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Thomas P, Arenberger P, Bader R, Bircher AJ, Bruze M, de Graaf N, Hartmann D, Johansen JD, Jowitz-Heinke A, Krenn V, Kurek M, Odgaard A, Rustemeyer T, Summer B, Thyssen JP. A literature review and expert consensus statement on diagnostics in suspected metal implant allergy. J Eur Acad Dermatol Venereol 2024. [PMID: 38606660 DOI: 10.1111/jdv.20026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/11/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Although rare, allergic reactions to metal implants represent a diagnostic challenge in view of missing guidelines. OBJECTIVES To develop an European expert consensus on characteristics of metal allergy reactions and the utility of various diagnostic tools in suspected metal implant allergy. METHODS A nominal group technique (NGT) was applied to develop consensus statements. Initially an online literature database was created on a secure server to enable a comprehensive information. Twenty-three statements were formulated on potential aspects of metal implant allergy with a focus on diagnostics and grouped into five domains. For the consensus development, the panel of 12 experts initially did refine and reformulate those statements that were ambiguous or had unclear wording. By face-to-face (9/12) or virtual participation (3/12), an anonymous online voting was performed. RESULTS Consensus (≥80% of agreement) was reached in 20/23 statements. The panel agreed that implant allergy despite being rare should be considered in case of persistent unexplained symptoms. It was, however, recommended to allow adequate time for resolution of symptoms associated with healing and integration of an implant. Obtaining questionnaire-aided standardized medical history and standardized scoring of patient outcomes was also considered an important step by all experts There was broad consensus regarding the utility/performance of patch testing with additional late reading. It was recognized that the lymphocyte transformation test (LTT) has to many limitations to be generally recommended. Prior to orthopaedic implant, allergy screening of patients without a history of potential allergy to implant components was not recommended. CONCLUSIONS Using an expert consensus process, statements concerning allergy diagnostics in suspected metal implant allergy were created. Areas of nonconsensus were identified, stressing uncertainty among the experts around topics such as preoperative testing in assumed allergy, histological correlate of periimplant allergy and in vitro testing, which underscores the need for further research.
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Affiliation(s)
- P Thomas
- Department of Dermatology and Allergology, University Hospital, Munich, Germany
| | - P Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University and University Hospital of Kralovske Vinohrady, Prague, Czech Republic
| | - R Bader
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - A J Bircher
- Department of Dermatology and Allergology, University Hospital and University of Basel, Basel, Switzerland
| | - M Bruze
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - N de Graaf
- Department of Dermatology, VU University Medical Center, Amsterdam, The Netherlands
| | - D Hartmann
- Department of Dermatology and Allergology, University Hospital, Munich, Germany
- München Klinik gGmbH, Munich, Germany
| | - J D Johansen
- Department of Dermatology and Allergy, National Allergy Research Centre, University of Copenhagen, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - A Jowitz-Heinke
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - V Krenn
- MVZHZMD Trier GmbH, Trier, Germany
| | - M Kurek
- Hospital MEDICAM, Gryfice, Poland
| | - A Odgaard
- Department of Orthopaedic Surgery, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
- Institute of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - T Rustemeyer
- Department of Dermatology, VU University Medical Center, Amsterdam, The Netherlands
| | - B Summer
- Department of Dermatology and Allergology, University Hospital, Munich, Germany
| | - J P Thyssen
- Department of Dermatology and Allergy, University of Copenhagen, Herlev and Gentofte Hospital, Hellerup, Denmark
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Bircher AJ, Parlar B, Mateluna CM, Heijnen I, Scherer Hofmeier K. [Skin Prick Test as a Provocation Test - Severe Anaphylactic Reaction to Skin Tests with Ceftriaxone in Two Occupationally Exposed Workers]. Laryngorhinootologie 2024; 103:128-132. [PMID: 37652036 DOI: 10.1055/a-2109-3463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Brockow K, Wurpts G, Trautmann A, Pfützner W, Treudler R, Bircher AJ, Brehler R, Buhl T, Dickel H, Fuchs T, Jakob T, Kurz J, Kreft B, Lange L, Merk HF, Mockenhaupt M, Mülleneisen N, Ott H, Ring J, Ruëff F, Sachs B, Sitter H, Wedi B, Wöhrl S, Worm M, Zuberbier T. Guideline for allergological diagnosis of drug hypersensitivity reactions: S2k Guideline of the German Society for Allergology and Clinical Immunology (DGAKI) in cooperation with the German Dermatological Society (DDG), the Association of German Allergologists (ÄDA), the German Society for Pediatric Allergology (GPA), the German Contact Dermatitis Research Group (DKG), the German Society for Pneumology (DGP), the German Society of Otorhinolaryngology, Head and Neck Surgery, the Austrian Society of Allergology and Immunology (ÖGAI), the Austrian Society of Dermatology and Venereology (ÖGDV), the German Academy of Allergology and Environmental Medicine (DAAU), and the German Documentation Center for Severe Skin Reactions (dZh). Allergol Select 2023; 7:122-139. [PMID: 37705676 PMCID: PMC10495942 DOI: 10.5414/alx02422e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/30/2023] [Indexed: 09/15/2023] Open
Abstract
Not available.
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Affiliation(s)
- Knut Brockow
- Department of Dermatology and Allergology Biederstein, Faculty of Medicine, Technical University of Munich, Munich
| | - Gerda Wurpts
- Department of Dermatology and Allergology, Germany, Aachen Comprehensive Allergy Center (ACAC), University Hospital of RWTH Aachen University, Aachen
| | - Axel Trautmann
- Department of Dermatology and Allergology, Allergy Center Mainfranken, University Hospital Würzburg, Würzburg
| | - Wolfgang Pfützner
- Department of Dermatology and Allergology, University Hospital Giessen and Marburg, Marburg
| | - Regina Treudler
- Department of Dermatology, Venerology and Allergology, University of Leipzig, Leipzig, Germany
| | - Andreas J. Bircher
- Facoltà di Scienze biomediche, Università della Svizzera italiana, Lugano, and Department of Dermatology and Allergology, University Hospital Basel, Switzerland
| | | | - Timo Buhl
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen
| | - Heinrich Dickel
- Department of Dermatology, Venerology and Allergology, St. Josef Hospital, University Hospital of the Ruhr University Bochum, Bochum
| | - Thomas Fuchs
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen
| | - Thilo Jakob
- Department of Dermatology and Allergology, University Hospital, Justus-Liebig University, Gießen
| | - Julia Kurz
- Department of Dermatology and Allergology, University Hospital Giessen and Marburg, Marburg
| | - Burkhard Kreft
- Department of Dermatology and Venereology, University Hospital Halle, Halle (Saale)
| | - Lars Lange
- Pediatric Clinic, Marienhospital Bonn, Bonn
| | - Hans F. Merk
- Department of Dermatology and Allergology, Germany, Aachen Comprehensive Allergy Center (ACAC), University Hospital of RWTH Aachen University, Aachen
| | - Maja Mockenhaupt
- Documentation Center for Severe Skin Reactions, Department of Dermatology and Venereology, University Medical Center Freiburg, Freiburg
| | | | - Hagen Ott
- Children’s and Youth Hospital Auf der Bult, Hanover
| | - Johannes Ring
- Department of Dermatology and Allergology Biederstein, Faculty of Medicine, Technical University of Munich, Munich
| | - Franziska Ruëff
- Department of Dermatology and Allergology, Allergy Center, Ludwig Maximilian University of Munich
| | - Bernhardt Sachs
- Department of Dermatology and Allergology, Germany, Aachen Comprehensive Allergy Center (ACAC), University Hospital of RWTH Aachen University, Aachen
| | - Helmut Sitter
- Institute for Theoretical Surgery, Philipps University of Marburg, Marburg
| | - Bettina Wedi
- Hanover Medical School, Department of Dermatology, Allergology and Venereology, Hanover, Germany
| | - Stefan Wöhrl
- Floridsdorf Allergy Center (FAZ), Vienna, Austria, and
| | - Margitta Worm
- Allergology and Immunology, Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Torsten Zuberbier
- Allergology and Immunology, Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Sarhan MS, Wurst C, Tzankov A, Bircher AJ, Wittig H, Briellmann T, Augsburger M, Hotz G, Zink A, Maixner F. A nontuberculous mycobacterium could solve the mystery of the lady from the Franciscan church in Basel, Switzerland. BMC Biol 2023; 21:9. [PMID: 36747166 PMCID: PMC9903526 DOI: 10.1186/s12915-022-01509-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 12/15/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND In 1975, the mummified body of a female has been found in the Franciscan church in Basel, Switzerland. Molecular and genealogic analyses unveiled her identity as Anna Catharina Bischoff (ACB), a member of the upper class of post-reformed Basel, who died at the age of 68 years, in 1787. The reason behind her death is still a mystery, especially that toxicological analyses revealed high levels of mercury, a common treatment against infections at that time, in different body organs. The computed tomography (CT) and histological analysis showed bone lesions in the femurs, the rib cage, and the skull, which refers to a potential syphilis case. RESULTS Although we could not detect any molecular signs of the syphilis-causing pathogen Treponema pallidum subsp. pallidum, we realized high prevalence of a nontuberculous mycobacterium (NTM) species in brain tissue sample. The genome analysis of this NTM displayed richness of virulence genes and toxins, and similarity to other infectious NTM, known to infect immunocompromised patients. In addition, it displayed potential resistance to mercury compounds, which might indicate a selective advantage against the applied treatment. This suggests that ACB might have suffered from an atypical mycobacteriosis during her life, which could explain the mummy's bone lesion and high mercury concentrations. CONCLUSIONS The study of this mummy exemplifies the importance of employing differential diagnostic approaches in paleopathological analysis, by combining classical anthropological, radiological, histological, and toxicological observations with molecular analysis. It represents a proof-of-concept for the discovery of not-yet-described ancient pathogens in well-preserved specimens, using de novo metagenomic assembly.
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Affiliation(s)
- Mohamed S Sarhan
- Eurac Research - Institute for Mummy Studies, 39100, Bolzano, Italy.
| | - Christina Wurst
- Eurac Research - Institute for Mummy Studies, 39100, Bolzano, Italy
| | - Alexandar Tzankov
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, 4031, Basel, Switzerland
| | - Andreas J Bircher
- Department of Allergology, University Hospital Basel, 4031, Basel, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - Holger Wittig
- Department of Biomedical Engineering, Institute of Forensic Medicine, University of Basel, 4056, Basel, Switzerland
| | - Thomas Briellmann
- Citizen Science Basel; formerly Institute of Forensic Medicine, Forensic Chemistry and Toxicology, University of Basel, 4056, Basel, Switzerland
| | - Marc Augsburger
- University Center of Legal Medicine, Lausanne, Geneva, Switzerland
| | - Gerhard Hotz
- Natural History Museum Basel, 4051, Basel, Switzerland
- Integrative Prehistory and Archaeological Science, University of Basel, 4056, Basel, Switzerland
| | - Albert Zink
- Eurac Research - Institute for Mummy Studies, 39100, Bolzano, Italy
| | - Frank Maixner
- Eurac Research - Institute for Mummy Studies, 39100, Bolzano, Italy.
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Hofmeier KS, Bircher AJ. [Isolated Tongue Swelling after Penicillin and Negative Allergy Workup - All Done and Dusted?]. Laryngorhinootologie 2023. [PMID: 36693385 DOI: 10.1055/a-1949-2916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
| | - Andreas J Bircher
- Allergologie, Dermatologie, Universitätsspital Basel, Schweiz.,Facoltà di scienze biomediche, Università della Svizzera italiana, Lugano, Schweiz
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Bircher AJ, Pelloni L, Terrani I, Spoerl D, Beltraminelli H. [Cutaneous Vasculitides - Clinical Manifestations, Diagnosis, and Aetiology]. Ther Umsch 2022; 79:238-246. [PMID: 35583020 DOI: 10.1024/0040-5930/a001356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Cutaneous Vasculitides - Clinical Manifestations, Diagnosis, and Aetiology Abstract. Vasculitides are a heterogeneous group of diseases that are classified differently, for example according to the size of the affected vessel or according to primary and secondary causes. The skin is most frequently affected; it can be involved both as single organ vasculitis and in the context of systemic forms. The combination of skin lesions, their anatomical location and information on the time course provide clues for a differential diagnosis. Purpura, blisters, necrosis, ulcerations and possibly a livedo are characteristic manifestations. Constitutional symptoms such as weight loss, exhaustion, fever, and arthralgias are indicative of a systemic form. It is important to differentiate vasculitides from vasculopathies, which can manifest similarly. The most common form in adults is cutaneous leukocytoclastic angiitis, in children IgA vasculitis (Schönlein-Henoch purpura). Various triggers are possible: infections, drugs, autoimmune diseases, and malignancies, whereby up to 50% remain etiologically unexplained. Skin biopsies and laboratory parameters, if necessary supplemented with imaging, are important steps in the clarification process. Treatment is primarily directed at the elimination of a possible triggering cause. Idiopathic cutaneous leukocytoclastic angiitis usually resolves spontaneously; treatment is symptomatic. In more severe cases, topical corticosteroids or calcineurin antagonists are primarily used. In case of therapeutic resistance, systemic immunosuppressants are recommended.
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Affiliation(s)
- Andreas J Bircher
- Facoltà di scienze biomediche, Università della Svizzera italiana, Lugano.,Allergologie, Dermatologische Klinik, Universitätsspital Basel
| | - Lorenzo Pelloni
- Servizio di Dermatologia EOC, Ospedale San Giovanni, Bellinzona
| | | | - David Spoerl
- Service d'immunologie et d'allergologie, Département de médecine, Hôpitaux Universitaires de Genève
| | - Helmut Beltraminelli
- Servizio di Dermatologia EOC, Ospedale San Giovanni, Bellinzona.,Servizio di Dermatopatologia, Istituto Cantonale di Patologia EOC, Locarno
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Bircher AJ, Spoerl D, Scherer Hofmeier K. Wespe statt Biene – Akzidentelle Neusensibilisierung auf Wespengift unter Immuntherapie mit Bienengift. Aktuelle Dermatologie 2022. [DOI: 10.1055/a-1660-4731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungWährend einer laufenden Immuntherapie mit Bienengift bei einer auf Bienengift monosensibilisierten Patientin wurde im 3. Jahr irrtümlicherweise eine Erhaltungsdosis Wespengift verabreicht. Es traten keine unmittelbaren Nebenwirkungen auf, hingegen konnte nach einigen Wochen ein Anstieg der initial negativen wespengiftspezifischen IgE- und IgG-Antikörper dokumentiert werden. Es muss somit von einer aktiven Sensibilisierung durch die hohe Einmaldosis Wespengift ausgegangen werden. Die Immuntherapie mit Bienengift konnte nach der empfohlenen Dauer von 5 Jahren vollendet werden. Eine akzidentelle nachweislich aktive Sensibilisierung auf ein Allergen ist sehr selten, dürfte aber einen Verstoß gegen die Pflichten aus dem Behandlungsvertrag darstellen und möglicherweise sogar den Tatbestand der Körperverletzung erfüllen. Die permanente Schädigung kann rechtlich schwerer wiegen als ein einmaliger Dosierungsfehler. Die strikte Anwendung von Leitlinienempfehlungen ist zur Vermeidung von systematischen und menschlichen Fehlern unabdingbar.
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Affiliation(s)
- Andreas J. Bircher
- Allergologie, Universitätsspital Basel, Schweiz
- Facoltà di scienze biomediche, Università della Svizzera italiana, Lugano, Schweiz
| | - David Spoerl
- Service d'immunologie et d'allergologie, Département de médecine, Hôpitaux Universitaires de Genève, Genève, Schweiz
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Scherer Hofmeier K, Bircher AJ. NaOH ist nicht NaCl – ulzeröse Reaktion auf Natronlauge bei der Epikutantestung der Inhaltsstoffe einer Sonnenschutzcreme. Aktuelle Dermatologie 2022. [DOI: 10.1055/a-1576-6758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ZusammenfassungBei der Epikutantestung mit patienteneigenem Material oder Einzelsubstanzen von komplexen Zubereitungen sind die Auswahl der Testsubstanzen und die Bedingungen, zu denen diese Substanzen getestet werden, von besonderer Wichtigkeit. Wir berichten über eine Patientin, bei der eine allergische Kontaktdermatitis nach Applikation einer Sonnencreme entstanden war. Im Rahmen der diagnostischen Epikutanteste wurden auch die einzelnen Inhaltstoffe der Sonnencreme, die vom Hersteller zur Verfügung gestellt worden waren, getestet. Dabei kam es zu einem folgenschweren Fehler, indem diese Inhaltsstoffe ohne ausreichende Überprüfung getestet wurden und u. a. Natronlauge appliziert wurde. Die entstandene Kolliquationsnekrose am Testort heilte erst innerhalb von ca. 2,5 Monaten spontan ab und gab Anlass für einen Haftpflichtfall. Die Aufarbeitung dieser Fehlleistung und die Konsequenzen, die in unserer Abteilung getroffen wurden, um dergleichen Probleme in Zukunft sicher vermeiden zu können, werden besprochen.
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Affiliation(s)
| | - Andreas J. Bircher
- Allergologie, Universitätsspital Basel, Schweiz
- Facoltà di scienze biomediche, Università della Svizzera italiana, Lugano, Schweiz
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Bircher AJ, Hofmeier KS. Akute Schwellung im Halsbereich nach iodhaltigem Kontrastmittel – der oft unerkannte Iodmumps anhand von drei Fallbeispielen. Aktuelle Dermatologie 2022. [DOI: 10.1055/a-1581-1663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
ZusammenfassungEs werden drei Patientinnen vorgestellt, die zur Abklärung einer akuten Halsschwellung nach einer Untersuchung mit iodierten Kontrastmitteln zugewiesen wurden. Bei allen drei war ein akutes Angioödem vermutet worden, das allerdings nicht ausreichend auf Antihistaminika und Kortikosteroide ansprach. Es wurde schließlich ein sog. „Iodmumps“ oder Iod-assoziierte Sialoadenopathie diagnostiziert. Sonografisch und histologisch finden sich lediglich ein Ödem der Speicheldrüsen, hingegen keine Hinweise für eine ausgeprägte entzündliche Reaktion. Diese Komplikation ist nicht so selten und wird von Iod selbst ausgelöst, wie mit einer Provokation mit Iod-Kaliumiodid (Lugolʼscher Lösung) nachgewiesen werden konnte. Die pathophysiologisch ungeklärte Iod-assoziierte Sialoadenopathie wird somit als idiosynkratische Reaktion klassifiziert.
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Affiliation(s)
- Andreas J. Bircher
- Allergologie, Universitätsspital Basel, Schweiz
- Facoltà di scienze biomediche, Università della Svizzera italiana, Lugano, Schweiz
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Bircher AJ, Scherer Hofmeier K. Tätowierung durch intradermale Hauttests mit farbstoffhaltigen Medikamenten. Aktuelle Dermatologie 2022. [DOI: 10.1055/a-1515-1517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ZusammenfassungBei zwei Individuen, einem 72-jährigen Patienten und einer 20-jährigen Kontrollprobandin, wurde bei der Durchführung von Hauttests mit farbigen Medikamenten eine iatrogene Tätowierung verursacht. Der Patient hatte eine anaphylaktische Reaktion auf ein Eisenpräparat erlitten, und es bestand die zwingende Indikation für eine erneute intravenöse Eisensubstitution. Deshalb wurden weiterführende Abklärungen inklusive Hauttests durchgeführt. Die zweite Tätowierung erfolgte im Rahmen einer Studie zur Evaluation des irritativen Potenzials von Intradermaltests mit Isosulfanblau, einem diagnostischen Farbstoff. In beiden Fällen war vorab eine Einverständniserklärung bzw. ein Ethikvotum eingeholt worden, sodass es zu keinen weiteren rechtlichen Konsequenzen kam.
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Affiliation(s)
- Andreas J. Bircher
- Allergologie, Universitätsspital Basel, Schweiz
- Facoltà di scienze biomediche, Università della Svizzera italiana, Lugano, Schweiz
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Bircher AJ, Jamiolkowski D, Steveling-Klein EH, Scherer Hofmeier K, Mateluna CM. Kleine Ursache – große Wirkung: Spättyp-Hauttests mit Medikamenten als Auslöser von disseminierten Rezidivexanthemen. Aktuelle Dermatologie 2022. [DOI: 10.1055/a-1539-2221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ZusammenfassungEs werden zwei Patienten vorgestellt, die wegen eines streuenden allergischen Kontakt- bzw. Arzneimittelexanthems auf Budesonid bzw. Antibiotika abgeklärt wurden. Bei beiden trat innerhalb einiger Stunden nach Anlegen eines Epikutantests mit Budesonid bzw. Intradermaltesten mit Amoxicillin eine stark positive Hauttestreaktion sowie ein Exanthem auf. Beim ersten Patienten lag eine Sensibilisierung auf die kreuzreagierenden Moleküle Budesonid und Amcinonid, bei der zweiten Patientin eine ausgeprägte Überempfindlichkeit auf Aminopenizilline vor. Aufflammphänomene (Flare-ups) sind v. a. aus der Kontaktallergologie bekannt, können aber auch bei der Abklärung von allergischen Arzneimittelexanthemen auftreten. Systemische Reaktionen vom verzögerten Typ auf Spättyp-Hauttests mit Medikamenten sind relativ selten, können aber eine erhebliche Morbidität bewirken. Verschiedene Formen von Aufflammphänomenen in der Allergologie werden diskutiert.
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Affiliation(s)
- Andreas J. Bircher
- Allergologie, Universitätsspital Basel, Schweiz
- Facoltà di scienze biomediche, Università della Svizzera italiana, Lugano, Schweiz
| | | | | | - Kathrin Scherer Hofmeier
- Allergologie, Universitätsspital Basel, Schweiz
- Allergologie, Dermatologie, Kantonsspital Aarau, Schweiz
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Scherer Hofmeier K, Bircher AJ. Isolierte Zungenschwellung nach Penizillin und negative Allergieabklärung – alles in Butter? Aktuelle Dermatologie 2022. [DOI: 10.1055/a-1543-0663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ZusammenfassungPenizilline können alle Arten spezifischer Immunreaktionen nach der erweiterten Coombs- und Gell-Klassifikation auslösen und zählen zu den häufigsten Ursachen unerwünschter Arzneimittelreaktionen. Das diagnostische Armamentarium umfasst neben den verschiedenen Hauttesten den Nachweis spezifischer IgE gegen allergene Determinanten am Betalaktam-Molekül und ggf. zelluläre Aktivierungsteste. Im Fall negativer Ergebnisse bei den genannten Testen kann ggf. noch die Toleranz im Rahmen eines Provokationstestes nachgewiesen werden. Die Sensitivität der diagnostischen Teste ist – mit Ausnahme des Provokationstests – aber limitiert, und falsch negative Teste sind möglich. Wir präsentieren zwei Fälle mit einer isolierten Zungenschwellung nach Gabe von Amoxicillin bei vollständig negativem, wiederholtem allergologischen Work-up. Bei beiden Patienten konnte die Überempfindlichkeit nur mit einer Reexposition nachgewiesen werden.
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Affiliation(s)
| | - Andreas J. Bircher
- Allergologie, Dermatologie, Universitätsspital Basel, Schweiz
- Facoltà di scienze biomediche, Università della Svizzera italiana, Lugano, Schweiz
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Bircher AJ, Imhof-Gex-Collet C, Scherer Hofmeier K. Aus den Augen, aus dem Sinn – Knacknuss-Anamnese bei disseminierten Arzneimittelexanthemen auf „vergessene“ Selbstmedikation. Aktuelle Dermatologie 2022. [DOI: 10.1055/a-1553-7278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ZusammenfassungEs werden zwei Patienten vorgestellt, die zur Abklärung unklarer Exantheme zugewiesen wurden, bei beiden wurde die Diagnose initial nicht gestellt. Der erste Patient hatte ein ausgeprägtes Arzneimittelexanthem, die Patientin ein generalisiertes fixes Arzneimittelexanthem. Die wegen Verdacht auf Arzneimittelallergie durchgeführte aufwändige allergologische Diagnostik fiel zunächst unergiebig aus. Bei beiden wurde initial der Auslöser anamnestisch nicht erfasst, da die Patienten die Selbsttherapie mit frei verkäuflichen Medikamenten vergessen hatten oder als nicht relevant betrachteten. Erst auf intensive Befragung konnten die Auslöser Pseudoephedrin bzw. Paracetamol eruiert und bestätigt werden. Die zentrale Rolle einer umfassenden Anamneseerhebung und Dokumentation aller eingenommenen Therapeutika wird dargestellt.
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Affiliation(s)
- Andreas J. Bircher
- Allergologie, Universitätsspital Basel, Schweiz
- Facoltà di scienze biomediche, Università della Svizzera italiana, Lugano, Schweiz
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Bircher AJ, Parlar B, Mateluna CM, Heijnen I, Scherer Hofmeier K. Pricktest als Provokation – schwere anaphylaktische Reaktion auf Hauttests mit Ceftriaxon bei beruflicher Exposition. Aktuelle Dermatologie 2021. [DOI: 10.1055/a-1539-1958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
ZusammenfassungEs werden zwei Patienten vorgestellt, die wegen eines Asthma bronchiale bei beruflichem Kontakt mit Ceftriaxon abgeklärt wurden. Bei beiden trat innerhalb von Minuten nach Anlegen eines Pricktests mit Ceftriaxon eine adrenalinpflichtige, anaphylaktische Reaktion auf. Systemische Reaktionen auf Hauttests mit Betalaktamantibiotika sind relativ selten, sie können auch bei Patienten mit vorausgegangenen milden Symptomen wie Urtikaria oder beruflichen Kontaktallergien auf Betalaktame auftreten. Als Risikofaktoren werden schwere Anaphylaxien in der Anamnese und ein kurzes Reaktionsintervall genannt. Eine korrekte Durchführung der Hauttests mit Titration und eine adäquate Überwachung sind zu beachten.
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Affiliation(s)
- Andreas J. Bircher
- Allergologie, Universitätsspital Basel, Schweiz
- Facoltà di scienze biomediche, Università della Svizzera italiana, Lugano, Schweiz
| | | | | | - Ingmar Heijnen
- Medizinische Immunologie, Labormedizin, Universitätsspital Basel, Schweiz
| | - Kathrin Scherer Hofmeier
- Allergologie, Universitätsspital Basel, Schweiz
- Allergologie, Dermatologie, Kantonsspital Aarau, Schweiz
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15
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Fortuny J, von Gersdorff G, Lassalle R, Linder M, Overbeek J, Reinold J, Toft G, Timmer A, Dress J, Blin P, Droz-Perroteau C, Ehrenstein V, Franzoni C, Herings R, Kollhorst B, Moore N, Odsbu I, Perez-Gutthann S, Schink T, Rascher K, Rasouliyan L, Rothman KJ, Saigi-Morgui N, Schaller M, Smits E, Forstner M, Bénichou J, Bircher AJ, Garbe E, Rampton DS, Gutierrez L. Use of intravenous iron and risk of anaphylaxis: A multinational observational post-authorisation safety study in Europe. Pharmacoepidemiol Drug Saf 2021; 30:1447-1457. [PMID: 34181291 PMCID: PMC8457074 DOI: 10.1002/pds.5319] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/18/2021] [Accepted: 06/24/2021] [Indexed: 11/11/2022]
Abstract
PURPOSE This post-authorisation safety study estimated the risk of anaphylaxis in patients receiving intravenous (IV) iron in Europe, with interest in iron dextran and iron non-dextrans. Studies conducted in the United States have reported risk of anaphylaxis to IV iron ranging from 2.0 to 6.8 per 10 000 first treatments. METHODS Cohort study of IV iron new users, captured mostly through pharmacy ambulatory dispensing, from populations covered by health and administrative data sources in five European countries from 1999 to 2017. Anaphylaxis events were identified through an algorithm that used parenteral penicillin as a positive control. RESULTS A total of 304 210 patients with a first IV iron treatment (6367 iron dextran), among whom 13-16 anaphylaxis cases were identified and reported as a range to comply with data protection regulations. The pooled unadjusted incidence proportion (IP) ranged from 0.4 (95% confidence interval [CI], 0.2-0.9) to 0.5 (95% CI, 0.3-1.0) per 10 000 first treatments. No events were identified at first dextran treatments. There were 231 294 first penicillin treatments with 30 potential cases of anaphylaxis (IP = 1.2; 95% CI, 0.8-1.7 per 10 000 treatments). CONCLUSION We found an IP of anaphylaxis from 0.4 to 0.5 per 10 000 first IV iron treatments. The study captured only a fraction of IV iron treatments administered in hospitals, where most first treatments are likely to happen. Due to this limitation, the study could not exclude a differential risk of anaphylaxis between iron dextran and iron non-dextrans. The IP of anaphylaxis in users of penicillin was consistent with incidences reported in the literature.
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Affiliation(s)
- Joan Fortuny
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Barcelona, Spain
| | - Gero von Gersdorff
- Department of Internal Medicine-QiN-group, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Régis Lassalle
- Bordeaux PharmacoEpi, INSERM CIC1401, University of Bordeaux, Bordeaux, France
| | - Marie Linder
- Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Jetty Overbeek
- Department Research, PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Jonas Reinold
- Clinical Epidemiology Group, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Gunnar Toft
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Antje Timmer
- Epidemiology and Biometry Group, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Jochen Dress
- Research Data Center (DaTraV), Federal Institute for Drugs and Medical Devices-BfArM, Bonn, Germany
| | - Patrick Blin
- Bordeaux PharmacoEpi, INSERM CIC1401, University of Bordeaux, Bordeaux, France
| | | | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Carla Franzoni
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Barcelona, Spain
| | - Ron Herings
- Department Research, PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Biostatistics, Amsterdam, The Netherlands
| | - Bianca Kollhorst
- Clinical Epidemiology Group, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Nicholas Moore
- Bordeaux PharmacoEpi, INSERM CIC1401, University of Bordeaux, Bordeaux, France
| | - Ingvild Odsbu
- Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
| | | | - Tania Schink
- Clinical Epidemiology Group, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Katherine Rascher
- Department of Internal Medicine-QiN-group, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Lawrence Rasouliyan
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Barcelona, Spain
| | - Kenneth J Rothman
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Waltham, Massachusetts, USA
| | - Nuria Saigi-Morgui
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Barcelona, Spain
| | - Mathias Schaller
- Department of Internal Medicine-QiN-group, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Elisabeth Smits
- Department Research, PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | | | | | - Jacques Bénichou
- Department of Biostatistics, Rouen University Hospital and Inserm U 1018, University of Rouen, Rouen, France
| | - Andreas J Bircher
- Allergy Unit, Dermatology Clinic University Hospital Basel, Basel, Switzerland.,Faculty of Biomedicine, Università della Svizzera italiana, Lugano, Switzerland
| | - Edeltraut Garbe
- Clinical Epidemiology Group, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - David S Rampton
- Department of Gastroenterology, Royal London Hospital, London, UK
| | - Lia Gutierrez
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Barcelona, Spain
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16
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Loman L, Uter W, Armario‐Hita JC, Ayala F, Balato A, Ballmer‐Weber BK, Bauer A, Bircher AJ, Buhl T, Czarnecka‐Operacz M, Dickel H, Fuchs T, Giménez Arnau A, John SM, Kränke B, Kręcisz B, Mahler V, Rustemeyer T, Sadowska‐Przytocka A, Sánchez‐Pérez J, Scherer Hofmeier K, Schliemann S, Simon D, Spiewak R, Spring P, Valiukevičienė S, Wagner N, Weisshaar E, Pesonen M, Schuttelaar MLA. European Surveillance System on Contact Allergies (ESSCA): Characteristics of patients patch tested and diagnosed with irritant contact dermatitis. Contact Dermatitis 2021; 85:186-197. [PMID: 33729576 PMCID: PMC8360089 DOI: 10.1111/cod.13833] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/07/2021] [Accepted: 03/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Irritant contact dermatitis (ICD) is caused by the acute locally toxic effect of a strong irritant, or the cumulative exposure to various weaker physical and/or chemical irritants. OBJECTIVES To describe the characteristics of patients with ICD in the population patch tested in the European Surveillance System on Contact Allergies (ESSCA; www.essca-dc.org) database. METHODS Data collected by the ESSCA in consecutively patch-tested patients from January 2009 to December 2018 were analyzed. RESULTS Of the 68 072 patients, 8702 were diagnosed with ICD (without concomitant allergic contact dermatitis [ACD]). Hand and face were the most reported anatomical sites, and 45.7% of the ICD was occupational ICD (OICD). The highest proportions of OICD were found in metal turners, bakers, pastry cooks, and confectionery makers. Among patients diagnosed with ICD, 45% were found sensitized with no relevance for the current disease. CONCLUSIONS The hands were mainly involved in OICD also in the subgroup of patients with contact dermatitis, in whom relevant contact sensitization had been ruled out, emphasizing the need for limiting irritant exposures. However, in difficult-to-treat contact dermatitis, unrecognized contact allergy, or unrecognized clinical relevance of identified allergies owing to incomplete or wrong product ingredient information must always be considered.
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Affiliation(s)
- Laura Loman
- Department of DermatologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and EpidemiologyFriedrich‐Alexander‐University Erlangen/NürnbergErlangenGermany
| | - José C. Armario‐Hita
- Department of DermatologyUniversity Hospital of Puerto Real, University of CádizCádizSpain
| | - Fabio Ayala
- Department of DermatologyUniversity of Naples Federico IINaplesItaly
| | - Anna Balato
- Department of Advanced Biomedical SciencesUniversity of Naples Federico IINaplesItaly
| | - Barbara K. Ballmer‐Weber
- Department of DermatologyUniversity Hospital ZürichZürichSwitzerland
- Department of DermatologyUniversity Hospital Zürich and Clinic of Dermatology and Allergology, Kantonsspital St GallenZürichSwitzerland
| | - Andrea Bauer
- Department of DermatologyUniversity Hospital Carl Gustav Carus, Technical University of DresdenDresdenGermany
| | - Andreas J. Bircher
- Department of DermatologyAllergy Unit, University Hospital BaselBaselSwitzerland
| | - Timo Buhl
- Department of Dermatology, Venereology and AllergologyUniversity Medical Center GöttingenGöttingenGermany
| | | | - Heinrich Dickel
- Department of Dermatology, Venereology and AllergologyRuhr University BochumBochumGermany
| | - Thomas Fuchs
- Department of Dermatology, Venereology and AllergologyUniversity Medical Center GöttingenGöttingenGermany
| | - Ana Giménez Arnau
- Department of DermatologyHospital del Mar, Universitat Autònoma de BarcelonaBarcelonaSpain
| | - Swen M. John
- Department of Dermatology and Environmental MedicineInstitute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm), University of Osnabrück, Lower Saxony Institute for Occupational Dermatology (NIB)OsnabrückGermany
| | - Birger Kränke
- Department of Dermatology and VenereologyMedical University of GrazGrazAustria
| | - Beata Kręcisz
- Faculty of Medicine and Health ScienceInstitute of Medical Science, Jan Kochanowski UniversityKielcePoland
- Department of DermatologyNofer Institute of Occupational MedicineŁódźPoland
| | - Vera Mahler
- Department of DermatologyUniversity Hospital of Erlangen, University of Erlangen‐Nuremberg (FAU)ErlangenGermany
- Division of AllergologyPaul‐Ehrlich‐InstitutLangenGermany
| | - Thomas Rustemeyer
- Department of Dermatology‐Allergology and Occupational DermatologyAmsterdam University Medical CentersAmsterdamThe Netherlands
| | | | | | | | - Sibylle Schliemann
- Department of Dermatology and AllergologyUniversity Hospital JenaJenaGermany
| | - Dagmar Simon
- Department of DermatologyInselspital, Bern University Hospital, University of BernBernSwitzerland
| | - Radoslaw Spiewak
- Department of Experimental Dermatology and Cosmetology, Faculty of PharmacyJagiellonian University Medical CollegeKrakowPoland
| | - Philip Spring
- Dermatologie et vénéréologie FMH, Center Médical d'EpalingesEpalingesSwitzerland
| | - Skaidra Valiukevičienė
- Department of Skin and Venereal DiseasesLithuanian University of Health SciencesKaunasLithuania
| | - Nicola Wagner
- Department of DermatologyUniversity Hospital of Erlangen, University of Erlangen‐Nuremberg (FAU)ErlangenGermany
| | - Elke Weisshaar
- Department of Dermatology, Occupational DermatologyUniversity Hospital HeidelbergHeidelbergGermany
| | - Maria Pesonen
- Division Occupational MedicineFinnish Institute of Occupational HealthHelsinkiFinland
| | - Marie L. A. Schuttelaar
- Department of DermatologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
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17
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Marxer CA, Frey N, Bodmer M, Bircher AJ, Jick SS, Meier CR, Spoendlin J. Survival after Stevens‒Johnson Syndrome or Toxic Epidermal Necrolysis: A United Kingdom‒Based Cohort Study. J Invest Dermatol 2020; 141:1349-1351.e1. [PMID: 33221338 DOI: 10.1016/j.jid.2020.09.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 09/22/2020] [Accepted: 09/29/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Carole A Marxer
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland; Hospital Pharmacy, University Hospital Basel, Basel, Switzerland
| | - Noel Frey
- Insel Data Coordination Lab, Inselspital Bern, Bern, Switzerland
| | - Michael Bodmer
- Internal Medicine, Zuger Kantonsspital, Baar, Switzerland
| | | | - Susan S Jick
- Boston Collaborative Drug Surveillance Program, Lexington, Massachusetts, USA; Boston University, School of Public Health, Boston, Massachusetts, USA
| | - Christoph R Meier
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland; Hospital Pharmacy, University Hospital Basel, Basel, Switzerland; Boston Collaborative Drug Surveillance Program, Lexington, Massachusetts, USA.
| | - Julia Spoendlin
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland; Hospital Pharmacy, University Hospital Basel, Basel, Switzerland
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18
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Uter W, Bauer A, Belloni Fortina A, Bircher AJ, Brans R, Buhl T, Cooper SM, Czarnecka-Operacz M, Dickel H, Dugonik A, Geier J, Giménez-Arnau AM, Gonçalo M, Johansen JD, Johnston GA, Mahler V, Rustemeyer T, Sanchez-Perez J, Schuttelaar MLA, Simon D, Spiewak R, Valiukevičienė S, Weisshaar E, White IR, Wilkinson M. Patch test results with the European baseline series and additions thereof in the ESSCA network, 2015-2018. Contact Dermatitis 2020; 84:109-120. [PMID: 32945543 DOI: 10.1111/cod.13704] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/12/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Clinical surveillance of the prevalence of contact allergy in consecutively patch tested patients is a proven instrument to continually assess the importance of contact allergens (haptens) assembled in a baseline series. OBJECTIVES To present current results from the European Surveillance System on Contact Allergies, including 13 countries represented by 1 to 11 departments. METHODS Anonymized or pseudonymized patch test and clinical data from various data capture systems used locally or nationally as transferred to the Erlangen data centre were pooled and descriptively analysed after quality control. RESULTS In the 4 years (2015-2018), data from 51 914 patients patch tested with the European baseline series (EBS) of contact allergens were analysed. Contact allergy to nickel was most frequent (17.6% positive), followed by contact allergy to fragrance mix I (6.9%), methylisothiazolinone (MI; 6.2%), and Myroxylon pereirae resin (balsam of Peru; 5.8%). CONCLUSIONS While the prevalence of MI contact allergy decreased substantially following regulatory intervention, the persistently high levels of allergy to metals, fragrances, other preservatives, and rubber chemicals point to problems needing further research and, potentially, preventive efforts. Results with national additions to the baseline series provide important information on substances possibly to be considered for inclusion in the EBS.
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Affiliation(s)
- Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen/Nürnberg, Erlangen, Germany
| | - Andrea Bauer
- Department of Dermatology, University Allergy Centre, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Anna Belloni Fortina
- Dermatology Unit, Department of Paediatrics, University of Padova, Padova, Italy
| | - Andreas J Bircher
- Allergy Unit, Department of Dermatology, University Hospital Basel, Basel, Switzerland.,Faculty of Biomedicine, Università della Svizzera Italiana, Lugano, Switzerland
| | - Richard Brans
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany
| | - Timo Buhl
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Susan M Cooper
- Department of Dermatology, Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - Heinrich Dickel
- Department of Dermatology, Venereology and Allergology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Aleksandra Dugonik
- Department of Dermatology, University Medical Centre Maribor, Maribor, Slovenia
| | - Johannes Geier
- Information Network of Department of Dermatology, University Medical Center, Göttingen, Germany
| | - Ana M Giménez-Arnau
- Department of Dermatology, Hospital del Mar. Universitat Autònoma and Pompeu Fabra, Barcelona, Spain
| | - Margarida Gonçalo
- Department of Dermatology, Coimbra University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Jeanne D Johansen
- National Allergy Research Centre, Department of Skin and Allergy, Gentofte Hospital, Hellerup, Denmark
| | | | - Vera Mahler
- Department of Dermatology, University Hospital Erlangen, Erlangen, Germany, Paul-Ehrlich-Institut, Langen, Germany
| | - Thomas Rustemeyer
- Department of Dermatology, Free University of Amsterdam, Amsterdam, The Netherlands
| | - Javier Sanchez-Perez
- Dermatology Department, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria la Princesa (IIS-IP), Madrid, Spain
| | - Marie L A Schuttelaar
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Dagmar Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Radoslaw Spiewak
- Department of Experimental Dermatology and Cosmetology, Jagiellonian University Medical College, Krakow, Poland
| | - Skaidra Valiukevičienė
- Department of Skin and Venereal Diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Elke Weisshaar
- Department of Clinical Social Medicine, Occupational and Environmental Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ian R White
- Cutaneous Allergy Team, St. John's Institute of Dermatology, Guy's Hospital, London, UK
| | - Mark Wilkinson
- Dermatology Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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19
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Romano A, Atanaskovic‐Markovic M, Barbaud A, Bircher AJ, Brockow K, Caubet J, Celik G, Cernadas J, Chiriac A, Demoly P, Garvey LH, Mayorga C, Nakonechna A, Whitaker P, Torres MJ. Towards a more precise diagnosis of hypersensitivity to beta-lactams - an EAACI position paper. Allergy 2020; 75:1300-1315. [PMID: 31749148 DOI: 10.1111/all.14122] [Citation(s) in RCA: 148] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/08/2019] [Accepted: 10/23/2019] [Indexed: 02/07/2023]
Abstract
A recent survey of the European Academy of Allergy and Clinical Immunology (EAACI) Drug Allergy Interest Group (DAIG) on how European allergy specialists deal with beta-lactam (BL) hypersensitivity demonstrated a significant heterogeneity in current practice, suggesting the need to review and update existing EAACI guidelines in order to make the diagnostic procedures as safe and accurate, but also as cost-effective, as possible. For this purpose, a bibliographic search on large studies regarding BL hypersensitivity diagnosis was performed by an EAACI task force, which reviewed and evaluated the literature data using the GRADE system for quality of evidence and strength of recommendation. The updated guidelines provide a risk stratification in BL hypersensitivity according to index reaction(s), as well as an algorithmic approach, based on cross-reactivity studies, in patients with a suspicion of BL hypersensitivity and an immediate need for antibiotic therapy, when referral to an allergist is not feasible. Furthermore, the update addresses availability and concentrations of skin test (ST) reagents, ST and drug provocation test (DPT) protocols, and diagnostic algorithms and administration of alternative BL in allergic subjects. Specifically, distinct diagnostic algorithms are suggested depending on risk stratification of the patient into high and low risk based on the morphology and chronology of the reaction, immediate (ie, occurring within 1-6 hours after the last administered dose) or nonimmediate (ie, occurring more than 1 hour after the initial drug administration), and the reaction severity. Regarding the allergy workup, the main novelty of this document is the fact that in some low-risk nonimmediate reactions ST are not mandatory, especially in children. For DPT, further studies are necessary to provide data supporting the standardization of protocols, especially of those regarding nonimmediate reactions, for which there is currently no consensus.
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Affiliation(s)
- Antonino Romano
- Casa di Cura Quisisana Rome & Fondazione Mediterranea G.B. Catania Italy
| | | | - Annick Barbaud
- Departement of Dermatology and Allergology Institut Pierre Louis d'Epidemiologie et de Sante Publique INSERM Tenon Hospital Sorbonne Université Paris France
| | | | - Knut Brockow
- Department of Dermatology and Allergy Biederstein Technische Universität München Munich Germany
| | | | - Gulfem Celik
- Department of Immunology and Allergy Ankara University School of Medicine Ankara Turkey
| | - Josefina Cernadas
- Department of Allergy and Immunology Centro Hospitalar Universitário de S João Porto Portugal
| | - Anca‐Mirela Chiriac
- Division of Allergy Department of Pulmonology Hôpital Arnaud de Villeneuve University Hospital of Montpellier Montpellier France
- UMRS 1136 Equipe ‐ EPAR ‐ IPLESP UPMC Univ Sorbonne Universités Paris France
| | - Pascal Demoly
- Division of Allergy Department of Pulmonology Hôpital Arnaud de Villeneuve University Hospital of Montpellier Montpellier France
- UMRS 1136 Equipe ‐ EPAR ‐ IPLESP UPMC Univ Sorbonne Universités Paris France
| | - Lene H. Garvey
- Allergy Clinic Department of Dermatology and Allergy Herlev and Gentofte Hospital University of Copenhagen Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Cristobalina Mayorga
- Allergy Research Group Instituto de Investigación Biomédica de Málaga-IBIMA Malaga Spain
- Allergy Unit Hospital Regional Universitario de Málaga-UMA-ARADyAL Malaga Spain
| | - Alla Nakonechna
- Clinical Immunology and Allergy Unit Sheffield Teaching Hospital Sheffield UK
- University of Liverpool Liverpool UK
| | - Paul Whitaker
- Regional Adult Cystic Fibrosis Unit St James's Hospital Leeds UK
| | - María José Torres
- Allergy Unit Hospital Regional Universitario de Málaga-UMA-ARADyAL Malaga Spain
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20
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Romano A, Atanaskovic-Markovic M, Barbaud A, Bircher AJ, Brockow K, Caubet JC, Celik G, Cernadas J, Chiriac AM, Demoly P, Garvey LH, Mayorga C, Nakonechna A, Whitaker P, Torres MJ. Towards a more precise diagnosis of hypersensitivity to beta-lactams - an EAACI position paper. Allergy 2020. [PMID: 31749148 DOI: 10.1111/all.14122)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A recent survey of the European Academy of Allergy and Clinical Immunology (EAACI) Drug Allergy Interest Group (DAIG) on how European allergy specialists deal with beta-lactam (BL) hypersensitivity demonstrated a significant heterogeneity in current practice, suggesting the need to review and update existing EAACI guidelines in order to make the diagnostic procedures as safe and accurate, but also as cost-effective, as possible. For this purpose, a bibliographic search on large studies regarding BL hypersensitivity diagnosis was performed by an EAACI task force, which reviewed and evaluated the literature data using the GRADE system for quality of evidence and strength of recommendation. The updated guidelines provide a risk stratification in BL hypersensitivity according to index reaction(s), as well as an algorithmic approach, based on cross-reactivity studies, in patients with a suspicion of BL hypersensitivity and an immediate need for antibiotic therapy, when referral to an allergist is not feasible. Furthermore, the update addresses availability and concentrations of skin test (ST) reagents, ST and drug provocation test (DPT) protocols, and diagnostic algorithms and administration of alternative BL in allergic subjects. Specifically, distinct diagnostic algorithms are suggested depending on risk stratification of the patient into high and low risk based on the morphology and chronology of the reaction, immediate (ie, occurring within 1-6 hours after the last administered dose) or nonimmediate (ie, occurring more than 1 hour after the initial drug administration), and the reaction severity. Regarding the allergy workup, the main novelty of this document is the fact that in some low-risk nonimmediate reactions ST are not mandatory, especially in children. For DPT, further studies are necessary to provide data supporting the standardization of protocols, especially of those regarding nonimmediate reactions, for which there is currently no consensus.
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Affiliation(s)
- Antonino Romano
- Casa di Cura Quisisana, Rome & Fondazione Mediterranea G.B., Catania, Italy
| | | | - Annick Barbaud
- Departement of Dermatology and Allergology, Institut Pierre Louis d'Epidemiologie et de Sante Publique, INSERM, Tenon Hospital, Sorbonne Université, Paris, France
| | | | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, Technische Universität München, Munich, Germany
| | | | - Gulfem Celik
- Department of Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Josefina Cernadas
- Department of Allergy and Immunology, Centro Hospitalar Universitário de S João, Porto, Portugal
| | - Anca-Mirela Chiriac
- Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France.,UMRS 1136, Equipe - EPAR - IPLESP, UPMC Univ, Sorbonne Universités, Paris, France
| | - Pascal Demoly
- Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France.,UMRS 1136, Equipe - EPAR - IPLESP, UPMC Univ, Sorbonne Universités, Paris, France
| | - Lene H Garvey
- Allergy Clinic, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Cristobalina Mayorga
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Malaga, Spain.,Allergy Unit, Hospital Regional Universitario de Málaga-UMA-ARADyAL, Malaga, Spain
| | - Alla Nakonechna
- Clinical Immunology and Allergy Unit, Sheffield Teaching Hospital, Sheffield, UK.,University of Liverpool, Liverpool, UK
| | - Paul Whitaker
- Regional Adult Cystic Fibrosis Unit, St James's Hospital, Leeds, UK
| | - María José Torres
- Allergy Unit, Hospital Regional Universitario de Málaga-UMA-ARADyAL, Malaga, Spain
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Affiliation(s)
- Andreas J Bircher
- Allergy Unit Department of Dermatology University Hospital Basel, Switzerland Allergy Unit Department of Dermatology University Hospital Basel, Switzerland. Kantonales Laboratorium Basel-Stadt Basel, Switzerland
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22
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Terrani I, Scherer Hofmeier K, Bircher AJ. Indium and iridium: Two rare metals with a high rate of contact sensitization. Contact Dermatitis 2020; 83:94-98. [DOI: 10.1111/cod.13549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 03/02/2020] [Accepted: 04/02/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Isabella Terrani
- Dermatology Unit, Ente Ospedaliero Cantonale Regional Hospital of Lugano Lugano Switzerland
| | | | - Andreas J. Bircher
- Allergy Unit, Dermatology ClinicUniversity Hospital of Basel Basel Switzerland
- Università della Svizzera Italiana, Faculty of Biomedical Sciences Lugano Switzerland
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23
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Dickel H, Kuhlmann L, Bauer A, Bircher AJ, Breuer K, Fuchs T, Grabbe J, Mahler V, Pföhler C, Przybilla B, Rieker-Schwienbacher J, Schröder-Kraft C, Simon D, Treudler R, Weisshaar E, Worm M, Trinder E, Geier J. Atopy patch testing with aeroallergens in a large clinical population of dermatitis patients in Germany and Switzerland, 2000-2015: a retrospective multicentre study. J Eur Acad Dermatol Venereol 2020; 34:2086-2095. [PMID: 32003071 DOI: 10.1111/jdv.16250] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 01/22/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND The diagnostic significance of the atopy patch test for the management of dermatitis possibly triggered by aeroallergens is still controversial. However, sufficiently large studies with routinely tested standardized aeroallergen patch test preparations in dermatitis patients are lacking. OBJECTIVE To evaluate the reaction frequency and the reaction profiles of 10 until mid-2015 commercially available, standardized aeroallergen patch test preparations of the 'Stallerpatch' test series (Stallergenes, Antony Cedex, France) in a large multicentre patient cohort. METHODS A retrospective data analysis of patients with suspected aeroallergen-dependent eczematous skin lesions was performed, who were patch tested in 15 Information Network of Departments of Dermatology-associated clinics between 2000 and 2015. Patients were stratified according to their atopic dermatitis (AD) status. RESULTS The study group included 3676 patients (median age 41 years, 34.8% males, 54.5% AD). The most common aeroallergens causing positive patch test reactions were Dermatophagoides pteronyssinus (19.6%), Dermatophagoides farinae (16.9%), birch (6.2%), timothy grass (6.0%), cat dander (5.4%), mugwort (4.9%) and dog dander (4.6%). Reactions to other pollen allergen preparations, that is 5 grasses (3.2%), cocksfoot (2.1%) and plantain (1.6%), were less common. Positive patch test reactions to aeroallergens were consistently more frequent in patients with AD. These patients showed proportionally less dubious, follicular, irritant and weak positive reactions. Independent of AD status, a patient history of past or present allergic rhinitis was associated with an increased chance of a positive aeroallergen patch test reaction to pollen allergens. CONCLUSION The aeroallergen patch test is a useful add-on tool in clinical routine, especially in patients with AD and/or respiratory allergy. A patch test series comprising Dermatophagoides pteronyssinus, Dermatophagoides farinae, birch, timothy grass, cat dander and mugwort seems to be suitable. Controlled studies with specific provocation and elimination procedures are required to further evaluate the diagnostic significance of the proposed screening series.
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Affiliation(s)
- H Dickel
- Department of Dermatology, Venereology and Allergology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - L Kuhlmann
- Department of Gynaecology and Obstetrics, St. Vincenz Hospital, Vestische Caritas Clinics GmbH, Datteln, Germany
| | - A Bauer
- Department of Dermatology, University Allergy Centre, University of Dresden, Dresden, Germany
| | - A J Bircher
- Allergy Unit, Dermatology Clinic, University Hospital Basel, University of Basel, Basel, Switzerland
| | - K Breuer
- Department of Allergology, Dermatologikum Hamburg, Hamburg, Germany
| | - T Fuchs
- Department of Dermatology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - J Grabbe
- Department of Dermatology and Allergology, Kantonsspital Aarau, Aarau, Switzerland
| | - V Mahler
- Department of Dermatology, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - C Pföhler
- Department of Dermatology, Saarland University Medical Center, Homburg/Saar, Germany
| | - B Przybilla
- Department of Dermatology and Allergology, Ludwig Maximilians University of Munich, Munich, Germany
| | - J Rieker-Schwienbacher
- Centre for Dermatology, Phlebology and Allergology, Hospital Stuttgart, Stuttgart, Germany
| | - C Schröder-Kraft
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), BG Hospital Hamburg, Hamburg, Germany
| | - D Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - R Treudler
- Department of Dermatology, Venerology and Allergology, University of Leipzig, Leipzig, Germany
| | - E Weisshaar
- Occupational Dermatology, Department of Dermatology, Ruprecht Karls University of Heidelberg, Heidelberg, Germany
| | - M Worm
- Division of Allergy and Immunology, Department of Dermatology, Allergy and Venerology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - E Trinder
- Department of Medicine I, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - J Geier
- Information Network of Departments of Dermatology (IVDK), University Medical Center Göttingen, Göttingen, Germany
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Uter W, Aalto-Korte K, Agner T, Andersen KE, Bircher AJ, Brans R, Bruze M, Diepgen TL, Foti C, Giménez Arnau A, Gonçalo M, Goossens A, McFadden J, Paulsen E, Svedman C, Rustemeyer T, White IR, Wilkinson M, Johansen JD. The epidemic of methylisothiazolinone contact allergy in Europe: follow-up on changing exposures. J Eur Acad Dermatol Venereol 2019; 34:333-339. [PMID: 31419348 DOI: 10.1111/jdv.15875] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/19/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Methylisothiazolinone (MI) has caused an unprecedented epidemic of contact allergy in Europe and elsewhere. Subsequently, regulatory action has been taken, at least in Europe, aiming at reducing risk of MI sensitization. OBJECTIVE To follow-up on the prevalence of contact allergy to MI in consecutively patch tested patients and assess the spectrum of products containing MI or methylchloroisothiazolinone (MCI)/MI in patients positive to MI which elicited current allergic contact dermatitis. METHODS A cross-sectional survey was performed in 2016 and 2017, including all adult patients patch tested with the baseline series (including MI 0.2% aq.) between 1 May and 31 October at 14 centres in 11 European countries. Patients with positive reactions (+ to +++) to MI were further examined regarding history, clinical characteristics and eliciting products, which were categorized into 34 types and 4 classes (leave-on, rinse-off, household, occupational). The results were compared with the reference year 2015. RESULTS A total of 317 patients, n = 202 of 4278 tested in 2016 (4.72%) and n = 115 of 3879 tested in 2017 (2.96%), had positive reactions to MI; the previous result from 2015 was 5.97% (P < 0.0001). The share of currently relevant contact allergy among all positive reactions declined significantly as well (P = 0.0032). Concerning product classes, a relative decline of leave-on and a relative increase of rinse-off and household products was noted. CONCLUSION The prevalence of MI contact allergy decreased by 50% from 2015 to 2017. As a consequence of regulation, the share of cosmetics products (leave-on in particular) eliciting allergic contact dermatitis is decreasing. The chosen method of analysing causative products in sensitized patients has proven useful to monitor effects of intervention.
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Affiliation(s)
- W Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen/Nürnberg, Erlangen, Germany
| | - K Aalto-Korte
- Occupational Medicine, Finnish Institute of Occupational Health, Helsinki, Finland
| | - T Agner
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - K E Andersen
- Department of Dermatology and Allergy Centre, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - A J Bircher
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - R Brans
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - M Bruze
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - T L Diepgen
- Department of Social Medicine, Occupational and Environmental Dermatology, University of Heidelberg, Heidelberg, Germany
| | - C Foti
- Unit of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - A Giménez Arnau
- Department of Dermatology, Hospital del Mar, IMIM, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Gonçalo
- Department of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - A Goossens
- Contact Allergy Unit, Department of Dermatology, University Hospital KU Leuven, Leuven, Belgium
| | - J McFadden
- Guy's Hospital, St John's Institute of Dermatology, London, UK
| | - E Paulsen
- Department of Dermatology and Allergy Centre, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - C Svedman
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - T Rustemeyer
- Department of Dermatology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - I R White
- Guy's Hospital, St John's Institute of Dermatology, London, UK
| | - M Wilkinson
- Department of Dermatology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J D Johansen
- Department of Dermato-Allergology, National Allergy Research Centre, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
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25
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Phillips EJ, Bigliardi P, Bircher AJ, Broyles A, Chang YS, Chung WH, Lehloenya R, Mockenhaupt M, Peter J, Pirmohamed M, Roujeau JC, Shear NH, Tanno LK, Trubiano J, Valluzzi R, Barbaud A. Controversies in drug allergy: Testing for delayed reactions. J Allergy Clin Immunol 2018; 143:66-73. [PMID: 30573342 DOI: 10.1016/j.jaci.2018.10.030] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/27/2018] [Accepted: 10/30/2018] [Indexed: 01/11/2023]
Abstract
Controversies exist with regard to in vivo approaches to delayed immunologically mediated adverse drug reactions, such as exanthem (maculopapular eruption), drug reaction with eosinophilia and systemic symptoms, acute generalized exanthematous pustulosis, Stevens-Johnson syndrome/toxic epidermal necrolysis, and fixed drug eruptions. In particular, widespread differences exist between regions and practice on the availability and use of intradermal and patch testing, the standard drug concentrations used, the use of additional drugs in intradermal and patch testing to help determine cross-reactivity, the timing of testing in relation to the occurrence of the adverse drug reaction, the use of testing in specific phenotypes, and the use of oral challenge in conjunction with delayed intradermal and patch testing to ascertain drug tolerance. It was noted that there have been advances in the science of delayed T cell-mediated reactions that have shed light on immunopathogenesis and provided a mechanism of preprescription screening in the case of HLA-B*57:01 and abacavir hypersensitivity and HLA-B*15:02 and carbamazepine Stevens-Johnson syndrome/toxic epidermal necrolysis in Southeast Asian subjects. Future directions should include the collaboration of large international networks to develop and standardize in vivo diagnostic approaches, such as skin testing and patch testing, combined with ex vivo and in vitro laboratory approaches.
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Affiliation(s)
- Elizabeth J Phillips
- Vanderbilt University Medical Center, Nashville, Tenn; Institute for Immunology and Infectious Diseases, Murdoch, Australia.
| | - Paul Bigliardi
- Department of Dermatology, Dermato-Allergy Division, University of Minnesota, Minneapolis, Minn
| | - Andreas J Bircher
- Department of Dermatology, Allergy Unit, University Hospital, University of Basel, Basel, Switzerland
| | - Ana Broyles
- Boston Children's Hospital and Harvard Medical School, Boston, Mass
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Wen-Hung Chung
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taipei, Linkou and Keelung, Taiwan
| | - Rannakoe Lehloenya
- Division of Dermatology and Combined Drug Allergy Clinic, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Maja Mockenhaupt
- Department of Dermatology, Dokumentationszentrum schwerer Hautreaktionen (dZh), Medical Center and Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Jonny Peter
- Division of Dermatology and Combined Drug Allergy Clinic, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Munir Pirmohamed
- Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
| | | | - Neil H Shear
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Luciana Kase Tanno
- University Hospital of Montpellier, Montpellier, and Sorbonne Université, INSERM, Paris, France; Hospital Sírio Libanês, São Paulo, Brazil
| | - Jason Trubiano
- Department of Infectious Diseases and Centre for Antibiotic Allergy and Research, Austin Health, University of Melbourne, Heidelberg, Australia; National Centre for Infections in Cancer, Department of Infectious Diseases, Peter MacCallum Cancer Centre, Parkville, Australia
| | - Rocco Valluzzi
- Allergy Department, Pediatric Hospital Bambino Gesù, Rome, Vatican City, Italy
| | - Annick Barbaud
- Dermatology and Allergy Department, Tenon Hospital, Medecine Sorbonne University, Paris, France; Assistance publique-hopitaux de Paris, Paris, France
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Furrer S, Scherer Hofmeier K, Grize L, Bircher AJ. Metal hypersensitivity in patients with orthopaedic implant complications-A retrospective clinical study. Contact Dermatitis 2018; 79:91-98. [PMID: 29888396 DOI: 10.1111/cod.13032] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/15/2018] [Accepted: 04/19/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Hypersensitivity to metals as a cause of implant-related complications has been a subject of controversy. Projections indicate an increase in the frequency of joint replacements of between 300% and 600% by the year 2030; therefore, this issue is of considerable interest. OBJECTIVE To evaluate sensitization to implant materials in patients with implant-related complications, to identify allergens, and to clarify whether hypersensitivity is a relevant cause. METHODS Patients with implant-related complications or a positive history of contact allergy and planned total joint replacements referred for allergological investigation between 2004 and 2017 were retrospectively analysed. RESULTS In total, 311 patients were included. A positive patch test reaction to a metal was seen in 64.4% of preoperative patients and in 54.6% of patients with implant-related complications. Common alloy metals such as cobalt, chromium and titanium gave positive reactions in up to 2.9% of patients with implant-related complications. None of the patients with skin changes had a positive patch test reaction to an implant metal. CONCLUSION Other factors, such as the type of replaced joint and mechanical stress, seem to be more relevant for implant-related complications. Sensitization to metals or other materials seems to rarely play a role, and is overestimated.
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Affiliation(s)
- Stefan Furrer
- Department of Dermatology, Allergy Unit, University Hospital, Basel, Switzerland
| | | | - Leticia Grize
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Andreas J Bircher
- Department of Dermatology, Allergy Unit, University Hospital, Basel, Switzerland.,University of Basel, Basel, Switzerland
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Spoerri I, Bircher AJ, Link S, Heijnen IAFM, Scherer Hofmeier K. Delayed-type allergy to cobalt-comparison of a flow cytometric lymphocyte proliferation test with patch testing. Contact Dermatitis 2018; 79:31-33. [DOI: 10.1111/cod.12990] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/31/2018] [Accepted: 02/10/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Iris Spoerri
- Department of Biomedicine, Research Group of Dermatology; University Hospital Basel; Basel Switzerland
| | - Andreas J. Bircher
- Department of Dermatology, Allergy Unit; University Hospital Basel and University of Basel; Basel Switzerland
| | - Susanne Link
- Medical Immunology, Laboratory Medicine; University Hospital Basel; Basel Switzerland
| | | | - Kathrin Scherer Hofmeier
- Department of Dermatology, Allergy Unit; University Hospital Basel and University of Basel; Basel Switzerland
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Dittmar D, Uter W, Bauer A, Fortina AB, Bircher AJ, Czarnecka‐Operacz M, Dugonik A, Elsner P, Gallo R, Ghaffar SA, Giménez‐Arnau A, Johnston GA, Kręcisz B, Filon FL, Rustemeyer T, Sadowska‐Przytocka A, Sánchez‐Pérez J, Schnuch A, Simon D, Spiewak R, Spring P, Corradin MT, Valiukevičienė S, Vok M, Weisshaar E, Wilkinson M, Schuttelaar ML, Aberer W, Ballmer‐Weber B, Grabbe J, Beiteke U, Brasch J, Fuchs T, John SM, Mahler V, Pesonen M, Jolanki R, Rantanen T, Armario‐Hita JC, Fernández‐Redondo V, García‐Gavín J, Mercader P, Ruiz I, Silvestre JF, Balato A, Ayala F, Peserico A, Sliuziaviciene G, Kieć‐Świerczyńska M, Kmecl T, Pandurovic MK, Kecelj N, Lunder T, Simončič Godnič M, Chowdhury MMU, Cooper SM, English JSC, Cousen P, Horne HL, Gawkrodger DJ, Holden C, Sabroe R, Green CM, King CM, Ormerod AD, Samson JE, Statham B, Stone N, White I. European Surveillance System on Contact Allergies (ESSCA): polysensitization, 2009–2014. Contact Dermatitis 2018; 78:373-385. [DOI: 10.1111/cod.12966] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/14/2017] [Accepted: 12/18/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Daan Dittmar
- University of Groningen, University Medical Centre GroningenDepartment of Dermatology 9700 RB Groningen The Netherlands
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and EpidemiologyUniversity of Erlangen/Nürnberg 91054 Erlangen Germany
| | - Andrea Bauer
- Department of DermatologyUniversity Allergy Centre, University Hospital Carl Gustav Carus, Technical University of Dresden 01307 Dresden Germany
| | - Ana B. Fortina
- Dermatology Unit, Department of PaediatricsUniversity of Padova 35137 Padova Italy
| | - Andreas J. Bircher
- Allergy Unit, Department of DermatologyUniversity Hospital 4031 Basel Switzerland
| | | | - Aleksandra Dugonik
- Department of DermatologyUniversity Medical Centre Maribor 2000 Maribor Slovenia
| | - Peter Elsner
- Department of DermatologyUniversity Hospital Jena 07743 Jena Germany
| | - Rosella Gallo
- Section of Dermatology, DISSAL – Department of Health SciencesUniversity of Genoa 16132 Genoa Italy
| | - Sharizan A. Ghaffar
- Department of DermatologyNinewells Hospital and Medical School Dundee DD1 9SY UK
| | - Anna Giménez‐Arnau
- Department of DermatologyHospital del Mar. Universitat Autònoma and Pompeu Fabra 08003 Barcelona Spain
| | - Graham A. Johnston
- Department of DermatologyLeicester Royal Infirmary Leicester, LE1 5WW, UK
| | - Beata Kręcisz
- Faculty of Medicine and Health ScienceThe Jan Kochanowski University 25‐317 Kielce Poland
| | | | - Thomas Rustemeyer
- Department of DermatologyFree University of Amsterdam 1081 HV Amsterdam The Netherlands
| | | | - Javier Sánchez‐Pérez
- Dermatology DepartmentHospital Universitario de la Princesa, Instituto de Investigación Sanitaria la Princesa (IIS‐IP) 28006 Madrid Spain
| | - Axel Schnuch
- Information Network of Departments of Dermatology at the University of Göttingen 37075 Göttingen Germany
| | - Dagmar Simon
- Department of DermatologyInselspital, Bern University Hospital, University of Bern 3010 Bern Switzerland
| | - Radoslaw Spiewak
- Department of Experimental Dermatology and CosmetologyJagiellonian University Medical College 30‐688 Krakow Poland
| | - Philipp Spring
- Department of DermatologyCentre Hospitalier Universitaire Vaudois 1011 Lausanne Switzerland
| | - Maria T. Corradin
- Department of DermatologyHospital of Pordenone 33170 Pordenone Italy
| | - Skaidra Valiukevičienė
- Department of Skin and Venereal DiseasesLithuanian University of Health Sciences 44307 Kaunas Lithuania
- Lithuanian University of Health Sciences Hospital 50009 Kaunas Lithuania
| | - Marko Vok
- Dermatovenerološka ambulanta 6310 Izola Slovenia
| | - Elke Weisshaar
- Department of Clinical Social Medicine, Occupational and Environmental DermatologyUniversity Hospital Heidelberg 69117 Germany
| | - Mark Wilkinson
- Dermatology, Leeds Teaching Hospitals NHS Trust Leeds LS7 4SA UK
| | - Marie L. Schuttelaar
- University of Groningen, University Medical Centre GroningenDepartment of Dermatology 9700 RB Groningen The Netherlands
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29
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Brockow K, Przybilla B, Aberer W, Bircher AJ, Brehler R, Dickel H, Fuchs T, Jakob T, Lange L, Pfützner W, Mockenhaupt M, Ott H, Pfaar O, Ring J, Sachs B, Sitter H, Trautmann A, Treudler R, Wedi B, Worm M, Wurpts G, Zuberbier T, Merk HF. Correction to: Guideline for the diagnosis of drug hypersensitivity reactions. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/s40629-017-0041-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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30
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Affiliation(s)
- Oliver Brandt
- Allergologische Poliklinik; Dermatologische Klinik; Universitätsspital Basel; Schweiz
| | - Andreas J. Bircher
- Allergologische Poliklinik; Dermatologische Klinik; Universitätsspital Basel; Schweiz
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Brandt O, Bircher AJ. Delayed-type hypersensitivity to oral and parenteral drugs. J Dtsch Dermatol Ges 2017; 15:1111-1132. [PMID: 29106000 DOI: 10.1111/ddg.13362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 09/07/2017] [Indexed: 01/22/2023]
Abstract
Adverse drug reactions of the delayed type rank among the most common dermatoses and are predominantly characterized by exanthematous macular or maculopapular eruptions. However, approximately 2 % of affected individuals develop severe or even life-threatening systemic immune reactions associated with organ involvement, requiring immediate diagnosis and treatment. Numerous drugs are capable of eliciting delayed-type hypersensitivity reactions, with antibiotics, anticonvulsant drugs, and the xanthine oxidase inhibitor allopurinol being the most common. Apart from genetic susceptibility, predisposing factors for the development of drug hypersensitivity reactions include high drug doses, polypharmacy, long treatment duration, female gender, as well as acute or chronic infections.
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Affiliation(s)
- Oliver Brandt
- Allergy Unit, Department of Dermatology, Basel University Hospital, Basel, Switzerland
| | - Andreas J Bircher
- Allergy Unit, Department of Dermatology, Basel University Hospital, Basel, Switzerland
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Bircher AJ, Sigg R, Scherer Hofmeier K, Schlegel U, Hauri U. Allergic contact dermatitis caused by a new temporary blue-black tattoo dye - sensitization to genipin from jagua (Genipa americana L.) fruit extract. Contact Dermatitis 2017; 77:374-378. [PMID: 28675523 DOI: 10.1111/cod.12844] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/10/2017] [Accepted: 05/12/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Temporary tattoos made with an extract of the jagua fruit (Genipa americana L.) are becoming increasingly popular. It is claimed that it is 'dermatologically tested' and does not contain p-phenylenediamine. Extracts of jagua and gardenia fruits have been used by indigenous people in South America, as well as in traditional Chinese medicine, for centuries. Genipin is currently used for its cross-linking effect in the manufacture of polysaccharides, and is being investigated for its anti-inflammatory and other properties. OBJECTIVES To report the presence of the allergenic substance genipin in a self-administered temporary tattoo dye made from the fruit juice of jagua (Genipa americana L.). PATIENTS AND METHODS A 39-year-old female who repeatedly applied 'completely natural and 100% safe' Earth Jagua® tattoo, obtained via the internet, to her left hand developed allergic contact dermatitis within 6 weeks. Analysis of the dye showed the presence of geniposide and genipin. RESULTS Patch tests with the dye and with its main components, including genipin, gave strong positive reactions to the latter. There was no sensitization to other ingredients or p-amino compounds. CONCLUSIONS We report an extensively evaluated case of allergic contact dermatitis caused by a temporary Earth Jagua® tattoo. The allergen identified is genipin, a substance that is increasingly used for tattoos and as a therapeutic agent in medicine. This could result in an increase in the number of allergic reactions in the future.
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Affiliation(s)
- Andreas J Bircher
- Allergy Unit, Dermatology Clinic, University Hospital Basel and University of Basel 4031, Basel, Switzerland
| | - Rita Sigg
- Private practice, 6004 Lucerne, Switzerland
| | - Kathrin Scherer Hofmeier
- Allergy Unit, Dermatology Clinic, University Hospital Basel and University of Basel 4031, Basel, Switzerland
| | - Urs Schlegel
- Kantonales Laboratorium Basel-Stadt, 4056 Basel, Switzerland
| | - Urs Hauri
- Kantonales Laboratorium Basel-Stadt, 4056 Basel, Switzerland
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Tschannen MP, Glück U, Bircher AJ, Heijnen I, Pletscher C. Thaumatin and gum arabic allergy in chewing gum factory workers. Am J Ind Med 2017; 60:664-669. [PMID: 28543634 DOI: 10.1002/ajim.22729] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2017] [Indexed: 11/11/2022]
Abstract
Thaumatin is a sweetener and flavor modifier commonly used in the food industry. Likewise, gum arabic is widely used as a food stabilizer and thickening agent. We report here that a powder mixture composed of 10% thaumatin and 90% gum arabic led to allergic symptoms in the upper airways in occupationally exposed individuals: four of eight workers of a chewing gum factory exposed to this powder mixture had pronounced rhinitis. A positive skin prick test result for pure thaumatin was obtained in all four individuals with rhinitis of whom two also had a positive skin prick test result for pure gum arabic and gum arabic-specific IgE. Subsitution of a powdered thaumatin with a liquid form reduced symptoms among the rhinitic workers. Although gum arabic is a well-known potential allergen, we were unable to find prior documentation of allergic symptoms to thaumatin when it is used in the food industry.
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Affiliation(s)
- Mattias P. Tschannen
- Suva (Swiss National Accident Insurance Fund); Division of Occupational Medicine; Lucerne Switzerland
| | - Ulrich Glück
- Suva (Swiss National Accident Insurance Fund); Division of Occupational Medicine; Lucerne Switzerland
| | - Andreas J. Bircher
- Division of Allergy and Immunology; University Hospital Basel; Basel Switzerland
| | - Ingmar Heijnen
- Division of Medical Immunology, Laboratory Medicine; University Hospital Basel; Basel Switzerland
| | - Claudia Pletscher
- Suva (Swiss National Accident Insurance Fund); Division of Occupational Medicine; Lucerne Switzerland
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Cesana P, Scherer K, Bircher AJ. Immediate Type Hypersensitivity to Heparins: Two Case Reports and a Review of the Literature. Int Arch Allergy Immunol 2017; 171:285-289. [DOI: 10.1159/000453525] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 11/14/2016] [Indexed: 11/19/2022] Open
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Uter W, Larese Filon F, Rui F, Balato A, Wilkinson M, Kręcisz B, Chomiczewska-Skora D, Kieć-Świerczyńska M, Schuttelaar MLA, Frosch PJ, Bircher AJ. ESSCA results with nickel, cobalt and chromium, 2009-2012. Contact Dermatitis 2016; 75:117-21. [DOI: 10.1111/cod.12582] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 02/28/2016] [Accepted: 02/29/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology; University of Erlangen/Nürnberg; 91054 Erlangen Germany
| | - Francesca Larese Filon
- Department of Public Health, Occupational Medicine; University of Trieste; 34129 Trieste Italy
| | - Francesca Rui
- Department of Public Health, Occupational Medicine; University of Trieste; 34129 Trieste Italy
| | - Anna Balato
- Department of Dermatology; University of Naples Federico II; 80131 Naples Italy
| | - Mark Wilkinson
- Department of Dermatology; Chapel Allerton Hospital; LS7 4SA Leeds UK
| | - Beata Kręcisz
- Nofer Institute of Occupational Medicine; 91-348 Lodz Poland
- Faculty of Medicine and Health Science, Institute of Medical Science; Jan Kochanowski University; 25-317 Kielce Poland
| | | | | | - Marie-Louise A. Schuttelaar
- Department of Dermatology, University Medical Centre Groningen; University of Groningen; 9700 RB Groningen The Netherlands
| | - Peter J. Frosch
- previously Department of Dermatology; University of Witten/Herdecke; 58448 Witten Germany
- previously Department of Dermatology; Klinikum Dortmund; 44137 Dortmund Germany
| | - Andreas J. Bircher
- Allergy Unit, Department of Dermatology; University Hospital and University of Basel; 4031 Basel Switzerland
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Abramson MJ, Schindler C, Schikowski T, Bircher AJ, Burdet L, Gerbase MW, Imboden M, Rochat T, Schmid-Grendelmeier P, Turk AJ, Zemp E, Künzli N, Probst-Hensch N. Rhinitis in Swiss adults is associated with asthma and early life factors, but not second hand tobacco smoke or obesity. Allergol Int 2016; 65:192-198. [PMID: 26724835 DOI: 10.1016/j.alit.2015.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 10/23/2015] [Accepted: 11/17/2015] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Second hand tobacco smoke (SHS) and overweight/obesity are risk factors for asthma and lower airway respiratory symptoms. We investigated whether SHS or overweight/obesity were also associated with allergic or non-allergic rhinitis. METHODS Cross-sectional data were obtained during the second SAPALDIA Study. Interviewer administered questionnaires were completed by 8047 participants from 8 communities in Switzerland. Blood was collected from 5841 participants and tested for allergen specific IgE. Allergic rhinitis was defined as nasal symptoms with detectable IgE. Data were analysed by multinomial logistic regression with four outcome categories defined according to the presence or absence of rhinitis and/or atopy. RESULTS The prevalence of allergic rhinitis was 885 (15.2%) and non-allergic rhinitis 323 (5.5%). The risk of allergic rhinitis was increased in subjects with physician diagnosed asthma (Relative Risk Ratio 6.81; 95%CI 5.39, 8.6), maternal atopy (1.56; 1.27, 1.92) and paternal atopy (1.41; 1.11, 1.79). Older subjects were at lower risk (0.96; 0.95,0.97 per year), as were those raised on a farm (0.64; 0.49,0.84), with older siblings (0.92; 0.86,0.97 per sib) or from rural areas. The risk of non-allergic rhinitis was also increased in subjects with physician diagnosed asthma (4.02; 2.86, 5.67), reduced in males (0.59; 0.46, 0.77), but not associated with upbringing on a farm or older siblings. There were no significant associations of SHS or overweight/obesity with either form of rhinitis. CONCLUSIONS Allergic and non-allergic rhinitis have different risk factors apart from asthma. There are significant regional variations within Switzerland, which are not explained by the factors examined.
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Macdougall IC, Bircher AJ, Eckardt KU, Obrador GT, Pollock CA, Stenvinkel P, Swinkels DW, Wanner C, Weiss G, Chertow GM, Adamson JW, Akizawa T, Anker SD, Auerbach M, Bárány P, Besarab A, Bhandari S, Cabantchik I, Collins AJ, Coyne DW, de Francisco ÁL, Fishbane S, Gaillard CA, Ganz T, Goldsmith DJ, Hershko C, Jankowska EA, Johansen KL, Kalantar-Zadeh K, Kalra PA, Kasiske BL, Locatelli F, Małyszko J, Mayer G, McMahon LP, Mikhail A, Nemeth E, Pai AB, Parfrey PS, Pecoits-Filho R, Roger SD, Rostoker G, Rottembourg J, Singh AK, Slotki I, Spinowitz BS, Tarng DC, Tentori F, Toblli JE, Tsukamoto Y, Vaziri ND, Winkelmayer WC, Wheeler DC, Zakharova E. Iron management in chronic kidney disease: conclusions from a “Kidney Disease: Improving Global Outcomes” (KDIGO) Controversies Conference. Kidney Int 2016; 89:28-39. [DOI: 10.1016/j.kint.2015.10.002] [Citation(s) in RCA: 167] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 09/22/2015] [Accepted: 09/29/2015] [Indexed: 12/21/2022]
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Scherer Hofmeier K, Bircher AJ. Arzneimittelallergien: klinische Präsentation und Warnzeichen. Therapeutische Umschau 2015; 72:729-36. [DOI: 10.1024/0040-5930/a000743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Prinzipiell können alle Medikamente allergische Reaktionen auslösen, allerdings gibt es erhebliche Unterschiede in der Häufigkeit und klinischen Präsentation. Antibiotika, Antiepileptika und NSAIDs gehören zu den häufigsten Auslösern. Das Risiko für Sensibilisierungen und für schwere Verläufe hängt vom Aussmass der Immunaktivierung des Einzelnen ab, von Dosis, Dauer der Behandlung, Verabreichungsart, Geschlecht und bei einigen Substanzen auch von HLA-Merkmalen. Im vorliegenden Artikel werden die häufigsten immunmediierten Hypersensitivitätsreaktionen gegen Arzneimittel vorgestellt und auf klinische Warnzeichen für schwere Verläufe hingewiesen.
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Affiliation(s)
| | - Andreas J. Bircher
- Abteilung Allergologie, Klinik für Dermatologie, Universitätsspital Basel
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Brockow K, Przybilla B, Aberer W, Bircher AJ, Brehler R, Dickel H, Fuchs T, Jakob T, Lange L, Pfützner W, Mockenhaupt M, Ott H, Pfaar O, Ring J, Sachs B, Sitter H, Trautmann A, Treudler R, Wedi B, Worm M, Wurpts G, Zuberbier T, Merk HF. Guideline for the diagnosis of drug hypersensitivity reactions: S2K-Guideline of the German Society for Allergology and Clinical Immunology (DGAKI) and the German Dermatological Society (DDG) in collaboration with the Association of German Allergologists (AeDA), the German Society for Pediatric Allergology and Environmental Medicine (GPA), the German Contact Dermatitis Research Group (DKG), the Swiss Society for Allergy and Immunology (SGAI), the Austrian Society for Allergology and Immunology (ÖGAI), the German Academy of Allergology and Environmental Medicine (DAAU), the German Center for Documentation of Severe Skin Reactions and the German Federal Institute for Drugs and Medical Products (BfArM). ACTA ACUST UNITED AC 2015; 24:94-105. [PMID: 26120552 PMCID: PMC4479479 DOI: 10.1007/s40629-015-0052-6] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Drug hypersensitivity reactions are unpredictable adverse drug reactions. They manifest either within 1–6 h following drug intake (immediate reactions) with mild to life-threatening symptoms of anaphylaxis, or several hours to days later (delayed reactions), primarily as exanthematous eruptions. It is not always possible to detect involvement of the immune system (allergy). Waiving diagnostic tests can result in severe reactions on renewed exposure on the one hand, and to unjustified treatment restrictions on the other. With this guideline, experts from various specialist societies and institutions have formulated recommendations and an algorithm for the diagnosis of allergies. The key principles of diagnosing allergic/hypersensitivity drug reactions are presented. Where possible, the objective is to perform allergy diagnostics within 4 weeks–6 months following the reaction. A clinical classification of symptoms based on the morphology and time course of the reaction is required in order to plan a diagnostic work-up. In the case of typical symptoms of a drug hypersensitivity reaction and unequivocal findings from validated skin and/or laboratory tests, a reaction can be attributed to a trigger with sufficient confidence. However, skin and laboratory tests are often negative or insufficiently reliable. In such cases, controlled provocation testing is required to clarify drug reactions. This method is reliable and safe when attention is paid to indications and contraindications and performed under appropriate medical supervision. The results of the overall assessment are discussed with the patient and documented in an „allergy passport“ in order to ensure targeted avoidance in the future and allow the use of alternative drugs where possible.
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Affiliation(s)
- Knut Brockow
- Department of Dermatology and Allergology Biederstein, Technical University of Munich, Biedersteiner Straße 29, 80802 Munich, Germany
| | - Bernhard Przybilla
- Department of Dermatology and Allergology, Allergy Center, Ludwig Maximilian University of Munich, Munich, Germany
| | - Werner Aberer
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Andreas J Bircher
- Department of Allergology, University Hospital Basle, Basle, Switzerland
| | - Randolf Brehler
- Department of Dermatology, Münster University Hospital, Münster, Germany
| | - Heinrich Dickel
- Department of Dermatology, Venereology and Allergology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Thomas Fuchs
- Department of Dermatology, Venereology and Allergology, Göttingen University Hospital, Göttingen, Germany
| | - Thilo Jakob
- Department of Dermatology and Venereology, Freiburg University Hospital, Freiburg, Germany
| | - Lars Lange
- Department of Pediatrics, Marien Hospital Bonn, Bonn, Germany
| | - Wolfgang Pfützner
- Department of Dermatology and Allergology, Gießen and Marburg University Hospital, Marburg, Germany
| | - Maja Mockenhaupt
- German Center for the Documentation of Severe Skin Reactions, Department of Dermatology and Venereology, Freiburg University Hospital, Freiburg, Germany
| | - Hagen Ott
- Children's and Adolescents' Hospital "Auf der Bult,", Hannover, Germany
| | - Oliver Pfaar
- ENT at Mannheim University Hospital, Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Johannes Ring
- Department of Dermatology and Allergology Biederstein, Technical University of Munich, Biedersteiner Straße 29, 80802 Munich, Germany
| | - Bernhardt Sachs
- Federal Institute for Drugs and Medicinal Products, Bonn, Germany
| | - Helmut Sitter
- Institute of Theoretical Surgery, Philipps University, Marburg, Germany
| | - Axel Trautmann
- Department of Dermatology and Allergology, Mainfranken Allergy, Würzburg University Hospital, Würzburg, Germany
| | - Regina Treudler
- Department of Dermatology, Venereology and Allergology, Leipzig University, Leipzig, Germany
| | - Bettina Wedi
- Department of Dermatology, Venereology and Allergology, Hannover Medical University, Hannover, Germany
| | - Margitta Worm
- Department of Dermatology, Venereology and Allergology, Charité University Hospital, Berlin, Germany
| | - Gerda Wurpts
- Department of Dermatology and Allergology, RTWH Aachen, Aachen, Germany
| | - Torsten Zuberbier
- Department of Dermatology, Venereology and Allergology, Charité University Hospital, Berlin, Germany
| | - Hans F Merk
- Department of Dermatology and Allergology, RTWH Aachen, Aachen, Germany
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Brockow K, Przybilla B, Aberer W, Bircher AJ, Brehler R, Dickel H, Fuchs T, Jakob T, Lange L, Pfützner W, Mockenhaupt M, Ott H, Pfaar O, Ring J, Sachs B, Sitter H, Trautmann A, Treudler R, Wedi B, Worm M, Wurpts G, Zuberbier T, Merk HF. Leitlinie Allergologische Diagnostik von Überempfindlichkeitsreaktionen auf Arzneimittel. Allergo J 2015. [DOI: 10.1007/s15007-015-0802-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bircher AJ. Lymphocyte transformation test in the diagnosis of immediate type hypersensitivity reactions to penicillins. Curr Probl Dermatol 2015; 22:31-7. [PMID: 7587330 DOI: 10.1159/000424228] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- A J Bircher
- Department of Dermatology, University Hospital, Basel, Switzerland
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Abstract
In the last several years, intravenous therapy with iron products has been more widely used. Although it has been a standard procedure in dialysis-associated anemia since the early 1990s, its use is expanding to a host of conditions associated with iron deficiency, especially young women with heavy uterine bleeding and pregnancy. Free iron is associated with unacceptable high toxicity inducing severe, hemodynamically significant symptoms. Subsequently, formulations that contain the iron as an iron carbohydrate nanoparticle have been designed. With newer formulations, including low-molecular-weight iron dextran, iron sucrose, ferric gluconate, ferumoxytol, iron isomaltoside, and ferric carboxymaltose, serious adverse events are rare.
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Affiliation(s)
- Andreas J Bircher
- Allergy Unit, Dermatology Clinic, University Hospital Basel, Petersgraben 4, Basel 4031, Switzerland.
| | - Michael Auerbach
- Georgetown University School of Medicine, 3900 Reservoir road northwest, Washington, DC 20007, USA; Hematology and Oncology, Private Practice, King Avenue #308, Baltimore, MD 21237, USA
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Hofmeier KS, Bircher AJ. Hypersensitivitätsreaktionen gegen moderne Thrombozytenaggregationshemmer und Antikoagulanzien. Allergo J 2015. [DOI: 10.1007/s15007-015-0770-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Muris J, Goossens A, Gonçalo M, Bircher AJ, Giménez-Arnau A, Foti C, Rustemeyer T, Feilzer AJ, Kleverlaan CJ. Sensitization to palladium and nickel in Europe and the relationship with oral disease and dental alloys. Contact Dermatitis 2015; 72:286-96. [DOI: 10.1111/cod.12327] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 11/01/2014] [Accepted: 11/15/2014] [Indexed: 01/09/2023]
Affiliation(s)
- Joris Muris
- Department of Dental Materials Science; Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam; Gustav Mahlerlaan 3004 1081 LA Amsterdam The Netherlands
| | - An Goossens
- Contact Allergy Unit, Department of Dermatology; K.U. Leuven University Hospital; Kapucijnenvoer 33 3000 Leuven Belgium
| | - Margarida Gonçalo
- Department of Dermatology; Faculty of Medicine, University Hospital, University of Coimbra; Praceta Mota Pinto 3000-075 Coimbra Portugal
| | - Andreas J. Bircher
- Allergy Unit, Department of Dermatology; University Hospital Basel; Spitalstrasse 26 4031 Basel Switzerland
| | - Ana Giménez-Arnau
- Department of Dermatology; Hospital del Mar. Parc de Salut Mar, Universitat Autònoma de Barcelona; Passeig Maritim 25-29 08003 Barcelona Spain
| | - Caterina Foti
- Department of Biomedical Science and Human Oncology; Dermatological Clinic, University of Bari; Policlinico di Bari, Piazza Giulio Cesare 11 70124 Bari Italy
| | - Thomas Rustemeyer
- Department of Dermatology; VU University Medical Centre; De Boelelaan 1117 1081 HV Amsterdam The Netherlands
| | - Albert J. Feilzer
- Department of Dental Materials Science; Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam; Gustav Mahlerlaan 3004 1081 LA Amsterdam The Netherlands
| | - Cornelis J. Kleverlaan
- Department of Dental Materials Science; Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam; Gustav Mahlerlaan 3004 1081 LA Amsterdam The Netherlands
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Muris J, Goossens A, Gonçalo M, Bircher AJ, Giménez-Arnau A, Foti C, Bruze M, Andersen KE, Rustemeyer T, Feilzer AJ, Kleverlaan CJ. Sensitization to palladium in Europe. Contact Dermatitis 2014; 72:11-9. [DOI: 10.1111/cod.12295] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Revised: 07/16/2014] [Accepted: 07/22/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Joris Muris
- Department of Dental Materials Science; Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam; Gustav Mahlerlaan 3004 1081 LA Amsterdam The Netherlands
| | - An Goossens
- Contact Allergy Unit, Department of Dermatology; K. U. Leuven University Hospital, Kapucijnenvoer 33; 3000 Leuven Belgium
| | - Margarida Gonçalo
- Department of Dermatology; University Hospital and Faculty of Medicine, University of Coimbra; Praceta Mota Pinto 3000-075 Coimbra Portugal
| | - Andreas J. Bircher
- Allergy Unit, Department of Dermatology; University Hospital Basel, Spitalstrasse 26; 4031 Basel Switzerland
| | - Ana Giménez-Arnau
- Department of Dermatology; Hospital del Mar, Universitat Autònoma; Passeig Maritim 25-29 08003 Barcelona Spain
| | - Caterina Foti
- Department of Biomedical Science and Human Oncology; Dermatological Clinic, University of Bari; Policlinico di Bari, Piazza Giulio Cesare 11, 70124 Bari Italy
| | - Magnus Bruze
- Department of Occupational and Environmental Dermatology; Skåne University Hospital, Lund University, SE-20502; Malmö Sweden
| | - Klaus Ejner Andersen
- Department of Dermatology and Allergy Centre; Odense University Hospital, University of Southern Denmark, DK-5000; Odense Denmark
| | - Thomas Rustemeyer
- Department of Dermatology; VU University Medical Centre; De Boelelaan 1117 1081 HV Amsterdam The Netherlands
| | - Albert J. Feilzer
- Department of Dental Materials Science; Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam; Gustav Mahlerlaan 3004 1081 LA Amsterdam The Netherlands
| | - Cornelis J. Kleverlaan
- Department of Dental Materials Science; Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam; Gustav Mahlerlaan 3004 1081 LA Amsterdam The Netherlands
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Abstract
Objective: To report a case of systemic hypersensitivity to the glucagon-like peptide-1 (GLP-1) receptor agonist exenatide used in diabetes care to provide significant information within the context of postmarketing safety surveillance of this new drug class. Case Summary: We report on a 52-year-old male with insufficiently controlled diabetes. GLP-1 agonist treatment was indicated and the patient was started on 5 to 10 µg exenatide (Byetta) twice daily, which had to be stopped after 1 month due to intolerable nausea. One year later, an attempt with 0.6 to 1.8 mg liraglutide (Victoza) once daily was well tolerated but lacked efficacy after a few months. Finally, the patient was started on 2 mg exenatide (Bydureon) once weekly. Concomitant treatment included metformine 1000 mg twice daily and candesartan/hydrochlorothiazide (Blopress Plus) 16/12.5 mg once daily. A few hours after the second injection, local urticaria and disseminated pruritus evolved and after the third injection pruritus, urticaria, and shortness of breath developed, which resolved to antihistamines and corticosteroids. Intradermal tests were positive for Byetta (1:1000) and Bydureon (1:100) (both exenatide), while Victoza (liraglutide) was negative (1:10). Specific immunoglobulin E (IgE) to the drugs was not available for testing. Discussion: An objective causality assessment revealed that the adverse effect to exenatide (Bydureon) was probable (Naranjo probability scale: score of 8). Consistency was established through positive skin tests and the biological explanation that the administration of GLP-1 receptor agonists has been associated with antibody formation. Conclusion: Considering emerging use of GLP-1 receptor agonists, systemic hypersensitivity should be recognized as a risk in clinical practice.
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Schneider Spence JA, Bircher AJ, Scherer Hofmeier K. [The significance of an allergological examination in asthma and COPD]. Ther Umsch 2014; 71:267-74. [PMID: 24794336 DOI: 10.1024/0040-5930/a000512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Of the two most common obstructive lung diseases - bronchial asthma and chronic obstructive pulmonary disease (COPD) - asthma is clearly associated with a possible allergic background, therefore an allergological examination should be included in the work-up of this disease. COPD on the other hand is usually not expected to be linked with an atopic diathesis. Medical history, clinical manifestations, the presence of other atopic diseases, prick tests and measurement of specific IgE antibodies in the serum provide an indication of an allergic genesis of the obstructive pulmonary disease. Bronchial asthma can be roughly divided into an allergic phenotype (TH2-weighted) and a non-allergic phenotype (non-TH2-weighted). The TH2- weighted form leads to an infiltration of eosinophils into the bronchial wall allowing the possibility of a higher concentration of nitrogen oxide in the exhaled air (FeNO measurement) to be detected. In addition to the differentiation between allergic and non-allergic bronchial obstruction, an evaluation of symptoms associated with the workplace (work related asthma) must take place. Furthermore, questions about an intolerance to aspirin (aspirin - exacerbated respiratory disease) or exercise induced symptoms (exercise-induced asthma) should be asked. After a careful interpretation of clinical symptoms and findings in allergy tests, an allergologist can analyze the usefulness of a specific immunotherapy (SIT). For children who suffer from allergic rhinoconjunctivitis, an early SIT can prevent the shift to inflammation of the lower respiratory tract (asthma). Due to the overlapping pathophysiology and symptomatology between bronchial asthma and chronic obstructive pulmonary disease an allergological examination should be considered also in COPD patients.
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Affiliation(s)
| | - Andreas J Bircher
- Allergologische Poliklinik, Dermatologische Klinik, Universitätsspital Basel
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Bircher AJ, Brockow K, Grosber M, Hofmeier KS. Late elicitation of maculopapular exanthemas to iodinated contrast media after first exposure. Ann Allergy Asthma Immunol 2013; 111:576-7. [PMID: 24267376 DOI: 10.1016/j.anai.2013.09.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Revised: 09/13/2013] [Accepted: 09/28/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Andreas J Bircher
- Allergy Unit, Dermatology Clinic, University Hospital Basel, Basel, Switzerland.
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Wehrle E, Bircher AJ. [Allergies to betalactam-antibiotics: when and how to evaluate?]. Praxis (Bern 1994) 2013; 102:973-979. [PMID: 23919937 DOI: 10.1024/1661-8157/a001374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
When there is the suspicion of an allergic reaction to betalactam-antibiotics, the allergological evaluation is an important tool to confirm the allergy and to test alternative medicaments. As all the testing methods for the allergologic evaluation (cutaneous tests and in-vitro tests) don't have a high sensitivity, a broad case report and the former documentation of the symptoms and diagnostic findings are essential, to enable a high significance of the examination and to assess the indication for the provocation test which is the gold standard in many cases. The documentation of the time flow is basic, to differentiate between immediate reactions (hours after intake) and nonimmediate reactions (several days after intake). The diagnostic evaluation not later than after six months increases the prospects for a successful allergic evaluation.
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Affiliation(s)
- Elisabeth Wehrle
- Klinik für Infektiologie und Spitalhygiene, Universitätsspital Basel, Basel, Switzerland
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Abstract
Allergic contact dermatitis from nonpermanent black henna tattoos has been frequently reported, particularly in children. Contamination or adulteration of the dyes with para-phenylendiamine has been identified as major cause of active sensitization and elicitation of severe allergic contact dermatitis. Sequelae include permanent sensitization, hyper- or hypopigmentation, scarring, keloids, and hypertrichosis. We report a rare case of irritant dermatitis to an unknown ingredient in a black henna tattoo with consecutive hypopigmentation. Sensitization to para-phenylendiamine and other para-compounds was excluded by patch test evaluation. This is relevant for future exposure to consumer products such as hair dyes or in occupational settings. Generally, black henna tattoos, particularly if done with dyes of unknown composition, should be strongly discouraged.
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Affiliation(s)
- Fabiola Kind
- Department of Dermatology, University Hospital, Basel, Switzerland
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