Biomedical subjects
Publications and source records attributed to E S Falk.
Sixty patients with scabies were typed for thirty-three antigens of the HLA-A, -B and -C series. A significantly increased frequency was found for HLA-AII (28.3%), compared to healthy controls (10.4%). This deviation was only found in those of the patients without signs of atopic disease.
The epidermal histological findings in the primary scabetic lesion are hyperkeratosis, acanthosis, and spongiotic edema and vesiculation. The dermal changes consist of perivascular and diffuse cell infiltrates, mainly mononuclear cells, and sometimes eosinophilic granulocytes. The number of mast cells are slightly greater in primary scabetic lesions compared with secondary lesions and normal skin. Vasculitis is found in those cases showing tissue eosinophils, severe dermatitis, and many mites. A nodular lesion shows perivascular infiltrates mainly containing histiocytes, some with atypical and hyperchromatic nuclei and a few in mitosis, and some lymphocytes and cells with pyroninophilic cytoplasm. Secondary scabetic lesions show acanthosis and perivascular inflammatory cell infiltrates, mainly mononuclear cells, whereas clinically normal skin presents very slight perivascular and diffuse mononuclear cell infiltrates in half of the patients. Both the number of circulating eosinophilic granulocytes and serum IgE concentrations correlate with the severity of the skin reaction. Ten of 60 patients with scabies had markedly increased numbers of circulating eosinophilic granulocytes during scabies infestation. In most of the patients, however, the number of circulating eosinophils decreased after scabies treatment.
Twenty-five antigens were demonstrated in a crude Dermatophagoides farinae (DF) extract by means of crossed immunoelectrophoresis (CIE), using a rabbit anti-DF serum. With the same antiserum, four antigens were demonstrated in a scabies mite preparations, indicating an immunological relationship between these scabies antigens and some of the DF antigens. In tandem CIE experiments the DF antigens were found to be partly identical to three of the scabies antigens. No IgE activity against any of these scabies antigens was evident in pooled sera from patients with house dust mite allergy by crossed radioimmunoelectrophoresis. However, one such patient had IgE antibodies to a DF antigen and a partial identical scabies antigen.
In 120 patients, treated for scabies infection, the serum IgE concentrations fell from high levels in 54 and normal levels in 66 to lower levels 12 months after treatment. The specific IgE antibodies to Dermatophagoides pteronyssinus (RAST) were also reduced 12 months after treatment. The decrease in both IgE concentrations and IgE antibodies was most conspicuous in non-atopic patients. These findings confirm previous observations of specific immunological hypersensitivity to scabies mite, and that scabies infection stimulates the production of IgE antibodies.
A man suffering from actinic reticuloid for 2 years showed highly abnormal light sensitivity over a broad action spectrum. He has been successfully treated with daily whole-body topical applications of mechlorethamine, initially for 4 weeks and after a 2-month interruption, for 3 weeks. Gauzes moistened with the same solution were placed over lichenified areas for 10-15 min. His skin became normal pale and the lichenification decreased. After treatment his tolerance for daylight increased.
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Serum total IgE levels were found to be increased in thirty-nine of ninety-four patients with scabies investigated at the time of clinical presentation. One hundred and fifty-four patients were found to have a slightly lower serum concentration of IgA during infection than when measured 6 weeks and 9 months following successful treatment (P less than 0.05). The serum concentration of IgA at 6 weeks and 9 months after treatment did not differ significantly. The serum concentration of IgG during infection was significantly higher than 6 weeks later (P less than 0.05), and than 9 months later (P less than 0.01). The 6 weeks levels were significantly higher than the results at 9 month (P less than 0.01). The serum concentration of IgM during infection was higher than 6 weeks later (P less than 0.1). The 6 weeks levels were lower than those at 9 months (P less than 0.1), whereas there was no difference between the pretreatment and 9 months levels. No differences were noted in the concentration of C3 and C4. Antinuclear antibodies (ANA) and rheumatoid factor (RF) were not found in any of the patients. In thirty-two patients with lichen planus no changes in immunoglobulins or complement were observed. This suggests that scabies infection may be associated with a humoral immumological response against the scabies infection.
Of 135 patients with scabies, forty-seven (35%) had a positive (Classes 1--4) radioallergosorbent test (RAST) to Dermatophagoides pteronyssinus (DP). Elevated serum IgE concentrations were found in sixty-one (45%) of the patients. Atopic disease was confirmed in twenty-eight (23%) of the 120 patients who completed a medical questionnaire satisfactorily. In a control group, well-matched for age and sex, of 201 employees at a local bank, only four (2%) had a positive RAST to DP, and eight (4%) had raised serum IgE levels. Atopic disease was confirmed in eighteen (9%) of them. These observations indicate that scabies infection stimulates the production of IgE antibodies, even in non-atopic individuals, and may suggest that IgE antibodies against the human pathogenic mite Sarcoptes scabiei cross-react with DP. Scabies infection in addition often seems to be associated with atopic disease.
An extract prepared from 200 adult female scabies mites was used for prick and intracutaneous testing in twelve patients with previous scabies infestation, as well as in six healthy controls and three persons with skin sensitivity to Dermatophagoides pteronyssinus who had never had scabies before. Seven individuals who had had scabies less than a year prior to the testing had positive intracutaneous (immediate type) reactions, whereas all the five who had had scabies more than a year before had negative reactions. The prick tests were negative in all cases. No skin reactions could be evoked in the controls. The passive transfer, or Prausnitz-Küstner, test was positive with the scabies mite extract and serum from three of five patients tested on one healthy individual, and with both of two sera tested on a second healthy individual. These findings indicate that immediate type hypersensitivity reactions may occur with scabies infection.
A case of subcutaneous nodular sarcoidosis presented low 25-hydroxy-vitamin D levels during the active phase of the disease, while the serum calcium levels were increased. During spontaneous remission both 25-OHD levels and serum calcium levels returned to normal.
Two cases of bullous disease had clinical and histological features suggestive of both dermatitis herpetiformis (DH) and bullous pemphigoid (BP). Immunofluorescence (IF) studies on both diseased and healthy skin tissue revealed in the one patient an intense linear deposit of IgG and C3 along the dermo-epidermal junction and in the other patient a linear deposit of IgA and C3 along the dermo-epidermal junction. No circulating anti-basement membrane antibodies were found. At the time of investigation in both cases normal jejunal mucosa was observed. Both patients carried the HLA-DRw3 antigen, which has been found associated with DH. One of them responded to treatment with diasone-sodium combined with a gluten-free diet (GFD). Combined treatment with a small dose of prednisone and diasone-sodium in addition to GFD controlled the disease of the other patient. Despite significant differences in typical cases of DH and BP, the diseases do overlap on rare occasions to form the so-called intermediate or mixed form.
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A 74-year-old male patient with rheumatoid arthritis and Sjögren's syndrome developed pemphigus foliaceus. Clinically healthy skin tissue revealed a fluorescent band of IgM along the basal membrane and an intercellular deposit of C3 and IgG in the deepest areas of the epidermis. Similar investigations of diseased skin revealed no deposits of IgM, and C3 and IgG were spread over a large area of the epidermis, though following the same pattern. In sero-positive rheumatoid patients with and without vasculitis, C3 and IgM are frequently found in small dermal vessels immediately below the epidermis in apparently normal skin. The fluorescent band of IgM along the basal membrane is thought to be an expression of the patient's rheumatoid arthritis, in spite of the fact that this IgM site is not typically associated with rheumatoid arthritis. The change in the pattern of deposition is thought to be due to pemphigus foliaceus.
This report concerns five cases of human infection resulting in lesions morphologically similar to human orf. Parapoxvirus infection in reindeer was the probable source of infection in four cases. The fifth case involved musk ox. Two of the cases involving reindeer are particularly interesting as transmission of infection occurred indirectly. Viral particles were not seen by electron microscopy of human tissues, due probably to the late stage of the illness at the time of examination. However, electron microscopy of negatively stained suspensions prepared from biopsy material collected from reindeer calves at the outbreak of the illness and of post-mortem material from the musk ox revealed characteristic parapoxvirus particles. In one patient the infection was accompanied by fever, lymphadenopathy and nausea, which cleared following a few days of treatment with doxycycline chloride. 4 cases were curetted after 4, 6, 12 and 20 weeks and healed withour scarring whereas the fifth patient was by request left alone. This resulted in localized dark pigmentation following completion of the healing process after 26 weeks.
The objective of this study was to describe the prevalence rate of atopic diseases among schoolchildren living in the heavily polluted Arctic town of Nikel, Russia. A self-administered questionnaire was distributed to the parents of 1,800 children aged 8-17 years, 1,684 of whom (93.6%) completed and returned the questionnaire. Atopic diseases were reported in 508 (30.2%) of the children and prevalence was similar for both sexes. Atopic dermatitis occurred most frequently (15.5%), followed by allergic rhinoconjunctivitis (13.9%) and asthma (3.9%). The most pronounced influence on atopic diseases in children was having parents with asthma. Indoor dampness was a significant risk factor eliciting atopic diseases, whereas furred pets, passive smoking and carpets did not influence the prevalence of allergy. We conclude that although atopic diseases are a common health problem in Nikel, they are less prevalent than has been reported in recent studies of Northern European countries. Air pollution does not seem to be a major risk factor for the development of atopic diseases.
BACKGROUND: Atopic diseases are common in western industrialized countries and their prevalence appears to be increasing. The prevalence seems to be higher in the cold, northerly regions of Europe. AIM: The aim of the study was to assess the prevalence of atopic diseases among adults in Sør-Varanger community, northern Norway, an arctic area at 70 degrees latitude north influenced by industrial pollution from smelting plants on the Kola peninsula. PATIENTS AND METHODS: The parents of all 575 schoolchildren aged 7-12 years in Sør-Varanger community (northern Norway) received a four page questionnaire concerning home environment and symptoms of allergy. A total of 1102 adults filled in and returned the questionnaire. RESULTS: 25.2% of the adults reported past and/or present symptoms (prevalence) of atopic diseases, whereas 38.7% of the children reported atopic symptoms. The prevalence of eczema occurred in 15.9%, followed by allergic rhinoconjunctivitis (10.3%) and asthma (5.6%), however, a significant difference between sexes was only found for eczema (p < 0.0005). Women smoked more frequently (45.6%) than men (39.0%). Keeping of furred pets occurred in 54.3% and dampness in 3.6% of the homes. CONCLUSION: This study indicates that the frequency of atopic diseases among adults is only two thirds of that reported in schoolchildren. Thus, the increased prevalence of atopic diseases over one generation could point towards factors associated with western lifestyle and living conditions (allergens and adjuvant factors).
One hundred and sixteen patients with severe nodulocystic acne were treated with 0.75 mg/kg isotretinoin daily for 6 months. One hundred and seven (92%) were completely healed or markedly improved at the end of treatment compared to 94 (81%) 42 months later. There was no significant difference in the clinical response between male and female patients. Seven of the 40 female patients gave birth to 7 fully developed and healthy children 39 months after discontinuation of therapy. Cheilitis (84%) and dry skin (54%) were the most common side effects, the severity of the side effects being dose-related. Increased serum triglyceride values following treatment were found in 31 (27%) of the patients. A better life quality was experienced by 99 (85%) patients after isotretinoin therapy.