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Pereira MP, Gutsche A, Weisshaar E, Halvorsen JA, Wallengren J, Legat FJ, Garcovich S, Savk E, Reich A, Bozek A, Lvov A, Bobko S, Metz M, Streit M, Misery L, Brenaut E, Serra-Baldrich E, Goncalo M, Szepietowski JC, Augustin M, Zeidler C, Ständer S. Chronic nodular prurigo: Association between comorbidities, itch and quality of life. J Eur Acad Dermatol Venereol 2024. [PMID: 38736376 DOI: 10.1111/jdv.20038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/02/2024] [Indexed: 05/14/2024]
Affiliation(s)
- M P Pereira
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - A Gutsche
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - E Weisshaar
- Division of Occupational Dermatology, Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - J A Halvorsen
- Department of Dermatology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - J Wallengren
- Department of Dermatology and Venereology, Skane University Hospital, Lund University, Lund, Sweden
| | - F J Legat
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - S Garcovich
- Catholic University of the Sacred Heart, Rome, Italy
| | - E Savk
- Department of Dermatology, Aydın Adnan Menderes University, Aydın, Turkey
| | - A Reich
- Department of Dermatology, University of Rzeszów, Rzeszów, Poland
| | - A Bozek
- Department of Dermatology, University of Rzeszów, Rzeszów, Poland
| | - A Lvov
- Department of Dermatovenereology and Cosmetology, Central State Medical Academy of Department of Presidential Affairs, Moscow, Russia
- Medical Research and Educational Center, Lomonosov Moscow State University, Moscow, Russia
| | - S Bobko
- Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology, Moscow, Russia
| | - M Metz
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - M Streit
- Department of Dermatology, Kantonsspital Aarau, Aarau, Switzerland
| | - L Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - E Brenaut
- Department of Dermatology, University Hospital of Brest, Brest, France
| | | | - M Goncalo
- Department of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - M Augustin
- Competence Center for Healthcare Research in Dermatology (CVderm), Institute for Healthcare Research in Dermatology and Nursing (IVDP), University Hospital of Hamburg-Eppendorf, Hamburg, Germany
| | - C Zeidler
- Department of Dermatology, Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - S Ständer
- Department of Dermatology, Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
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Ständer S, Pereira MP, Zeidler C, Legat FJ, Misery L, Lönndahl L, Bewley AP, Brenaut E, Bobko S, Elberling J, Evers AWM, Garcovich S, Gieler U, Gonçalo M, Kupfer J, Lambert J, Lvov A, Metz M, Michenko A, Papadavid E, Reich A, Savk E, Schneider G, Schut C, Serra-Baldrich E, Ständer HF, Szepietowski JC, Wallengren J, Weisshaar E, Augustin M. EADV Task Force Pruritus White Paper on chronic pruritus and chronic prurigo: Current challenges and future solutions. J Eur Acad Dermatol Venereol 2024. [PMID: 38738586 DOI: 10.1111/jdv.20102] [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: 02/12/2024] [Accepted: 04/02/2024] [Indexed: 05/14/2024]
Abstract
Chronic pruritus (CP) is frequent in general medicine and the most common complaint in general dermatology. The prevalence of CP is expected to rise in the future due to the ageing population. The clinical presentation, underlying aetiology and treatment strategy of CP are heterogeneous. Also, individual treatment aims and physical, psychic and economic burdens of patients might vary. Chronic prurigo (CPG) is the most severe disease in the chronic pruritus spectrum, being associated with long-standing scratch-induced skin lesions and a therapy refractory itch-scratch-cycle. It is thus important to raise disease awareness for CP and CPG in the general public and among decision-makers in the health system. Further, there is a need to support a rational clinical framework to optimize both diagnostics and therapeutics. Currently, there is still a shortcoming regarding approved therapies and understanding CP/CPG as severe medical conditions. Therefore, the EADV Task Force Pruritus decided to publish this white paper based on several consensus meetings. The group consented on the following goals: (a) ensure that CP is recognized as a serious condition, (b) increase public awareness and understanding of CP and CPG as chronic and burdensome diseases that can greatly affect a person's quality of life, (c) clarify that in most cases CP and CPG are non-communicable and not caused by a psychiatric disease, (d) improve the support and treatment given to patients with CP to help them manage their disease and (e) publicize existing therapies including current guidelines. We aim to point to necessary improvements in access and quality of care directed to decision-makers in health policy, among payers and administrations as well as in practical care.
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Affiliation(s)
- S Ständer
- Section Pruritus Medicine of the Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - M P Pereira
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - C Zeidler
- Section Pruritus Medicine of the Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - F J Legat
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - L Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - L Lönndahl
- Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - A P Bewley
- Barts Health NHS Trust & Queen Mary University, London, UK
| | - E Brenaut
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - S Bobko
- Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology, Moscow, Russia
| | - J Elberling
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - A W M Evers
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
| | | | - U Gieler
- Department for Psychosomatics, Vitos-Klinikum Gießen, Gießen, Germany
| | - M Gonçalo
- Department of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - J Kupfer
- Institute of Medical Psychology, Justus-Liebig-University Gießen, Gießen, Germany
| | - J Lambert
- Department of Dermatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - A Lvov
- Department of Dermatovenereology and Cosmetology, Central State Medical Academy of Department of Presidential Affairs, Moscow, Russia
- Medical Research and Educational Center, Lomonosov Moscow State University, Moscow, Russia
| | - M Metz
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - A Michenko
- Department of Dermatovenereology and Cosmetology, Central State Medical Academy of Department of Presidential Affairs, Moscow, Russia
- Medical Research and Educational Center, Lomonosov Moscow State University, Moscow, Russia
| | - E Papadavid
- National and Kapodistrian University of Athens, 2nd Department of Dermatology and Venereology, Attikon General Hospital, University of Athens, Chaidari, Greece
| | - A Reich
- Department of Dermatology, University of Rzeszów, Rzeszów, Poland
| | - E Savk
- Department of Dermatology, Aydın Adnan Menderes University, Aydın, Turkey
| | - G Schneider
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Münster, Münster, Germany
| | - C Schut
- Institute of Medical Psychology, Justus-Liebig-University Gießen, Gießen, Germany
| | | | - H F Ständer
- Dermatological Practice, Bad Bentheim, Germany
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - J Wallengren
- Department of Dermatology and Venereology, Lund University, Lund, Sweden
| | - E Weisshaar
- Division of Occupational Dermatology, Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - M Augustin
- Competence Center for Healthcare Research in Dermatology (CVderm), Institute for Healthcare Research in Dermatology and Nursing (IVDP), University Hospital of Hamburg-Eppendorf, Hamburg, Germany
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Moñino-Romero S, Kolkhir P, Ohanyan T, Szépfalusi Z, Weller K, Metz M, Scheffel J, Maurer M, Altrichter S. Elevated baseline soluble FcεRI may be linked to early response to omalizumab treatment in chronic spontaneous urticaria. J Eur Acad Dermatol Venereol 2024; 38:167-174. [PMID: 37641982 DOI: 10.1111/jdv.19485] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 08/03/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Omalizumab, an anti-IgE monoclonal antibody, is an effective treatment in chronic spontaneous urticaria (CSU). Predictors of fast and good response for omalizumab treatment have not yet been identified and characterized. OBJECTIVE To evaluate whether soluble FcεRI (sFcεRI), a marker of IgE-mediated mast cell activation, predicts the time of response to omalizumab in CSU. METHODS Sera of 67 CSU patients were obtained before omalizumab treatment and analysed for sFcεRI levels by ELISA (2 ng/mL was used as cut-off for elevated sFcɛRI). Treatment response during the first 4 weeks was assessed with the urticaria activity score (UAS7), urticaria control test (UCT) and the rolling UAS7 (rUAS7). RESULTS Elevated pre-treatment sFcɛRI levels were detected in more than 70% of patients with completely controlled disease (UCT = 16) and well-controlled disease (UCT = 12-15) and were significantly associated with disease control (χ2 = 4.94, p < 0.05). More than half of the patients (14/25) with low levels had poor disease control (UCT < 12). Of the patients who achieved complete and marked UAS7 response, respectively, 75% and 63% had elevated baseline sFcɛRI levels. Post-treatment UAS7 scores were lower in patients with elevated sFcɛRI levels reaching statistical significance at Week 3 (p < 0.05). Patients with elevated baseline sFcɛRI levels achieved rUAS7 ≤ 6 and = 0 earlier than those with lower levels (Days 9 vs. 13 and Days 12 vs. 14, respectively). CONCLUSION Elevated sFcεRI serum levels predict early and good response to treatment with omalizumab, which may help to better design treatment options for CSU patients.
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Affiliation(s)
- S Moñino-Romero
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
- Division of Pediatric Pulmonology, Allergy and Endocrinology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - P Kolkhir
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - T Ohanyan
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Z Szépfalusi
- Division of Pediatric Pulmonology, Allergy and Endocrinology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - K Weller
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - M Metz
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - J Scheffel
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - M Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - S Altrichter
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
- Department of Dermatology and Venereology, Kepler University Hospital, Linz, Austria
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Birhanu S, Winterhalter FS, Stupp P, Cates M, Rottinghaus E, Yavo D, Wray-Gordon F, Lupoli K, Ndongmo CB, Longwe H, Reid GA, Metz M, Saito S, McCracken S, Brown K, Voetsch AC, Duong YT, Parekh BS, Patel HK. Point of Care CD4 Testing in National Household Surveys - Results and Quality Indicators from Eleven Population-Based HIV Impact Assessment (PHIA) Surveys. Microbiol Spectr 2023; 11:e0314822. [PMID: 37071009 PMCID: PMC10269725 DOI: 10.1128/spectrum.03148-22] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 03/13/2023] [Indexed: 04/19/2023] Open
Abstract
Population-based HIV Impact Assessments (PHIAs) are national household (HH) surveys that provide HIV diagnosis and CD4 testing with an immediate return of results. Accurate CD4 results improve HIV-positive participants' clinical care and inform the effectiveness of HIV programs. Here, we present CD4 results from the PHIA surveys that were conducted in 11 countries in sub-Saharan Africa between 2015 and 2018. All of the HIV-positive participants and 2 to 5% of the HIV-negative participants were offered Pima CD4 (Abbott, IL, USA) point-of-care (POC) tests. The quality of the CD4 test was ensured by conducting instrument verification, comprehensive training, quality control, a review of testing errors and an analysis of unweighted CD4 data by HIV status, age, gender, and antiretroviral (ARV) treatment status. Overall, CD4 testing was completed for 23,085 (99.5%) of the 23,209 HIV-positive and 7,329 (2.7%) of the 270,741 negative participants in 11 surveys. The instrument error rate was 11.3% (range, 4.4% to 15.7%). The median CD4 values among HIV-positive and HIV-negative participants (aged 15+) were 468 cells/mm3 (interquartile range [IQR], 307 to 654) and 811 cells/mm3 (IQR, 647 to 1,013), respectively. Among the HIV-positive participants (aged 15+), those with detectable ARVs had higher CD4 values (508 cells/mm3) than those with undetectable ARVs (385.5 cells/mm3). Among the HIV-positive participants (aged 15+), 11.4% (2,528/22,253) had a CD4 value of less than 200 cells/mm3, and approximately half of them (1,225/2,528 = 48.5%) had detectable ARVs, whereas 51.5% (1,303/2,528) had no detectable ARVs (P < 0.0001). We successfully implemented high quality POC CD4 testing using Pima instruments. Our data come from nationally representative surveys in 11 countries and provide unique insights regarding the CD4 distribution among HIV-positive individuals as well as the baseline CD4 values among HIV-negative individuals. IMPORTANCE The manuscript describes CD4 levels among HIV-positive individuals and baseline CD4 levels among HIV-negative individuals from 11 sub-Saharan countries, thereby highlighting the importance of CD4 markers in the context of the HIV epidemic. Despite increased ARV access in each country, advanced HIV disease (CD4 < 200 cells/mm3) persists among approximately 11% of HIV-positive individuals. Therefore, it is important that our findings are shared with the scientific community to assist with similar implementations of point-of-care testing and to conduct a review of HIV programmatic gaps.
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Affiliation(s)
- Sehin Birhanu
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
| | | | - Paul Stupp
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
| | - Melissa Cates
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
| | - Erin Rottinghaus
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
| | - Daniel Yavo
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
| | - Floris Wray-Gordon
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
| | - Kathryn Lupoli
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
| | - Clement B. Ndongmo
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
| | | | - Giles A. Reid
- ICAP at Columbia University, New York, New York, USA
| | - Melissa Metz
- ICAP at Columbia University, New York, New York, USA
| | - Suzue Saito
- ICAP at Columbia University, New York, New York, USA
| | - Stephen McCracken
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
| | - Kristin Brown
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
| | - Andrew C. Voetsch
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
| | - Yen T. Duong
- ICAP at Columbia University, New York, New York, USA
| | - Bharat S. Parekh
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
| | - Hetal K. Patel
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
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5
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Hawro M, Sahin E, Steć M, Różewicka-Czabańska M, Raducha E, Garanyan L, Philipp S, Kokolakis G, Christou D, Kolkhir P, Pogorelov D, Weller K, Metz M, Sabat R, Maleszka R, Olisova O, Maurer M, Hawro T. A comprehensive, tri-national, cross-sectional analysis of characteristics and impact of pruritus in psoriasis. J Eur Acad Dermatol Venereol 2022; 36:2064-2075. [PMID: 35699348 DOI: 10.1111/jdv.18330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 05/05/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Pruritus is prevalent in psoriasis but still many features of pruritus, its response to therapy and its burden in psoriasis remain to be better characterized. OBJECTIVE To investigate characteristics and burden of pruritus in an international cohort of patients with psoriasis. METHODS This cross-sectional study included a total of 634 patients and 246 controls from Germany, Poland and Russia. Physicians examined and interviewed participants, recording clinical characteristics, such as severity, therapy and localization of psoriatic lesions. Participants filled out self-reported questionnaires including questions on pruritus severity and impact, characteristics, and response to therapy, and quality of life (QoL). Localization patterns of pruritus and skin lesions were visualized using body heat maps. RESULTS Most patients (82%) experienced pruritus throughout their disease, and 75% had current pruritus. The majority of patients (64%) perceived pure pruritus, and those who reported additional painful and/or burning sensations (36%) reported overall stronger pruritus. The scalp was the most frequently reported localization of pruritus, even in the absence of skin lesions. Body surface area (BSA) of pruritus was not linked to pruritus intensity, but to BSA of psoriatic lesions (rho = 0.278; P < 0.001). One third of patients (31%) reported impaired sex-life, and 4% had suicidal ideations due to pruritus. In up to one third of patients, psoriasis therapies had little or no effect on pruritus. The only therapeutic option offered to some of these patients were antihistamines, which appeared to be effective in most cases. CONCLUSION Pruritus is highly prevalent in psoriasis and is linked to a significant burden. Current psoriasis therapies are frequently insufficient to control pruritus. Managing psoriasis should include the assessment and control of itch. Efficient antipruritic therapies should be developed and be made available for patients with psoriasis.
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Affiliation(s)
- M Hawro
- Department of Dermatology, Allergology and Venereology, Institute and Comprehensive Center for Inflammation Medicine, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - E Sahin
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - M Steć
- Department of Computer Science, Chair of Embedded Systems Architectures for Signal Processing, University of Potsdam, Potsdam, Germany
| | - M Różewicka-Czabańska
- Department of Skin and Venereal Diseases, Pomeranian Medical University, Szczecin, Poland
| | - E Raducha
- Department of Skin and Venereal Diseases, Pomeranian Medical University, Szczecin, Poland
| | - L Garanyan
- V.A. Rakhmanov Department of Skin and Venereal Diseases, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russian Federation
| | - S Philipp
- Department of Dermatology and Allergy, Institute of Medical Immunology, Psoriasis Research and Treatment Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - G Kokolakis
- Department of Dermatology and Allergy, Institute of Medical Immunology, Psoriasis Research and Treatment Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - D Christou
- Department of Dermatology and Allergy, Institute of Medical Immunology, Psoriasis Research and Treatment Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - P Kolkhir
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany.,Division of Immune-Mediated Skin Diseases, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - D Pogorelov
- Division of Immune-Mediated Skin Diseases, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.,Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - K Weller
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - M Metz
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - R Sabat
- Department of Dermatology and Allergy, Institute of Medical Immunology, Psoriasis Research and Treatment Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - R Maleszka
- Department of Skin and Venereal Diseases, Pomeranian Medical University, Szczecin, Poland
| | - O Olisova
- V.A. Rakhmanov Department of Skin and Venereal Diseases, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russian Federation
| | - M Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - T Hawro
- Department of Dermatology, Allergology and Venereology, Institute and Comprehensive Center for Inflammation Medicine, University Medical Center Schleswig-Holstein, Lübeck, Germany
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6
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Sahin E, Hawro M, Weller K, Sabat R, Philipp S, Kokolakis G, Christou D, Metz M, Maurer M, Hawro T. Prevalence and factors associated with sleep disturbance in adult patients with psoriasis. J Eur Acad Dermatol Venereol 2022; 36:688-697. [PMID: 35020226 DOI: 10.1111/jdv.17917] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 05/22/2021] [Accepted: 12/16/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Sleep, which is crucial for restoring of physiological functions and health, is reportedly impaired in psoriasis. The role of different potential sleep confounding factors, including detailed pruritus characteristics, and the complex interplay between psychological variables (anxiety and depression), pruritus and sleep disturbance in psoriasis remain insufficiently investigated. OBJECTIVES To investigate sleep characteristics and to identify clinical, demographic, and psychological factors associated with sleep disturbance in psoriasis. METHODS This cross-sectional study included 334 psoriasis patients (response rate 86%) and 126 control subjects (response rate 82%). Measures included sleep quality [Pittsburgh Sleep Quality Index (PSQI)], psoriasis severity, pruritus characteristics, including average pruritus intensity [Visual Analogue Scale (VAS)], severity of comorbidities, anxiety and depression (Hospital Anxiety and Depression Scale - HADS), and quality of life (Dermatology Life Quality Index - DLQI, and Short Form 12 - SF12). RESULTS Fifty-nine percent of patients, and 34% of control subjects (P<0.001) suffered from sleep disturbance (PSQI>5). Patients slept 1 hour less than control subjects (median 6 vs. 7 hours, P<0.001). Patients without pruritus had less impaired sleep (global PSQI) than patients with strong (P<0.001) and very strong pruritus (P<0.001). Anxiety (HADS-A) and depression (HADS-D) levels were the strongest predictors of sleep impairment, followed by pruritus exacerbation at night, age, female sex, pruritus exacerbation in the morning, average pruritus intensity (VAS), diagnosed depression and gastroesophageal reflux disease, altogether explaining 32% - 37% of the variance in global sleep quality. Both, anxiety (HADS-A) and depression (HADS-D) were significant mediators explaining the association between pruritus intensity (VAS) and sleep impairment in 42% and 37%, respectively. CONCLUSIONS Sleep disturbance in patients with psoriasis is highly prevalent. Patients with psoriasis should be assessed for sleep impairment, pruritus, anxiety, and depression. Reduction of pruritus should be considered as an important therapeutic goal, along with therapies aimed at reducing anxiety and depression.
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Affiliation(s)
- E Sahin
- Dermatological Allergology, Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Hawro
- Dermatological Allergology, Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - K Weller
- Dermatological Allergology, Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - R Sabat
- Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Psoriasis Research and Treatment Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - S Philipp
- Psoriasis Research and Treatment Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - G Kokolakis
- Psoriasis Research and Treatment Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - D Christou
- Psoriasis Research and Treatment Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Metz
- Dermatological Allergology, Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Maurer
- Dermatological Allergology, Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - T Hawro
- Dermatological Allergology, Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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van den Broek A, de Vroege L, Metz M, Gribling G, de Ridder A, van Eerd J. [Adaptation to changing needs in mental health care: mental health centers]. Tijdschr Psychiatr 2022; 64:101-107. [PMID: 35420153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND The increasing healthcare needs in the Netherlands lead to increasing healthcare costs and waiting lists and warrants sufficient (staff-)capacity. The current market-driven organization of care affects qualitative, accessible, and affordable care. Whether the Dutch mental healthcare system can adapt efficiently is questioned in this article. AIM Gaining insight into the developments and bottlenecks that can contribute to the realization of appropriate care in mental health. METHOD An overview of literature is given regarding developments and necessary adjustments in mental healthcare. RESULTS Appropriate care is value-driven, focused on health (instead of the absence of illness), based on management of health of the client and his network, is accessible, affordable and is offered at the right time and place. The collaborative innovation of Mental Healthcare Centers, in which GGz Breburg (specialized mental health care), Indigo Brabant (general mental health care), and health insurance company, form a sustainable coalition which is presented as a solution for manageability of the mental healthcaresystem. This coalition aims to improve the public values of mental healthcare as a response to the required paradigm shift and future model of mental healthcare. CONCLUSION As a regional network model, the Mental Healthcare Centers offer a desirable answer to the demand for an appropriate and future-proof mental healthcare. w.
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8
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Darr C, Zschäbitz S, Ivanyi P, Wirth M, Staib P, Schostak M, Müller L, Metz M, Bergmann L, Steiner T, Lorch A, Schütt P, Rafiyan MR, Hellmis E, Hinke A, Mänz M, Meiler J, Kretz T, Flörcken A, Grünwald V. 679P Final results on efficacy and patient reported outcomes (PRO) of a randomized phase II trial investigating nivolumab switch-maintenance after TKI induction in metastatic clear cell renal cell carcinoma (mRCC) patients (NIVOSWITCH). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.075] [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: 10/20/2022] Open
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9
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Domaoal RA, Sleeman K, Sawadogo S, Dzinamarira T, Frans N, Shatumbu SP, Kakoma LN, Shuumbwa TK, Cox MH, Stephens S, Nisbet L, Metz M, Saito S, Williams DB, Voetsch AC, Patel H, Parekh B, Duong YT. Successful Use of Near Point-of-Care Early Infant Diagnosis in NAMPHIA to Improve Turnaround Times in a National Household Survey. J Acquir Immune Defic Syndr 2021; 87:S67-S72. [PMID: 34166314 PMCID: PMC8754064 DOI: 10.1097/qai.0000000000002706] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 04/07/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the population-based HIV impact assessment surveys, early infant diagnosis (EID) was provided to infants <18 months without a prior diagnosis. For the Namibia population-based HIV impact assessment (NAMPHIA), the GeneXpert platform was assessed for the feasibility of near POC EID testing compared with the standard Roche COBAS AmpliPrep/COBAS TaqMan (CAP/CTM) platform. Quality assurance measures and turnaround time were compared to improve EID results reporting. METHODS NAMPHIA participants were screened for HIV exposure using Determine HIV-1/2 rapid test; samples reactive on Determine received EID testing on the GeneXpert instrument and Xpert HIV-1 Qual assay using whole blood. Results were confirmed at the Namibia Institute of Pathology using dried blood spots on the Roche CAP/CTM platform per national guidelines. RESULTS Of the 762 screened infants, 61 (8.0%) were Determine-reactive and considered HIV-exposed. Of the 61 exposed infants, 2 were found to be HIV-infected whereas 59 were negative on both GeneXpert and Roche platforms, achieving 100% concordance. Average turnaround time was 3.4 days for the Xpert HIV-1 Qual assay, and average time from collection to testing was 1.0 days for GeneXpert compared with 10.7 days for Roche. No samples failed using GeneXpert whereas 1 sample failed using Roche and was repeated. CONCLUSION Quality POC EID testing is feasible in a national survey through extensive training and external quality assurance measures. The use of decentralized POC EID for national testing would provide rapid diagnosis and improve TATs which may prevent loss to follow-up, ensure linkage to care, and improve clinical outcomes for infants.
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Affiliation(s)
- Robert A. Domaoal
- International Laboratory Branch, Division of Global HIV & TB, CGH, CDC, Atlanta, GA, USA
| | - Katrina Sleeman
- International Laboratory Branch, Division of Global HIV & TB, CGH, CDC, Atlanta, GA, USA
| | | | | | | | | | | | | | - Mackenzie Hurlston Cox
- International Laboratory Branch, Division of Global HIV & TB, CGH, CDC, Atlanta, GA, USA
| | - Sally Stephens
- University of California San Francisco, Windhoek, Namibia
| | - Lydia Nisbet
- University of California San Francisco, Windhoek, Namibia
| | | | | | | | - Andrew C. Voetsch
- Epidemiology and Surveillance Branch, Division of Global HIV & TB, CGH, CDC, Atlanta, GA, USA
| | - Hetal Patel
- International Laboratory Branch, Division of Global HIV & TB, CGH, CDC, Atlanta, GA, USA
| | - Bharat Parekh
- International Laboratory Branch, Division of Global HIV & TB, CGH, CDC, Atlanta, GA, USA
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Patel HK, Duong YT, Birhanu S, Dobbs T, Lupoli K, Moore C, Detorio M, Sleeman K, Manjengwa J, Wray-Gordon F, Yavo D, Jackson K, Domaoal RA, Yufenyuy EL, Vedapuri S, Ndongmo CB, Ogollah FM, Dzinamarira T, Rubinstein P, Sachathep KK, Metz M, Longwe H, Saito S, Brown K, Voetsch AC, Parekh BS. A Comprehensive Approach to Assuring Quality of Laboratory Testing in HIV Surveys: Lessons Learned From the Population-Based HIV Impact Assessment Project. J Acquir Immune Defic Syndr 2021; 87:S17-S27. [PMID: 34166309 DOI: 10.1097/qai.0000000000002702] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Conducting HIV surveys in resource-limited settings is challenging because of logistics, limited availability of trained personnel, and complexity of testing. We described the procedures and systems deemed critical to ensure high-quality laboratory data in the population-based HIV impact assessments and large-scale household surveys. METHODS Laboratory professionals were engaged in every stage of the surveys, including protocol development, site assessments, procurement, training, quality assurance, monitoring, analysis, and reporting writing. A tiered network of household, satellite laboratories, and central laboratories, accompanied with trainings, optimized process for blood specimen collection, storage, transport, and real-time monitoring of specimen quality, and test results at each level proved critical in maintaining specimen integrity and high-quality testing. A plausibility review of aggregate merged data was conducted to confirm associations between key variables as a final quality check for quality of laboratory results. RESULTS Overall, we conducted a hands-on training for 3355 survey staff across 13 surveys, with 160-387 personnel trained per survey on biomarker processes. Extensive training and monitoring demonstrated that overall, 99% of specimens had adequate volume and 99.8% had no hemolysis, indicating high quality. We implemented quality control and proficiency testing for testing, resolved discrepancies, verified >300 Pima CD4 instruments, and monitored user errors. Aggregate data review for plausibility further confirmed the high quality of testing. CONCLUSIONS Ongoing engagement of laboratory personnel to oversee processes at all levels of the surveys is critical for successful national surveys. High-quality population-based HIV impact assessments laboratory data ensured reliable results and demonstrated the impact of HIV programs in 13 countries.
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Affiliation(s)
- Hetal K Patel
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | | | - Sehin Birhanu
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Trudy Dobbs
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Kathryn Lupoli
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Carole Moore
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Mervi Detorio
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Katrina Sleeman
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | | | - Floris Wray-Gordon
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Daniel Yavo
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Keisha Jackson
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Robert A Domaoal
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Ernest L Yufenyuy
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Shanmugam Vedapuri
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Clement B Ndongmo
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | | | | | | | | | | | | | | | - Kristin Brown
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Andrew C Voetsch
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Bharat S Parekh
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
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Metz M, Smith R, Mitchell R, Duong YT, Brown K, Kinchen S, Lee K, Ogollah FM, Dzinamarira T, Maliwa V, Moore C, Patel H, Chung H, Mtengo H, Saito S. Data Architecture to Support Real-Time Data Analytics for the Population-Based HIV Impact Assessments. J Acquir Immune Defic Syndr 2021; 87:S28-S35. [PMID: 34166310 PMCID: PMC10897861 DOI: 10.1097/qai.0000000000002703] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 04/07/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND SETTING Electronic data capture facilitates timely use of data. Population-based HIV impact assessments (PHIAs) were led by host governments, with funding from the President's Emergency Plan for AIDS Relief, technical assistance from the Centers for Disease Control, and implementation support from ICAP at Columbia University. We described data architectures, code-based processes, and resulting data volume and quality for 14 national PHIA surveys with concurrent timelines and varied country-level data governance (2015-2020). METHODS PHIA project data were collected through tablets, point-of-care and laboratory testing instruments, and inventory management systems, using open-source software, vendor solutions, and custom-built software. Data were securely uploaded to the PHIA data warehouse daily or weekly and then used to populate survey-monitoring dashboards and return timely laboratory-based test results on an ongoing basis. Automated data processing allowed timely reporting of survey results. RESULTS Fourteen data architectures were successfully established, and data from more than 450,000 participants in 30,000 files across 13 countries with completed PHIAs, and blood draws producing approximately 6000 aliquots each week per country, were securely collected, transmitted, and processed by 17 full-time equivalent staff. More than 25,600 viral load results were returned to clinics of participants' choice. Data cleaning was not needed for 98.5% of household and 99.2% of individual questionnaires. CONCLUSION The PHIA data architecture permitted secure, simultaneous collection and transmission of high-quality interview and biomarker data across multiple countries, quick turnaround time of laboratory-based biomarker results, and rapid dissemination of survey outcomes to guide President's Emergency Plan for AIDS Relief epidemic control.
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Affiliation(s)
| | | | - Rick Mitchell
- ICAP at Columbia University, New York, NY
- Clinical Trials Unit, Westat, Rockville, MD
| | | | - Kristin Brown
- Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA
| | - Steve Kinchen
- Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA
| | - Kiwon Lee
- ICAP at Columbia University, New York, NY
| | | | | | | | - Carole Moore
- Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA
| | - Hetal Patel
- Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | - Suzue Saito
- ICAP at Columbia University, New York, NY
- Department of Epidemiology, Mailman School of Public Health at Columbia University, New York, NY
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Gober M, Riegler A, Zagler N, Cires D, Beck F, Kirschner M, Steiner E, Metz M. PO-1372: Feasibility of treatment planning on contrast enhanced CTs for HN cancer. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01391-8] [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: 10/22/2022]
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13
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Bernstein J, Maurer M, Giménez-Arnau A, Soong W, Metz M, Barbier N, Barve A, Severin T, Balp M, Janocha R. P153 COMPLETE CONTROL OF URTICARIA SYMPTOMS WITH LIGELIZUMAB HELPS NORMALIZE QUALITY OF LIFE. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.086] [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: 11/30/2022]
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14
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Sussman G, Sitz K, Metz M, Hide M, Maurer M, Barbier N, Hua E, Janocha R, Severin T. D101 EFFICACY OF LIGELIZUMAB IN PATIENTS WITH CHRONIC SPONTANEOUS URTICARIA INADEQUATELY CONTROLLED WITH OMALIZUMAB. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.062] [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: 11/29/2022]
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Pereira MP, Hoffmann V, Weisshaar E, Wallengren J, Halvorsen JA, Garcovich S, Misery L, Brenaut E, Savk E, Potekaev N, Lvov A, Bobko S, Szepietowski JC, Reich A, Bozek A, Legat FJ, Metz M, Streit M, Serra-Baldrich E, Gonçalo M, Storck M, Greiwe I, Nau T, Steinke S, Dugas M, Ständer S, Zeidler C. Chronic nodular prurigo: clinical profile and burden. A European cross-sectional study. J Eur Acad Dermatol Venereol 2020; 34:2373-2383. [PMID: 32078192 DOI: 10.1111/jdv.16309] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/27/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Chronic nodular prurigo (CNPG) is a condition characterized by chronic itch, a prolonged scratching behaviour and the presence of pruriginous nodules. A comprehensive understanding of this condition, especially regarding its clinical characteristics and impact on quality of life is still lacking. OBJECTIVES Aim of this pan-European multicentre cross-sectional study was to establish the clinical profile of CNPG, including its associated burden. METHODS Fifteen centres from 12 European countries recruited CNPG patients presenting at the centre or using the centres' own databases. Patients were asked to complete a questionnaire in paper or electronic format. Demography, current co-morbidities, underlying disease, itch intensity, additional sensory symptoms, quality of life, highest burden and emotional experience of itch were assessed. RESULTS A total of 509 patients (210 male, median age: 64 years [52; 72]) were enrolled. Of these, 406 reported itch and CNPG lesions in the previous 7 days and qualified to complete the whole questionnaire. We recorded moderate to severe worst itch intensity scores in the previous 24 h. Scores were higher in patients with lower educational levels and those coming from Eastern or Southern Europe. Most patients experience itch often or always (71%) and report that their everyday life is negatively affected (53%). Itch intensity was considered to be the most burdensome aspect of the disease by 49% of the patients, followed by the visibility of skin lesions (21%) and bleeding of lesions (21%). The majority of patients was unaware of an underlying condition contributing to CNPG (64%), while psychiatric diseases were the conditions most often mentioned in association with CNPG (19%). CONCLUSIONS This multicentre cross-sectional study shows that itch is the dominant symptom in CNPG and reveals that the profile of the disease is similar throughout Europe.
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Affiliation(s)
- M P Pereira
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - V Hoffmann
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - E Weisshaar
- Occupational Medicine, Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - J Wallengren
- Department of Clinical Sciences Lund, Dermatology and Venereology and Skane University Hospital, Lund, Sweden
| | - J A Halvorsen
- Department of Dermatology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - S Garcovich
- Institute of Dermatology, F. Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - L Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - E Brenaut
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - E Savk
- Department of Dermatology, Aydin Adnan Menderes University, Aydın, Turkey
| | - N Potekaev
- Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology, Moscow, Russia
| | - A Lvov
- Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology, Moscow, Russia
| | - S Bobko
- Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology, Moscow, Russia
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - A Reich
- Department of Dermatology, University of Rzeszów, Rzeszów, Poland
| | - A Bozek
- Department of Dermatology, School of Medicine, University of Information Technology and Management, Rzeszow, Poland
| | - F J Legat
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - M Metz
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Streit
- Department of Dermatology, Kantonsspital Aarau, Aarau, Switzerland
| | | | - M Gonçalo
- Department of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - M Storck
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - I Greiwe
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - T Nau
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - S Steinke
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - M Dugas
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - S Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - C Zeidler
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
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Schön S, Cabello J, Liesche-Starnecker F, Molina-Romero M, Eichinger P, Metz M, Karimov I, Preibisch C, Keupp J, Hock A, Meyer B, Weber W, Zimmer C, Pyka T, Yakushev I, Gempt J, Wiestler B. Imaging glioma biology: spatial comparison of amino acid PET, amide proton transfer, and perfusion-weighted MRI in newly diagnosed gliomas. Eur J Nucl Med Mol Imaging 2020; 47:1468-1475. [PMID: 31953672 PMCID: PMC7188730 DOI: 10.1007/s00259-019-04677-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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: 09/07/2019] [Accepted: 12/30/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Imaging glioma biology holds great promise to unravel the complex nature of these tumors. Besides well-established imaging techniques such O-(2-[18F]fluoroethyl)-L-tyrosine (FET)-PET and dynamic susceptibility contrast (DSC) perfusion imaging, amide proton transfer-weighted (APTw) imaging has emerged as a promising novel MR technique. In this study, we aimed to better understand the relation between these imaging biomarkers and how well they capture cellularity and vascularity in newly diagnosed gliomas. METHODS Preoperative MRI and FET-PET data of 46 patients (31 glioblastoma and 15 lower-grade glioma) were segmented into contrast-enhancing and FLAIR-hyperintense areas. Using established cutoffs, we calculated hot-spot volumes (HSV) and their spatial overlap. We further investigated APTw and CBV values in FET-HSV. In a subset of 10 glioblastoma patients, we compared cellularity and vascularization in 34 stereotactically targeted biopsies with imaging. RESULTS In glioblastomas, the largest HSV was found for APTw, followed by PET and CBV (p < 0.05). In lower-grade gliomas, APTw-HSV was clearly lower than in glioblastomas. The spatial overlap of HSV was highest between APTw and FET in both tumor entities and regions. APTw correlated significantly with cellularity, similar to FET, while the association with vascularity was more pronounced in CBV and FET. CONCLUSIONS We found a relevant spatial overlap in glioblastomas between hotspots of APTw and FET both in contrast-enhancing and FLAIR-hyperintense tumor. As suggested by earlier studies, APTw was lower in lower-grade gliomas compared with glioblastomas. APTw meaningfully contributes to biological imaging of gliomas.
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Affiliation(s)
- S Schön
- Department of Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - J Cabello
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - F Liesche-Starnecker
- Department of Neuropathology, Institute of Pathology, Technical University of Munich, Munich, Germany
| | - M Molina-Romero
- Image-based Biomedical Modeling, Technical University of Munich, Munich, Germany
| | - P Eichinger
- Department of Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - M Metz
- Department of Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - I Karimov
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - C Preibisch
- Department of Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - J Keupp
- Philips Research, Hamburg, Germany
| | - A Hock
- Philips Health Systems, Zurich, Switzerland
| | - B Meyer
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - W Weber
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - C Zimmer
- Department of Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - T Pyka
- Department of Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - I Yakushev
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - J Gempt
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - B Wiestler
- Department of Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
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Misery L, Brenaut E, Pereira M, Augustin M, Bobko S, Dalgard F, Evers A, Garcovich S, Gieler U, Gonçalo M, Halvorsen J, Lambert J, Legat F, Leslie T, Metz M, Reich A, Savk E, Serra-Baldrich E, Streit M, Szepietowski J, Weisshaar E, Ständer S. Consensus d’experts européens pour la définition, la classification et la terminologie du prurigo chronique. Ann Dermatol Venereol 2019. [DOI: 10.1016/j.annder.2019.09.477] [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: 10/25/2022]
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Affiliation(s)
- M. Metz
- Department of Dermatology, Venereology and Allergology Charité – Universitätsmedizin Berlin Charitéplatz 1 10117 Berlin Germany
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Grünwald V, Grüllich C, Ivanyi P, Wirth M, Staib P, Schostak M, Dargatz P, Müller L, Metz M, Bergmann L, Welslau M, Schütt P, Rafiyan MR, Hellmis E, Hinke A, Meiler J, Kretz T, Loidl W, Flörcken A, Steiner T. A phase II trial of TKI induction followed by a randomized comparison between nivolumab or TKI continuation in renal cell carcinoma (NIVOSWITCH). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz249.055] [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: 11/13/2022] Open
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André F, Fluhr JW, Hawro T, Church MK, Maurer M, Metz M. Characterization of cowhage-induced pruritus in inflamed and non-inflamed skin. J Eur Acad Dermatol Venereol 2019; 34:202-206. [PMID: 31419339 DOI: 10.1111/jdv.15871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/27/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Pruritus is a major symptom of many inflammatory diseases and impacts greatly the quality of life in patients. We aimed to specify the characteristics of experimentally induced pruritus in normal skin and in experimentally induced inflammatory dermatitis in healthy volunteers. METHODS Skin inflammation was induced by the repeated application of sodium lauryl sulphate (SLS 2%) on the volar forearms of 30 healthy volunteers. Inflammatory dermatitis intensity was assessed using the eczema score adapted from Frosch and Kligman. Non-histaminergic pruritus was induced by cowhage spicules rubbed on the volar forearms and recorded for 30 min on a 10-cm visual analogue scale (VAS) in both non-inflamed and inflamed skin. RESULTS Induction of inflammatory dermatitis by SLS resulted in a mild inflammatory dermatitis with an inflammation score of 2.3 ± 0.1 within 7 days of treatment. Cowhage-induced pruritus was of markedly higher intensity (P < 0.001), and all but two individuals had higher maximum pruritus intensity in inflamed skin as compared to non-inflamed skin, whereas the kinetics of the pruritus response were similar. The quality of cowhage-induced pruritus was significantly different with more 'burning' and 'painful sensations' in inflamed skin (P < 0.01). Maximum pruritus intensity in inflamed skin strongly correlated with maximum pruritus intensity in non-inflamed skin (r = 0.51, P = 0.004). Skin hydration, skin barrier integrity and dermatitis severity did not correlate with pruritus intensity. CONCLUSION Taken together, pruritus in inflamed skin is perceived as more intense, painful and burning. This may explain, in part, why pruritus is a major driver of quality-of-life impairment in patients with chronic inflammatory skin conditions such as atopic dermatitis.
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Affiliation(s)
- F André
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - J W Fluhr
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - T Hawro
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M K Church
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Maurer
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Metz
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Hawro T, Lehmann S, Deuring E, Weller K, Altrichter S, Church M, Maurer M, Metz M. Comparison of pruritus and sensory qualities induced by capsaicin, histamine and cowhage. J Eur Acad Dermatol Venereol 2019; 33:1755-1761. [DOI: 10.1111/jdv.15743] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 05/29/2019] [Indexed: 11/29/2022]
Affiliation(s)
- T. Hawro
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - S. Lehmann
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - E. Deuring
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - K. Weller
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - S. Altrichter
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - M.K. Church
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - M. Maurer
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - M. Metz
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
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Fastner G, Sedlmayer F, Widder J, Metz M, Geinitz H, Kapp K, Sölkner L, Greil R, Jakesz R, Kwasny W, Heck D, Bjelic-Radisic V, Balic M, Stöger H, Wieder U, Zwrtek R, Semmler D, Horvath W, Melbinger-Zeinitzer E, Wiesholzer M, Wette V, Gnant M. OC-0270 Antihormones with or without irradiation in breast cancer: 10-year results of the ABCSG 8A trial. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30690-5] [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: 10/26/2022]
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Fastner G, Sedlmayer F, Widder J, Metz M, Geinitz H, Kapp K, Sölkner L, Greil R, Jakesz R, Gnant M. Antihormonal treatment with or without whole breast irradiation in low risk breast cancer patients after breast conserving surgery: 10-year results of the ABCSG 8A trial. Breast 2019. [DOI: 10.1016/s0960-9776(19)30286-3] [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: 11/30/2022] Open
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Pereira MP, Zeidler C, Nau T, Bobko S, Evers AWM, Garcovich S, Gonçalo M, Halvorsen JA, Lambert J, Legat FJ, Leslie T, Metz M, Misery L, Nordlind K, Reich A, Schneider G, Ständer H, Streit M, Szepietowski JC, Wallengren J, Weisshaar E, Ständer S. Position Statement: Linear prurigo is a subtype of chronic prurigo. J Eur Acad Dermatol Venereol 2018; 33:263-266. [PMID: 30288812 DOI: 10.1111/jdv.15275] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 07/26/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Chronic prurigo (CPG) is a distinct disease characterized by chronic pruritus, history and/or signs of prolonged scratching and multiple pruriginous lesions. It may present with various clinical manifestations, including papules, nodules, plaques or umbilicated lesions. Some patients with chronic pruritus show pruriginous linear and scaring scratch lesions (LSSL) and it is unclear whether these lesions belong to the spectrum of CPG. OBJECTIVE To achieve a consensus on the classification of pruriginous LSSL and establish criteria to differentiate them from similar appearing conditions of different nature. METHODS Members of the Task Force Pruritus (TFP) of the European Academy of Dermatology and Venereology participated in the consensus conference, discussing representative clinical cases. Using the Delphi method, consensus was reached when ≥75% of members agreed on a statement. RESULTS Twenty-one members of the TFP with voting rights participated in the meeting. It was consented that LSSL occurs due to chronic pruritus and prolonged scratching, and share common pathophysiological mechanisms with CPG. LSSL were thus considered as belonging to the spectrum of CPG and the term 'linear prurigo' was chosen to describe this manifestation. CONCLUSION Considering linear prurigo as belonging to the spectrum of CPG has important clinical implications, since both the diagnostic and therapeutic approach of these patients should be performed as recommended for CPG. Importantly, linear prurigo should be differentiated from self-inflicted skin lesions as factitious disorders or skin picking syndromes. In the latter, artificial manipulation rather than pruritus itself leads to the development of cutaneous lesions, which can show clinical similarities to linear prurigo.
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Affiliation(s)
- M P Pereira
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - C Zeidler
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - T Nau
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - S Bobko
- Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology, Moscow, Russia
| | - A W M Evers
- Department of Health, Medical and Neuropsychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - S Garcovich
- Institute of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
| | - M Gonçalo
- Department of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - J A Halvorsen
- Department of Dermatology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - J Lambert
- Department of Dermatology, University Hospital of Antwerp, Antwerp, Belgium
| | - F J Legat
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - T Leslie
- Department of Dermatology, Royal Free Hospital, London, UK
| | - M Metz
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - L Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - K Nordlind
- Dermatology and Venereology Unit, Department of Medicine, Karolinska University Hospital, Solna, Sweden
| | - A Reich
- Department of Dermatology, University of Rzeszów, Rzeszów, Poland
| | - G Schneider
- Department of Psychosomatics and Psychotherapy, Münster University Hospital, Münster, Germany
| | - H Ständer
- Dermatological Practice, Bad Bentheim and Department of Dermatology, Klinikum Dortmund GmbH, Dortmund, Germany
| | - M Streit
- Department of Dermatology, Kantonsspital Aarau, Aarau, Switzerland
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - J Wallengren
- Department of Dermatology and Venereology, Skåne University Hospital SUS Lund, Lund University, Lund, Sweden
| | - E Weisshaar
- Department of Social Medicine, Occupational and Environmental Dermatology, University of Heidelberg, Heidelberg, Germany
| | - S Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
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Weller K, Church MK, Hawro T, Altrichter S, Labeaga L, Magerl M, Metz M, Zuberbier T, Maurer M. Updosing of bilastine is effective in moderate to severe chronic spontaneous urticaria: A real-life study. Allergy 2018; 73:2073-2075. [PMID: 29869790 DOI: 10.1111/all.13494] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- K. Weller
- Department of Dermatology and Allergy Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - M. K. Church
- Department of Dermatology and Allergy Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - T. Hawro
- Department of Dermatology and Allergy Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - S. Altrichter
- Department of Dermatology and Allergy Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - L. Labeaga
- Medical Department FAES FARMA SA Leioa (Bizkaia) Spain
| | - M. Magerl
- Department of Dermatology and Allergy Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - M. Metz
- Department of Dermatology and Allergy Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - T. Zuberbier
- Department of Dermatology and Allergy Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - M. Maurer
- Department of Dermatology and Allergy Charité ‐ Universitätsmedizin Berlin Berlin Germany
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Zuberbier T, Aberer W, Asero R, Abdul Latiff AH, Baker D, Ballmer-Weber B, Bernstein JA, Bindslev-Jensen C, Brzoza Z, Buense Bedrikow R, Canonica GW, Church MK, Craig T, Danilycheva IV, Dressler C, Ensina LF, Giménez-Arnau A, Godse K, Gonçalo M, Grattan C, Hebert J, Hide M, Kaplan A, Kapp A, Katelaris CH, Kocatürk E, Kulthanan K, Larenas-Linnemann D, Leslie TA, Magerl M, Mathelier-Fusade P, Meshkova RY, Metz M, Nast A, Nettis E, Oude-Elberink H, Rosumeck S, Saini SS, Sánchez-Borges M, Schmid-Grendelmeier P, Staubach P, Sussman G, Toubi E, Vena GA, Vestergaard C, Wedi B, Werner RN, Zhao Z, Maurer M. The EAACI/GA²LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy 2018; 73:1393-1414. [PMID: 29336054 DOI: 10.1111/all.13397] [Citation(s) in RCA: 767] [Impact Index Per Article: 127.8] [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: 12/18/2017] [Indexed: 02/06/2023]
Abstract
This evidence- and consensus-based guideline was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. The conference was held on 1 December 2016. It is a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the EU-founded network of excellence, the Global Allergy and Asthma European Network (GA²LEN), the European Dermatology Forum (EDF) and the World Allergy Organization (WAO) with the participation of 48 delegates of 42 national and international societies. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease, presenting with wheals, angioedema, or both. The lifetime prevalence for acute urticaria is approximately 20%. Chronic spontaneous urticaria and other chronic forms of urticaria are disabling, impair quality of life and affect performance at work and school. This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors and pathomechanisms. In addition, it outlines evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.
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Affiliation(s)
- T. Zuberbier
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Dermatology and Allergy; Allergy-Centre-Charité; Berlin Germany
| | - W. Aberer
- Department of Dermatology; Medical University of Graz; Graz Austria
| | - R. Asero
- Department of Allergology; Clinica San Carlo; Paderno Dugnano MI Italy
| | - A. H. Abdul Latiff
- Allergy& Immunology Centre; Pantai Hospital Kuala Lumpur; Kuala Lumpur Malaysia
| | - D. Baker
- Baker Allergy Asthma and Dermatology Clinic; Portland OR USA
| | - B. Ballmer-Weber
- Allergy Unit; Department of Dermatology; University Hospital; Zürich Switzerland
| | - J. A. Bernstein
- University of Cincinnati Physicians Immunology Research Center; Cincinnati OH USA
| | - C. Bindslev-Jensen
- Department of Dermatology and Allergy Centre; Odense University Hospital and University of Southern Denmark; Odense Denmark
| | - Z. Brzoza
- Department of Internal Diseases, Allergology and Clinical Immunology in Katowice; Medical University of Silesia; Katowice Poland
| | | | - G. W. Canonica
- Personalized Medicine Asthma and Allergy Clinic-Humanitas University & Research Hospital; Milano Italy
| | - M. K. Church
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Dermatology and Allergy; Allergy-Centre-Charité; Berlin Germany
| | - T. Craig
- Department of Medicine and Pediatrics; Penn State University; Hershey Medical Center; Hershey PA USA
| | - I. V. Danilycheva
- National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia; Moscow Russia
| | - C. Dressler
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Division of Evidence Based Medicine; Department of Dermatology; Berlin Germany
| | - L. F. Ensina
- Federal University of Sao Paulo; Sao Paulo Brazil
| | - A. Giménez-Arnau
- Hospital del Mar; IMIM; Universitat Autònoma Barcelona; Barcelona Spain
| | - K. Godse
- Department of Dermatology; Dr. D. Y. Patil Medical College & Hospital; Nerul Navi Mumbai India
| | - M. Gonçalo
- Clinic of Dermatology; Faculty of Medicine and University Hospital; Coimbra Portugal
| | - C. Grattan
- St John's’ Institute of Dermatology; Guy's’ and St. Thomas’ Hospital; NHS Foundation Trust; London UK
| | - J. Hebert
- Service d'allergie; Centre Hospitalier Université Laval/Centre Hospitalier Universitaire de Québec; Québec QC Canada
| | - M. Hide
- Department of Dermatology; Institute of Biomedical and Health Sciences; Hiroshima University; Hiroshima Japan
| | - A. Kaplan
- Department of Medicine; Division of Pulmonary and Critical Care Medicine; Allergy and Clinical Immunology; Medical University of South Carolina; Charleston SC USA
| | - A. Kapp
- Department of Dermatology and Allergy; Hannover Medical School; Hannover Germany
| | - C. H. Katelaris
- Campbelltown Hospital and Western Sydney University; Sydney Australia
| | - E. Kocatürk
- Department of Dermatology; Okmeydani Training and Research Hospital; Istanbul Turkey
| | - K. Kulthanan
- Department of Dermatology; Faculty of Medicine Siriraj Hospital; Mahidol University; Bangkok Thailand
| | | | | | - M. Magerl
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Dermatology and Allergy; Allergy-Centre-Charité; Berlin Germany
| | - P. Mathelier-Fusade
- Department of Dermatology and Allergy; University Hospital of Tenon; Paris France
| | - R. Y. Meshkova
- Department of Clinical Immunology and Allergy; Smolensk State Medical University; Smolensk Russia
| | - M. Metz
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Dermatology and Allergy; Allergy-Centre-Charité; Berlin Germany
| | - A. Nast
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Division of Evidence Based Medicine; Department of Dermatology; Berlin Germany
| | - E. Nettis
- Scuola e Cattedra di Allergologia e Immunologia Clinica; Dipartimento dell'Emergenza e dei Trapianti d'Organo; Università di Bari; Bari Italy
| | | | - S. Rosumeck
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Division of Evidence Based Medicine; Department of Dermatology; Berlin Germany
| | - S. S. Saini
- Johns Hopkins Asthma and Allergy Center; Baltimore MD USA
| | - M. Sánchez-Borges
- Allergy and Clinical Immunology Department; Centro Médico-Docente La Trinidad; Caracas Venezuela
| | | | - P. Staubach
- Department of Dermatology; University Medical Center Mainz; Mainz Germany
| | - G. Sussman
- Division of Allergy and Clinical Immunology; University of Toronto; Toronto ON Canada
| | - E. Toubi
- Bnai-Zion Medical Center; Faculty of Medicine; Technion Haifa Israel
| | - G. A. Vena
- Dermatology and Venereology Private Practice; Bari and Barletta Italy
| | - C. Vestergaard
- Department of Dermatology and Venereology; Aarhus University Hospital; Aarhus Denmark
| | - B. Wedi
- Department of Dermatology and Allergy; Hannover Medical School; Hannover Germany
| | - R. N. Werner
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Division of Evidence Based Medicine; Department of Dermatology; Berlin Germany
| | - Z. Zhao
- Department of Dermatology and Venereology; Peking University; First Hospital; Beijing China
| | - M. Maurer
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Dermatology and Allergy; Allergy-Centre-Charité; Berlin Germany
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Zeidler C, Metz M, Steinke S, Ständer S. [Treatment of chronic pruritus-what is new?]. Hautarzt 2018; 69:641-646. [PMID: 29931387 DOI: 10.1007/s00105-018-4221-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chronic pruritus is one of the most common and stressful symptoms in medicine. Therapy remains a great challenge because of the lack of approved therapies. In the recent past a greater understanding of the pathogenesis has enabled the results to be translated into new forms of therapy. The various therapies target a wide range of points in the pruritic cascade-from blockade of intracellular and intercellular signaling pathways in the skin to the modulation of neurotransmission. This article provides a summary of current therapeutic options based on the current S2K guideline and gives an overview about recent developments in antipruritic treatments.
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Affiliation(s)
- C Zeidler
- Kompetenzzentrum Chronischer Pruritus (KCP) und Klinik für Hautkrankheiten, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland.
| | - M Metz
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - S Steinke
- Kompetenzzentrum Chronischer Pruritus (KCP) und Klinik für Hautkrankheiten, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland
| | - S Ständer
- Kompetenzzentrum Chronischer Pruritus (KCP) und Klinik für Hautkrankheiten, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland
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Dressler C, Rosumeck S, Werner RN, Magerl M, Metz M, Maurer M, Nast A, Zuberbier T. Executive summary of the methods report for 'The EAACI/GA 2 LEN/EDF/WAO Guideline for the Definition, Classification, Diagnosis and Management of Urticaria. The 2017 Revision and Update'. Allergy 2018; 73:1145-1146. [PMID: 29336489 DOI: 10.1111/all.13414] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- C. Dressler
- Division of Evidence-Based Medicine; Department of Dermatology; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Berlin Germany
| | - S. Rosumeck
- Division of Evidence-Based Medicine; Department of Dermatology; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Berlin Germany
| | - R. N. Werner
- Division of Evidence-Based Medicine; Department of Dermatology; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Berlin Germany
| | - M. Magerl
- Department of Dermatology; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Berlin Germany
| | - M. Metz
- Department of Dermatology; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Berlin Germany
| | - M. Maurer
- Department of Dermatology; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Berlin Germany
| | - A. Nast
- Division of Evidence-Based Medicine; Department of Dermatology; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Berlin Germany
| | - T. Zuberbier
- Department of Dermatology; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Berlin Germany
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Saito S, Duong YT, Metz M, Lee K, Patel H, Sleeman K, Manjengwa J, Ogollah FM, Kasongo W, Mitchell R, Mugurungi O, Chimbwandira F, Moyo C, Maliwa V, Mtengo H, Nkumbula T, Ndongmo CB, Vere NS, Chipungu G, Parekh BS, Justman J, Voetsch AC. Returning HIV-1 viral load results to participant-selected health facilities in national Population-based HIV Impact Assessment (PHIA) household surveys in three sub-Saharan African Countries, 2015 to 2016. J Int AIDS Soc 2018; 20 Suppl 7. [PMID: 29171193 PMCID: PMC5978652 DOI: 10.1002/jia2.25004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 04/06/2017] [Accepted: 08/21/2017] [Indexed: 11/21/2022] Open
Abstract
Introduction Logistical complexities of returning laboratory test results to participants have precluded most population‐based HIV surveys conducted in sub‐Saharan Africa from doing so. For HIV positive participants, this presents a missed opportunity for engagement into clinical care and improvement in health outcomes. The Population‐based HIV Impact Assessment (PHIA) surveys, which measure HIV incidence and the prevalence of viral load (VL) suppression in selected African countries, are returning VL results to health facilities specified by each HIV positive participant within eight weeks of collection. We describe the performance of the specimen and data management systems used to return VL results to PHIA participants in Zimbabwe, Malawi and Zambia. Methods Consenting participants underwent home‐based counseling and HIV rapid testing as per national testing guidelines; all confirmed HIV positive participants had VL measured at a central laboratory on either the Roche CAP/CTM or Abbott m2000 platform. On a bi‐weekly basis, a dedicated data management team produced logs linking the VL test result with the participants’ contact information and preferred health facility; project staff sent test results confidentially via project drivers, national courier systems, or electronically through an adapted short message service (SMS). Participants who provided cell phone numbers received SMS or phone call alerts regarding availability of VL results. Results and discussion From 29,634 households across the three countries, 78,090 total participants 0 to 64 years in Zimbabwe and Malawi and 0 to 59 years in Zambia underwent blood draw and HIV testing. Of the 8391 total HIV positive participants identified, 8313 (99%) had VL tests performed and 8245 (99%) of these were returned to the selected health facilities. Of the 5979 VL results returned in Zimbabwe and Zambia, 85% were returned within the eight‐week goal with a median turnaround time of 48 days (IQR: 33 to 61). In Malawi, where exact return dates were unavailable all 2266 returnable results reached the health facilities by 11 weeks. Conclusions The first three PHIA surveys returned the vast majority of VL results to each HIV positive participant's preferred health facility within the eight‐week target. Even in the absence of national VL monitoring systems, a system to return VL results from a population‐based survey is feasible, but it requires developing laboratory and data management systems and dedicated staff. These are likely important requirements to strengthen return of results systems in routine clinical care.
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Affiliation(s)
- Suzue Saito
- ICAP at Columbia University, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health at Columbia University, New York, NY, USA
| | - Yen T Duong
- ICAP at Columbia University, New York, NY, USA
| | | | - Kiwon Lee
- ICAP at Columbia University, New York, NY, USA
| | - Hetal Patel
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Katrina Sleeman
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | | | - Owen Mugurungi
- Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe
| | | | | | | | | | | | | | | | | | - Bharat S Parekh
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jessica Justman
- ICAP at Columbia University, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health at Columbia University, New York, NY, USA
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Durski M, Metz M, Crim G, Hass S, Mazur R, Vieira S. Effect of Chlorhexidine Treatment Prior to Fiber Post Cementation on Long-Term Resin Cement Bond Strength. Oper Dent 2018; 43:E72-E80. [PMID: 29504878 DOI: 10.2341/16-241-lr2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The purpose of this study was to evaluate the push-out bond strength of two different adhesive cements (total etch and self-adhesive) for glass fiber post (GFP) cementation in simulated, long-term service (thermocycling) when the root canal is treated with chlorhexidine before cementation. One hundred twenty premolar specimens with a single root canal were selected, endodontically treated, and shaped for GFP cementation (n=120). The specimens were randomly placed into one of 12 groups (10 specimens each) according to cement (T = total-etch RelyX ARC or S = self-adhesive RelyX Unicem), treatment with chlorhexidine (N or Y: without or with), and number of thermal cycles (00, 20, or 40: 0, or 20,000 or 40,000 cycles): 1. TN00, 2. TN20, 3. TN40, 4. TY00, 5. TY20, 6. TY40, 7. SN00, 8. SN20, 9. SN40, 10. SY00, 11. SY20, 12. SY40. The root of each specimen was cut perpendicular to the vertical axis, yielding six 1.0 mm-thick sections. A push-out bond strength test was performed followed by statistical analysis using a factorial analysis of variance. Pairwise comparisons of significant factor interactions were adjusted using the Tukey test. Significant differences of push-out bond strengths were found in the four main effects (resin cement [ p<0.0001], treatment with chlorhexidine [ p<0.0001], number of cycles [ p<0.0001], and root third [ p<0.0001]) and all interactions ( p<0.05 for all). Both resin cements produced higher bond strength in the cervical third followed by the middle third, and lower values were detected in the apical third. Additionally, the results suggest that the use of an additional disinfection treatment with chlorhexidine before the cement application produced the highest push-out bond strength regardless of root third. Further, the thermocycling simulation decreased the bond strength for both resin cements long-term when the chlorhexidine was not applied before cementation. However, when the root canal was treated with chlorhexidine and the fiber post was cemented with self-adhesive cement, the bond strength increased after 0, 20,000 and 40,000 cycles.
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Staubach P, Metz M, Chapman-Rothe N, Sieder C, Bräutigam M, Maurer M, Weller K. Omalizumab rapidly improves angioedema-related quality of life in adult patients with chronic spontaneous urticaria: X-ACT study data. Allergy 2018; 73:576-584. [PMID: 29058822 PMCID: PMC5836932 DOI: 10.1111/all.13339] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [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] [Accepted: 10/18/2017] [Indexed: 01/11/2023]
Abstract
Background The X‐ACT study aimed to examine the effect of omalizumab treatment on quality of life (QoL) in chronic spontaneous urticaria (CSU) patients with angioedema refractory to high doses of H1‐antihistamines. Methods In X‐ACT, a phase III, double‐blind, placebo‐controlled study, CSU patients (18‐75 years) with ≥4 angioedema episodes during the 6 months before inclusion were randomized (1:1) to receive omalizumab 300 mg or placebo every 4 weeks for 28 weeks. Angioedema‐related QoL, skin‐related QoL impairment, and psychological well‐being were assessed. Results Ninety‐one patients were randomized and 68 (omalizumab, n = 35; placebo, n = 33) completed the 28‐week treatment period. At baseline, the mean (SD) total Angioedema QoL (AE‐QoL; 56.2 [18.7] and 59.9 [19.2]) and Dermatology Life Quality Index (DLQI; 14.6 [5.7] and 16.6 [7.3]) score were high in the omalizumab and placebo group, respectively. At Week 4 (after the first treatment), the least squares mean difference in the AE‐QoL and DLQI score between groups was −17.6 (P < .001) and −7.2 (P < .001), respectively. Significant QoL improvements in the omalizumab vs placebo groups continued until Week 28, but returned to placebo levels at the follow‐up visit. The mean (SD) baseline 5‐item World Health Organization Well‐being Index was 10.0 (5.5, omalizumab) and 7.7 (5.3, placebo), which increased above the depression threshold (<13) from Week 4 and throughout with omalizumab but not placebo treatment. Compared to placebo, omalizumab was also associated with decreased fear of suffocation due to angioedema. Conclusions Our findings support omalizumab treatment in patients with severe H1‐antihistamine‐refractory CSU with angioedema.
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Affiliation(s)
- P. Staubach
- Department of Dermatology; University Medical Center Mainz; Mainz Germany
| | - M. Metz
- Department of Dermatology and Allergy; Charité - Universitätsmedizin Berlin; Berlin Germany
| | | | - C. Sieder
- Novartis Pharma GmbH; Nuernberg Germany
| | | | - M. Maurer
- Department of Dermatology and Allergy; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - K. Weller
- Department of Dermatology and Allergy; Charité - Universitätsmedizin Berlin; Berlin Germany
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Maurer M, Altrichter S, Metz M, Zuberbier T, Church MK, Bergmann KC. Benefit from reslizumab treatment in a patient with chronic spontaneous urticaria and cold urticaria. J Eur Acad Dermatol Venereol 2018; 32:e112-e113. [PMID: 28924988 DOI: 10.1111/jdv.14594] [Citation(s) in RCA: 41] [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] [Indexed: 11/29/2022]
Affiliation(s)
- M Maurer
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - S Altrichter
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Metz
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - T Zuberbier
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M K Church
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - K-C Bergmann
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Hawro T, Ohanyan T, Schoepke N, Metz M, Peveling‐Oberhag A, Staubach P, Maurer M, Weller K. Comparison and interpretability of the available urticaria activity scores. Allergy 2018; 73:251-255. [PMID: 28815631 DOI: 10.1111/all.13271] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [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: 08/11/2017] [Indexed: 11/28/2022]
Abstract
The urticaria activity score (UAS) is the gold standard for assessing disease activity in patients with chronic spontaneous urticaria (CSU). Two different versions, the UAS7 and UAS7TD , are currently used in clinical trials and routine care. To compare both versions and to obtain data on their interpretability, 130 CSU patients applied both versions and globally rated their disease activity as none, mild, moderate, or severe. UAS7 and UAS7TD values correlated strongly (r = .90, P < .001). Interquartile ranges for UAS7 and UAS7TD values for mild, moderate, and severe CSU were 11-20 and 10-24, 16-30 and 16-32, and 27-37 and 28-40. UAS7 values were slightly, but significantly lower as compared to UAS7TD values (mean difference: 1.6 ± 4.6, P < .001). This difference was driven by lower wheal subscores (2.1 ± 3.5, P < .001) and was most pronounced in patients with severe CSU (2.5 ± 5.6, P < .01). The UAS7/UAS7TD ratio was 0.96 ± 0.21 and did not differ significantly between mild, moderate, and severe CSU. Since the results of both UAS versions are comparable, we recommend the use of the UAS7, which is less burdensome in administration and scoring.
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Affiliation(s)
- T. Hawro
- Department of Dermatology and Allergy Allergie‐Centrum‐Charité Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - T. Ohanyan
- Department of Dermatology and Allergy Allergie‐Centrum‐Charité Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - N. Schoepke
- Department of Dermatology and Allergy Allergie‐Centrum‐Charité Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - M. Metz
- Department of Dermatology and Allergy Allergie‐Centrum‐Charité Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | | | - P. Staubach
- Department of Dermatology University Medical Center Mainz Mainz Germany
| | - M. Maurer
- Department of Dermatology and Allergy Allergie‐Centrum‐Charité Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - K. Weller
- Department of Dermatology and Allergy Allergie‐Centrum‐Charité Charité ‐ Universitätsmedizin Berlin Berlin Germany
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Abstract
Chronic spontaneous urticaria (CSU) is a mast cell-driven disease that is defined as the recurrence of weals, angioedema or both for > 6 weeks due to known or unknown causes. As of yet, disease diagnosis is purely clinical. Objective tools are needed to monitor the activity of CSU and the efficacy of treatment. Recently, several reports have suggested that blood parameters may be considered as potential disease-related biomarkers. Here, we reviewed available literature on blood biomarkers for CSU diagnosis, activity monitoring, duration, patient subgroup allocation or response to treatment. We performed a PubMed, Google Scholar and Web of Science search and identified and analysed 151 reports published prior to January 2016. We found strong evidence for significant differences between patients with CSU and healthy controls in blood levels or values of D-dimer, C-reactive protein (CRP), matrix metalloproteinase-9 (MMP-9), mean platelet volume (MPV), factor VIIa, prothrombin fragment 1 + 2 (F1 + 2), tumour necrosis factor, dehydroepiandrosterone sulphate and vitamin D. Also, there is strong evidence for a significant association between CSU activity and blood levels or values of D-dimer, F1 + 2, CRP, IL-6 and MPV. Strong evidence for reduced basophil count and high levels of IgG anti-FcεRI in the subgroup of CSU patients with positive autologous serum skin test was shown. In contrast, the evidence for all reported blood biomarkers for differentiating CSU from other diseases, or a role in prognosis, is weak, inconsistent or non-existent. Taken together, we identified 10 biomarkers that are supported by strong evidence for distinguishing patients with CSU from healthy controls, or for measuring CSU activity. There is a need for further research to identify biomarkers that predict outcome or treatment response in CSU.
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Affiliation(s)
- P Kolkhir
- Department of Dermatology and Venereology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - F André
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M K Church
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Maurer
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Metz
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Terhorst D, Koti I, Krause K, Metz M, Maurer M. In chronic spontaneous urticaria, high numbers of dermal endothelial cells, but not mast cells, are linked to recurrent angio-oedema. Clin Exp Dermatol 2017; 43:131-136. [PMID: 29064119 DOI: 10.1111/ced.13254] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) is an inflammatory skin disorder characterized by recurrent weals, angio-oedema or both. Recent studies have shown that the number of endothelial cells is increased in the skin of patients with CSU, but the underlying mechanisms and clinical implications of this are unclear. AIM To evaluate whether mast cell (MC) or endothelial cell (EC) numbers correlate with CSU and whether they are relevant for disease duration, disease activity or the presence of clinical features. METHODS We determined the numbers of CD31+ ECs and MCs in nonlesional skin of 30 patients with CSU using quantitative histomorphometry, and assessed their correlation with each other and with clinical features such as disease duration, disease activity and occurrence of angio-oedema. RESULTS The numbers of MCs and ECs were high in the nonlesional skin of patients with CSU, but did not correlate with each other. Neither MC number nor EC number correlated with disease duration or disease activity. Interestingly, patients with high numbers of cutaneous CD31+ ECs had higher rates of recurrent angio-oedema and vice versa. CONCLUSIONS Based on these findings, we speculate that vascular remodelling and MC hyperplasia in patients with CSU occurs independently and via different mechanisms. Targeting of the mechanisms that drive neoangiogenesis in CSU may result in novel therapeutic strategies for the management of patients with angio-oedema.
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Affiliation(s)
- D Terhorst
- Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - I Koti
- Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - K Krause
- Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - M Metz
- Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - M Maurer
- Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Hawro T, Przybylowicz K, Ellrich A, Spindler M, Weller K, Altrichter S, Reidel U, Maurer M, Metz M. 041 Prevalence, characteristics and burden of pruritus in chronic dermatoses. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.07.137] [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: 11/24/2022]
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Kolkhir P, Metz M, Altrichter S, Maurer M. Comorbidity of chronic spontaneous urticaria and autoimmune thyroid diseases: A systematic review. Allergy 2017; 72:1440-1460. [PMID: 28407273 DOI: 10.1111/all.13182] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2017] [Indexed: 02/01/2023]
Abstract
Patients with chronic spontaneous urticaria (CSU) are widely held to often have other autoimmune disorders, including autoimmune thyroid disease. Here, we systematically evaluated the literature on the prevalence of thyroid autoimmunity in CSU and vice versa. There is a strong link between CSU and elevated levels of IgG antithyroid autoantibodies (AAbs), with most of a large number of studies reporting rates of ≥10%. Levels of IgG against thyroid peroxidase (TPO) are more often elevated in CSU than those of other IgG antithyroid AAbs (strong evidence). Levels of IgG antithyroid AAbs are more often elevated in adult patients with CSU than in children (strong evidence). Patients with CSU exhibit significantly higher levels of IgG antithyroid AAbs (strong evidence) and IgE-anti-TPO (weak evidence) than controls. Elevated IgG antithyroid AAbs in CSU are linked to the use of glucocorticoids (weak evidence) but not to disease duration or severity/activity, gender, age, or ASST response (inconsistent evidence). Thyroid dysfunction rates are increased in patients with CSU (strong evidence). Hypothyroidism and Hashimoto's thyroiditis are more common than hyperthyroidism and Graves' disease (strong evidence). Thyroid dysfunction is more common in adult patients with CSU than in children (strong evidence) and in female than in male patients with CSU (weak evidence). Urticaria including CSU is more prevalent in patients with thyroid autoimmunity than in controls (weak evidence). CSU can improve in response to treatment with levothyroxine or other thyroid drugs (strong evidence). Pathogenic mechanisms in CSU patients with thyroid autoimmunity may include IgE against autoantigens, immune complexes, and complement.
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Affiliation(s)
- P. Kolkhir
- Department of Dermatology and Venereology; I.M. Sechenov First Moscow State Medical University; Moscow Russia
| | - M. Metz
- Department of Dermatology and Allergy; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - S. Altrichter
- Department of Dermatology and Allergy; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - M. Maurer
- Department of Dermatology and Allergy; Charité - Universitätsmedizin Berlin; Berlin Germany
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Pereira M, Steinke S, Zeidler C, Forner C, Riepe C, Augustin M, Bobko S, Dalgard F, Elberling J, Garcovich S, Gieler U, Gonçalo M, Halvorsen JA, Leslie T, Metz M, Reich A, Şavk E, Schneider G, Serra-Baldrich E, Ständer H, Streit M, Wallengren J, Weller K, Wollenberg A, Bruland P, Soto-Rey I, Storck M, Dugas M, Weisshaar E, Szepietowski J, Legat F, Ständer S. European academy of dermatology and venereology European prurigo project: expert consensus on the definition, classification and terminology of chronic prurigo. J Eur Acad Dermatol Venereol 2017; 32:1059-1065. [DOI: 10.1111/jdv.14570] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 08/03/2017] [Indexed: 11/27/2022]
Affiliation(s)
- M.P. Pereira
- Department of Dermatology; Competence Center for Chronic Pruritus; University Hospital Münster; Münster Germany
| | - S. Steinke
- Department of Dermatology; Competence Center for Chronic Pruritus; University Hospital Münster; Münster Germany
| | - C. Zeidler
- Department of Dermatology; Competence Center for Chronic Pruritus; University Hospital Münster; Münster Germany
| | - C. Forner
- Department of Dermatology; Competence Center for Chronic Pruritus; University Hospital Münster; Münster Germany
| | - C. Riepe
- Department of Dermatology; Competence Center for Chronic Pruritus; University Hospital Münster; Münster Germany
| | - M. Augustin
- Competence Center for Healthcare Research in Dermatology (CVderm); Institute for Healthcare Research in Dermatology and Nursing (IVDP); University Hospital of Hamburg-Eppendorf; Hamburg Germany
| | - S. Bobko
- Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology; Moscow Russia
| | - F. Dalgard
- Department of Dermatology and Venereology; Skåne University Hospital; Lund University; Malmö Sweden
| | - J. Elberling
- Department of Dermatology; University Hospital Gentofte; Copenhagen Denmark
| | - S. Garcovich
- Institute of Dermatology; Catholic University of the Sacred Heart; Rome Italy
| | - U. Gieler
- Justus Liebig University; Giessen Germany
| | - M. Gonçalo
- Department of Dermatology; University Hospital and Faculty of Medicine; University of Coimbra; Coimbra Portugal
| | - J. A. Halvorsen
- Department of Dermatology; Oslo University Hospital; University of Oslo; Oslo Norway
| | - T.A. Leslie
- Department of Dermatology; Royal Free Hospital; London UK
| | - M. Metz
- Department of Dermatology and Allergy; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - A. Reich
- Department of Dermatology; University of Rzeszow; Rzeszow Poland
| | - E. Şavk
- Department of Dermatology; Adnan Menderes University; Aydın Turkey
| | - G. Schneider
- Department of Psychosomatics and Psychotherapy; Münster University Hospital; Münster Germany
| | - E. Serra-Baldrich
- Department of Dermatology; Cutaneous Allergy Unit; Hospital Sant Pau; Universitat Autònoma Barcelona; Barcelona Spain
| | - H.F. Ständer
- Dermatological Practice; Bad Bentheim and Department of Dermatology; Klinikum Dortmund GmbH; Dortmund Germany
| | - M. Streit
- Department of Dermatology; Kantonsspital Aarau; Aarau Switzerland
| | - J. Wallengren
- Department of Dermatology and Venereology; Skåne University Hospital SUS Lund; Lund University; Lund Sweden
| | - K. Weller
- Department of Dermatology and Allergy; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - A. Wollenberg
- Department of Dermatology and Allergology; Ludwig Maximilian University; Munich Germany
| | - P. Bruland
- Institute of Medical Informatics; University of Münster; Münster Germany
| | - I. Soto-Rey
- Institute of Medical Informatics; University of Münster; Münster Germany
| | - M. Storck
- Institute of Medical Informatics; University of Münster; Münster Germany
| | - M. Dugas
- Institute of Medical Informatics; University of Münster; Münster Germany
| | - E. Weisshaar
- Department of Social Medicine, Occupational and Environmental Dermatology; University of Heidelberg; Heidelberg Germany
| | - J.C. Szepietowski
- Department of Dermatology, Venereology and Allergology; Wroclaw Medical University; Wroclaw Poland
| | - F.J. Legat
- Department of Dermatology; Medical University of Graz; Graz Austria
| | - S. Ständer
- Department of Dermatology; Competence Center for Chronic Pruritus; University Hospital Münster; Münster Germany
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Forshaw D, Horwitz AM, Ellard K, Friend JA, Greed L, Metz M. Hyperoxaluria, hyperglycoluria and renal oxalosis in Gilbert's potoroos (Potorous gilbertii
). Aust Vet J 2017; 95:250-258. [DOI: 10.1111/avj.12596] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 03/21/2016] [Accepted: 05/23/2016] [Indexed: 11/29/2022]
Affiliation(s)
- D Forshaw
- Department of Agriculture and Food; 444 Albany Highway; Albany Western Australia 6330 Australia
| | - AM Horwitz
- Lockyer Avenue Veterinary Hospital; Albany WA Australia
| | - K Ellard
- Department of Agriculture and Food; 444 Albany Highway; Albany Western Australia 6330 Australia
| | - JA Friend
- Department of Parks and Wildlife; Albany WA Australia
| | - L Greed
- Department of Clinical Biochemistry; Princess Margaret Hospital; Subiaco WA Australia
| | - M Metz
- Women's and Children's Hospital; North Adelaide; South Australia Australia
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40
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Grey VL, Loh TP, Metz M, Lang T, Hersberger M. Paediatric Laboratory Medicine - Some reflections on the sub-specialty. Clin Biochem 2017; 50:648-650. [PMID: 28410851 DOI: 10.1016/j.clinbiochem.2017.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2017] [Indexed: 11/27/2022]
Affiliation(s)
- V L Grey
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.
| | - T P Loh
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - M Metz
- SAPath at The Women's & Children's Hospital, North Adelaide, SA, Australia
| | - T Lang
- Department of Clinical Biochemistry, University Hospital of North Durham, Durham DH1 5TW, UK
| | - M Hersberger
- Division of Clinical Chemistry and Biochemistry, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
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Hawro T, Lehmann S, Altrichter S, Fluhr JW, Zuberbier T, Church MK, Maurer M, Metz M. Skin provocation tests may help to diagnose atopic dermatitis. Allergy 2016; 71:1745-1752. [PMID: 27472813 DOI: 10.1111/all.12995] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 07/26/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is a common skin disorder. Its diagnosis relies on clinical judgment. Mild and untypical manifestations may cause diagnostic difficulties. Biomarkers for the differential diagnostic workup of AD are needed. OBJECTIVE To test whether the results of skin provocation with cowhage, an established model of histamine-independent pruritus, and histamine are different in AD patients and healthy subjects and whether these tests may be used as diagnostic markers of AD. METHODS Twenty-two AD patients and 18 healthy controls were subjected to topical cowhage provocation and skin prick testing with histamine and assessed for differences in the quality, intensity, and persistence of itch, for wheal diameter, volume, and flare size and intensity. RESULTS Patients with AD, compared with healthy controls, exhibited significantly smaller histamine-induced flares (P < 0.01) and markedly longer itch persistence after provocation with cowhage (P < 0.01). Both parameters showed good diagnostic properties for AD (area under the receiver operating characteristic (ROC) curve 0.78 and 0.80, respectively). The persistence of cowhage-induced itch for at least 30 min and a histamine-induced flare of less than 2 cm in diameter were reliable thresholds for the diagnosis of AD. If combinations of the results of both tests were used, their sensitivity and specificity of diagnosing AD were up to 91% and 94%, respectively. CONCLUSION The clinical benefit of cowhage and histamine skin provocation tests should be investigated in further studies. Long persistence of cowhage-induced itch and diminished histamine-induced flare in nonlesional skin may support diagnosis of AD.
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Affiliation(s)
- T. Hawro
- Department of Dermatology and Allergy; Allergie-Centrum Charité; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - S. Lehmann
- Department of Dermatology and Allergy; Allergie-Centrum Charité; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - S. Altrichter
- Department of Dermatology and Allergy; Allergie-Centrum Charité; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - J. W. Fluhr
- Department of Dermatology and Allergy; Allergie-Centrum Charité; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - T. Zuberbier
- Department of Dermatology and Allergy; Allergie-Centrum Charité; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - M. K. Church
- Department of Dermatology and Allergy; Allergie-Centrum Charité; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - M. Maurer
- Department of Dermatology and Allergy; Allergie-Centrum Charité; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - M. Metz
- Department of Dermatology and Allergy; Allergie-Centrum Charité; Charité-Universitätsmedizin Berlin; Berlin Germany
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Metz M, Durski M, Chou J, Crim G, Harris B, Lin WS. Microleakage of Lithium Disilicate Crown Margins Finished on Direct Restorative Materials. Oper Dent 2016; 41:552-562. [PMID: 27689837 DOI: 10.2341/15-225-l] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE For some esthetic clinical situations, it is necessary to finish crown margins on direct restorative materials to preserve tissue integrity, bonding integrity, and biological width. The purpose of this research was to investigate microleakage at the interface between bonded lithium disilicate crowns and various direct restorative materials in a class III and class V position. METHODS AND MATERIALS Class III or class V restorations were prepared on one side of extracted incisors with either Tetric EvoCeram, Tetric Evoceram Bulk, Fuji II LC, or Tetric Evoflow. The teeth were prepared for and received a lithium disilicate crown. After load fatiguing, the specimens were thermo-cycled with a fuchsin dye and sectioned. The depth and area of dye penetration were measured with a dimensional grid in micrometers using stereomicroscopy and reported as mean dye depth and area (μm) ± SD. The comparison of multiple categorical independent variables with ratio scale dependent variables was evaluated with an analysis of variance and Tukey's post hoc analysis. RESULTS A statistically significant higher dye penetration was noted for all treatment groups compared with the positive control (side opposite the restoration after sagittal sectioning was used as positive control) regardless of material or placement area (p<0.05). In comparing treatment groups, the Tetric EvoFlow experienced a statistically higher dye penetration than did the other treatment groups regardless of material or placement area (p<0.05). There was no statistically significant difference between the Tetric EvoCeram, Tetric Evoceram Bulk, and Fuji II LC materials regardless of placement area (p>0.05). CONCLUSIONS Within the limitations of this study, it can be concluded that flowable composite materials as finish lines that interact with resin cements could lead to exacerbated interfacial degradation. Finishing lithium disilicate all-ceramic crowns on flowable resin composite materials in the esthetic zone should be used with caution. If necessary, finishing lithium disilicate all-ceramic crowns on nanofilled resin composite or resin-modified glass ionomer materials seems to provide the least dye penetration depth and area.
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Staubach P, Metz M, Chapman-Rothe N, Sieder C, Bräutigam M, Canvin J, Maurer M. Effect of omalizumab on angioedema in H1 -antihistamine-resistant chronic spontaneous urticaria patients: results from X-ACT, a randomized controlled trial. Allergy 2016; 71:1135-44. [PMID: 27010957 DOI: 10.1111/all.12870] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [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: 02/26/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) severely impacts quality of life (QoL), especially in patients with wheals and angioedema. Omalizumab is approved as add-on therapy for CSU patients; however, its effect on patients who are double-positive for wheals and angioedema has not been systematically studied. OBJECTIVE The primary objective was to evaluate the efficacy of omalizumab vs placebo at week 28 using the Chronic Urticaria Quality of Life (CU-Q2oL) questionnaire. Number of angioedema-burdened days, time interval between successive angioedema episodes, disease activity, angioedema-specific and overall QoL impairment were secondary objectives. METHODS X-ACT was a phase III, randomized, double-blind study conducted in 24 centres (Germany), which selectively included CSU patients with angioedema and wheals. Patients were randomized (1 : 1) to omalizumab 300 mg or placebo (every 4 weeks up to week 24) (ClinicalTrials.gov number: NCT01723072). RESULTS Of the 91 patients randomized to omalizumab (n = 44) or placebo (n = 47) at baseline, 68 completed the 28-week treatment phase (omalizumab, 35; placebo, 33). Omalizumab was superior to placebo in improving CU-Q2oL scores at week 28 (P < 0.001). There was a threefold improvement in angioedema-burdened days/week with omalizumab (0.3) vs placebo (1.1). The median time to first recurrence of angioedema was 57-63 days with omalizumab and <5 days with placebo. Omalizumab significantly improved angioedema-specific QoL (P < 0.001). The adverse events reported are in line with the established safety profile of omalizumab. CONCLUSION Omalizumab was an effective treatment option for patients with moderate-to-severe CSU symptoms and angioedema unresponsive to high doses of antihistamine treatment.
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Affiliation(s)
- P. Staubach
- Hautklinik und Poliklinik; Universitätsmedizin der Johannes Gutenberg-Universität Mainz; Mainz Germany
| | - M. Metz
- Allergie-Centrum-Charité; Klinik für Dermatologie, Venerologie und Allergologie; Charité - Universitätsmedizin Berlin; Berlin Germany
| | | | - C. Sieder
- Novartis Pharma GmbH; Nürnberg Germany
| | | | - J. Canvin
- Novartis Pharma AG; Basel Switzerland
| | - M. Maurer
- Allergie-Centrum-Charité; Klinik für Dermatologie, Venerologie und Allergologie; Charité - Universitätsmedizin Berlin; Berlin Germany
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Maurer M, Metz M, Bindslev-Jensen C, Bousquet J, Canonica GW, Church MK, Godse KV, Grattan CE, Hide M, Kocatürk E, Magerl M, Makris M, Meshkova R, Saini SS, Sussman G, Toubi E, Zhao Z, Zuberbier T, Gimenez-Arnau A. Definition, aims, and implementation of GA(2) LEN Urticaria Centers of Reference and Excellence. Allergy 2016; 71:1210-8. [PMID: 27038243 DOI: 10.1111/all.12901] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [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: 03/26/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND GA²LEN, the Global Allergy and Asthma European Network, has recently launched a program for the development, interaction, and accreditation of centers of reference and excellence in special areas of allergy embedded in its overall quality management of allergy centers of excellence. The first area chosen is urticaria. Urticaria is a common and debilitating condition and can be a challenge for both patients and treating physicians, especially when chronic. Centers of reference and excellence in urticaria (UCAREs) can help to improve the management of hard-to-treat conditions such as urticaria. AIMS Here, we describe the aims, the requirements and deliverables, the application process, and the audit and accreditation protocol for GA²LEN UCAREs. RESULTS The main aims of GA²LEN UCAREs are to provide excellence in urticaria management, to increase the knowledge of urticaria by research and education, and to promote the awareness of urticaria by advocacy activities. To become a certified GA²LEN UCARE, urticaria centers have to apply and fulfill 32 requirements, defined by specific deliverables that are assessed during an audit visit. DISCUSSION AND CONCLUSION The GA²LEN UCARE program will result in a strong network of urticaria specialists, promote urticaria research, and harmonize and improve urticaria management globally.
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Affiliation(s)
- M. Maurer
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - M. Metz
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - C. Bindslev-Jensen
- Department of Dermatology and Allergy Center; Odense Research Center for Anaphylaxis; Odense University Hospital; Odense Denmark
| | - J. Bousquet
- University Hospital; Montpellier France
- VIMA: Ageing and Chronic Diseases, Epidemiological and Public Health Approaches; INSERM; Paris France
- UVSQ; UMR-S 1168; Université Versailles St-Quentin-en-Yvelines; St-Quentin-en-Yvelines France
| | - G. W. Canonica
- IRCCS AOU San Martino-IST; University of Genoa; Genoa Italy
| | - M. K. Church
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - K. V. Godse
- Department of Dermatology; D.Y. Patil School of Medicine; Nerul Navi Mumbai India
| | | | - M. Hide
- Department of Dermatology; Institute of Biomedical and Health Sciences; Hiroshima University; Hiroshima Japan
| | - E. Kocatürk
- Department of Dermatology; Okmeydani Training and Research Hospital; Istanbul Turkey
| | - M. Magerl
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - M. Makris
- 2nd Department of Dermatology and Venereology; Attikon University Hospital; Athens Greece
| | - R. Meshkova
- Department of Clinical Immunology and Allergy; Smolensk State Medical University; Smolensk Russia
| | - S. S. Saini
- Department of Medicine; Johns Hopkins University; Baltimore MD USA
| | - G. Sussman
- Division Allergy and Immunology; University of Toronto; Toronto ON Canada
| | - E. Toubi
- Allergy and Clinical Immunology; Bnai-Zion Medical Center; The Technion; Haifa Israel
| | - Z. Zhao
- Department of Dermatology and Venereology; Peking University, First Hospital; Beijing China
| | - T. Zuberbier
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - A. Gimenez-Arnau
- Department of Dermatology; Hospital del Mar, IMIM; Universitat Autònoma; Barcelona Spain
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Magerl M, Altrichter S, Borzova E, Giménez-Arnau A, Grattan CEH, Lawlor F, Mathelier-Fusade P, Meshkova RY, Zuberbier T, Metz M, Maurer M. The definition, diagnostic testing, and management of chronic inducible urticarias - The EAACI/GA(2) LEN/EDF/UNEV consensus recommendations 2016 update and revision. Allergy 2016; 71:780-802. [PMID: 26991006 DOI: 10.1111/all.12884] [Citation(s) in RCA: 200] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2016] [Indexed: 01/13/2023]
Abstract
These recommendations for the definition, diagnosis and management of chronic inducible urticaria (CIndU) extend, revise and update our previous consensus report on physical urticarias and cholinergic urticaria (Allergy, 2009). The aim of these recommendations is to improve the diagnosis and management of patients with CIndU. Our recommendations acknowledge the latest changes in our understanding of CIndU, and the available therapeutic options, as well as the development of novel diagnostic tools.
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Affiliation(s)
- M. Magerl
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - S. Altrichter
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - E. Borzova
- Department of Clinical Allergology; Russian Medical Academy of Postgraduate Education; Moscow Russia
| | - A. Giménez-Arnau
- Department of Dermatology; Hospital del Mar; Institut Mar d′Investigacions Mèdiques IMIM; Universitat Autònoma Barcelona; Barcelona Spain
| | - C. E. H. Grattan
- Cutaneous Allergy; St John's Institute of Dermatology; St Thomas' Hospital; London UK
| | - F. Lawlor
- Cutaneous Allergy; St John's Institute of Dermatology; St Thomas' Hospital; London UK
| | | | - R. Y. Meshkova
- Klinika Medicinskoy Immunologii I Allergologii; Smolensk Russia
| | - T. Zuberbier
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - M. Metz
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - M. Maurer
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
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Krull C, Schoepke N, Ohanyan T, Brachaczek M, Maurer M, Lange-Asschenfeldt B, Metz M. Increased angiogenesis and VEGF expression correlates with disease severity in prurigo patients. J Eur Acad Dermatol Venereol 2015; 30:1357-61. [DOI: 10.1111/jdv.13406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 07/13/2015] [Indexed: 11/29/2022]
Affiliation(s)
- C. Krull
- Department of Dermatology and Allergy; Charité -Universitätsmedizin Berlin; Berlin Germany
| | - N. Schoepke
- Department of Dermatology and Allergy; Charité -Universitätsmedizin Berlin; Berlin Germany
| | - T. Ohanyan
- Department of Dermatology and Allergy; Charité -Universitätsmedizin Berlin; Berlin Germany
| | - M. Brachaczek
- Department of Dermatology and Allergy; Charité -Universitätsmedizin Berlin; Berlin Germany
| | - M. Maurer
- Department of Dermatology and Allergy; Charité -Universitätsmedizin Berlin; Berlin Germany
| | - B. Lange-Asschenfeldt
- Department of Dermatology and Allergy; Charité -Universitätsmedizin Berlin; Berlin Germany
- Department of Dermatology and Allergy; Klinikum Klagenfurt am Wörthersee; Klagenfurt am Wörthersee Austria
| | - M. Metz
- Department of Dermatology and Allergy; Charité -Universitätsmedizin Berlin; Berlin Germany
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Kirian RA, Awel S, Eckerskorn N, Fleckenstein H, Wiedorn M, Adriano L, Bajt S, Barthelmess M, Bean R, Beyerlein KR, Chavas LMG, Domaracky M, Heymann M, Horke DA, Knoska J, Metz M, Morgan A, Oberthuer D, Roth N, Sato T, Xavier PL, Yefanov O, Rode AV, Küpper J, Chapman HN. Simple convergent-nozzle aerosol injector for single-particle diffractive imaging with X-ray free-electron lasers. Struct Dyn 2015; 2:041717. [PMID: 26798816 PMCID: PMC4711644 DOI: 10.1063/1.4922648] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 05/18/2015] [Indexed: 05/06/2023]
Abstract
A major challenge in high-resolution x-ray free-electron laser-based coherent diffractive imaging is the development of aerosol injectors that can efficiently deliver particles to the peak intensity of the focused X-ray beam. Here, we consider the use of a simple convergent-orifice nozzle for producing tightly focused beams of particles. Through optical imaging we show that 0.5 μm particles can be focused to a full-width at half maximum diameter of 4.2 μm, and we demonstrate the use of such a nozzle for injecting viruses into a micro-focused soft-X-ray FEL beam.
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Affiliation(s)
| | | | - N Eckerskorn
- Laser Physics Centre, Research School of Physics and Engineering, Australian National University , Canberra, Australia
| | - H Fleckenstein
- Center for Free-Electron Laser Science , DESY, 22607 Hamburg, Germany
| | | | - L Adriano
- Deutsches Elektronen-Synchrotron DESY , 22607 Hamburg, Germany
| | - S Bajt
- Deutsches Elektronen-Synchrotron DESY , 22607 Hamburg, Germany
| | - M Barthelmess
- Center for Free-Electron Laser Science , DESY, 22607 Hamburg, Germany
| | - R Bean
- European XFEL GmbH , 22761 Hamburg, Germany
| | - K R Beyerlein
- Center for Free-Electron Laser Science , DESY, 22607 Hamburg, Germany
| | - L M G Chavas
- Center for Free-Electron Laser Science , DESY, 22607 Hamburg, Germany
| | | | - M Heymann
- Center for Free-Electron Laser Science , DESY, 22607 Hamburg, Germany
| | - D A Horke
- Center for Free-Electron Laser Science , DESY, 22607 Hamburg, Germany
| | | | | | - A Morgan
- Center for Free-Electron Laser Science , DESY, 22607 Hamburg, Germany
| | - D Oberthuer
- Center for Free-Electron Laser Science , DESY, 22607 Hamburg, Germany
| | - N Roth
- Center for Free-Electron Laser Science , DESY, 22607 Hamburg, Germany
| | - T Sato
- Center for Free-Electron Laser Science , DESY, 22607 Hamburg, Germany
| | | | - O Yefanov
- Center for Free-Electron Laser Science , DESY, 22607 Hamburg, Germany
| | - A V Rode
- Laser Physics Centre, Research School of Physics and Engineering, Australian National University , Canberra, Australia
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Abdel-Azim T, Zandinejad A, Metz M, Morton D. Maxillary and Mandibular Rehabilitation in the Esthetic Zone Using a Digital Impression Technique and CAD/CAM-fabricated Prostheses: A Multidisciplinary Clinical Report. Oper Dent 2015; 40:350-6. [DOI: 10.2341/13-286-t] [Citation(s) in RCA: 3] [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: 11/23/2022]
Abstract
SUMMARY
Interdisciplinary treatment planning is necessary in certain clinical situations to optimize esthetic treatment outcomes. Patients presenting with severe wear of their anterior teeth from iatrogenic influences pose a particularly difficult problem in terms of esthetic treatment planning. Collaboration of practitioners from the disciplines of orthodontics, periodontics, and restorative dentistry is essential for the treatment of patients with complex esthetic dental needs. Careful assessment of clinical situations and corresponding specialty consultations are of utmost importance to achieve more predictable and esthetic treatment outcomes. The purpose of this clinical case is to report to the readership a novel digital fabrication of computer-aided design/computer-aided manufacturing milled acrylic provisional restorations and final lithium disilicate definitive restorations after orthodontic and periodontal therapy with virtual master impressions, casts, and articulation.
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Affiliation(s)
- T Abdel-Azim
- Tamer Abdel-Azim, DDS, University of Louisville School of Dentistry, Oral Health & Rehabilitation, Louisville, KY, USA
| | - A Zandinejad
- Amirali Zandinejad, DDS, MSc, University of Louisville School of Dentistry, Oral Health & Rehabilitation, Louisville, KY, USA
| | - M Metz
- Michael Metz, DMD, MSD, MS, MBA, University of Louisville School of Dentistry, General Dentistry & Oral Medicine, Louisville, KY USA
| | - D Morton
- Dean Morton, BDS, MS, University of Louisville School of Dentistry, Oral Health & Rehabilitation, Louisville, KY, USA
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Gericke J, Ohanyan T, Church M, Maurer M, Metz M. Omalizumab may not inhibit mast cell and basophil activation in vitro. J Eur Acad Dermatol Venereol 2014; 29:1832-6. [DOI: 10.1111/jdv.12693] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 07/16/2014] [Indexed: 02/02/2023]
Affiliation(s)
- J. Gericke
- Department of Dermatology, Venerology and Allergology; Allergie-Centrum-Charité; Charité-Universitätsmedizin; Berlin Germany
| | - T. Ohanyan
- Department of Dermatology, Venerology and Allergology; Allergie-Centrum-Charité; Charité-Universitätsmedizin; Berlin Germany
| | - M.K. Church
- Department of Dermatology, Venerology and Allergology; Allergie-Centrum-Charité; Charité-Universitätsmedizin; Berlin Germany
| | - M. Maurer
- Department of Dermatology, Venerology and Allergology; Allergie-Centrum-Charité; Charité-Universitätsmedizin; Berlin Germany
| | - M. Metz
- Department of Dermatology, Venerology and Allergology; Allergie-Centrum-Charité; Charité-Universitätsmedizin; Berlin Germany
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