Tanaka M, Aiba S, Matsumura N, Aoyama H, Tagami H
Department of Dermatology, Tohoku University School of Medicine, Sendai, Japan.
Dermatology. 1995;190(4):269-76. doi: 10.1159/000246715.
Prurigo nodularis (PN) is a characteristic chronic dermatosis of unknown etiology showing severely pruritic nodules mainly on the extremities. Atopic diathesis has been implicated as a contributing factor.
Our purpose was to analyze the role of environmental allergens from living organisms in the pathogenesis of PN, to report hypersensitivity against various environmental allergens and to relate this to atopic history in 31 PN patients.
Positive and negative controls were studied including 52 patients with atopic dermatitis (AD) and 22 healthy controls. RAST, prick tests and scarification patch tests were performed on the patients and specimens from lesions of 8 patients were stained with anti-eosinophil cationic protein (ECP) antibody.
The 31 PN patients were divided into two groups, those with a past or present history of AD (PN + AD patients) and those without (PN-only patients). Twenty patients (65%) had PN + AD (median age at onset 19 years) and 11 (35%) had PN only (median age at onset 48 years). Analyses of serum IgE levels. RAST scores, prick test and scarification patch test results revealed that the PN + AD patients showed hypersensitive reactions to the environmental allergens in a pattern almost identical to that noted in AD without PN. In contrast, most of those with PN only did not show any hypersensitivity reactions to the environmental allergens. Histologically, many activated eosinophils, identified by monoclonal antibody to ECP, were observed only in the dermis of the PN+AD patients, in contrast to few eosinophils in the lesion of PN-only patients.
These results indicate that there are two forms of PN: an atopic and a non-atopic one. The PN+AD group is closely associated with AD, being accompanied by cutaneous hypersensitivity to various environmental allergens (a pattern similar to that displayed by AD patients) and has a younger age of onset, whereas the PN-only group, which showed a much older age of onset, does not show any such hypersensitive reactions against these allergens.
结节性痒疹（PN）是一种病因不明的特征性慢性皮肤病，主要表现为四肢出现严重瘙痒的结节。特应性素质被认为是一个促成因素。
我们的目的是分析来自生物体的环境过敏原在PN发病机制中的作用，报告31例PN患者对各种环境过敏原的超敏反应，并将其与特应性病史相关联。
研究了阳性和阴性对照，包括52例特应性皮炎（AD）患者和22例健康对照。对患者进行了放射变应原吸附试验（RAST）、点刺试验和划痕斑贴试验，并用抗嗜酸性粒细胞阳离子蛋白（ECP）抗体对8例患者的皮损标本进行染色。
31例PN患者分为两组，有既往或目前AD病史的患者（PN + AD患者）和无AD病史的患者（仅PN患者）。20例患者（65%）患有PN + AD（发病中位年龄19岁），11例（35%）仅患有PN（发病中位年龄48岁）。血清IgE水平、RAST评分、点刺试验和划痕斑贴试验结果分析显示，PN + AD患者对环境过敏原表现出超敏反应，其模式与无PN的AD患者几乎相同。相比之下，大多数仅患有PN的患者对环境过敏原未表现出任何超敏反应。组织学上，通过抗ECP单克隆抗体鉴定，仅在PN + AD患者的真皮中观察到许多活化的嗜酸性粒细胞，而仅患有PN的患者皮损中嗜酸性粒细胞较少。
这些结果表明PN有两种形式：特应性和非特应性。PN + AD组与AD密切相关，伴有对各种环境过敏原的皮肤超敏反应（与AD患者表现出的模式相似）且发病年龄较轻，而发病年龄大得多的仅PN组对这些过敏原未表现出任何此类超敏反应。
