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Chronic urticaria and concurrent angioedema are disappointing problems for both physicians and patients. The disease can result from multiple causes and probably does not have a single etiology. Several factors have been identified that appear to be important in the pathogenesis of individual cases, some drugs, food additives, physical factors and internal diseases. In some cases no pathogenesis are identified and those cases are classified as idiopathic. In recent years several articles has emphasized autoimmunity and infections due to Helicobacter pylori. Our article reviewed the etiology of chronic urticaria at current concepts.

A 28 year old West Indian patient is described who had a relapsing and remitting steroid-sensitive illness for 3 years. The clinical features included uveitis and widespread CNS involvement. The patient was treated as though he had neurosarcoidosis. Post mortem examination revealed histological changes compatible with a diagnosis of Behq:et's disease, but at no time did he suffer from oral or genital ulceration or arthritis.The authors suggest a new term to encompass such an entity: the "Beh9et's MINUS" syndrome (multifocal intermittent neurological and uveitic syndrome). 37.40), but his visual acuity was 6/9 on the left and 6/12 on the right, with bilateral uveitis, new vessel formation at the posterior poles, but no papilloedema. His left pupil was larger than the right, and there was a mild left ptosis. He had a right upper motor neuron facial weakness, and a mild right hemiparesis. There was truncal and limb ataxia, more marked on the right. Reflexes were brisk, more so on the right, and both plantar responses were equivocal. Sensory examination was normal.The full blood count, urea, electrolytes, glucose and liver function tests were normal but the ESR was raised at 46 and later 62 mm/hr. Serum angiotensin converting enzyme was normal (31 units/l), as were his immunoglobulins, chest and sinus x rays. A Mantoux test at 1 in 10 000 was negative. An initial CSF contained 143 red cells, and 16 white cells (mostly neutrophils)/mL, protein 0-3 g/l, and glucose of 2-9 mMol/Il (blood 5-6). Viral and fungal screens were negative, as were oligoclonal bands. A second CSF showed 5 red cells and 45 white cells (75% lymphocytes)/mL, protein 0-2 g/l, and normal glucose.Whilst in hospital, he became drowsy and dysarthric. He developed a complete left third nerve palsy, a depressed gag reflex and slowed tongue movements. Two CT scans were performed four days apart, and both were normal. The differential diagnosis of sarcoidosis and tuberculosis could not be settled, and he was treated for both with 80 mg prednisolone/day, and triple anti-tuberculous therapy.On this medication he improved and was discharged. In outpatients his steroids were reduced to 40 mg/day, and his uveitis was quiescent in September 1989. In October 1989, however, he developed increasing somnolence. Rather than increase his steroids, he was started on azathioprine, 150 mg/day. A MRI scan was performed which showed a lesion deep in the right hemisphere at the posterior end of the internal capsule and adjacent thalamus.He remained stable until January 1990 when he developed increasing drowsiness and blurred vision. Examination at this point showed that his mild right-sided facial weakness and right hemiparesis had returned. A lumbar puncture showed 12 red cells, 1 white cell/ml and a protein 0-2 g/l. A repeat MRI scan again showed the lesion in the right thalamus and internal capsule extending down to the midbrain, but it had clearly enlarged since 505 on 12 May 2018 by guest. Protected by copyright.

CONTEXT AND OBJECTIVE: Knowledge of the profile of allergen sensitization among children is important for planning preventive measures. The objective of this study was to assess the prevalence and profile of sensitization to inhaled allergens and food among children and adolescents in an outpatient population in the city of Palmas. DESIGN AND SETTING: Cross-sectional study at outpatient clinics in Palmas, Tocantins, Brazil. METHODS: Ninety-four patients aged 1-15 years who were attending two pediatric outpatient clinics were selected between September and November 2008. All of the subjects underwent clinical interviews and skin prick tests. RESULTS:A positive skin prick test was observed in 76.6% of the participants (72.3% for inhalants and 28.9% for food allergens). The most frequent allergens were Dermatophagoides pteronyssinus (34%), cat epithelium (28.7%), dog epithelium (21.3%), Dermatophagoides farinae (19.1%), Blomia tropicalis (18.1%), cow's milk (9.6%) and grasses (9.6%). A positive skin prick test correlated with a history of atopic disease (odds ratio, OR = 5.833; P = 0.002), a family history of atopic disease (OR = 8.400; P < 0.001), maternal asthma (OR = 8.077; P = 0.048), pet exposure (OR = 3.600; P = 0.012) and cesarean delivery (OR = 3.367; P = 0.019). CONCLUSION: Dermatophagoides pteronyssinus was the most frequent aeroallergen and cow's milk was the most prevalent food allergen. There was a positive correlation between a positive skin prick test and several factors, such as a family history of atopic disease, maternal asthma, pet exposure and cesarean delivery.RESUMO CONTEXTO E OBJETIVO: O conhecimento sobre o perfil da sensibilização a alérgenos em crianças é importante para o planejamento de medidas preventivas. O objetivo deste estudo foi avaliar a prevalência e perfil de sensibilização a alérgenos inalados e alimentares em crianças e adolescentes em uma população ambulatorial na cidade de Palmas. TIPO DE ESTUDO E LOCAL: Estudo transversal em unidades ambulatoriais em Palmas, Tocantins, Brasil. MÉTODOS: Foram selecionados 94 pacientes com idades entre 1 a 15 anos em 2 ambulatórios de pediatria entre setembro e novembro de 2008. Todos os sujeitos foram submetidos a entrevistas clínicas e testes cutâneos de puntura. RESULTADOS: Um teste cutâneo de puntura positivo foi observado em 76,6% dos participantes (72,3% para inalantes, 28,9% para alérgenos alimentares). Os alérgenos mais frequentes foram Dermatophagoides pteronyssinus (34%), epitélio de gato (28,7%), epitélio de cão (21,3%), Dermatophagoides farinae (19,1%), Blomia tropicalis (18,1%), leite de vaca (9,6%) e gramíneas (9,6%). Um teste cutâneo de puntura positivo foi relacionado à história de doença atópica (razão de chances RC = 5,833, P = 0,002), história familiar de atopia (RC = 8,400, P < 0,001), asma materna (RC = 8,077, P = 0,048), exposição a animal de estimação (RC = 3,600, P = 0,012) e parto cesáreo (RC = 3,367, P = 0,019). CONCLUSÃO: Dermatophagoides pteronyssinus foi o aeroalérgeno mais prevalente e, dentre alérgenos a...

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We report a case of a 44-year-old woman with an 8-year history of gnatophyma. Rosacea is a facial dermatosis that may present as flushing, erythema, telangiectases, papules, pustules and phyma. Phyma is considered the final evolution stage of rosacea and is a rare variant. Treatment of phyma with atypical localization may be a challenge for dermatologists in clinical practice.

Pityriasis Rubra Pilaris (PRP) is a chronic and rare papulosquamous disorder. Treatment of Pityriasis Rubra Pilaris is based on empiric evidence because of several doubts regarding its etiology and also because of its relative rarity, making randomized studies difficult to perform. Some factors suggest that the metabolism of vitamin A is involved in pathogenesis. We report a case of Pityriasis Rubra Pilaris associated with autoimmune hypothyroidism which presented rapid and complete response after thyroid hormone replacement, without any association with other systemic treatment. In literature there are only three other reports of significant improvement of the lesions after hormonal correction. Deficiency of thyroid hormone inhibits the conversion of carotene into vitamin A, which would be responsible for the occurrence of Pityriasis Rubra Pilaris in this patient.