See PDF Question Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis? A. Lichen amyloidosis. Most cases are idiopathic, but ...lichen amyloidosis may be associated with multiple endocrine neoplasia type 2A, atopic dermatitis, and autoimmune diseases.1–3 This patient's laboratory findings were within normal limits (blood cell count, biochemistry, thyroid-stimulating hormone, HIV), except for an immunoglobulin E level of 2,575 IU per mL (normal = 100 IU per mL or less). Other treatments include topical and oral corticosteroids, topical calcineurin inhibitors, antihistamines, cyclosporine (Sandimmune), and fractional carbon-dioxide laser therapy.3 Lichen planus hypertrophicus classically involves the shins, ankles, and dorsum of the feet.
Keywords: allergic contact dermatitis; spongiosis; patch tests; red ink; tattoo Article Note: Correction added on 15 January 2021 after first online publication: The 4th author's surname was ...misspelled and has been corrected in this version. Byline: Elisa Gomez Torrijos
Background
In allergology, the intradermal approach is generally used to establish an aetiological diagnosis, with limited experience in specific allergen immunotherapy.
Objective
To evaluate the ...efficacy and safety of immunotherapy with an allergen extract of glutaraldehyde‐polymerized Phleum pratense, administered intradermally, in patients with rhinoconjunctivitis sensitized to grass pollen.
Methods
Multicentre, randomized, double‐blind, placebo‐controlled clinical trial in patients from 12 to 65 years of age with rhinitis or rhinoconjunctivitis, with or without asthma, due to grass pollen allergy. Patients were divided into three groups and received a total of six doses in a weekly interval, of either placebo; 0.03 or 0.06 μg of protein per dose of P pratense allergoid. The primary objective was to evaluate the combined symptoms and medication consumption score (CSMS). The secondary objectives were symptoms and medication, tolerance to the conjunctival provocation test, specific IgE and IgG4 antibodies and the safety profile according to the WAO scale.
Results
The dose of 0.06 μg of protein proved to be effective versus the placebo by significantly reducing CSMS and increasing tolerance to the allergenic extract in the conjunctival provocation test, after the first pollen season. This group showed a significant reduction in specific IgE after the second pollen season relative to the baseline. There were no variations in IgG4 levels. Only one grade 2 systemic reaction was recorded.
Conclusion & Clinical Relevance
Intradermal immunotherapy with P pratense allergoid has been shown to be effective and safe, reducing CSMS, increasing tolerance to the conjunctival provocation test and reducing IgE levels.
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