Dubai Final-v20.indd - World Allergy Organization

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patients with acquired cold urticaria (ACU), unresponsive to standard treatment with high doses of antihistamines, montelukast and/
or corticosteroids.
methods: Four patients with ACU (three males, one female, median age = 34 years) with a critical stimulation time threshold (Cstt)
at 3 minutes. three out of the four cold urticaria patients had a history of systemic anaphylactic reactions after exposure to cold
environment and episodes of urticaria-angioedema several times a week during the winter, spring and autumn.
results: treatment with omalizumamb, resolved symptoms in three out four patients with cold urticaria (time to clinical response
1.5 months). Only the patient with the lowest total igE (4.1 iU/ml) had a mild response to treatment, although the Csst became
negative on the second month of treatment. Conclusion:treatment with omalizumab can be beneficial in selected patients with cold
urticaria refractory to standard treatment with antihistamines and /or corticosteroids. Patients with low levels of total igE may not
respond adequately to treatment with Omalizumab.
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THE aCTiVE Form oF D ViTamin, CalCiTriol 1,25(oH)2D3 anD naTUral PPrgamma agoniST, -3 PolYUnSaTUraTED
FaTTY aCiDS (PUFaS) migHT SErVE aS a nEgaTiVE FEEDBaCK looP To PrEVEnT EXCESSiVE inFlammaTion in PaTiEnTS
WiTH SEVErE aToPiC DErmaTiTiS
Zaharov, t. 1 , Chaynava, A. 2 , Kamenov, B. A. 3 and Kamenov, s. 4
1 2 3 Pediatrics, regional Hospital næstved, naestvad, Denmark. Pediatrics, regional Hospital næstved, naestved, Denmark. Pediatric
Clinic, Clinical Centre of nis, nis, serbia and montenegro. 4Pediatric, Helth Centre of nis, nis, serbia and montenegro.
the function of vitamin D is promoting cell differentiation, cell maturation and inhibiting (uncontrolled) cell proliferation. VDr is
expressed by almost all immune cells, including activated CD4+ and CD8+ t cells, B cells, neutrophils, and APCs . 1,25(OH)2D
inhibits th-1 type immune function in adult (memory) cells, induces t regulatory cells, and enhances phagocytosis by white blood
cells. Vitamin D inhibits the activation of t cells, and promotes tolerance in dendritic cells.39,40 VDr has also been implicated in
toll-like-receptor (tlr) signaling and regulation of the innate immune response in macrophages. Current evidence indicates that
PUFAs can prevent the development of inflammatory diseases by affecting different steps of the immune response.
Case reports:
14 months old girl, known with severe atopic dermatitis, debuted at first days of life, had relapsed several staphylococci cutaneous
infections, vasculitis like syndrome without positive verification of PCr/Antibody of Herpes family virus and was many times in
treatment with per os and i.v. antibiotics. in the first 9 months of age exclusive breastfeedings, but due to event stimulation after
mothers diet, stopped. started with diet restriction, only specific milk formula neocat, PUFAs , calcitriol and probiotics(lgg).
results: 1) before immunomodulatory therapy, only with skin care and topical Cs, intermittent topical calcineurin inhibitors and
pruritis control: very high igE over 5000, over 100 for cows milk, eggs and cross reaction almost of all, one that was normal was
fish and shrimps igE, high Eo counts, 1.68, thrombocytosis and neu-peni. Calcitrol 204, normal levels of immunoglobulin’s, C1q
concentration 77%, slightly below ref. intervals, reduced activity of complement via the mBl pathway and decreased concentration
of B cells. 2) After: normalization of le and tr counts, especially nice response in Eo are decreasing to 0.53, reduction in igE level
to 2500.EDtA blood for t, B and nK cell: normal proportions and concentrations of t and B / nK lymphocytes, nice response of
virgin tcell, normal exposure of adhesions molecules, normal t cell proliferation by polyclonal stimulation, normal value of somatic
mutation. there are no signs of maternal engraftment on the CD4/CD8 separated cells. there is not sign of stAt3 deficiency.
Clinical benefit, much better without signs of acute infections and severe itching, almost normal skin without lesions, normal
growth.
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mETHoTrEXaTE For UrTiCarial VaSCUliTiS anD angioEDEma WiTH CrYogloBUlinEmia
Butt, A. , Alkhalil, m. , ledford, D. and lockey, r. F.
Division of Allergy & immunology, University of south Florida and James A. Haley Veterans’ Hospital, tampa, Fl.
Background: Cryoglobulinemia (Cg) is associated with a leukocytoclastic vasculitis primarily affecting the kidneys, skin and
peripheral nerves. Urticaria, but not usually angioedema, is a potential presentation for Cg. Cryoglobulins are usually associated
with infectious, autoimmune and lymphoproliferative disorders; therefore, treatment options are varied. We report a patient with
corticosteroid (Cs)-dependent urticaria and angioedema (U/AE) who was able to discontinue Cs therapy following weekly oral
methotrexate (mtX).
results: 57-year- old Caucasian male presented with a seven month history of recurring symptoms of generalized urticaria and
facial angioedema. the symmetrical rash initially developed after a dental procedure requiring penicillin therapy. the findings
were attributed to penicillin, but persistence of the rash prompted a skin biopsy which demonstrated a leukocytoclastic vasculitis.
Prednisone, 10 mg twice daily, resulted in minimal improvement of the rash, but arthritic pain in the hands and knees developed.
An immunologic and rheumatologic evaluation showed type 3 mixed Cg without monoclonal protein, 2+ urinary protein, decreased
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