Journal of Cutaneous Immunology and Allergy最新文献

A 7-year-old, otherwise healthy Japanese boy, who lived in Wisconsin State, the United States, developed pruritic rash on his lower extremities 10 days earlier. Since lesions increased in number, he was treated with triamcinolone ointment as eczema at a dermatology clinic in the United States. He then returned to Japan temporarily for a legal matter and was treated with olopatadine hydrochloride, an antihistamine drug, and betamethasone butyrate propionate ointment at a dermatology clinic. Since lesions were not improved despite the treatments described above, the patient was introduced to our department. Figure 1A–D shows a physical examination on his initial visit: We noted vesicles and serous papules and edematous swelling on the left lower thigh (A), papules on the lower back (B), tense blisters on edematous erythema on the right forearm (C), and edematous erythema with papules on left gluteal and femoral regions (D). We suspected contact dermatitis to plants, paint, or resin of bench based on morphology, and those lesions improved by administration of prednisolone, 10 mg for 3 days, and betamethasone butyrate propionate ointment for 7 days. During the interview, we could confirm that poison ivy was growing wild in the yard of the patient's house. As his mother wanted to identify the course, patch testing was performed with Japanese standard series 2015: Patch Test Panel® (S) (the trade name of T.R.U.E. TEST in Japan, Sato Pharmaceutical Co.) and 0.002% urushiol and 0.05% mercuric chloride (Torii Pharmaceutical Co.) 1 month after the initial visit. These were applied on the back for 2 days, and the results read utilizing the International Contact Dermatitis Research Group (ICDRG) scoring system 2 and 6 days after application.¹ Extremely positive reactions to urushiol were recorded on Days 2 and 6 (Figure 1E). Hence, we diagnosed it as contact dermatitis to poison ivy.

In Wisconsin State, where the patient lives, poison ivy is considered a typical noxious plant.² It is widely known that urushiol is the causative agent in allergic reactions to poison ivy. Urushiol is a typical causative agent of contact dermatitis in Japan, too. According to the Japanese contact dermatitis research group's tally in 2021, the positive rate to it was 8.7%: The fifth highest rate after gold thiosulfate, nickel sulfate, cobalt chloride, paraphenylenediamine among 24 allergens of the Japanese standard series.³ Hence, the Ministry of Foreign Affairs of Japan has issued a warning to travelers to the United States against poison ivy on its website.⁴ In this case, lesions developed not only at contact sites to poison ivy but at noncontact sites like the back and gluteal region. This is a condition that should be called contact dermatitis syndrome⁵ or stage 3A of allergic contact dermatitis syndrome: It is considered that the causative allergen

A 27-year-old woman developed dyspnea and wheezing within 10 min after eating a piece of raspberry walnut cake, and visited an emergency hospital. Based on a presumptive diagnosis of anaphylaxis, she was successfully treated with intravenous corticosteroid and intramuscular injection of adrenaline. She was referred for further investigation. Her medical history included mild asthma, cat allergy, and bipolar disorder, being treated with pranlukast, quetiapine, lamotrigine, and lorazepam. She could eat bread containing wheat and heated eggs without problem after this attack. Laboratory tests showed normal serum level of immunoglobulin (Ig) E 44 IU/mL. Multiple antigen simultaneous test (MAST)-36 (BML Inc) to examine allergen-specific IgE showed 15.2 lumicount (LC) (class 3) of cat dander and 4.89 LC (class 2) of dog dander, whereas the other results were negative. Specific IgE antibodies to strawberry, peach, apple, walnut, Jug r1, egg yolk, egg white, ovomucoid, gluten, ω-5 gliadin, birch pollen tested by CAP fluoro-enzyme immunoassay (CAP-FEIA) and prick-to-prick tests with ingredients of the cake and their related foods, including raspberry, strawberry, blackberry, blueberry, apple, walnut, almond, peanut, wheat, egg yolk, and egg white, were all negative. Then, an open oral provocation test was performed on admission initially with raspberry. Twenty minutes after eating 1.5 pieces of raspberry (about 4.5 g), she developed discomfort of the throat, dyspnea, repetitive cough, audible wheezing, and tachycardia (145 beats/min). Cutaneous symptoms were absent except for mild pruritus of the neck. Her blood pressure and percutaneous oxygen saturation (SpO2) levels were normal. She was treated with intravenous administration of 4 mg betamethasone and 5 mg chlorpheniramine, followed by an intramuscular injection of 0.3 mg adrenaline. Within 10 min, the patient's dyspnea and tachycardia subsided without sequelae. Further investigation with CD203c expression-based basophil activation test (BAT) to raspberry was negative. After avoiding raspberry and all the other berries, as well as still unchallenged walnuts, she has not experienced any episode of acute respiratory reactions for 3 years.

Raspberry (Rubus idaeus) is a small fruit belonging to the Rosaceae family: subfamily Rosoideae along with strawberry. To the best of our knowledge, there have been only five reported cases of hypersensitivity reactions related to raspberry including our case (Table 1).^1-4 Three cases had evidence of cross-reactivities with other fruits belonging to Rosaceae family, such as strawberry (n = 2), and/or rPru p 3 (n = 2) from peach.^2-4 Our case demonstrated negative results on the skin-prick test, which is reliable but not infallible, exhibiting an 85% sensitivity rate.⁵ Despite a lack of cutaneous or mucosal involvement, our case demonstrated the acute

NVX-CoV2373 (Novavax) is a protein-based vaccine targeting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and composed of recombinant full-length, stabilized prefusion spike protein homotrimers that form approximately 30-nm nanoparticles based on hydrophobic interaction with a central polysorbate-80 micelle.¹ A two-dose regimen of the NVX-CoV2373 administered to adult participants conferred 89.7% protection against SARS-CoV-2 infection,² and studies evaluating its efficacy against Omicron variant are ongoing.³ Herein, we report a case displaying angioedema-like eyelid edema after NVX-CoV2373 coronavirus disease 2019 (COVID-19) vaccination.

A 43-year-old woman noticed a pruritic edematous eruption of the left ear on day +2 after the second NVX-CoV2373 vaccination (all date numbers refer to the second dose). Treatment with oral fexofenadine hydrochloride, introduced on day +5, was insufficient to suppress the skin lesions, and swelling of eyelids appeared on day +6 (Figure 1A). The patient was referred to our department on day +7. There was no family history of skin diseases and her medical history was unremarkable except for 2-year history of fibromyalgia and migraine, which were treated with celecoxib, duloxetine, lomerizine hydrochloride, and Japanese herbal medicines. Physical examination revealed swelling of eyelids with erythema extending to the forehead, a circumscribed erythema on the chin, and an edematous erythema on the right ear (Figure 1B,C), whereas the eruption on the left ear subsided and the vaccination site on the left arm was unaffected. Similarly, there was no swelling of the axillary lymph nodes at the injection site. Laboratory findings showed a normal white blood cell count of 4810/μL, 74.9% neutrophils, 1.0% eosinophils, and slightly increased levels of serum C-reactive protein (CRP) at 0.17 mg/dL and plasma D-dimer at 1.4 μg/mL, whereas serum antinuclear antibody, immunoglobulin E, and complement levels, such as complement 3 (C3), C4 and total complement hemolytic activity (CH50), were within normal ranges. The patient's general condition was otherwise stable without fever and dyspnea. The patient was treated with oral prednisolone 15 mg/day. One week later, the skin lesions almost resolved (Figure 1D) and serum CRP and plasma D-dimer levels normalized. The prednisolone was tapered off on day +13 without any signs of recurrence.

These clinical and laboratory features resembled angioedema, which demonstrated elevated levels of CRP and D-dimer in some cases.⁴ NVX-CoV2373 is considered safe and the incidence of serious adverse events in the clinical trials was similar to the placebo group.² On the other hand, recent studies of Novavax clinical trials revealed several cases of myocarditis or pericarditis, one case of angioedema, and one case of Guillain-Barré syndrome.⁵

Dupilumab was approved for treating adult patients with atopic dermatitis (AD) refractory to topical therapy in Japan in April 2018, and self-injection of dupilumab has been available since May 2019. Subcutaneous self-injection of medication has benefits for patients and the healthcare system. However, anxiety about self-injection, lack of confidence, and the complicated procedure could prevent initiating self-injection. In this study, we assessed the experience of AD patients treated with dupilumab before and after introducing self-injection, utilizing the Self-Injection Assessment Questionnaire (SIAQ). Adult AD patients who received dupilumab by self-injection and had been treated for more than 3 months after initiating self-injection in our hospital from March 1, 2020, to June 19, 2021, were included in this study. Patients rated their perceptions about self-injections using the SIAQ before the first self-injection and 3 months after initiating self-injection. Data were collected retrospectively from their charts. Data on 36 patients were analyzed. The mean age was 34.1 ± 11.5 years. Twenty patients used a prefilled auto-injector, and the others used a prefilled syringe. Scores on self-confidence and satisfaction with self-injection significantly improved after introducing self-injection. Feelings about injections improved in patients over 40 years and in those who felt anxious about self-injection. A strong correlation in scores between satisfaction with self-injection and the ease of use was observed. The results were not affected by clinical severity, gender, or device. Our results could encourage patients who dither to introduce self-injection of dupilumab due to anxiety and/or lack of self-confidence about self-injection to initiate self-injection.

This study reports a case of a 46-year-old Japanese man with Kyrle's disease successfully treated with topical benzoyl peroxide (BPO). Topical BPO, along with topical ozenoxacin, were initially administered. The latter was discontinued after 4 weeks, while topical BPO continued to be administered, as the patient's lesions had flattened. His skin lesions had almost fully resolved after 5 months.

We report a case of Sézary syndrome aggravated by dupilumab. Although a diagnosis of atopic dermatitis was made previously, our retrospective diagnosis was cutaneous T-cell lymphoma.

Our cases suggest that thymus and activation-regulated chemokine (TARC) levels are correlated with bullous pemphigoid (BP) disease area index for skin uriticaria/erythema, and serum anti-BP180-NC16a antibody titers in patients with BP. TARC might be an important chemokine involved in the pathogenesis of BP (Br J Dermatol 2003;148:203; J Eur Acad Dermatol Venereol 2021;35:e121). We speculate that TARC is useful for predicting the clinical condition of patients with BP, similar to anti-BP180-NC16a antibody titers.

IgG4-related disease (IgG4-RD) is a systemic inflammatory disease characterized by elevated levels of serum IgG4 and infiltration of IgG4-positive plasma cells and tissue fibrosis. Some patients with IgG4-RD exhibit skin lesions, and this was defined as IgG4-related skin disease (IgG4-RSD). Here, we report a case of IgG4-RSD with plaques on the lower legs.

Dear Editor,

Cutaneous bullous eruptions triggered after COVID-19 vaccination have been reported.¹ However, a few cases of these blistering disorders have shown an atypical immunological profile. We present a distinctive case of an acquired bullous eruption in a 79-year-old patient appearing days after COVID-19 booster vaccination shot.

A 79-year-old female patient, with no past medical history or regular drug intake presented with a new onset of pruritic cutaneous blisters appearing 1 week after COVID-19 vaccination booster shot. She received two shots of Sinovac-CoronaVac vaccine, and a third shot using Pfizer-BioNTech Vaccine. Physical examination revealed tense and hemorrhagic blisters on normal-appearing, purpuric or erythematous skin (Figure 1A–C). Lesions were symmetrically distributed on the upper and lower limbs and sparing oral and genital mucosa. Nikolsky's sign was positive on purpuric skin. Skin biopsies were repeatedly performed showing similar results (Figure 1D,E). Histopathological examination revealed subepidermal blisters with numerous necrotic keratinocytes and vacuolar degeneration of basal epidermal cells associated with a lymphocytic inflammatory infiltrate of the dermis with no eosinophils. Direct immunofluorescence examination showed marked intradermal deposits of IgG, IgM, IgA, C3, and C1q within necrotic keratinocytes of the epidermis (Figure 1F). Indirect immunofluorescence and ELISA Testing for anti-desmoglein1, anti-desmoglein3, anti-BP180, and anti-BP230 were negative. A complete blood count results including eosinophil count were within normal range. Lesions kept progressing for 8 months. The patient denied any drug intake or infection preceding disease onset or relapse. The diagnosis of subepidermal blistering disease triggered by COVID-19 vaccination was made. The patient received clobetasol ointment leading to temporary control of the disease. However, blisters relapsed days after treatment discontinuation and were similarly managed with topical corticosteroids.

Subepidermal bullous eruptions following vaccination represent an immune-mediated event related to nonspecific off-target immune response.¹ Bullous pemphigoid is the most frequently reported auto-immune blistering disorder appearing after COVID-19 vaccination.² Pemphigus was less frequently associated with vaccination.³ Our patient was remarkable as she had a chronic and relapsing disease that failed to meet the diagnostic criteria of pemphigus, pemphigoid, or any other auto-immune blistering disorder.

A few cases of Steven-Johnson syndrome/Toxic epidermal necrosis have been reported in response to virotope antigens of the COVID-19 vaccine.⁴ These virotopes are expressed on the keratinocyte surface. This leads to CD8⁺ T lymphocyte activation and epidermal cell apoptosis with subepidermal detachment.