An alternating checkerboard pattern subtending a visual angle of 25 min arc is capable of eliciting remarkably high amplitudes of visually evoked potentials (VEP) outside a visual angle of 2.5 degree. These contributions cannot be neglected when evaluating a VEP response obtained with a larger field of stimulation. When the retina is consecutively stimulated by concentric frame-shaped stimuli, the algebraic sum of all single cortical responses augmented the cortical response obtained when stimulating the whole field simultaneously by approximately 30%. This finding may be explained by the inhibiting interactions within the receptive field organisation of the retina.

Summary Background and objectives Patients with chronic urticaria are often unsatisfied with their treatment. We aimed to assess patient satisfaction, chronic urticaria control, treatment goals, self‐treatment competence, knowledge, and factors influencing treatment satisfaction. Patients and methods Eighty‐seven adult patients with chronic urticaria who were previously insufficiently treated with oral antihistamines received guideline‐based care for six months and completed questionnaires. Results This study included patients with chronic spontaneous (80 %) and/or inducible urticaria (CIndU, 32 %). Significant median improvements were observed with the urticaria control test (UCT, from 7 to 11), the urticaria activity score for patients with chronic spontaneous urticaria (from 19 to 10), and treatment satisfaction (from 5.2 to 8.4). Six significant, independent factors of treatment satisfaction after six months of treatment were identified (negative: male sex, CIndU, sleep disturbances; positive: UCT, baseline treatment satisfaction, perceived competence of the study physician). Adequate urticaria control (UCT ≥ 12) was achieved in 19 % of patients with CIndU and 61 % of patients without CIndU. Conclusions In patients with chronic urticaria who were previously insufficiently treated with antihistamines, six months of guideline‐based therapy significantly improved disease control and treatment satisfaction. Adequate control requires several consultations for many patients and is considerably more difficult to achieve for CIndU.

Background: In agricultural meat production, adding enzymes such as phytase to animal feed is widespread, but there is little awareness of the allergenic potential and health risks of these fungal enzymes. Patients and Methods: We report on eight patients working in a plant producing phytase granulates. All patients complained about work-related rhinitis occurring within six months of the onset of exposure to phytase dust. Asthmatic symptoms and contact urticaria also occurred. To detect sensitizations to phytase, skin prick-, patch-, and basophil activation test were carried out with the factory product. Levels of IgE and IgG against phytase were also measured. Results: There was a positive reaction to phytase with skin prick testing in seven of the eight patients. IgE specific to phytase was detectable in four of the eight patients, and IgG specific to phytase was detectable in six of the eight patients. The basophil activation test was positive in four out of seven patients tested, but the patch test was negative in all patients tested. Transfer to a different workplace with no exposure to phytase completely eliminated the symptoms. Conclusions: Mold enzymes such as phytase are highly potent occupational allergens. Occupational safety measures must be strictly implemented in order to protect the health of workers.

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References 1 Worm M , Babina M , Hompes S . Causes and risk factors for anaphylaxis . J Dtsch Dermatol Ges 2013 ; 11 ( 1 ): 44 -50 . 2 Werner-Busse A , Zuberbier T , Worm M . The allergic emergency -management of severe allergic reactions . J Dtsch Dermatol Ges 2014 ; 12 ( 5 ): 379 -87 . 3 Henning T . Polyethylene glycols (PEGs) and the pharmaceutical industry . FharmaChem 2002 ; 1 : 57 -9 .

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