Quantitative assessment of allergic shiners in children with allergic rhinitis Chien-Han Chen, MD, Yu-Tsan Lin, MD, PhD, Che-Yen Wen, PhD, Li-Chieh Wang,

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Quantitative assessment of allergic shiners in children with allergic rhinitis Chien-Han Chen, MD, Yu-Tsan Lin, MD, PhD, Che-Yen Wen, PhD, Li-Chieh Wang, MD, Kuo-Hung Lin, MS, Shih-Hsuan Chiu, PhD, Yao-Hsu Yang, MD, PhD, Jyh-Hong Lee, MD, Bor-Luen Chiang, MD, PhD Journal of Allergy and Clinical Immunology Volume 123, Issue 3, Pages 665-671.e6 (March 2009) DOI: 10.1016/j.jaci.2008.12.1108 Copyright © 2009 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 1 Measurement of darkness of shiners. Darkness of shiners was measured by using the semiautomatic method (A and B) and the manual method (C and D). The gray-level mean values in the infraorbital groove and cheek were computed in the upper and lower slanted triangle regions, respectively, in both of the 2 methods. Journal of Allergy and Clinical Immunology 2009 123, 665-671.e6DOI: (10.1016/j.jaci.2008.12.1108) Copyright © 2009 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 2 Eyelid sampling and measurement of area values of shiners. The lower eyelid curve (A) was sketched with automatic downward extension of 242 pixels from the lowest point of the red curve to mark a boundary. This region was examined with the entropy theorem, and a line of demarcation was plotted automatically to circumscribe the area of shiners (B). Journal of Allergy and Clinical Immunology 2009 123, 665-671.e6DOI: (10.1016/j.jaci.2008.12.1108) Copyright © 2009 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 3 The effect of allergic rhinitis on the formation of allergic shiners. A, Dave, Average of darkness of shiners on the left and right sides. B,Aave, average of area values of body surface area on the left and right sides. Journal of Allergy and Clinical Immunology 2009 123, 665-671.e6DOI: (10.1016/j.jaci.2008.12.1108) Copyright © 2009 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 4 The thresholds of symptoms associated with enhanced darkness (A, B, E, and F) or increased sizes (C and D) of shiners on different visits. Dave, Average of darkness of shiners on the left and right sides; Aave, average of area values of body surface area on the left and right sides; SGAE1d, SGAE recorded on the day before visits; SGAE1wk, SGAE summed from daily scores in the past week. Journal of Allergy and Clinical Immunology 2009 123, 665-671.e6DOI: (10.1016/j.jaci.2008.12.1108) Copyright © 2009 American Academy of Allergy, Asthma & Immunology Terms and Conditions

The position of the color checker. Journal of Allergy and Clinical Immunology 2009 123, 665-671.e6DOI: (10.1016/j.jaci.2008.12.1108) Copyright © 2009 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Correlations of shiners between 2 sides (A, B, and D) and between the semiautomatic and manual methods (C). DL, Darkness of shiners on the left side; DR, darkness of shiners on the right side; Dave, average of darkness of shiners on the left and right sides; AL, area value of shiners normalized by body surface area on the left side; AR, area value of shiners normalized by body surface area on the right side. Journal of Allergy and Clinical Immunology 2009 123, 665-671.e6DOI: (10.1016/j.jaci.2008.12.1108) Copyright © 2009 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Reliabilities for measurement of darkness by using the semiautomatic method (A) and for measurement of area values (B) of shiners. Test 2 performed on the same digital photographs was carried out 2 years after test 1. Dave, Average of darkness of shiners on the left and right sides; ICC, intraclass correlation coefficient; Aave, average of area values of body surface area on the left and right sides. Journal of Allergy and Clinical Immunology 2009 123, 665-671.e6DOI: (10.1016/j.jaci.2008.12.1108) Copyright © 2009 American Academy of Allergy, Asthma & Immunology Terms and Conditions

A and B, The thresholds between the control and allergic rhinitis groups at the first visit. PDF, Frequency count/numbers of all samples; AR, allergic rhinitis; NC, normal control. Journal of Allergy and Clinical Immunology 2009 123, 665-671.e6DOI: (10.1016/j.jaci.2008.12.1108) Copyright © 2009 American Academy of Allergy, Asthma & Immunology Terms and Conditions