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Bullous pemphigoid (BP) is a prototypic autoimmune disorder of the elderly, characterized by serum IgG autoantibodies, namely anti-BP180 and anti-BP230, directed against components of the basal membrane zone that lead to sub-epidermal loss of adhesion. Pruritus may be indicative of a pre-clinical stage of BP, since a subset of these patients shows serum IgG autoantibodies against BP230 and/or BP180 while chronic pruritus is increasingly common in the elderly population and is associated with a variety of dermatoses. Clinical and experimental evidence further suggests that pruritus of the elderly may be linked to autoimmunity with loss of self-tolerance against cutaneous autoantigens. Thus, the objective of this study was to determine autoreactive T cell responses against BP180 in elderly patients in comparison to patients with BP. A total of 22 elderly patients with pruritic disorders, 34 patients with bullous or non-bullous BP and 34 age-matched healthy controls were included in this study. The level of anti-BP180 and anti-BP230 IgG serum autoantibodies, Bullous Pemphigoid Disease Area Index (BPDAI), and pruritus severity were assessed for all patients and controls. For characterization of the autoreactive T cell response, peripheral blood mononuclear cells were stimulated ex vivo with recombinant BP180 proteins (NH2- and COOH-terminal domains) and the frequencies of BP180-specific T cells producing interferon-γ, interleukin (IL)-5 or IL-17 were subsequently determined by ELISpot assay. Patients with BP showed a mixed Th1/Th2 response against BP180 while autoreactive Th1 cells were identified in a minor subset of elderly patients with pruritic disorders. Furthermore, our T cell characterization revealed that therapeutic application of topical clobetasol propionate ointment in BP patients significantly reduced peripheral blood BP180-specific T cells, along with clinically improved symptoms, strongly suggesting a systemic immunosuppressive effect of this treatment.

Sesam (Sesamum indicum) gehort zur Pflanzenfamilie der Sesamgewachse (Pedaliaceae) und wird in erster Linie zur Zubereitung von Speisen, vor allem in der orientalischen und asiatischen Kuche, verwendet. Als sogenanntes aufstrebendes Allergen („emerging allergen“) erlangt es infolge der Globalisierung von Ernahrungsgewohnheiten sowie dem allgemeinen Trend zu vegetarischer und veganer Lebensweise zunehmend Bedeutung im Alltag des allergologisch tatigen Arztes. Aufgrund des vermehrten Auftretens anaphylaktischer Reaktionen auf Sesam hat die Europaische Union Sesam in die Liste der kennzeichnungspflichtigen Nahrungsmittelallergene aufgenommen. Neben der Verwendung in der privaten und industriellen Nahrungsmittelzubereitung wird Sesam zudem in der Kosmetik- und der Arzneimittelindustrie eingesetzt. Diese Arbeit ist ein Uberblick ausgewahlter, wissenschaftlicher Artikel und wurde mit Recherchen in Pubmed, Studien und Fachdatenbanken erstellt. Gegenuber sesam- und sesamolhaltigen Produkten sind sowohl IgE-vermittelte Reaktionen vom Soforttyp (Typ I nach Coombs und Gell) als auch kontaktallergische Reaktionen vom Spattyp (Typ IV nach Coombs und Gell) beschrieben. Das klinische Spektrum ist breit gefachert und reicht von einer Kontakturtikaria und Ekzemen bis hin zu fatalen Anaphylaxien. Bedeutsame Allergene der Soforttypallergie sind Albumine, Viciline, Oleosine und Globuline; relevante Kontaktallergene Sesamolin, Sesamin und Sesamol. Die Diagnostik zur Abklarung eines Verdachts auf Sesamallergie beinhaltet Hauttests, die aufgrund einer hoheren Sensitivitat und Spezifitat praferenziell mit nativen Allergenen erfolgen sollten, sowie die Untersuchung auf sesamspezifische IgE-Antikorper. Insbesondere die lipophilen Oleosine sind in der Analytik allerdings unterreprasentiert. Eine differenzierte, komponentenbasierte IgE-Diagnostik ware wunschenswert. Goldstandard ist die orale Provokation, wobei auf niedrige und unbedenkliche Anfangs- und ausreichende Maximaldosen zu achten ist. Bei Allergien auf Sesam ist der Patientenedukation im Nachgang einer stattgehabten allergischen Reaktion eine besonders hohe Bedeutung beizumessen. Sie dient zum einen der Verhinderung erneuter Allergenexpositionen, und sollte zum anderen Informationen zum Selbstmanagement bei Rezidivreaktionen enthalten. Der Stellenwert einer oralen Toleranzinduktion und praventiver Masnahmen wie einer fruhzeitigen Einfuhrung als Beikost bleibt in Zukunft zu klaren.

Sesame (Sesameum indicum) belongs to the pedalium family (Pedaliaceae) and is used primarily in the preparation of food, especially in oriental and Asian cuisine. As a so-called emerging allergen, it is becoming increasingly relevant in the everyday routine of physicians active in the field of allergology in the wake of the globalization of dietary habits and the general trend towards vegetarian and vegan lifestyles. Due to the increased occurrence of anaphylactic reactions to sesame, the European Union has included sesame in the list of food allergens requiring labeling. In addition to its use in private and industrial food preparation, sesame is also utilized in the cosmetics and pharmaceutical industries. This paper is an overview of selected scientific articles and is based on research in PubMed and specialist databases. Immediate-type IgE-mediated reactions (type I according to Coombs and Gell), as well as delayed-type contact allergic reactions (type IV according to Coombs and Gell), to products containing sesame and sesame oil have been described. The clinical spectrum is broad and ranges from contact urticaria and dermatitis to fatal anaphylaxis. Important allergens in immediate-type allergy include albumins, vicilins, oleosins, and globulins; relevant contact allergens include sesamolin, sesamin, and sesamol. The diagnostic work-up for suspected sesame allergy includes skin tests, which should preferentially be carried out with native allergens due to their higher sensitivity and specificity, as well as determination of sesame-specific IgE antibodies. However, lipophilic oleosins in particular are underrepresented in analytical methods. Differentiated, component-based IgE diagnostic testing is desirable. Oral provocation is the gold standard, whereby it is important to ensure low and safe initial doses as well as adequate maximum doses. Beside diagnostic measurements including skin tests, detection of IgE antibodies and oral provocation tests, the education of patients with sesame allergy is of particular importance. This serves, firstly, to prevent recurrence of allergen exposure and, secondly, should contain information on self-management in the case of repeated reactions. The value of oral tolerance induction and preventive measures such as early introduction as a dietary supplement remains to be clarified in the future.