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A 6-week-old Caucasian male was referred for evaluation of generalized pruritic rash, chronic emesis, and intractable diarrhea. He vomited after every feeding and had 5 to 6 loose stools per day. His symptoms did not improve after switching from cow milk formula to an extensively hydrolyzed formula. The family history obtained on admission was ''negative for history of skin disease/eczema.'' Physical examination showed an irritable infant with generalized erythroderma, severe skin scaling, purulent drainage from an ear canal, and crusted eyelids (Figure 1). His white blood cell count was 9900/mm 3 , hemoglobin 8.3 mg/dL, and platelets 605 000/mm 3 , with 31% neutrophils, 33% lymphocytes, 9% monocytes, and 27% eosinophils. The absolute eosinophil count was elevated at 3753 cells/mm 3 . IgG and IgM were within normal limits, but IgE was elevated to 157 kU/L (normal range < 17). Milk-specific IgE was not detected, but the infant's diet was changed to an amino acid-based formula. Lymphocyte subset profile showed a normal percentage of T and B cells. Mitogen response tests were normal. He was diagnosed with otitis externa and started on intravenous broad-spectrum antibiotics. Eye culture grew methicillin-sensitive Staphylococcus aureus (MSSA), and ear culture grew Pseudomonas aeruginosa. Skin biopsy showed psoriasiform dermatitis.

Momordica charantia (bitter melon) is popular in systems of traditional medicine to treat a variety of diseases including atopic dermatitis, which is an inflammatory, chronically relapsing skin disorder characterized by dry, scaly, pruritic skin. While there is growing community interest in adopting bitter melon as a complementary medicine, there are no clinical studies looking at its use for atopic dermatitis. Here we report a case of a 6-yearold female with severe refractory atopic dermatitis that responded to treatment with topical bitter melon in an open half-side comparison trial.

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RATIONALE: Adverse events (AEs) associated with sublingual immunotherapy (SLIT)-tablets used to treat allergic rhinoconjunctivitis and/or asthma occur at a rate of approximately 57%-83%, most of which are mildto-moderate. Biomarkers that could identify patients at risk of more severe reactions would be useful. Baseline specific IgE data from 11 trials of timothy grass, ragweed, house dust mite (HDM), and tree SLIT-tablets were evaluated for associations with frequency and severity of firstreported AEs. METHODS: Specific IgE (kUA/L) was divided into Class 0/1/2 (<3.5), Class 3 (3.5-17.4), Class 4 (17.5-49), Class 5 (50-99), or Class 6 (> _100).Patients' first-reported AEs were classified as none, mild, moderate, or severe. RESULTS: Overall, 9187 AEs were reported with SLIT-tablet treatment (n55298 patients). The percentages of patients with any AE were 51.7%, 62.4%, 64.4%, 64.9%, and 67.5% for baseline IgE Classes 0/1/2, Class 3, Class 4, Class 5, and Class 6, respectively. Most AEs were mild. The percentages of patients with moderate/severe AEs were slightly higher for Classes 5 (11.7%) and 6 (10.6%) versus lower Classes (5.1%-7.9%). Patterns of slightly increasing AE frequency with increasing IgE levels were observed for seasonal SLIT-tablets, whereas AE frequencies with HDM SLIT-tablet were comparable among IgE classes. AE frequency decreased over time, with approximately 80% of AEs occurring by week 5. CONCLUSIONS: The magnitude of baseline specific IgE corresponds with the frequency of AEs and appears to be a class effect of seasonal SLITtablets. The majority of AEs are mild and high IgE is not clearly associated with severe AEs. AE frequency decreases over time.

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