A six‐month old male infant with severe atopic dermatitis was admitted with hypoalbuminemia, oliguria and cyanosis of the extremitie. s. There was marked edema and generalized eczema with foul, yellowish exudates. The patient's major clinical manifestations were attributed to the loss of albumin through the skin. Although atopic dermatitis is a common disease in children, here we want to show that systemic disturbances may arise from such condition, describe the total care given the patient, and emphasize the wholistic approach in managing cases of severe atopic dermatitis, intensive treatment was instituted and the patient was discharged after three weeks and remained in a stable condition.

We studied the l-type isoproterenol inhalation therapy for patients with severe asthmatic attacks who were admitted at the Department of Allergy of National Children’s Hospital from 1981 to 1991. One hour after l-type isoproterenol inhalation therapy, statistically significant effects were noted with regard to the asthmatic status. Moreover, no side effect was found amoung the subjects. From these data, l-type isoproterenol inhalation therapy is thought to be effective for severe asthmatic attacks.

A 5-year-old female with severe atopic dermatitis with secondary bacterial infection is presented. The patient had been managed with topical steroids and anti-allergic drugs for several months prior to admission to the National Children's Hospital, Tokyo. This case is reported to emphasize that drugs alone are not sufficient in treating severe atopic dermatitis. Skin care and environmental control are equally important and should form a part in the management of the disease. Key wordsatopic dermatitis, environmental control, skin care. treatment. 2 Rajka G E.s.wntiul Acprch oj' Alopic. Drrmcilitis. Springer-Verlag. Berlin. 19x9. 3 Charlesworth EN. Practical appmaches to the treatment of atopic dermatitih. A/fer,qv Pnw. Iw; 1s: 269-74. 4 Krauw L. Shu\ter S. hlechanisrn of action of antipruritic 5 Huena-Loper JG. Ketotifen in allergic diseases. Rrv. Alcrg. Mrn. 1991; 38. IS1 -7. 6 likura Y, Naspitr C . hlikaua II rr ul Prevention of asthma by Ketotifen in infants with atop~c dermatitis. Ann. A / / u y ?~ 1992; 7 Jacob\ A. Galdwbel A. Atopic dermatitis. In. Bierman CW, Pearlman D red\). A//rr,gic Disriisu~ jhmi lnjiincy r o Adu/ihomd. WB Saunders. Philadelphia. 19XX. 385 -404. X Glohal Initiative for A\thrna. A Six-Purr A.funugrmt.nt Pmgrurn. National Institute$ of Health Publication No. 95-drug\. Bhfl 1983: 287. I I W -2(M) 68: 233-6. 3659. 1995; 70-117.

The patient was a 10-year-old boy who complained of urticaria upon exposure to cold air and after swimming in the pool. He also had seasonal asthma and wheezing after strenuous activities. To determine whether he had primary acquired cold urticaria, we performed a cold stimulation test twice. We likewise wanted to know whether a difference in response with regard to histamine release existed between blood samples taken from the challenged and the unchallenged sites. We obtained blood samples for histamine release initially at the site opposite the challenged forearm, and then on the same side on two separate occasions. We noted the appearance of constitutional signs and symptoms and correlated the time of their appearance with the result of histamine levels. The patient complained of pruritus and wheals appeared at the 5 minute in both tests. Results of plasma histamine release in the two measurements showed the highest releasability at 15 min. Our findings revealed that histamine is released systemically in response to cold stimulation regardless of the site where the blood sample was obtained.