S172 Childhood urticaria

s40

Symposia

0S169 8.

-

Urticaria

Hospital,

Kristianstad,

Sweden

Epidemiological studies can be categorized as etiologic, descriptive and intervention studies. The information from such studies may provide answers to many clinically important questions for example endogenous and exogenous risk factors, prognostic factors and the natural history of the disease. Studies among patient populations from dermatology clinics are often not adequate for estimating prognostic factors, prevalence or incidence rates. Results from different epidemiological studies may help the dermatologist to get better information about clinically relevant factors which are important in everyday work. 0 S170 What is the best treatment, doctor? Thomas L. Diepgen. Germany Abstract not available.

Dermatoepidemiology practice

P. Elsner. Dept. Zuerich,

Urticaria - Recent Advances

Will my skin disease get better, doctor?

Svensson. Central

I Si 71

- Recent Advances

of Dermatology, Switzerland

and future clinical

University

of Zuerich,

The recent interest in dermatoepidemiology is certainly welcome by epidemiologists, but the possible impact of these scientific activities on everyday clinical practice seem to remain obscure to many clinical dermatologists. However, we can expect profound changes in the way we are delivering dermatologic care to our patients in several respects: . Diagnosis: As we are already experiencing, diagnosis of skin diseases will depend less on subjective intuition and experience, but will relate to clear disease definitions and diagnostic tests of which sensitivity, specificity, positive and negative predictive value will be known. . Treatment: With clearly defined diseases and outcomes, treatment research in the form of clinical trials will become much more scientific and will allow an adequate comparison of therapeutic options for the individual patient. 0 Prevention: Considering the staggering increase in skin cancer incidence, the need of preventive action has become evident to the public and to policy makers. However, only epidemiological research will show the optimal and ressource-sparing strategies to cut the trend in skin cancer epidemiology. . Dermatologic services: It is no law of nature but the result of a historical development that dermatology exists as a specialty. If and which skin diseases need to be treated by dermatologists is subject of increasing debate in many countries. Only epidemiological, health systems and life quality research will provide the urgently needed scientific basis to prove dermatologists’ contribution to our communities.

I S172 Childhood urticaria Anne Kobza Black. St John’s Thomas’

Hospital,

London,

Institute UK

of Dermatology,

St

Childhood urticaria may be very acute and severe. Lesions in infants can be haemorrhagic Urticaria resulting from upper respiratory tract infections and IgE-mediated allergic reactions to ingested food are commoner in children compared to adults. Allergic contact u&aria particularly to foods is underestimated in children with atopic dermatitis. Allergic reactions to foods such as to peanuts can result in anaphylaxis. Physical urticarias including dermographism, cholinergic urticaria cold, solar and aquagenic urticaria occur in children. Rare conditions including Muckle-Wells Syndrome and hereditary angio-oedema present frequently first in childhood. A thorough history from the parents and child if possible is vital for diagnosis and for appropriate investigation. Management includes avoidance of known causative factors, explanation and reassurance. Symptomatic treatment is with low sedation antihistamines during the day, with additional sedating ones at night if necessary. Parents may need to be taught the technique of administering adrenaline in an emergency. The long term prognosis of childhood urticaria is good. I S173 Autoantibodies

directed against FceRlol: IgG subtype composition, prevalence, and disease specificity

E. Fiebiger ’ , F. Hammerschmid, G. Sting1 ’ , D. Maurer . ’ University of Vienna Medical School, Vienna; 2Sandoz Research

Coop.

Center;

Vienna,

Austria

Recently, we identified IgG autoantibodies (autoAbs) directed against the a-chain of FcsRI (FcsRIcu) in sera from chronic urticaria (CU) patients. The aim of the present study was to investigate the prevalence of these autoAbs in a larger panel of CU sera and in sera from individuals suffering from other (auto-) immune-mediated skin diseases. In keeping with our previous results, IgG anti-FccRh autoreactivity was detected in 37% (36/99) of CU patients but in neither atopic dermatitis patients (O/32) nor healthy individuals (O/35). Whereas IgG anti-FccRIo Abs were not or only rarely detected in psoriasis (0130, 0%), bullous pemphigoid (BP; 3/22, 13%) or systemic lupus erythematosus (SLE; 3/15, 20%) sera, these autoAbs were present in a considerable proportion of sera from dermatomyositis (DM; 22/45,49%) and pemphigus vulgaris (PV, 12/28,43%) patients. The comparative analysis of IgG subtypes responsible for the observed anti-FcaRIa! reactivity in these disease states revealed striking differences. Whereas CU sera contained predominantly IgGl and IgG3 autoAbs, FccRIo-specific IgG2 and IgG4 were rarely detected. In fact, only 1 out of 22 CU samples contained IgG4 autoAbs solely. In sharp contrast, IgG2 and/or IgG4 rather than IgGl and/or IgG3 were the dominant IgG subtypes responsible for FcsRIo-specific autoreactivity in sera from patients with DM, PV or BP. These differences in the IgG subtypes and, thus, in the complement-and/or Fc receptor-binding properties of these autoAbs are appearantly of functional importance. While it is not yet clear whether the various autoAb isotypes