801 Serum IgE Concentrations in Bullous Pemphigoid Correlatewith Disease Activity

L. A. Kelly, R. Holubkov, M. A. Campbell, K. S. Herlevi, T. Taylor,

C. Hull, G. J. Gleich, J. J. Zone, K. M. Leiferman; University of Utah,

Salt Lake City, UT.

RATIONALE: Bullous pemphigoid (BP) is an immune-mediated, blister-

ing cutaneous disease with a Th2 phenotype including prominent tissue

eosinophilia. Characteristic IgG autoantibodies are directed at basement

membrane zone (BMZ) antigens, termed BP180 and BP230. Recent infor-

mation suggests that IgE antibodies to BMZ antigens are present. We tested

whether total serum IgE correlated with IgG antibodies to BMZ antigens as

well as clinical disease activity.

METHODS: IgG antibodies to BP180 and BP230, and serum IgE levels

were measured by ELISA. Sera from 140 BP patients were tested by indi-

rect immunofluorescence on human skin and monkey esophagus to detect

BMZ reactivity. Results of direct immunofluorescence (DIF) on perile-

sional skin biopsies from 48 patients were also analyzed.

RESULTS: The area under the curve (AUC) of BP180 in predicting dis-

ease is 77.0 (p<0.001); BP 230 alone has an AUC of 77.5 (p<0.001). In

combination, the two ELISAs predict disease presence better than either

individually (AUC 85.3, p<0.001). BP180 correlates better with IgG stain-

ing intensity on DIF than BP230 (correlation coefficient 0.66 vs. 0.29,

p<0.001 and 0.05, respectively). Serum IgE was not only highly correlated

with disease state (AUC 71.7, p<0.001), but IgE levels increased as BP180

and BP230 ELISA levels increased (correlation coefficient 0.3, p<0.001).

CONCLUSIONS: Serum IgE levels correlate with BP disease activity

suggesting that IgE is involved in BP pathogenesis.

Funding: University of Utah

802 Study of the Effect of the Antihistamine Agent Fexofenadineon Pruritus Associated with Asteatotic Dermatitis in theElderly

T. Yudate; Sakai Hospital Kinki University School of Medicine, Sakai,

JAPAN.

RATIONALE: We compared the changes in the symptom status of pruri-

tus over time and the QOL between two patient groups, one in which the

oral antihistamine was continued after improvement of the pruritus, and

the other in which the agent was discontinued after the improvement of

pruritus.

METHODS: Fifty-five patients aged 65 years or older with asteatotic der-

matitis who visited our department from December 2005 through March

2006 were treated with the combination of a topical steroid, a moisturizer

and Fexofenadine (FEX) for 1 month. The patients in whom symptomatic

improvement was noted were divided into the antihistamine discontinua-

tion group and FEX continuation group, and followed up for another

1 month. The patients were evaluated for the pruritus status by Visual

Analog Scale (VAS) and a 5-grade scale assessment, and for the QOL by

Skindex 16, before the start of the treatment, and after 4 and 8 weeks of

treatment.

RESULTS: The results could be evaluated in 47 out of the 55 patients, ex-

cluding the 8 who were lost to follow-up. There were 26 patients in FEX

continuation group and 21 in the antihistamine discontinuation group.

Significantly greater improvement was observed after 8 weeks in FEX con-

tinuation group, especially VAS (p50.0001). Similar results were obtained

with the 5-grade scale assessment of the pruritus status and the Skindex 16.

CONCLUSIONS: These results demonstrate that continued treatment

with an antihistamine even after symptomatic improvement is obtained

is safe, prevents the relapse of dermal symptoms, and maintains a favorable

QOL of patients with asteatotic dermatitis.

Funding: Sanofi-aventis K.K.

803 Combination Therapy with Dapsone, Colchine andHydroxychloroquine in the Treatment of Urticarial Vasculitis

J. Melamed1, H. Laznickova2; 1Allergy and Asthma Specialists, Chelms-

ford, MA, 2Allergy and Asthma Clinic P.C., Lexington, MA.

RATIONALE: Therapy of uticarial vasculitis represents a challenge in

terms of maintaining adequate symptom relief and disease remission.

Oral steroids may improve these outcomes but with unacceptable side

effects. Treatment witheither Colchicine, Dapsone or hydroxychloroquine

usually provides control. We describe 2 patients that required combination

therapy.

METHODS: Patient 1: a 44 year old female with a history of urticaria and

angioedema. She was treated with H1 and H2 blockers and corticosteroids.

Her symptoms progressed and a skin biopsy showed features consistent

with urticarial vasculitis. Treatment with Dapsone 25 mg twice daily pro-

vided only partial control.

Patient 2: is a 40 year old male with a history of urticaria and angioedema

unresponsive to therapy with H1 and H2 blockers. Prednisone therapy

provided improvement only at doses >520 mg. A skin biopsy demon-

strated features of urticarial vasculitis. Colchicine 0.6 mg twice daily was

ineffective.

RESULTS: Patient 1: Colchicine 0.6 mg three times a day was added to

her regimen of H1 and dapsone with excellent control, that was not sus-

tained with colchicine alone.

Patient 2: Hydroxychloroquine 200 mg twice daily resulted in 80%

improvement and allowed taper off oral steroids. Dapsone was added at

100 mg daily and tapered to 50 mg daily with excellent response.

Both patients had features of thyroid autoimmunity and were placed on

suppressive therapy and had elevated CRP that was somewhat correlated

with disease activity.

CONCLUSIONS: Combination therapy with Dapsone, colchicine and

hydroxychloroquine should be considered in patients with urticarial vascu-

litis failing on monotherapy.

804 Cutaneous Leukocytoclastic Vasculitis in a Patient with HIVS. A. Hodes, M. Carlson; University of California, Los

Angeles, Los Angeles, CA.

RATIONALE: We report a rare case of cutaneous leukocytoclastic vascu-

litis (LV) due to crystal methamphetamine versus acquired syphilis.

METHODS: A 47 year-old man with AIDS complained of 1wk of slowly-

progressive, non-pruritic rash. He described an upper respiratory illness

followed by rash spreading from ankles over extremities and abdomen,

with fever, headache and arthralgias. No respiratory compromise, vomiting

or diarrhea. Past history included treated ocular and neurosyphilis, gonor-

rhea, chronic Hepatitis B, and Hepatitis A. Four months prior, he stopped

all HAART and prophylaxis. He was taking OTC cold preparations,

Pseudoephedrine, Acetaminophen, Hydrocodone and restarted

Venlafaxine. No known allergies. No ill contacts. He used IV crystal meth-

amphetamine until 1 day prior. No recent hiking, bug bites or pets.

Admission vitals showed temperature 36C, pulse 124, blood pressure 97/

73. Physical exam demonstrated erythematous non-blanching maculopap-

ular 1cm coin lesions over extremities and abdomen, sparing face and gen-

italia. Rash involved plantar surfaces and left palm with petechiae. He had

1cm ulceration of the hard palate and oral thrush. Anisocoria with left pupil

2 mm, right 3 mm. No adenopathy or splenomegaly.

RESULTS: Labs revealed CD4 126. CBC, electrolytes, LFTs, and chest

radiography were normal. ESR 30. All cultures and serologies were nega-

tive except serum RPR titer 1:256 with FTA 41 reactive, and CSF VDRL

reactive at 4 dilutions. Biopsy revealed LV. Within 1wk of stopping IV

drugs and initiating 2wks IV penicillin for neurosyphilis, the rash

improved.

CONCLUSIONS: Crystal methamphetamine with associated contami-

nants and syphilis are rare potential causes of cutaneous hypersensitivity

vasculitis.

Funding: Department of Internal Medicine, University of California,

Los Angeles

J ALLERGY CLIN IMMUNOL

JANUARY 2007

S204 Abstracts

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