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P332 A case of shiitake mushroom-induced flagellate dermatitis
S120
Abstracts: Poster Sessions / Ann Allergy Asthma Immunol 117 (2016) S22eS124
(2G) with non-IgE-mediated forms of AD. 2G had no IgE-sensitization to HDM and observed a decline in macrophage-phagocytic immunity (MPI). The IgE-mediated phenotype of AD includes 3 forms of AD: Allergic; Mixed with allergic rhinitis, asthma; Immunocompromised form (ICF). Allergic and Mixed have a proven sensitivity to HDM, which provoke the development of symptoms in AD. Immunocompromised has shown a decline in the MPI. On the basis of immune system disorders (ISD), we developed a different complex of immunotherapy (CIT). For 1G it has been suggested to conduct a regimen of comprehensive IT, consisting of traditional therapy (TT) and parenteral AIT in an accelerated scheme, and an immunomodulator (IM). In 2G we have used TT and IM. Conclusion: The developed algorithm of examination and diagnosis of patients with AD allows the choice of an adequate CIT in accordance with IPGF based on detected ISD. The above improves the treatment of Ch, increases the duration of remission, reduces the risk of the developing severe and chronic AD, and it improves their quality of life.
entire body with markedly lichenified skin. His recent flare, also his most severe occurred ten days after completing an oral steroid course. It included extensive blistering and bleeding poorly responsive to topical steroids, oral and topical antibiotics. He was unable to walk secondary to pain and tired from nights spent scratching his skin. He was started TCM therapy, consisting of herbal baths twice daily with increasing amount of additives each day, oral herbal She Zhen Tea and Herbal Cream Io-bzc. His skin improved immediately after treatment with resolution of oozing, erythema, bleeding and pruritus within two days. Conclusion: The mainstay treatment of eczema flares continues to be topical corticosteroid, yet there are side effects, and they don’t always work, such as in our patient. TCM should be considered sooner and more often in treatment of severe eczema with its low side effect profile and remarkable results. Further research on the safety and efficacy of this treatment are still needed.
P332 A CASE OF SHIITAKE MUSHROOM-INDUCED FLAGELLATE DERMATITIS L. Leigh*, New York, NY. A 59-year-old Caucasian woman with atopic dermatitis and hypothyroidism presented with linear, pruritic rash for two days. Skin eruptions lasted 20-30 minutes, brought on by heat exposure. She denied constitutional symptoms, recent illnesses, bug bites, or travel to wooded areas. She was on a stable dose of levothyroxine and dexamethasone cream with no known drug allergies. Review of systems was positive for raw shiitake mushroom ingestion several days earlier. She was afebrile and hemodynamically stable. Her exam was notable for linear erythematous patches on her trunk, arms, axillae, and neck with no mucosal involvement. She was referred to a dermatologist. Though the patient declined skin biopsy, her clinical presentation was most consistent with flagellate dermatitis. She was given topical steroids and fexofenadine. Flagellate dermatitis is a rare, toxic dermatitis caused by the thermolabile polysaccharide lentinan found in shiitake mushrooms. Though not well characterized, the proposed pathophysiology is IL-1 release by lentinan. A T-cell mediated delayed reaction has also been proposed given the delayed onset (median 24-48 hours), clearance in 3 days to 3 weeks, pruritus, and lack of outbreaks with shared meals. The rash can occur anywhere, with the trunk most frequently involved. Skin prick and patch testing are often not useful. Skin biopsy shows nonspecific lymphocytic infiltrates and epidermal spongiosis. Triggers such as genetic predisposition or certain medications are not well understood at this time. Treatment consists of removal of exposure, topical steroids, and antihistamines with overall good prognosis.
Effects of Treatment on Right Arm
P334 P333 SEVERE ATOPIC DERMATITIS POORLY RESPONSIVE TO STANDARD TREATMENTS SUCCESSFULLY TREATED WITH TRADITIONAL CHINESE MEDICINE A. Schneider*1, P. Ehrlich2, P. Parikh2, S. Park2, X. Li2, 1. Merrick, NY; 2. New York, NY. Background: Atopic Dermatitis affects 15-20% and is the most common chronic skin disease in children. Its management is multifaceted, long-term, dynamic, often involving prescription steroids and immunomodulators with side effects including skin thinning and discoloration. We present the case of a boy with eczema poorly responsive to standard treatments despite good compliance; therefore he’s started on Traditional Chinese Medicine (TCM) with almost complete resolution. Results: 7 year-old boy with eczema since infancy previously well controlled with daily moisturizer and topical steroid creams with increasing severity over the last two years, spreading to involve his
FILAGGRIN MUTATION-ASSOCIATED ATOPIC DERMATITIS WITH PRURIGO NODULARIS P. Uong*, J. Abbott, P. Hauk, K. Brar, Denver, CO. Introduction: Filaggrin protein is necessary for an intact skin barrier, and mutations have been associated with ichthyosis vulgaris, and atopic dermatitis (AD). Prurigo Nodularis (PN) is a skin disorder characterized by intensely pruritic, hyperkeratotic, hyperpigmented papulonodules created by repetitive scratching and picking of the skin, which typically occurs in pruritic conditions such as AD. In our case, a 5-year-old Caucasian boy presented with AD and PN of his distal extremities, which had been recalcitrant to multiple therapies including topical and oral corticosteroids (CS), UV light therapy, methotrexate, azathioprine, and cyclosporine A. Methods: A filaggrin mutation analysis and skin biopsies of affected areas of AD and PN were performed. Results: The patient had a homozygous filaggrin mutation (2282del4). The skin biopsies confirmed diagnoses of AD and PN.
Abstracts: Poster Sessions / Ann Allergy Asthma Immunol 117 (2016) S22eS124
(2G) with non-IgE-mediated forms of AD. 2G had no IgE-sensitization to HDM and observed a decline in macrophage-phagocytic immunity (MPI). The IgE-mediated phenotype of AD includes 3 forms of AD: Allergic; Mixed with allergic rhinitis, asthma; Immunocompromised form (ICF). Allergic and Mixed have a proven sensitivity to HDM, which provoke the development of symptoms in AD. Immunocompromised has shown a decline in the MPI. On the basis of immune system disorders (ISD), we developed a different complex of immunotherapy (CIT). For 1G it has been suggested to conduct a regimen of comprehensive IT, consisting of traditional therapy (TT) and parenteral AIT in an accelerated scheme, and an immunomodulator (IM). In 2G we have used TT and IM. Conclusion: The developed algorithm of examination and diagnosis of patients with AD allows the choice of an adequate CIT in accordance with IPGF based on detected ISD. The above improves the treatment of Ch, increases the duration of remission, reduces the risk of the developing severe and chronic AD, and it improves their quality of life.
entire body with markedly lichenified skin. His recent flare, also his most severe occurred ten days after completing an oral steroid course. It included extensive blistering and bleeding poorly responsive to topical steroids, oral and topical antibiotics. He was unable to walk secondary to pain and tired from nights spent scratching his skin. He was started TCM therapy, consisting of herbal baths twice daily with increasing amount of additives each day, oral herbal She Zhen Tea and Herbal Cream Io-bzc. His skin improved immediately after treatment with resolution of oozing, erythema, bleeding and pruritus within two days. Conclusion: The mainstay treatment of eczema flares continues to be topical corticosteroid, yet there are side effects, and they don’t always work, such as in our patient. TCM should be considered sooner and more often in treatment of severe eczema with its low side effect profile and remarkable results. Further research on the safety and efficacy of this treatment are still needed.
P332 A CASE OF SHIITAKE MUSHROOM-INDUCED FLAGELLATE DERMATITIS L. Leigh*, New York, NY. A 59-year-old Caucasian woman with atopic dermatitis and hypothyroidism presented with linear, pruritic rash for two days. Skin eruptions lasted 20-30 minutes, brought on by heat exposure. She denied constitutional symptoms, recent illnesses, bug bites, or travel to wooded areas. She was on a stable dose of levothyroxine and dexamethasone cream with no known drug allergies. Review of systems was positive for raw shiitake mushroom ingestion several days earlier. She was afebrile and hemodynamically stable. Her exam was notable for linear erythematous patches on her trunk, arms, axillae, and neck with no mucosal involvement. She was referred to a dermatologist. Though the patient declined skin biopsy, her clinical presentation was most consistent with flagellate dermatitis. She was given topical steroids and fexofenadine. Flagellate dermatitis is a rare, toxic dermatitis caused by the thermolabile polysaccharide lentinan found in shiitake mushrooms. Though not well characterized, the proposed pathophysiology is IL-1 release by lentinan. A T-cell mediated delayed reaction has also been proposed given the delayed onset (median 24-48 hours), clearance in 3 days to 3 weeks, pruritus, and lack of outbreaks with shared meals. The rash can occur anywhere, with the trunk most frequently involved. Skin prick and patch testing are often not useful. Skin biopsy shows nonspecific lymphocytic infiltrates and epidermal spongiosis. Triggers such as genetic predisposition or certain medications are not well understood at this time. Treatment consists of removal of exposure, topical steroids, and antihistamines with overall good prognosis.
Effects of Treatment on Right Arm
P334 P333 SEVERE ATOPIC DERMATITIS POORLY RESPONSIVE TO STANDARD TREATMENTS SUCCESSFULLY TREATED WITH TRADITIONAL CHINESE MEDICINE A. Schneider*1, P. Ehrlich2, P. Parikh2, S. Park2, X. Li2, 1. Merrick, NY; 2. New York, NY. Background: Atopic Dermatitis affects 15-20% and is the most common chronic skin disease in children. Its management is multifaceted, long-term, dynamic, often involving prescription steroids and immunomodulators with side effects including skin thinning and discoloration. We present the case of a boy with eczema poorly responsive to standard treatments despite good compliance; therefore he’s started on Traditional Chinese Medicine (TCM) with almost complete resolution. Results: 7 year-old boy with eczema since infancy previously well controlled with daily moisturizer and topical steroid creams with increasing severity over the last two years, spreading to involve his
FILAGGRIN MUTATION-ASSOCIATED ATOPIC DERMATITIS WITH PRURIGO NODULARIS P. Uong*, J. Abbott, P. Hauk, K. Brar, Denver, CO. Introduction: Filaggrin protein is necessary for an intact skin barrier, and mutations have been associated with ichthyosis vulgaris, and atopic dermatitis (AD). Prurigo Nodularis (PN) is a skin disorder characterized by intensely pruritic, hyperkeratotic, hyperpigmented papulonodules created by repetitive scratching and picking of the skin, which typically occurs in pruritic conditions such as AD. In our case, a 5-year-old Caucasian boy presented with AD and PN of his distal extremities, which had been recalcitrant to multiple therapies including topical and oral corticosteroids (CS), UV light therapy, methotrexate, azathioprine, and cyclosporine A. Methods: A filaggrin mutation analysis and skin biopsies of affected areas of AD and PN were performed. Results: The patient had a homozygous filaggrin mutation (2282del4). The skin biopsies confirmed diagnoses of AD and PN.