Faculty Bibliography

BACKGROUND: The patch test is an important tool for the diagnosis of contact dermatitis. In the past few years, allergists have shown increased interest in the diagnosis of contact dermatitis and the use of patch testing. OBJECTIVE: The aim of this study was to determine (1) the frequency of usage of the patch test among allergists, (2) the factors that affect the decision to patch test, and (3) the need for training the allergist to perform patch testing. METHOD: A single mailing survey was sent to all the members of the American College of Allergy, Asthma and Immunology (ACAAI). RESULTS: Fifty-seven percent of responding allergists performed patch testing but did so infrequently. Those who were fellowship trained in patch testing or attended a sponsored workshop performed the test more frequently than those with no training. Those who perceived the patch test as useful also were more likely to perform the test. Fellowship-trained members felt more confident than workshop-trained members in performing the test, and both, in turn, were more confident than members with no training. Trained physicians also were more likely to find the test useful compared with those with no training in patch testing. CONCLUSIONS: Education through fellowship training and workshop was associated with greater self-confidence of the allergist in his/her ability to perform patch testing. Education also was associated with increased perception of patch test utility and increased usage of the test.

Ocular allergic disease affects not only the conjunctivae but also surrounding structures including the eyelids. Allergic diseases of the eyelid include atopic dermatitis, contact dermatitis, and urticaria/angioedema. They must be differentiated from nonallergic eyelid diseases. Allergic diseases of the conjunctivae comprise a spectrum of disorders from common, non-sight-threatening conditions such as seasonal allergic conjunctivitis, perennial allergic conjunctivitis, and giant papillary conjunctivitis to less common and potentially sight-threatening diseases such as vernal keratoconjunctivitis and atopic keratoconjunctivitis. Each of these conditions is mediated primarily by type I hypersensitivity reactions. The clinical manifestations, differential diagnosis, and treatment of these conditions are reviewed in this article.

A 15-y-old male patient with chronic mucocutaneous candidiasis (CMCC) and new onset adrenal insufficiency developed Pneumocystis carinii pneumonia (PCP). The literature on infectious complications of CMCC is reviewed and clinical and laboratory characteristics of the only previously described case of PCP in CMCC are compared with those of the patient reported here.

To test the hypothesis that inflammatory cytokine production might be an early event in the development of the disease associated with smoking, we used alveolar cells from healthy nonsmokers stimulated with TGP as a model system. TGP, a phenol-rich glycoprotein which is present in tobacco leaves and cigarette smoke condensate, activates the immune system. It stimulates polyclonal B cell differentiation, induces primarily an IgE response, and activates human leukocytes to produce IL-1. Using in situ nucleic acid hybridization we show that the steady-state levels of IL-1 alpha, IL-1 beta, IL-6, platelet-derived growth factor (PDGF)-A, and PDGF-B mRNAs are consistently elevated in the alveolar cells of all donors following TGP stimulation. The kinetics of mRNA expression suggest that IL-1 alpha and IL-1 beta mRNAs are independently regulated in alveolar cells, while the regulation of PDGF-A and PDGF-B mRNA seems to be similar. The activated cells also synthesize elevated levels of IL-1 and IL-6. These findings lend support to the suggestion that some clinical consequences of smoking might be initiated and enhanced by the production of inflammatory cytokines. Moreover, IL-6 could also activate a polyclonal B cell response, which could lead to the synthesis of autoantibodies and thus cause immune-mediated tissue injury.