During the treatment of atopic dermatitis, it is important to consider how topical corticosteroids and tacrolimus ointment, which have been demonstrated to consistently and rapidly suppress skin inflammation in atopic dermatitis patients, should be selected and combined. Recent studies have reported that intermittent therapy is effective against flare-ups in patients that are administered corticosteroids or tacrolimus two or three times a week for stabilized atopic dermatitis. In order to treat dry skin with decreased barrier function and prevent recurrent inflammation, it is necessary to apply topical emollients. A recent study demonstrated that the daily application of emollients during the first 32 weeks of life reduced the risk of atopic dermatitis in infants.

　Recent findings about epicutaneous sensitization have resulted in a paradigm shift in our understanding about airway sensitization and food allergies. The establishment of epicutaneous sensitization requires many factors including allergen penetration through the skin, allergen uptake via the elongated dendrites of epidermal Langerhans cells, and a suitable cytokine microenvironment. In atopic dermatitis, skin inflammation often induces these conditions. In other words, the suppression of skin inflammation in atopic dermatitis using appropriate treatments, including the application of anti-inflammatory drugs, might reduce the risk of epicutaneous sensitization, which would contribute to preventing the progression of the atopic march.

　In order to clarify the current situation regarding drug-induced photosensitivity in Japan, we conducted database searches for such cases using the Japanese Adverse Drug Event Report database (JADER) . Among the cases recorded in the JADER, we targeted "photosensitivity reaction" , "solar dermatitis" , "photodermatosis" , and "actinic cheilitis" , and analyzed the patients' backgrounds, the drugs used, the date of onset, and outcomes.

　The total number of reported cases was 293 (males : 160, females : 133) , with elderly patients (60s : 75, 70s : 83) comprising the largest group. The most frequently reported drug suspected to have been the cause was losartan potassium-hydrochlorothiazide combination (72) , followed by ketoprofen (25) . Drug-induced photosensitivity tended to occur between April and August. Although no improvements were seen in some cases, many others did show improvement.

　Our survey was able to reveal the situation associated with onset of drug-induced photosensitivity, which will aid the prevention and treatment of this condition.

　Objective: We investigated the clinical utility of measuring allergen component-specific IgE antibodies for diagnosing fruit and soybean allergies. Method: The levels of IgE antibodies that were specific to crude extracts or purified allergen components from kiwi fruit, apples, peaches, or soybeans were measured in patients that had been diagnosed with food allergies to kiwi fruit (n=25) , apples (n=23) , peaches (n=27) , or soybeans (n=13) . Results: Most patients were diagnosed with pollen-food allergy syndrome. The sensitivities of the IgE antibodies specific to the purified fruit allergen components (Act d 8, Mal d 1, Pru p 1) were higher than those of the IgE antibodies to the individual crude extracts. Mal d 1 exhibited particularly high diagnostic sensitivity and specificity. In the patients with soybean allergy, the sensitivity of Gly m 4-specific IgE antibodies was much higher than that of IgE antibodies specific to the crude soybean extract.

　Conclusions: The measurement of the levels of IgE antibodies specific to purified allergen components or crude extracts is of significant benefit for the diagnosis of food allergies.

　A 69-year-old male had been attending our department to receive treatment for vitiligo vulgaris and was prescribed topical medications for white patches on his face and bilateral forearms. After 2 years' treatment, he started daily treatment with a valsartan/hydrochlorothiazide compound drug for hypertension and noticed asymptomatic erythema on the sun-exposed lesions as well as irregular hypo- and hyperpigmented macules. Under a diagnosis of photoleukomelanoderma induced by the hydrochlorothiazide in the compound drug, we instructed the patient to discontinue taking the compound drug and avoid sun exposure. Thereafter, the leukomelanoderma lesions improved without any treatment, but the vitiligo lesions remained unchanged. A photochallenge test with the compound drug produced a positive result. Although there have been some case reports about leukomelanoderma patients that displayed phototoxic responses to hydrochlorothiazide, this is the first report about a patient who exhibited both photoleukomelanoderma and non-segmental vitiligo vulgaris. Herein, we present a rare case of vitiligo vulgaris case combined with photoleukomelanoderma and discuss the differences in the histological and immunohistochemical findings between the vitiligo and leukomelanoderma lesions.

　Studies conducted outside of Japan have described methods for diagnosing anaphylaxis triggered by general anesthetics and have reported various epidemiological findings. In this study, we used these diagnostic methods and tested two patients who suffered general anesthetic-induced anaphylaxis in order to determine the causative agents and identify alternative anesthetic agents that could be used in such patients. Case 1 : A 31-year-old female presented with hypertension and asthma immediately after the administration of remifentanil hydrochloride, rocuronium bromide, and propofol for uterine myomectomy. Propofol was determined to be the causative agent based on intradermal tests conducted using a 1 : 1000 dilution of propofol. We concluded that ketamine hydrochloride and fentanyl citrate could be used as alternative agents in this patient based on intradermal tests using a 1 : 1 dilution of each agent.

　Case 2 : A 53-year-old female presented with upper body flushing and hypertension immediately after the administration of propofol, fentanyl citrate, and rocuronium bromide for laparoscopic cholecystectomy. Rocuronium bromide was determined to be the causative agent based on skin prick tests using a 1 : 1 dilution and an intradermal test involving a 1 : 100 dilution. We concluded that remifentanil hydrochloride and suxamethonium chloride could be used as alternative agents in this patient based on skin prick and intradermal tests.

　We report four cases of allergies caused by citrus fruits. In these cases, in addition to oral allergy syndrome (OAS) caused by citrus fruits, all of the patients also had OAS induced by other fruits and vegetables. Sensitization to various forms of pollen was seen in these patients: cedar (3 of 4 cases) , white birch (2 of 4 cases) , black alder (2 of 4 cases) , Gramineae (1 of 4 cases) , ragweed (1 of 4 cases) , and mugwort (1 of 4 cases) . As all 3 patients who underwent skin prick tests of the component allergens produced positive results for Bet v2, it was strongly suggested that profilin contributes to OAS caused by citrus fruits. In studies of European patients with citrus fruit allergies, it has been reported that gramineous pollen sensitization was common among profilin-specific IgE antibody-positive patients. In contrast, only one of our patients was sensitized to gramineous pollen, and it was suggested that cross reactivity between citrus fruits and Japanese cedar pollen might have been responsible our patients' citrus fruit-induced OAS. In addition, one patient had pollinosis, but their symptoms included marked anaphylaxis, so their condition might have been associated with lipid transfer protein.