in the abnormal differentiation pathway of psoriatic epidermal cells. Moreover, they underline the relative independence of the acrosyringium from interfollicular epidermis.
In a study on 76 patients suffering from psoriasis, we found melanocytic nevi (MCN) within psoriatic lesions in 7%, and in perilesional areas of about 2 cm in 13% of the patients. Under magnification (operating microscope), we failed to detect any signs of psoriasis in both the epidermis covering the MCN and the adjacent epidermis. Histopathologically, 6 out of 7 MCN examined did not show any psoriatic alterations of the epidermis, and in all the 7 cases, the adjacent epidermis was free of psoriasis. Using unfixed frozen sections in histochemistry, we studied the lectin binding of FITC-labeled ConA and UEA I in 5 MCN. The epidermal reaction was comparable to that of psoriatic lesions. In contrast to psoriatic lesions, there was no staining of the spinous layer with a polyclonal antiserum against calmodulin, but only the staining of basal cells as in non-lesional psoriasis. We discuss possible 'protective' factors against psoriasis.
In a pilot study the antimycetic effect of the lectin anti-AHP in 40 patients suffering from different mycoses was studied. The treatment with an aqueous solution of anti-AHP resulted in a complete healing in 15 of 40 cases and in 16 patients in a remarkable improvement, whereas in 9 cases such an effect has not been observed. The mode of operations remains still unknown, possible actions of anti-AHP on fungi and stratum corneum are discussed.
Frozen sections from psoriatic lesions were investigated regarding their reactivity with endothelial markers (UEA I, EEA I, LTA, Con A, factor VIII-related antigen). We compared the findings obtained with those of both uninvolved psoriatic skin and normal skin. Although all lectins showed altered epidermal binding in comparison to the controls, the endothelial lectin binding as well as the expression of factor VIII-related antigen were the same in both psoriatric lesions and controls. Our findings argue for (1) intact dimorphic genetic control of ABH expression in both epidermal and endothelial cells, (2) altered epidermal differentiation of lesional psoriatric skin, and (3) secondary vascular alterations.
Dermal nevocytic nevi (NN) were histochemically studied with the help of FITC-conjugated lectins as well as antisera against keratin and plasminogen activators of the urokinase type. 3 out of 18 NN showed interpenetrating nevus cells in atrophic parts of the epidermis. These cells revealed strong lectin reactivity both with Con A (cytoplasmatic binding) and WGA/RCA II (membraneous binding). In addition we found membraneous reaction with anti-urokinase, whereas there was no anti-keratin staining. Our findings suggest active transepidermal elimination of nevus cells in dermal nevocytic nevi.
Using 11 different kinds of lectins, we histochemically studied 18 dermal nevocytic nevi (NCN). The investigation included both unfixed frozen sections and pretreated sections fixed with acetone (pretreatment: chloroform/methanol, Triton X-100, neuraminidase). In this way, we hoped to get some information both on the expression of surface glycoconjugates and the chemical nature of the sites of lectin binding. Our results argue for an abundance of glucosyl, mannosyl, galactosyl, and N-acetyl galactosamine residues on the surface of nevus cells. In comparison to keratinocytes, we found a greater sensitivity to chloroform/methanol, which suggests a relative increase of glycolipids. Dermal NCN showed heterogenic lectin binding: The highest intensity was seen in the marginal nevus cells, the lowest in the central cells of epidermal nests. Dermal cells showed a moderate binding intensity. Epidermal cells lying above the NCN disclosed some modifications of their lectin binding pattern. In contrast to normal epidermis, basal keratinocytes failed to bind LCA; suprabasal cells showed cytoplasmic staining. In some NCN, we observed an intensive perinuclear staining of the upper keratinocytes with granular ConA. Our results suggest (1) a modified lectin binding pattern of nevus cells depending on their microenvironment, as well as (2) a distinctly altered lectin binding of keratinocytes in the adjacent epidermis.
The purpose of this paper is to describe the occurrence and distribution of glycoconjugates in normal human epidermis and skin appendages (pilosebaceous unit, eccrine sweat gland) by means of FITC-labelled lectins (ConA, WGA, UEA I). Both the outer hair root and the follicular ostium-epithel disclosed a glycoconjugate expression with close homology to interfollicular epidermis. The acinar epithelium of sebaceous glands and the inner layers of hair follicles showed a more or less distinct staining pattern. Lectin binding of eccrine sweat glands revealed marked differences between ducts and secretory coils. The epithelial distribution of glycoconjugates indicates a relatively independent differentiation pathway of eccrine sweat glands compared with other specialized epithelia of the human skin.
FITC-insulin was prepared and applied to frozen human skin sections. In normal and nonlesional psoriatic epidermis, the binding was cytoplasmic in suprabasal cells. In psoriatic lesions, fairly stained or even unstained cells were littered in suprabasal epidermis indicating the expansion of selected basal cell qualities into the stratum spinosum.
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A typical eruptive capillary hemangioma developed at the margin of an argon laser-treated nevus flammeus. The relationship of argon laser-induced vascular reactions to eruptive capillary hemangioma is discussed.