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Albert E, Walsemann T, Behrends J, Jappe U. Lipid transfer protein syndrome in a Northern European patient: An unusual case report. Front Med (Lausanne) 2023; 10:1049477. [PMID: 36824608 PMCID: PMC9941155 DOI: 10.3389/fmed.2023.1049477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/03/2023] [Indexed: 02/09/2023] Open
Abstract
Non-specific lipid transfer proteins (nsLTPs) as the primary sensitizer in plant-food allergic patients used to be seen primarily in the Mediterranean area. However, more recently, increasing numbers of clinically relevant sensitizations are being observed in Northern Europe. We herein report an unusual case of a woman who developed an anaphylactic reaction during a meal including a variety of different foods ranging from fruits and nuts to oats, wheat, and salmon. Allergy diagnostics showed no Bet v 1 sensitization but an nsLTP-mediated food allergy. Despite the much more prominent birch food syndrome in Central and Northern Europe, LTPs should be considered disease-causing agents, especially for patients developing severe reactions after consuming LTP-containing foods.
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Affiliation(s)
- E. Albert
- Division of Clinical and Molecular Allergology, Research Center Borstel, Leibniz Lung Center, Airway Research Center North (ARCN), Member of the German Center for Lung Research, Borstel, Germany
| | - T. Walsemann
- Division of Clinical and Molecular Allergology, Research Center Borstel, Leibniz Lung Center, Airway Research Center North (ARCN), Member of the German Center for Lung Research, Borstel, Germany
| | - J. Behrends
- Core Facility Fluorescence Cytometry, Research Center Borstel, Leibniz Lung Center, Borstel, Germany
| | - U. Jappe
- Division of Clinical and Molecular Allergology, Research Center Borstel, Leibniz Lung Center, Airway Research Center North (ARCN), Member of the German Center for Lung Research, Borstel, Germany,Interdisciplinary Allergy Outpatient Clinic, Medical Clinic III - Pneumology, University of Lübeck, Lübeck, Germany,*Correspondence: U. Jappe,
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Maris I, Dölle‐Bierke S, Renaudin J, Lange L, Koehli A, Spindler T, Hourihane J, Scherer K, Nemat K, Kemen C, Neustädter I, Vogelberg C, Reese T, Yildiz I, Szepfalusi Z, Ott H, Straube H, Papadopoulos NG, Hämmerling S, Staden U, Polz M, Mustakov T, Cichocka‐Jarosz E, Cocco R, Fiocchi AG, Fernandez‐Rivas M, Worm M, Grünhagen J, Wittenberg M, Beyer K, Henschel A, Küper S, Möser A, Fuchs T, Ruëff F, Wedi B, Hansen G, Buck T, Büsselberg J, Drägerdt R, Pfeffer L, Dickel H, Körner‐Rettberg C, Merk H, Lehmann S, Bauer A, Nordwig A, Zeil S, Hannapp C, Wagner N, Rietschel E, Hunzelmann N, Huseynow I, Treudler R, Aurich S, Prenzel F, Klimek L, Pfaar O, Reider N, Aberer W, Varga E, Bogatu B, Schmid‐Grendelmeier P, Guggenheim R, Riffelmann F, Kreft B, Kinaciyan K, Hartl L, Ebner C, Horak F, Brehler R, Witte J, Buss M, Hompes S, Bieber T, Gernert S, Bücheler M, Rabe U, Brosi W, Nestoris S, Hawranek T, Lang R, Bruns R, Pföhler C, Eng P, Schweitzer‐Krantz S, Meller S, Rebmann H, Fischer J, Stichtenoth G, Thies S, Gerstlauer M, Utz P, Neustädter I, Klinge J, Volkmuth S, Plank‐Habibi S, Schilling B, Kleinheinz A, Brückner A, Schäkel K, Manolaraki I, Kowalski M, Solarewicz‐Madajek K, Tscheiller S, Seidenberg J, Cardona V, Garcia B, Bilo M, Cabañes Higuero N, Vega Castro A, Poziomkowska‐Gęsicka I, Büsing S, Virchow C, Christoff G, Jappe U, Müller S, Knöpfel F, Correard A, Rogala B, Montoro A, Brandes A, Muraro A, Zimmermann N, Hernandez D, Minale P, Niederwimmer J, Zahel B, Dahdah L, Arasi S, Reissig A, Eitelberger F, Asero R, Hermann F, Zeidler S, Pistauer S, Geißler M, Ensina L, Plaza Martin A, Meister J, Stieglitz S, Hamelmann E. Peanut-induced anaphylaxis in children and adolescents: Data from the European Anaphylaxis Registry. Allergy 2021; 76:1517-1527. [PMID: 33274436 DOI: 10.1111/all.14683] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/26/2020] [Accepted: 11/10/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Peanut allergy has a rising prevalence in high-income countries, affecting 0.5%-1.4% of children. This study aimed to better understand peanut anaphylaxis in comparison to anaphylaxis to other food triggers in European children and adolescents. METHODS Data was sourced from the European Anaphylaxis Registry via an online questionnaire, after in-depth review of food-induced anaphylaxis cases in a tertiary paediatric allergy centre. RESULTS 3514 cases of food anaphylaxis were reported between July 2007 - March 2018, 56% in patients younger than 18 years. Peanut anaphylaxis was recorded in 459 children and adolescents (85% of all peanut anaphylaxis cases). Previous reactions (42% vs. 38%; p = .001), asthma comorbidity (47% vs. 35%; p < .001), relevant cofactors (29% vs. 22%; p = .004) and biphasic reactions (10% vs. 4%; p = .001) were more commonly reported in peanut anaphylaxis. Most cases were labelled as severe anaphylaxis (Ring&Messmer grade III 65% vs. 56% and grade IV 1.1% vs. 0.9%; p = .001). Self-administration of intramuscular adrenaline was low (17% vs. 15%), professional adrenaline administration was higher in non-peanut food anaphylaxis (34% vs. 26%; p = .003). Hospitalization was higher for peanut anaphylaxis (67% vs. 54%; p = .004). CONCLUSIONS The European Anaphylaxis Registry data confirmed peanut as one of the major causes of severe, potentially life-threatening allergic reactions in European children, with some characteristic features e.g., presence of asthma comorbidity and increased rate of biphasic reactions. Usage of intramuscular adrenaline as first-line treatment is low and needs to be improved. The Registry, designed as the largest database on anaphylaxis, allows continuous assessment of this condition.
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Affiliation(s)
- Ioana Maris
- Bon Secours Hospital Cork/Paediatrics and Child HealthUniversity College Cork Cork Ireland
| | - Sabine Dölle‐Bierke
- Division of Allergy and Immunology Department of Dermatology, Venereology and Allergology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | | | - Lars Lange
- Department of Paediatrics St. Marien‐Hospital Bonn Germany
| | - Alice Koehli
- Division of Allergology University Children’s Hospital Zurich Zürich Switzerland
| | - Thomas Spindler
- Department of Paediatrics Medical Campus Hochgebirgsklinik Davos Davos Switzerland
| | - Jonathan Hourihane
- Paediatrics and Child Health Royal College of Surgeons in Ireland Dublin Ireland
- Children’s Health Ireland Dublin Ireland
| | | | - Katja Nemat
- Practice for paediatric pneumology and allergology Kinderzentrum Dresden‐Friedrichstadt Dresden Germany
| | - C. Kemen
- Department of Paediatrics Children’s Hospital WILHELMSTIFT Hamburg Germany
| | - Irena Neustädter
- Department of Paediatrics Hallerwiese Cnopfsche Kinderklinik Nuremberg Germany
| | - Christian Vogelberg
- Department of Paediatrics Universitätsklinikum Carl Gustav CarusTechnical University Dresden Germany
| | - Thomas Reese
- Department of Paediatrics Mathias‐Spital Rheine Rheine Germany
| | - Ismail Yildiz
- Department of Paediatrics Friedrich‐Ebert‐Krankenhaus Neumuenster Germany
| | - Zsolt Szepfalusi
- Division of Paediatric Pulmonology, Allergology and Endocrinology Department of Paediatrics and Adolescent Medicine Competence Center Paediatrics Medical University of Vienna Vienna Austria
| | - Hagen Ott
- Division of Paediatric Dermatology and Allergology Epidermolysis bullosa‐Centre HannoverChildren’s Hospital AUF DER BULT Hanover Germany
| | - Helen Straube
- Division of Allergology Darmstädter Kinderkliniken Prinzessin Margaret Darmstadt Germany
| | - Nikolaos G. Papadopoulos
- Allergy Department 2nd Paediatric Clinic National and Kapodistrian University of Athens Athens Greece
- Division of Infection Immunity& Respiratory Medicine University of Manchester Manchester UK
| | - Susanne Hämmerling
- Division of Paediatric Pulmonology and Allergology University Children`s Hospital Heidelberg Heidelberg Germany
| | - Ute Staden
- Paediatric Pneumology & Allergology Medical practice Klettke/Staden Berlin Germany
| | - Michael Polz
- Department of Paediatrics GPR Klinikum Rüsselsheim Germany
| | - Tihomir Mustakov
- Chair of Allergy University Hospital Alexandrovska Sofia Bulgaria
| | - Ewa Cichocka‐Jarosz
- Department of Paediatrics Jagiellonian University Medical College Krakow Poland
| | - Renata Cocco
- Division of Allergy Clinical Immunology and Rheumatology Department of Paediatrics Federal University of São Paulo São Paulo Brazil
| | | | | | - Margitta Worm
- Division of Allergy and Immunology Department of Dermatology, Venereology and Allergology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
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Ferastraoaru D, Bax HJ, Bergmann C, Capron M, Castells M, Dombrowicz D, Fiebiger E, Gould HJ, Hartmann K, Jappe U, Jordakieva G, Josephs DH, Levi-Schaffer F, Mahler V, Poli A, Rosenstreich D, Roth-Walter F, Shamji M, Steveling-Klein EH, Turner MC, Untersmayr E, Karagiannis SN, Jensen-Jarolim E. AllergoOncology: ultra-low IgE, a potential novel biomarker in cancer-a Position Paper of the European Academy of Allergy and Clinical Immunology (EAACI). Clin Transl Allergy 2020; 10:32. [PMID: 32695309 PMCID: PMC7366896 DOI: 10.1186/s13601-020-00335-w] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/11/2020] [Indexed: 12/13/2022] Open
Abstract
Elevated serum IgE levels are associated with allergic disorders, parasitosis and specific immunologic abnormalities. In addition, epidemiological and mechanistic evidence indicates an association between IgE-mediated immune surveillance and protection from tumour growth. Intriguingly, recent studies reveal a correlation between IgE deficiency and increased malignancy risk. This is the first review discussing IgE levels and links to pathological conditions, with special focus on the potential clinical significance of ultra-low serum IgE levels and risk of malignancy. In this Position Paper we discuss: (a) the utility of measuring total IgE levels in the management of allergies, parasitosis, and immunodeficiencies, (b) factors that may influence serum IgE levels, (c) IgE as a marker of different disorders, and d) the relationship between ultra-low IgE levels and malignancy susceptibility. While elevated serum IgE is generally associated with allergic/atopic conditions, very low or absent IgE may hamper anti-tumour surveillance, indicating the importance of a balanced IgE-mediated immune function. Ultra-low IgE may prove to be an unexpected biomarker for cancer risk. Nevertheless, given the early stage of investigations conducted mostly in patients with diseases that influence IgE levels, in-depth mechanistic studies and stratification of malignancy risk based on associated demographic, immunological and clinical co-factors are warranted.
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Affiliation(s)
- D Ferastraoaru
- Department of Internal Medicine/Allergy and Immunology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY USA
| | - H J Bax
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, 9th Floor, Guy's Tower, London, SE1 9RT UK.,School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Hospital, London, UK
| | - C Bergmann
- ENT Research Institute for Clinical Studies, Essen, Germany
| | - M Capron
- LIRIC-Unite Mixte de Recherche 995 INSERM, Universite de Lille 2, CHRU de Lille, Lille, France
| | - M Castells
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA
| | - D Dombrowicz
- Recepteurs Nucleaires, Maladies Cardiovasculaires et Diabete, Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, 59000 Lille, France
| | - E Fiebiger
- Division of Gastroenterology, Hepatology and Nutrition Research, Department of Medicine Research, Children's University Hospital Boston, Boston, MA USA
| | - H J Gould
- Randall Centre for Cell and Molecular Biophysics, School of Basic & Medical Biosciences, King's College London, New Hunt's House, London, SE1 1UL UK.,Medical Research Council & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - K Hartmann
- Department of Dermatology, University of Luebeck, Luebeck, Germany
| | - U Jappe
- Interdisciplinary Allergy Outpatient Clinic, Department of Pneumology, University of Luebeck, Luebeck, Germany.,Division of Clinical and Molecular Allergology, Research Center Borstel, Leibniz Lung Center, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Borstel, Germany
| | - G Jordakieva
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - D H Josephs
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, 9th Floor, Guy's Tower, London, SE1 9RT UK.,School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Hospital, London, UK
| | - F Levi-Schaffer
- Pharmacology and Experimental Therapeutics Unit, The Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - V Mahler
- Division of Allergology, Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines, Langen, Germany
| | - A Poli
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-Sur-Alzette, Luxembourg
| | - D Rosenstreich
- Department of Internal Medicine/Allergy and Immunology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY USA
| | - F Roth-Walter
- The Interuniversity Messerli Research Inst, Univ. of Vet. Medicine Vienna, Med. Univ. Vienna, Univ. Vienna, Vienna, Austria
| | - M Shamji
- Immunomodulation and Tolerance Group, Imperial College London, and Allergy and Clinical Immunology, Imperial College London, London, UK
| | - E H Steveling-Klein
- Department of Dermatology, Allergy Division, University Hospital Basel, Basel, Switzerland
| | - M C Turner
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Canada
| | - E Untersmayr
- Institute of Pathophysiology and Allergy Research, Medical University Vienna, Vienna, Austria
| | - S N Karagiannis
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, 9th Floor, Guy's Tower, London, SE1 9RT UK.,NIHR Biomedical Research Centre at Guy's and St. Thomas' Hospitals and King's College London, Guy's Hospital, King's College London, London, UK
| | - E Jensen-Jarolim
- The Interuniversity Messerli Research Inst, Univ. of Vet. Medicine Vienna, Med. Univ. Vienna, Univ. Vienna, Vienna, Austria.,Institute of Pathophysiology and Allergy Research, Medical University Vienna, Vienna, Austria
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Abstract
In a 30-year-old chef with recurrent delayed angioedema history as well as the experimental detection of IgE antibodies against galactose-alpha-(1,3)-galactose (alpha-Gal) pointed to alpha-Gal as the causative agent. The diagnosis, therefore, was delayed anaphylaxis due to alpha-Gal. Because of the potential relationship to his profession, we submitted a dermatologist's report BK 5101 to the liability and insurance association, whereupon his contract of employment was terminated without notice. As a consequence, we reported an occupational disease. This case demonstrates an underdiagnosed, potentially life-threatening allergy to the disaccharide alpha-Gal in red meat as an occupational disease.
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Affiliation(s)
- W Anemüller
- Klinik für Dermatologie, Allergologie und Venerologie, Universität zu Lübeck, Lübeck, Deutschland
| | - M Mohr
- Klinik für Dermatologie, Allergologie und Venerologie, Universität zu Lübeck, Lübeck, Deutschland
| | - R Brans
- Institut für Gesundheitsforschung und Bildung (IGB), Abteilung Dermatologie, Umweltmedizin und Gesundheitstheorie, Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm), Universität Osnabrück, Osnabrück, Deutschland
| | - A Homann
- Forschungsgruppe Klinische und Molekulare Allergologie des Forschungszentrums Borstel, Airway Research Center North (ARCN), Mitglied des Deutschen Zentrums für Lungenforschung (DZL), Parkallee 35, 23845, Borstel, Deutschland
| | - U Jappe
- Forschungsgruppe Klinische und Molekulare Allergologie des Forschungszentrums Borstel, Airway Research Center North (ARCN), Mitglied des Deutschen Zentrums für Lungenforschung (DZL), Parkallee 35, 23845, Borstel, Deutschland.
- Interdisziplinäre Allergie-Ambulanz, Medizinische Klinik III, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland.
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Affiliation(s)
- F Schocker
- Division of Clinical and Molecular Allergology, Priority Research Area Asthma and Allergy, Research Center Borstel, Airway Research Center North (ARCN), Member of the German Center for Lung Research, Borstel, Germany
| | - A Recke
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - S Kull
- Division of Clinical and Molecular Allergology, Priority Research Area Asthma and Allergy, Research Center Borstel, Airway Research Center North (ARCN), Member of the German Center for Lung Research, Borstel, Germany
| | - M Worm
- Department of Dermatology and Allergology, Allergy-Center- Charité, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - J Behrends
- Core Facility Fluorescence Cytometry at the Research Center Borstel, Borstel, Germany
| | - U Jappe
- Division of Clinical and Molecular Allergology, Priority Research Area Asthma and Allergy, Research Center Borstel, Airway Research Center North (ARCN), Member of the German Center for Lung Research, Borstel, Germany.,Interdisciplinary Allergy Outpatient Clinic, Department of Pneumology, University of Lübeck, Lübeck, Germany
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Abstract
Summary We describe a case of a woman who developed three separate episodes of urticaria and ana-phylaxis during exercise after consuming an apple, with immunological evidence that nonspecific lipid transfer proteins (LTP) may have been responsible for these reactions. LTP sensitivity can cause life-threatening allergies and anaphylaxis. Although LTP sensitization is common in Mediterranean countries, the frequency of knowledge and diagnoses is increasing in Europe. Despite the geographic differences, LTP allergy should be kept on sight when facing severe anaphylaxis after consuming LTP-included food.
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Affiliation(s)
- A Gülsen
- Division of clinical and molecular allergology, Research Center Borstel, Airway Research Center North (ARCN), member of the German Center for lung research, Borstel, Germany.,Interdisciplinary Allergy Outpatient Clinic, department of Pneumology, University of Luebeck, Germany
| | - U Jappe
- Division of clinical and molecular allergology, Research Center Borstel, Airway Research Center North (ARCN), member of the German Center for lung research, Borstel, Germany.,Interdisciplinary Allergy Outpatient Clinic, department of Pneumology, University of Luebeck, Germany
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Schocker F, Recke A, Kull S, Worm M, Jappe U. Persistent cow's milk anaphylaxis from early childhood monitored by IgE and BAT to cow's and human milk under therapy. Pediatr Allergy Immunol 2018; 29:210-214. [PMID: 29197130 DOI: 10.1111/pai.12843] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- F Schocker
- Division of Clinical and Molecular Allergology, Priority Research Area Asthma and Allergy, Research Center Borstel, Airway Research Center North (ARCN), Member of the German Center for Lung Research, Germany
| | - A Recke
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - S Kull
- Division of Clinical and Molecular Allergology, Priority Research Area Asthma and Allergy, Research Center Borstel, Airway Research Center North (ARCN), Member of the German Center for Lung Research, Germany
| | - M Worm
- Department of Dermatology and Allergology, Allergy-Center-Charité, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - U Jappe
- Division of Clinical and Molecular Allergology, Priority Research Area Asthma and Allergy, Research Center Borstel, Airway Research Center North (ARCN), Member of the German Center for Lung Research, Germany.,Interdisciplinary Allergy Outpatient Clinic, Department of Pneumology, University of Lübeck, Lübeck, Germany
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Jappe U, Minge S, Kreft B, Ludwig A, Przybilla B, Walker A, Varga R, Seidel P, Biedermann T, Anemüller W, Kromminga A, Ruëff F, Merk H, Wagner N, Treudler R, Worm M, Waldmann I, Saloga J, Becker WM, Goldmann T, Platts‐Mills TA, Homann A. Meat allergy associated with galactosyl-α-(1,3)-galactose (α-Gal)-Closing diagnostic gaps by anti-α-Gal IgE immune profiling. Allergy 2018; 73:93-105. [PMID: 28670695 DOI: 10.1111/all.13238] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Glycoproteins and glycolipids of some mammalian species contain the disaccharide galactosyl-α-(1,3)-galactose (α-Gal). It is known that α-Gal is immunogenic in humans and causes glycan-specific IgG and also IgE responses with clinical relevance. α-Gal is part of the IgE-reactive monoclonal therapeutic antibody cetuximab (CTX) and is associated with delayed anaphylaxis to red meat. In this study, different α-Gal-containing analytes are examined in singleplex and multiplex assays to resolve individual sensitization patterns with IgE against α-Gal. METHODS Three serum groups, α-Gal-associated meat allergy (MA) patients, idiopathic anaphylaxis (IA) patients with suspected MA, and non-meat-allergic healthy control individuals (HC), were analyzed via singleplex allergy diagnostics and a newly established immunoblot diagnostic system. The new dot blot detection system resolved individual IgE sensitization profiles for α-Gal-containing analytes CTX, bovine thyroglobulin (Bos d TG), and human serum albumin (HSA)-conjugated α-Gal. RESULTS Singleplex allergy diagnostics using the α-Gal analytes CTX and Bos d TG confirms the history of MA patients in 91% and 88% of the cases, respectively. A novel dot blot-based assay system for the detection of IgE against α-Gal reveals individual IgE sensitization profiles for α-Gal-containing analytes. An α-Gal-associated IgE cross-reactivity profile (IgE against CTX, Bos d TG, and HSA-α-Gal) was identified, which is associated with MA. CONCLUSIONS Detection of individual sensitization patterns with different α-Gal-containing analytes provides the basis for an individual allergy diagnosis for α-Gal-sensitized patients. Higher amounts of α-Gal in pork and beef innards compared to muscle meat as indicated by a higher staining intensity are a plausible explanation for the difference in allergic symptom severity.
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Affiliation(s)
- U. Jappe
- Division of Clinical and Molecular Allergology Priority Research Area Asthma & Allergy Research Center Borstel Airway Research Center North (ARCN) Member of the German Center for Lung Research (DZL) Borstel Germany
- Interdisciplinary Allergy Division Department of Internal Medicine University of Lübeck Lübeck Germany
| | - S. Minge
- Division of Clinical and Molecular Allergology Priority Research Area Asthma & Allergy Research Center Borstel Airway Research Center North (ARCN) Member of the German Center for Lung Research (DZL) Borstel Germany
| | - B. Kreft
- Department of Dermatology and Venereology Martin‐Luther‐University Halle‐Wittenberg Halle (Saale) Germany
| | - A. Ludwig
- Department of Dermatology and Allergology Klinikum Augsburg Augsburg Germany
| | - B. Przybilla
- Department of Dermatology Ludwig‐Maximilians University Munich Germany
| | - A. Walker
- Department of Dermatology Ludwig‐Maximilians University Munich Germany
| | - R. Varga
- Department of Dermatology Ludwig‐Maximilians University Munich Germany
| | - P. Seidel
- Department of Dermatology University of Tübingen Tübingen Germany
| | - T. Biedermann
- Department of Dermatology University of Tübingen Tübingen Germany
- Department of Dermatology and Allergology Technical University of Munich Munich Germany
| | - W. Anemüller
- Department of Dermatology University of Lübeck Lübeck Germany
| | | | - F. Ruëff
- Department of Dermatology Ludwig‐Maximilians University Munich Germany
| | - H. Merk
- Department of Dermatology RWTH Aachen University Aachen Germany
| | - N. Wagner
- Department of Dermatology Klinikum Darmstadt Germany
| | - R. Treudler
- Department of Dermatology, Venereology and Allergology University of Leipzig Leipzig Germany
| | - M. Worm
- Department of Dermatology and Allergy Allergy Center Charité Berlin Germany
| | - I. Waldmann
- Dermatology & Allergology St. Bernward Klinik Hildesheim Germany
| | - J. Saloga
- Department of Dermatology University of Mainz Mainz Germany
| | - W. M. Becker
- Division of Clinical and Molecular Allergology Priority Research Area Asthma & Allergy Research Center Borstel Airway Research Center North (ARCN) Member of the German Center for Lung Research (DZL) Borstel Germany
| | - T. Goldmann
- Pathology of the University Medical Center Schleswig‐Holstein (UKSH) Campus Lübeck and Research Center Borstel Airway Research Center North (ARCN) Member of the German Center for Lung Research (DZL) Borstel Germany
| | - T. A. Platts‐Mills
- University of Virginia Asthma and Allergic Diseases Center Charlottesville USA
| | - A. Homann
- Division of Clinical and Molecular Allergology Priority Research Area Asthma & Allergy Research Center Borstel Airway Research Center North (ARCN) Member of the German Center for Lung Research (DZL) Borstel Germany
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9
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Affiliation(s)
- U Jappe
- Forschungsgruppe Klinische und Molekulare Allergologie, Forschungszentrum Borstel, Mitglied im Deutschen Zentrum für Lungenforschung (DZL), Parkallee 35, 23845, Borstel, Deutschland. .,Interdisziplinäre Allergie-Ambulanz, Medizinische Klinik III, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland.
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Jappe U, Kull S, Opitz A, Zabel P. Anaphylaxis to vanilla ice cream: a near fatal cross-reactivity phenomenon. J Eur Acad Dermatol Venereol 2017; 32:e22-e23. [PMID: 28662315 DOI: 10.1111/jdv.14445] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- U Jappe
- Division of Clinical and Molecular Allergology, Priority Research Area Asthma and Allergy, Research Center Borstel, Borstel, Germany.,Department of Pneumology, Medical Clinic, Research Center Borstel, Borstel, Germany.,Interdisciplinary Allergy Outpatient Clinic, Department of Pneumology, University of Luebeck, Luebeck, Germany.,Airway Research Center North (ARCN); Member of the German Center for Lung Research (DZL)
| | - S Kull
- Division of Clinical and Molecular Allergology, Priority Research Area Asthma and Allergy, Research Center Borstel, Borstel, Germany.,Airway Research Center North (ARCN); Member of the German Center for Lung Research (DZL)
| | - A Opitz
- Division of Clinical and Molecular Allergology, Priority Research Area Asthma and Allergy, Research Center Borstel, Borstel, Germany.,Airway Research Center North (ARCN); Member of the German Center for Lung Research (DZL)
| | - P Zabel
- Department of Pneumology, Medical Clinic, Research Center Borstel, Borstel, Germany.,Airway Research Center North (ARCN); Member of the German Center for Lung Research (DZL)
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Kleine-Tebbe J, Jappe U. Molecular allergy diagnostic tests: development and relevance in clinical practice. Allergol Select 2017; 1:169-189. [PMID: 30402615 PMCID: PMC6040004 DOI: 10.5414/alx01617e] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 07/10/2013] [Indexed: 01/09/2023] Open
Abstract
Molecular allergy is based on identification, characterization and subsequent use of single allergens, being components of complex allergen sources like pollen, mites, furred animals, foods or insect venoms. Only few protein families contain relevant allergens of similar sequence and structure, carrying common IgE epitopes as the basis of cross reactivity. Used as purified or recombinant (glyco)proteins single allergens can potentially improve in-vitro diagnostics, particularly allergen-specific IgE assays through a) increased sensitivity, b) use of risk and marker allergens, c) component-resolved diagnostics (CRD). CRD can differentiate primary, species-specific from secondary, cross-reactive sensitizations to single allergens. Allergen components facilitate an increased analytical sensitivity, particularly if they are underrepresented or missing in conventional allergen extracts. They are mainly used in single assays (singleplex) for the detection of IgE, but also in a microarray format (multiplex) with 112 components from 50 allergen sources with slightly decreased analytical sensitivity. Concepts of molecular allergy can only be separately defined and utilized for each allergen source (pollen, mites, foods or insect venoms). As soon as essential singe allergens are available, their specific role in diagnostics should be defined. This requires well characterized patient cohorts from various countries, since exposure, allergic immune response and clinical relevance can vary substantially between individual subjects and geographical regions. The patient's clinical information is essential for proper interpretation of molecular allergology results. The history and/or challenge test results will finally provide evidence, in how far a sensitization to single allergens might be clinically relevant or not.
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Affiliation(s)
- J. Kleine-Tebbe
- Allergie- und Asthma-Zentrum Westend, Praxis Hanf, Ackermann und Kleine-Tebbe, Berlin
| | - U. Jappe
- Forschungsgruppe Klinische und Molekulare Allergologie, Forschungszentrum Borstel, Deutsches Zentrum für Lungenforschung, and
- Klinik für Dermatologie, Allergologie und Venerologie, Universität zu Lübeck, Germany
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Treudler R, Franke A, Schmiedeknecht A, Ballmer-Weber B, Worm M, Werfel T, Jappe U, Biedermann T, Schmitt J, Brehler R, Kleinheinz A, Kleine-Tebbe J, Brüning H, Ruëff F, Ring J, Saloga J, Schäkel K, Holzhauser T, Vieths S, Simon JC. BASALIT trial: double-blind placebo-controlled allergen immunotherapy with rBet v 1-FV in birch-related soya allergy. Allergy 2017; 72:1243-1253. [PMID: 27998002 DOI: 10.1111/all.13112] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [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] [Accepted: 12/17/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND Conflicting results exist on the effect of allergen immunotherapy (AIT) on pollen-related food allergy. We aimed to investigate the efficacy of one-year AIT with the folding variant (FV) of recombinant (r) Bet v 1 on birch-related soya allergy. METHODS Of 138 subjects with Bet v 1 sensitization, 82 were positive at double-blind placebo-controlled food challenge (DBPCFC) with soya. A total of 56 of 82 were randomized in the ratio of 2:1 (active: placebo). Per-protocol population (PPP) had received ≥150 μg of allergen or placebo preparation. OUTCOME MEASURES lowest observed adverse effect levels (LOAEL), postinterventional occurrence of objective signs (objS) at any dose level, sIgE/IgG4 against Bet v 1 and Gly m 4. Between-group changes were investigated (ancova, Mann-Whitney U-test, Fisher exact test). RESULTS Baseline characteristics including LOAELs were comparable in both groups with objS and subjS occurring in 82% and 95% of active (n = 38) vs 78% and 83% of placebo group (n = 18). After AIT, objS occurred in 24% and 47%, respectively. LOAEL group differences showed a beneficial tendency (P = 0.081) for LOAELobjective in PPP (30 active, 15 placebo). sIgG4 raised only in active group (Bet v 1: P = 0.054, Gly m 4: P = 0.037), and no relevant changes occurred for sIgE. Only 56% of the intended sample size was recruited. CONCLUSION For the first time, we present data on the effect of rBet v 1-FV on birch-related soya allergy. rBet v 1-FV AIT induced significant immunogenic effects. Clinical assessment showed a tendency in favour of the active group but did not reach statistical significance.
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Affiliation(s)
- R Treudler
- Department of Dermatology, Venerology and Allergology, Universität Leipzig, Leipzig, Germany
| | - A Franke
- Clinical Trial Centre Leipzig (ZKS), Universität Leipzig, Leipzig, Germany
| | - A Schmiedeknecht
- Clinical Trial Centre Leipzig (ZKS), Universität Leipzig, Leipzig, Germany
| | - B Ballmer-Weber
- Allergy Unit, Department of Dermatology, University Hospital Zürich and Centre of Dermatology and Allergology, Luzerner Kantonsspital, Luzern, Germany
| | - M Worm
- Allergy Center Charité, Department of Dermatology, Venerology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - T Werfel
- Department of Dermatology and Allergology, MH Hannover, Hannover, Germany
| | - U Jappe
- Division of Clinical & Molecular Allergology Research Center Borstel, Airway Research Center North (ARCN) and Member of the German Center for Lung Research (DZL), Borstel, Germany
- Interdisciplinary Allergy Outpatient Clinic, Department of Internal Medicine, University of Lübeck, Lübeck, Germany
| | - T Biedermann
- Department of Dermatology, Universität Tübingen, Tübingen, Germany
- Department of Dermatology and Allergology, Technical University Munich, Munich, Germany
| | - J Schmitt
- Department of Dermatology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
- Center for Evidence-based Healthcare, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - R Brehler
- Department of Dermatology, Universität Münster, Münster, Germany
| | - A Kleinheinz
- Department of Dermatology, Elbekliniken Buxtehude, Buxtehude, Germany
| | | | - H Brüning
- Day care clinic for Allergy and Dermatology, Kiel, Germany
| | - F Ruëff
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
| | - J Ring
- Department of Dermatology and Allergology, Technical University Munich, Munich, Germany
| | - J Saloga
- Department of Dermatology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - K Schäkel
- Department of Dermatology, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - T Holzhauser
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - S Vieths
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - J C Simon
- Department of Dermatology, Venerology and Allergology, Universität Leipzig, Leipzig, Germany
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Gollnick H, Barasso R, Jappe U, Ward K, Eul A, Carey-Yard M, Milde K. Safety and efficacy of imiquimod 5% cream in the treatment of penile genital warts in uncircumcised men when applied three times weekly or once per day. Int J STD AIDS 2017. [DOI: 10.1177/095646240101200105] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This dose-escalation study was performed to evaluate safety and efficacy of imiquimod 5% cream in the treatment of uncircumcised men with penile warts associated with the foreskin. The cream was applied 3 times/week (n=34) or once per day (n=30) over 8 ± 2h. Imiquimod 5% cream was safe in both treatment groups. However, the 3 times/week regimen was better tolerated with a lower incidence of local skin reactions. In both groups, the 2 most frequently reported local skin reactions were erythema and erosion; they were more severe with the once-daily dosing. The most frequently reported application site reactions were burning, pruritus and irritation or pain (once-daily patients only). Total clearance was achieved in 62% of the patients in the 3 times/week group and by 57% in the once-daily group. Thus, imiquimod 5% cream administered 3 times/week was the optimal dosing regimen in the treatment of penile warts in uncircumcised men.
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Affiliation(s)
- H Gollnick
- Department of Dermatology and Venereology, University of Magdeburg, Magdeburg, Germany
| | - R Barasso
- Department of Gynaecology and Obstetrics, Hôpital Bichat, Paris, France
| | - U Jappe
- Department of Dermatology and Venereology, University of Magdeburg, Magdeburg, Germany
| | - K Ward
- 3M Health Care Ltd, Loughborough, UK
| | - A Eul
- 3M Medica, Borken, Germany
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Treudler R, Franke A, Schmiedeknecht A, Ballmer-Weber BK, Worm M, Werfel T, Jappe U, Biedermann T, Schmitt J, Brehler R, Kleinheinz A, Kleine-Tebbe J, Brüning H, Ruëff F, Ring J, Saloga J, Schäkel K, Holzhauser T, Vieths S, Simon JC. Standardization of double blind placebo controlled food challenge with soy within a multicentre trial. Clin Transl Allergy 2016; 6:39. [PMID: 27826414 PMCID: PMC5098282 DOI: 10.1186/s13601-016-0129-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 10/14/2016] [Indexed: 11/17/2022] Open
Abstract
Background Multicentre trials investigating food allergies by double blind placebo controlled food challenges (DBPCFC) need standardized procedures, challenge meals and evaluation criteria. We aimed at developing a standardized approach for identifying patients with birch related soy allergy by means of DBPCFC to soy, including determination of threshold levels, in a multicentre setting. Methods Microbiologically stable soy challenge meals were composed of protein isolate with consistent Gly m 4 levels. Patients sensitized to main birch allergen Bet v 1 and concomitant sensitization to its soy homologue Gly m 4 underwent DBPCFC. Outcome was defined according to presence and/or absence of ten objective signs and intensity of eight subjective symptoms as measured by visual analogue scale (VAS). Results 138 adult subjects (63.8% female, mean age 38 years) underwent DBPCFC. Challenge meals and defined evaluation criteria showed good applicability in all centres involved. 45.7% presented with objective signs and 65.2% with subjective symptoms at soy challenge. Placebo challenge meals elicited non-cardiovascular objective signs in 11.6%. In 82 (59.4%) subjects DBPCFC was judged as positive. 70.7% of DPBCFC+ showed objective signs and 85.4% subjective symptoms at soy challenge. Subjective symptoms to soy challenge meal in DBPCFC+ subjects started at significantly lower dose levels than objective signs (p < 0.001). Median cumulative eliciting doses for first objective signs in DBPCFC+ subjects were 4.7 g [0.7–24.7] and 0.7 g [0.2–4.7] total soy protein for first subjective symptoms (p = 0.01). Conclusions We present the hitherto largest group of adults with Bet v 1 and Gly m 4 sensitization being investigated by DBPCFC. In this type of food allergy evaluation of DBPCFC outcome should not only include monitoring of objective signs but also scoring of subjective symptoms. Our data may contribute to standardize DBPCFC in pollen-related food allergy in multicentre settings. Trial registration EudraCT: 2009-011737-27.
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Affiliation(s)
- R Treudler
- Department of Dermatology, Venerology and Allergology, Universität Leipzig, Leipzig, Germany ; Leipziger Interdisziplinäres Centrum für Allergologie (LICA) - Comprehensive Allergy Centre (CAC), Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig, Philipp-Rosenthal-Straße 23, 04103 Leipzig, Germany
| | - A Franke
- Clinical Trial Centre Leipzig (ZKS), Universität Leipzig, Leipzig, Germany
| | - A Schmiedeknecht
- Clinical Trial Centre Leipzig (ZKS), Universität Leipzig, Leipzig, Germany
| | - B K Ballmer-Weber
- Allergy Unit, Department of Dermatology, University Hospital Zürich, Zurich, Switzerland
| | - M Worm
- Allergy Center Charité, Department of Dermatology, Venerology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - T Werfel
- Department of Dermatology and Allergology, MH Hannover, Hannover, Germany
| | - U Jappe
- Division of Clinical and Molecular Allergology Research Center Borstel, Airway Research Center North (ARCN), Borstel, Germany ; Department of Internal Medicine, University of Lübeck, Lübeck, Germany
| | - T Biedermann
- Department of Dermatology, Universität Tübingen, Tübingen, Germany ; Department of Dermatology and Allergology, Technical University Munich, Munich, Germany
| | - J Schmitt
- Department of Dermatology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany ; Center for Evidence-Based Healthcare, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - R Brehler
- Department of Dermatology, Universität Münster, Münster, Germany
| | - A Kleinheinz
- Department of Dermatology, Elbekliniken Buxtehude, Buxtehude, Germany
| | | | - H Brüning
- Day Care Clinic for Allergy and Dermatology, Kiel, Germany
| | - F Ruëff
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
| | - J Ring
- Department of Dermatology and Allergology, Technical University Munich, Munich, Germany
| | - J Saloga
- Department of Dermatology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - K Schäkel
- Department of Dermatology, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - T Holzhauser
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - St Vieths
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - J C Simon
- Department of Dermatology, Venerology and Allergology, Universität Leipzig, Leipzig, Germany ; Leipziger Interdisziplinäres Centrum für Allergologie (LICA) - Comprehensive Allergy Centre (CAC), Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig, Philipp-Rosenthal-Straße 23, 04103 Leipzig, Germany
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Stein K, Jenckel A, Jappe U, Heine H. Innate immune network in asthma: studies on dendritic cell interaction with airway epithelium. Pneumologie 2016. [DOI: 10.1055/s-0036-1584648] [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: 10/19/2022]
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Homann A, Minge S, Röckendorf N, Kromminga A, Frey A, Platts-Mills T, Jappe U. Adverse Reactions against Biologicals – Identification and Characterization of Immunogenic Epitopes and Potential Biomarkers. Pneumologie 2016. [DOI: 10.1055/s-0036-1584604] [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: 10/19/2022]
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Gonzalez Roldan N, Jappe U, Duda KA. Glycolipids of house dust mites – studying the impact of allergen-lipid association. Pneumologie 2016. [DOI: 10.1055/s-0036-1584617] [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: 10/19/2022]
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Matricardi PM, Kleine-Tebbe J, Hoffmann HJ, Valenta R, Hilger C, Hofmaier S, Aalberse RC, Agache I, Asero R, Ballmer-Weber B, Barber D, Beyer K, Biedermann T, Bilò MB, Blank S, Bohle B, Bosshard PP, Breiteneder H, Brough HA, Caraballo L, Caubet JC, Crameri R, Davies JM, Douladiris N, Ebisawa M, EIgenmann PA, Fernandez-Rivas M, Ferreira F, Gadermaier G, Glatz M, Hamilton RG, Hawranek T, Hellings P, Hoffmann-Sommergruber K, Jakob T, Jappe U, Jutel M, Kamath SD, Knol EF, Korosec P, Kuehn A, Lack G, Lopata AL, Mäkelä M, Morisset M, Niederberger V, Nowak-Węgrzyn AH, Papadopoulos NG, Pastorello EA, Pauli G, Platts-Mills T, Posa D, Poulsen LK, Raulf M, Sastre J, Scala E, Schmid JM, Schmid-Grendelmeier P, van Hage M, van Ree R, Vieths S, Weber R, Wickman M, Muraro A, Ollert M. EAACI Molecular Allergology User's Guide. Pediatr Allergy Immunol 2016; 27 Suppl 23:1-250. [PMID: 27288833 DOI: 10.1111/pai.12563] [Citation(s) in RCA: 494] [Impact Index Per Article: 61.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The availability of allergen molecules ('components') from several protein families has advanced our understanding of immunoglobulin E (IgE)-mediated responses and enabled 'component-resolved diagnosis' (CRD). The European Academy of Allergy and Clinical Immunology (EAACI) Molecular Allergology User's Guide (MAUG) provides comprehensive information on important allergens and describes the diagnostic options using CRD. Part A of the EAACI MAUG introduces allergen molecules, families, composition of extracts, databases, and diagnostic IgE, skin, and basophil tests. Singleplex and multiplex IgE assays with components improve both sensitivity for low-abundance allergens and analytical specificity; IgE to individual allergens can yield information on clinical risks and distinguish cross-reactivity from true primary sensitization. Part B discusses the clinical and molecular aspects of IgE-mediated allergies to foods (including nuts, seeds, legumes, fruits, vegetables, cereal grains, milk, egg, meat, fish, and shellfish), inhalants (pollen, mold spores, mites, and animal dander), and Hymenoptera venom. Diagnostic algorithms and short case histories provide useful information for the clinical workup of allergic individuals targeted for CRD. Part C covers protein families containing ubiquitous, highly cross-reactive panallergens from plant (lipid transfer proteins, polcalcins, PR-10, profilins) and animal sources (lipocalins, parvalbumins, serum albumins, tropomyosins) and explains their diagnostic and clinical utility. Part D lists 100 important allergen molecules. In conclusion, IgE-mediated reactions and allergic diseases, including allergic rhinoconjunctivitis, asthma, food reactions, and insect sting reactions, are discussed from a novel molecular perspective. The EAACI MAUG documents the rapid progression of molecular allergology from basic research to its integration into clinical practice, a quantum leap in the management of allergic patients.
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Affiliation(s)
- P M Matricardi
- Paediatric Pneumology and Immunology, Charitè Medical University, Berlin, Germany
| | - J Kleine-Tebbe
- Allergy & Asthma Center Westend, Outpatient Clinic Ackermann, Hanf, & Kleine-Tebbe, Berlin, Germany
| | - H J Hoffmann
- Department of Respiratory Diseases and Allergy, Institute of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - R Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - C Hilger
- Department of Infection & Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - S Hofmaier
- Paediatric Pneumology and Immunology, Charitè Medical University, Berlin, Germany
| | - R C Aalberse
- Sanquin Research, Department of Immunopathology, Amsterdam, The Netherlands
- Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - I Agache
- Department of Allergy and Clinical Immunology, Faculty of Medicine, Transylvania University of Brasov, Brasov, Romania
| | - R Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Italy
| | - B Ballmer-Weber
- Allergy Unit, Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
| | - D Barber
- IMMA-School of Medicine, University CEU San Pablo, Madrid, Spain
| | - K Beyer
- Paediatric Pneumology and Immunology, Charitè Medical University, Berlin, Germany
| | - T Biedermann
- Department of Dermatology and Allergology, Technical University Munich, Munich, Germany
| | - M B Bilò
- Allergy Unit, Department of Internal Medicine, University Hospital Ospedali Riuniti di Ancona, Ancona, Italy
| | - S Blank
- Center of Allergy and Environment (ZAUM), Helmholtz Center Munich, Technical University of Munich, Munich, Germany
| | - B Bohle
- Division of Experimental Allergology, Department of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology & Immunology, Medical University of Vienna, Vienna, Austria
| | - P P Bosshard
- Allergy Unit, Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
| | - H Breiteneder
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - H A Brough
- Paediatric Allergy, Department of Asthma, Allergy and Respiratory Science, King's College London, Guys' Hospital, London, UK
| | - L Caraballo
- Institute for Immunological Research, The University of Cartagena, Cartagena de Indias, Colombia
| | - J C Caubet
- Pediatric Allergy Unit, Department of Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
| | - R Crameri
- Swiss Institute of Allergy and Asthma Research, University of Zürich, Davos, Switzerland
| | - J M Davies
- School of Biomedical Sciences, Institute of Biomedical Innovation, Queensland University of Technology, Brisbane, Qld, Australia
| | - N Douladiris
- Allergy Unit, 2nd Paediatric Clinic, National & Kapodistrian University, Athens, Greece
| | - M Ebisawa
- Department of Allergy, Clinical Research Center for Allergology and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan
| | - P A EIgenmann
- Pediatric Allergy Unit, Department of Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
| | - M Fernandez-Rivas
- Allergy Department, Hospital Clinico San Carlos IdISSC, Madrid, Spain
| | - F Ferreira
- Division of Allergy and Immunology, Department of Molecular Biology, University of Salzburg, Salzburg, Austria
| | - G Gadermaier
- Division of Allergy and Immunology, Department of Molecular Biology, University of Salzburg, Salzburg, Austria
| | - M Glatz
- Allergy Unit, Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
- Christine Kühne Center for Allergy Research and Education CK-CARE, Davos, Switzerland
| | - R G Hamilton
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - T Hawranek
- Department of Dermatology, Paracelsus Private Medical University, Salzburg, Austria
| | - P Hellings
- Department of Otorhinolaryngology, Academic Medical Center (AMC), Amsterdam, The Netherlands
- Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium
| | - K Hoffmann-Sommergruber
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - T Jakob
- Department of Dermatology and Allergology, University Medical Center Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany
| | - U Jappe
- Division of Clinical and Molecular Allergology, Research Centre Borstel, Airway Research Centre North (ARCN), Member of the German Centre for Lung Research (DZL), Borstel, Germany
- Interdisciplinary Allergy Division, Department of Pneumology, University of Lübeck, Lübeck, Germany
| | - M Jutel
- Department of Clinical Immunology, 'ALL-MED' Medical Research Institute, Wrocław Medical University, Wrocław, Poland
| | - S D Kamath
- Molecular Allergy Research Laboratory, Centre for Biodiscovery and Molecular Development of Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville City, Qld, Australia
| | - E F Knol
- Departments of Immunology and Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P Korosec
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
| | - A Kuehn
- Department of Infection & Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - G Lack
- King's College London, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
- Division of Asthma, Allergy and Lung Biology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A L Lopata
- Department of Clinical Immunology, 'ALL-MED' Medical Research Institute, Wrocław Medical University, Wrocław, Poland
| | - M Mäkelä
- Skin and Allergy Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - M Morisset
- National Service of Immuno-Allergology, Centre Hospitalier Luxembourg (CHL), Luxembourg, UK
| | - V Niederberger
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - A H Nowak-Węgrzyn
- Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - N G Papadopoulos
- Centre for Paediatrics and Child Health, Institute of Human Development, University of Manchester, Manchester, UK
| | - E A Pastorello
- Unit of Allergology and Immunology, Niguarda Ca' Granda Hospital, Milan, Italy
| | - G Pauli
- Service de Pneumologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - T Platts-Mills
- Department of Microbiology & Immunology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - D Posa
- Paediatric Pneumology and Immunology, Charitè Medical University, Berlin, Germany
| | - L K Poulsen
- Allergy Clinic, Copenhagen University Hospital, Copenhagen, Denmark
| | - M Raulf
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Ruhr-University Bochum (IPA), Bochum, Germany
| | - J Sastre
- Allergy Division, Fundación Jimenez Díaz, Madrid, Spain
| | - E Scala
- Experimental Allergy Unit, IDI-IRCCS, Rome, Italy
| | - J M Schmid
- Department of Respiratory Diseases and Allergy, Institute of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - P Schmid-Grendelmeier
- Allergy Unit, Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
- Christine Kühne Center for Allergy Research and Education CK-CARE, Davos, Switzerland
| | - M van Hage
- Department of Medicine Solna, Clinical Immunology and Allergy Unit, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - R van Ree
- Departments of Experimental Immunology and of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - S Vieths
- Department of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - R Weber
- School of Medicine, University of Colorado, Denver, CO, USA
- Department of Medicine, National Jewish Health Service, Denver, CO, USA
| | - M Wickman
- Sachs' Children's Hospital, Karolinska Institutet, Stockholm, Sweden
| | - A Muraro
- The Referral Centre for Food Allergy Diagnosis and Treatment Veneto Region, Department of Mother and Child Health, University of Padua, Padua, Italy
| | - M Ollert
- Department of Infection & Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
- Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis, University of Southern Denmark, Odense, Denmark
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Jappe U, Nikolic J, Opitz A, Homann A, Zabel P, Gavrovic-Jankulovic M. Apparent IgE negative anaphylactic reaction to banana combined with kiwi allergy - complementary diagnostic value of purified single banana allergens. J Eur Acad Dermatol Venereol 2015; 30:1220-2. [PMID: 25827794 DOI: 10.1111/jdv.13146] [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] [Indexed: 11/28/2022]
Affiliation(s)
- U Jappe
- Division of Clinical and Molecular Allergology, Research Center Borstel, Member of the German Center for Lung Research (DZL), Borstel, Germany.,Department of Pneumology, Medical Clinic, Research Center Borstel, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Borstel, Germany.,Department of Dermatology, Allergology and Venereology, University of Luebeck, Luebeck, Germany
| | - J Nikolic
- Department of Biochemistry, Faculty of Chemistry, University of Belgrade, Belgrade, Serbia
| | - A Opitz
- Division of Clinical and Molecular Allergology, Research Center Borstel, Member of the German Center for Lung Research (DZL), Borstel, Germany.,Department of Pneumology, Medical Clinic, Research Center Borstel, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Borstel, Germany
| | - A Homann
- Division of Clinical and Molecular Allergology, Research Center Borstel, Member of the German Center for Lung Research (DZL), Borstel, Germany
| | - P Zabel
- Department of Pneumology, Medical Clinic, Research Center Borstel, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Borstel, Germany
| | - M Gavrovic-Jankulovic
- Department of Biochemistry, Faculty of Chemistry, University of Belgrade, Belgrade, Serbia
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21
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Kull S, Petersen A, Vrtala S, Jappe U. Characterization of lipophilic house dust mite-allergens with regard to the allergic phenotype. Pneumologie 2014. [DOI: 10.1055/s-0034-1376772] [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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Abstract
The association between the carbohydrate galactose-[alpha]-1,3-galactose (α-Gal) and anaphylaxis was first documented after severe hypersensitivity reactions to cetuximab, a chimeric mouse-human IgG1 monoclonal antibody approved for targeted therapy of carcinomas of colon, as well as of the head and neck region. α-Gal is a ubiquitous glycan moiety expressed on cells and tissue of non-primate mammals. Since this epitope is not expressed in humans, it is very immunogenic for them. α-Gal is located on the Fab portion of cetuximab and thus on the murine part of the chimera. The anaphylactic reactions to the antibody were mediated by IgE specific for α-Gal. Anti-α-Gal-IgE were first detected in sera of patients from the southeastern U.S. and reacted with a wide range of mammalian allergens. The geographic distribution prompted investigations of sensitization routes apart from the ingestion of red meat, such as tick bites und parasitic infections. Anti-α-Gal-IgE seems to be of clinical relevance for allergy to red meat and for the pork-cat syndrome. It is also associated with a novel form of delayed anaphylaxis, which appears more than 3 hours following the ingestion of red meat (beef, pork and lamb), a phenomenon which is still to be elucidated. For most of these patients conventional skin prick tests with commercial reagents proved insufficient for diagnosis.
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Affiliation(s)
- U Jappe
- Klinik für Dermatologie, Allergologie und Venerologie, Universität Lübeck, Lübeck, Deutschland.
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23
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Jappe U. Nahrungsmittelallergie: Klinik, Diagnostik und Therapie. Akt Dermatol 2011. [DOI: 10.1055/s-0030-1256478] [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: 10/18/2022]
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24
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Stutz N, Becker D, Jappe U, John SM, Ladwig A, Spornraft-Ragaller P, Uter W, Löffler H. Nurses' perceptions of the benefits and adverse effects of hand disinfection: alcohol-based hand rubs vs. hygienic handwashing: a multicentre questionnaire study with additional patch testing by the German Contact Dermatitis Research Group. Br J Dermatol 2008; 160:565-72. [PMID: 19067700 DOI: 10.1111/j.1365-2133.2008.08951.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Nurses have a high risk of developing hand eczema due to hand disinfection procedures. OBJECTIVES To investigate the perception of nurses regarding the adverse effects of hand washing (HW) and alcoholic disinfection (ADI), and to obtain data on the prevalence of hand dermatitis and sensitization to alcohols and alcohol-based hand rubs (ABHRs). METHODS A self-administered questionnaire survey, carried out as a pilot study (PS), followed by a modified multicentre study (MC) in five hospitals. Patch tests to ethanol (80%), 1-propanol (60%), 2-propanol (70%) and ABHRs were performed in a subsample. RESULTS The majority (PS 60.1%; MC 69.5%) of nurses considered ADI to be more damaging than HW. Mostly, ADI and HW were suspected to have irritant effects (ADI 79.2%/52.1%; HW 65.5%/36.2%) compared with an allergenic potential (ADI 10.4%/5.8%; HW 7.8%/3.9%). The prevalence of hand dermatitis in the MC was 13.4% by self-diagnosis and 22.4% by symptom-based questions. In 50 tested individuals no sensitization and only two irritant reactions to alcohols and three single-positive reactions to ABHRs were observed, none of the latter related to alcohols. CONCLUSIONS Although ADI is known to cause less skin irritation than HW, nurses perceive ADI as more damaging, resulting in: (i) a low compliance with ADI and (ii) a higher prevalence of hand dermatitis because the more deleterious HW is preferred. This may result in an increase in occupational disease and nosocomial infections. Educational programmes should promote ADI as a procedure with good efficiency and skin tolerability to reduce the prevalence of hand eczema in nurses and to enhance compliance with hand hygiene standards.
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Affiliation(s)
- N Stutz
- Department of Dermatology, Philipp University, Marburg, Germany.
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Jappe U, Schäfer T, Schnuch A, Uter W. Contact allergy in patients with rosacea: a clinic-based, prospective epidemiological study. J Eur Acad Dermatol Venereol 2008; 22:1208-14. [DOI: 10.1111/j.1468-3083.2008.02778.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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26
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Geier J, Lessmann H, Jappe U, Hillen U, Uter W, Schnuch A. P61
EPOX 2002: concomitant sensitizations to epoxy resin components. Contact Dermatitis 2008. [DOI: 10.1111/j.0105-1873.2004.0309gq.x] [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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Huter E, Wortham NC, Hartschuh W, Enk A, Jappe U. Single Base Mutation in the Fumarate Hydratase Gene Leading to Segmental Cutaneous Leiomyomatosis. Acta Derm Venereol 2008; 88:63-5. [DOI: 10.2340/00015555-0341] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Affiliation(s)
- U Jappe
- Paul-Ehrlich-Institut, Division of Allergology, Paul-Ehrlich-Strasse 51-59, D-63225 Langen.
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29
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Meissner PE, Jappe U, Niemeyer CM, Peters AM, Kulozik A, Zilow EP. Pyoderma Gangraenosum, a Rare, but Potentially Fatal Complication in Paediatric Oncology Patients. Klin Padiatr 2007; 219:296-9. [PMID: 16865656 DOI: 10.1055/s-2006-933544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Pyoderma gangraenosum (PG) is a serious chronic, ulcerative skin disorder afflicting both adults and children. As PG is often associated with systemic diseases (>50%) such as inflammatory bowel disease, rheumatoid arthritis or haematological disorders, it requires a multidisciplinary approach. This disorder is not commonly reported in paediatrics; therefore children with PG represent a particularly difficult diagnostic challenge. Clinical diagnosis is often delayed and PG is only considered after eliminating other causes of cutaneous ulcers. We report a 4-year-old boy with secondary myelodysplastic syndrome following treatment for acute lymphoblastic leukaemia who presented with a massive inflammatory, ulcerative proliferation of the lower lip which was diagnosed as PG. We have reviewed the literature with reference to diagnostic criteria and treatment options of this disorder that is particularly rare in childhood.
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Affiliation(s)
- P E Meissner
- Department of Neonatology, Heidelberg University, Germany.
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Abstract
Isolated allergy to the common housefly (Musca domestica) has only been described in four cases. Predisposing factors include high concentrations of allergens and prolonged exposure time. Two pharmaceutical industry workers, 59 and 34 years of age, both without atopy, presented with recent onset of allergic rhinitis. Their symptoms appeared about 30 minutes after exposure to Musca domestica in the closed breeding rooms. They were symptom-free with other insects, on weekends and on vacation. Skin prick tests with common inhalant allergens were negative. Prick testing with crushed Musca domestica adults, hatched eggs, contaminated nets and sand, as well as fly feces were all positive. One patient had specific IGE antibodies against Musca domestica. Both patients lacked specific IgE antibodies against other insect species and common aeroallergens. In these two patients there was a species-specific sensitization without relevant cross reactions to other arthropods. The patients were transferred to new work sites where they had no contact with Musca domestica and became symptom-free. Thus this common insect can be a relevant occupational aeroallergen.
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Affiliation(s)
- E Tas
- Allergologische Poliklinik der Universitäts-Hautklinik Heidelberg, Vossstrasse 2, 69115 Heidelberg
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31
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Tschachler E, Brockmeyer N, Effendy I, Geiss HK, Harder S, Hartmann M, Jappe U, Plettenberg A, Rasokat H, Reimann H, Shah P, Stücker M, Wichelhaus TA, Schöfer H. Streptococcal infections of the skin and mucous membranes. J Dtsch Dermatol Ges 2007; 5:527-32. [PMID: 17537048 DOI: 10.1111/j.1610-0387.2007.06287.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- E Tschachler
- Department of Dermatology, University of Vienna Medical School, Ludwig Boltzmann Institute for Research of Infectious Venero-dermatologic Diseases, Vienna, Austria.
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32
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Tschachler E, Brockmeyer N, Effendy I, Geiss H, Harder S, Hartmann M, Jappe U, Plettenberg A, Rasokat H, Reimann H, Shah P, Stcker M, Wichelhaus T, Schöfer H. Streptokokkeninfektionen der Haut und Schleimhäute. J Dtsch Dermatol Ges 2007. [DOI: 10.1111/j.1610-0387.2007.06287_supp.x] [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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Abstract
We present a case of cutaneous myiasis (Tumbu fly; Cordylobia anthropophaga) in a German traveller returning from Africa. Myiasis is caused by dipterous larvae invading human or animal tissues. The diagnosis is based on the travel history and specific features of the furunculoid skin lesions. Larvae are extracted with forceps or are surgically removed.
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Affiliation(s)
- T Göksu
- Sektion Klinische Tropenmedizin, Universitätsklinikum Heidelberg, INF 324, 69120 Heidelberg, Deutschland.
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Brasch J, Jappe U, Reese G, Vieths S. Symposium 15: Neue Allergene — wieder entdeckte Allergene. Allergo J 2007. [DOI: 10.1007/bf03370590] [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: 11/27/2022]
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Grosber M, Eberlein B, Engst R, Kerzl R, Manstein P, Ring J, Darsow U, Termeer C, Termeer J, Salmann S, Averbeck M, Simon J, Pfaar O, von Weikersthal-Drachenberg KF, Amersdorffer J, Baumann-Noss S, Woroniecki S, Klimek L, Lauter H, Sager A, Laszczyk M, Scheffler A, Martin S, Kespohl S, Schlünssen V, Jacobsen G, Sigsgaard T, Maryska S, Meurer U, Brüning T, Raulf-Heimsoth M, Riecken S, Lindner B, Petersen A, Jappe U, Becker W, Saloga J, Häringer B, Bellinghausen I, Lafargue B, Decker H, Grabbe S, Baratli J, Asturias J, Hunzelmann N, Kahlert H, Weber B, Cromwell O, Fiebig H, Nandy A, Wald M. Allergene — Allergenträger — Pseudoallergien — Adjuvanzien. Allergo J 2007. [DOI: 10.1007/bf03370606] [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: 10/21/2022]
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Wiedemeyer K, Enk A, Jappe U. Erythema Multiforme Following Allergic Contact Dermatitis: Case Report and Literature Review. Acta Derm Venereol 2007; 87:559-61. [DOI: 10.2340/00015555-0316] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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38
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Jappe U, Raulf-Heimsoth M, Hoffmann M, Burow G, Hübsch-Müller C, Enk A. In vitro hymenoptera venom allergy diagnosis: improved by screening for cross-reactive carbohydrate determinants and reciprocal inhibition. Allergy 2006; 61:1220-9. [PMID: 16942573 DOI: 10.1111/j.1398-9995.2006.01232.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Immunoglobulin (Ig) E-double positivity for honeybee (HB) and yellow jacket (YJ) venom causes diagnostic difficulties concerning therapeutical strategies. The aim of this study was to clarify the cause and relation of the cross-reactivity in patients with insect venom allergy. METHODS For this purpose, 147 patients with suspected stinging insect allergy and CAP-FEIA-double positivity were investigated for specific sIgE to additional cross-reactive carbohydrate determinant (CCD)-containing allergens: timothy grass pollen, rape pollen, natural rubber latex (NRL), bromelain, and horseradish peroxidase (HRP). Sera with sIgE to NRL were further investigated with the commercially available recombinant latex allergens. Reciprocal inhibition assays with both venoms and HRP were performed. RESULTS About 36 of 147 (24.5%) patients had sIgE to both venoms only. However, 111 of 147 (75.5%) additionally reacted to CCD-carrying allergens. 89 of 111 CCD-reactive sera had NRL-sIgE. In cases where inhibition experiments were performed, the NRL-sIgE binding was completely abolished in the presence of HRP. Only nine of 61 sera were positive for at least one recombinant latex allergen; all of them were negative in history and NRL-skin prick test. In 43 sera containing sIgE to CCD, HRP inhibition revealed unequivocal results: In 28 of 43 (65%) an HRP-inhibition >70% of sIgE to one venom occurred, pointing out the relevant venom. In three of 43 sIgE proved to be entirely CCD-specific. CONCLUSIONS Our data indicate that in cases of IgE positivity to both insect venoms supplementary screening tests with at least one CCD-containing allergen should be performed; HRP being a suitable tool for this test. In addition, subsequent reciprocal inhibition is an essential diagnostic method to specify cross-reacting sIgE results.
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Affiliation(s)
- U Jappe
- Department of Dermatology and Venereology, University of Heidelberg, Heidelberg, Germany
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Hillen U, Jappe U, Frosch PJ, Becker D, Brasch J, Lilie M, Fuchs T, Kreft B, Pirker C, Geier J. Late reactions to the patch-test preparations para-phenylenediamine and epoxy resin: a prospective multicentre investigation of the German Contact Dermatitis Research Group. Br J Dermatol 2006; 154:665-70. [PMID: 16536809 DOI: 10.1111/j.1365-2133.2006.07159.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Late patch-test reactions, developing at day (D) 7 or later have been described for several allergens. Late reactions may reflect patch-test sensitization. Para-phenylenediamine (PPD) and epoxy resins (ER) are potent allergens and therefore may potentially induce patch-test sensitization. Up to now, there has been no prospective study on the frequency of late reactions in routine patch testing with these allergens. OBJECTIVES To assess the frequency of late reactions to PPD and ER. PATIENTS/METHODS In 1748 patients PPD (PPD-base, 1% pet.) and ER [based on diglycidylether of bisphenol A (DGEBA, 1% pet.)], and in 812 patients, nickel sulphate (5% pet.) were removed from the test panel of the standard series and applied on the medial side of the upper arm. Patch-test occlusion time was 24 h in 588 (PPD and ER) and 241 patients (nickel sulphate), respectively, and 48 h in 1160 (PPD and ER) and 571 (nickel sulphate) patients, respectively. Patch tests were read on D1-3 and D2-3, respectively; additional late readings were performed on D7, D14 and D21 after patch-test application. Patients who were not able to return for all scheduled late readings were telephoned on D7, D14 or D21, and questioned about a reaction at the test sites. Patients were instructed to perform daily self-examination from D4 onwards and to return immediately to the clinic if a reaction at the upper arm became visible. RESULTS Data of 1428 patients (ER and PPD) and 638 patients (nickel) were evaluable. In 25 patients (1.8%), patch tests became positive not before D7, among them 21 reactions to PPD (1.5%) and four reactions to ER (0.3%). In five of seven patients, repeated patch tests with PPD disclosed patch-test sensitization as the cause of the late reaction. All late reactions, except for one, occurred in patients in whom patch tests were applied for 48 h. No late reactions were seen with nickel sulphate. CONCLUSIONS PPD (1% pet.) elicited late reactions in 1.5% of routine patch tests, the majority of them probably being caused by patch-test sensitization. Therefore, the German Contact Dermatitis Research Group decided to remove PPD 1% pet. from the German standard series and to take efforts to optimize the patch-test conditions of PPD. One way to optimize PPD testing could be to reduce the exposure of PPD 1% to 24 h. Alternatively the patch-test concentration of PPD might be reduced.
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Affiliation(s)
- U Hillen
- Department of Dermatology, University of Duisburg-Essen, Germany.
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Abstract
Treatment options for infections with MRSA are extremely limited because of resistance to all beta-lactam antibiotics and primarily because of the fast acquisition of further antibiotic resistance. During the past six years MRSA possessing the genomic determinant of an additional virulence factor emerged. This virulence factor, Panton-Valentine-Leukocidin, seems to be responsible for deep skin infections as well as necrotizing pneumonia. In order to avoid a continuous spread of MRSA, consequent prevention measures both in dermatological practices and for colonized patients in their general environment are essential.
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Affiliation(s)
- W Witte
- Bereich Wernigerode, Robert-Koch-Institut.
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41
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Weber M, Jappe U, Essig M, Krix M, Ittrich C, Huttner H, Meyding-Lamadé U, Hartmann M, Kauczor H, Delorme S. Diagnostische Wertigkeit des kontrastmittelverstärkten Ultraschalls verglichen mit der Magnetresonanztomographie bei Dermato- und Polymyositis. Akt Neurol 2006. [DOI: 10.1055/s-2006-953359] [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]
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42
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Knauer K, Weber M, Jappe U, Essig M, Kauczor H. Ganzkörper Magnetresonanztomographie bei entzündlichen Muskelerkrankungen. Akt Neurol 2006. [DOI: 10.1055/s-2006-953323] [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]
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Abstract
The demand for permanent make up and especially permanent lip liner has increased in recent years in Germany. Information about complications is not available in the medical literature, because tattooing is a trade whose results and problems are not monitored and documented, as is the case for medical procedures. A female patient with permanent lip liner experienced no complications for one year. Then, after intensive sun exposure she developed solid, linear papules along the outer margin of her lips. Histology revealed a granulomatous tissue reaction with a marked lymphohistiocytic infiltrate including epithelioid histiocytes. Treatment with topical steroids over three weeks led to a complete healing without relapse. To the best of our knowledge this is the first report on UV-light-induced granulomatous reaction to permanent lip liner.
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Affiliation(s)
- C Jäger
- Universitäts-Hautklinik Heidelberg.
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Jappe U, Geier J, Hausen BM. Contact vitiligo following a strong patch test reaction to triglycidyl-p-aminophenol in an aircraft industry worker: case report and review of the literature. Contact Dermatitis 2005; 53:89-92. [PMID: 16033402 DOI: 10.1111/j.0105-1873.2005.00651.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Epoxy resin systems (ERSs) are a frequent cause of occupational allergic contact dermatitis. A 50-year-old patient developed eczematous skin lesions on the back of his hands, lower arms and eye lids, 2 months after he had started working in aircraft construction. Patch tests showed positive reactions at day 3 to nickel sulfate, epoxy resin based on diglycidyl ether of bisphenol F (DGEBF) and 1,4-butanediol diglycidyl ether (1,4-BDDGE). The chemical triglycidyl-p-aminophenol (TGPAP) applied at 1% and 0.1% induced the strongest (+++ positive) reaction. About 4 months after the patch test with TGPAP, the patient presented with 2 circular depigmented spots in the former TGPAP-patch test areas. Dermatohistopathology confirmed the diagnosis of contact vitiligo.
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Affiliation(s)
- U Jappe
- Department of Dermatology and Venereology, University of Heidelberg, Heidelberg, Germany.
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Schnuch A, Kelterer D, Bauer A, Schuster C, Aberer W, Mahler V, Katzer K, Rakoski J, Jappe U, Krautheim A, Bircher A, Koch P, Worm M, Löffler H, Hillen U, Frosch PJ, Uter W. Quantitative patch and repeated open application testing in methyldibromo glutaronitrile-sensitive patients. Contact Dermatitis 2005; 52:197-206. [PMID: 15859992 DOI: 10.1111/j.0105-1873.2005.00529.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Contact allergy to methyldibromo glutaronitrile (MDBGN), often combined with phenoxyethanol (PE) (e.g., Euxyl K 400), increased throughout the 1990s in Europe. Consequently, in 2003, the European Commission banned its use in leave-on products, where its use concentration was considered too high and the non-sensitizing use concentration as yet unknown. The 2 objectives of the study are (a) to find a maximum non-eliciting concentration in a leave-on product in MDBGN/PE-sensitized patients, which could possibly also be considered safe regarding induction and (b) to find the best patch test concentration for MDBGN. We, therefore, performed a use-related test (ROAT) in patients sensitized to MDBGN/PE (n = 39) with 3 concentrations of MDBGN/PE (50, 100 and 250 p.p.m. MDBGN, respectively). A subset of these patients (n = 24) was later patch-tested with various concentrations (0.1, 0.2, 0.3 and 0.5% MDBGN, respectively). 15 patients (38%, 95% confidence interval (CI) = 23-55%) had a negative and 24 (62%; 95% CI = 45-77%) a positive overall repeated open application test (ROAT) result. 13 reacted to the lowest (50 p.p.m.), 8 to the middle (100 p.p.m.) and 3 to the highest concentration (250 p.p.m.) only. In those 13 reacting to the lowest ROAT concentration, dermatitis developed within a few days (1-7). The strength of the initial and the confirmatory patch test result, respectively, and the outcome of the ROAT were positively associated. Of the 24 patients with a use and confirmatory patch test, 15 reacted to 0.1% MDBGN, 16 to 0.2%, 17 to 0.3% and 22 to 0.5%. With the patch test concentration of 0.5%, the number of ROAT-negative patients but patch-test-positive patients increases considerably, particularly due to + reactions. A maximum sensitivity of 94% (95% CI = 70-100%) is reached with a patch test concentration of 0.2%, and is not further improved by increasing the concentration. However, the specificity decreases dramatically from 88 (95% CI = 47-100%) with 0.2% to a mere 12.5% (95% CI = 0-53%) with 0.5%. It can be concluded (a) that for MDBGN 0.2% is very likely the best patch test concentration and (b) that 50 p.p.m. in a leave-on product can elicit contact dermatitis in sensitized persons. We were, therefore, unable to find a safe, still microbicidal, concentration for leave-on products. By contrast, with other contact allergens, dose-response use tests may be able to identify a non-eliciting concentration, which could give valuable clues to a non-inducing (i.e., safe) concentration in products.
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Affiliation(s)
- A Schnuch
- Information Network of Department of Dermatology (IVDK), University of Göttingen, Germany.
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Jappe U, Schnuch A, Uter W. Rosacea and contact allergy to cosmetics and topical medicaments - retrospective analysis of multicentre surveillance data 1995-2002. Contact Dermatitis 2005; 52:96-101. [PMID: 15725288 DOI: 10.1111/j.0105-1873.2005.00514.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The role of contact allergy in rosacea has rarely been investigated. In this retrospective study, 361 out of 76,697 patients tested and documented by the Information Network of Departments of Dermatology between 1995 and 2002 had rosacea. Patch tests included standard series and constituents of cosmetics and topical medicaments. 118/361 had additionally been patch tested with their own cosmetics/medicaments. Positive reactions occurred to nickel (II) sulfate in 9.3%, fragrance mix in 8.8%, thimerosal in 6.9%, Myroxylon pereirae resin in 5.9%, potassium dichromate in 4.6% and propolis in 2.8%. Whereas rosacea patients had a significantly higher risk of contact allergy to propolis compared to the remaining patients, in an age- and sex-adjusted analysis, contact allergy to nickel was significantly less frequent in this group. For Lyral, the risk was elevated, albeit not significantly. Only 2/329 patients were positive to neomycin sulfate and 1/100 to gentamicin sulfate, among the panel of (topical) antibiotics tested. Among 118 patients tested with their own products, 3 were tested to metronidazole, 1 reacting positively. Irritant or doubtful patch test reactions were provoked by various substances (vehicles, oxidants and preservatives of various creams), which might also be clinically important, considering the heightened sensitivity of rosaceous skin.
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Affiliation(s)
- U Jappe
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany.
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Thiel M, Drews O, Behrendt H, Görg A, Traidl-Hoffmann C, Kasche A, Klaus S, Buters J, Weichenmeier I, Krämer U, Gehlhar K, Betzel C, Werner S, Weber W, Bufe A, Rozynek P, Gaspar Â, Rihs HP, Pires G, Brüning T, Raulf-Heimsoth M, Boldt A, Bade S, Gorris HH, Reese G, Riecken S, Becker WM, Viebranz J, Randow S, Lauer I, Moncin MSM, Lehrer SB, Vieths S, van Kampen V, Haamann F, Merget R, Sander I, Jappe U, Hoffmann M, Burow G, Enk A, Kespohl S, Foerster S, Eyerich K, Lubitz S, Schober W, Belloni B, Eberlein-König B, Stassen M, Klein M, Klein-Heßling S, Palmetshofer A, Serfling E, Bopp T, Richter C, Schild H, Schmitt E, Blume C, Förster S, Petersen A, Güttsches A, Zähringer U, Löseke S, Ebling A, Draheim R, Rundfeldt C, Rieber EP, Schäkel K, Abraham S, Meurer M, Rieber P, Gutermuth J, O’Keeffe M, Alessandrini F, Schlatter B, Ring J, Hochrein H, Jakob T, Heib V, Schmitt S, Kubach J, Lutter P, Huter E, Ohlemacher S, Weingarten P, Müller C, Bailey S, Becker C, Knop J, Blüggel M, Hüls C, Jonuleit H, Bellinghausen I, König B, Böttcher I, Saloga J, Hüter E, Schneider FJ, Wicklein D, Stöcker M, Klockenbring T, Huhn M, Barth S, Trujillo-Vargas CM, Erb KJ, Milovanovic M, Heine G, Landeck L, Sabat R, Worm M, Veres T, Weikum O, Weigt H, Krug N, Braun A, Hahn C, Schuhmann B, Mkhlof S, Pirayesh A, Renz H, Nockher WA, Erpenbeck VJ, Sommer S, Malherbe DC, Wright JR, Hohlfeld JM, Bilitewski C, Reinitz-Rademacher K, Rohde G, Ewig S, Schmelz S, Zindler E, Montermann E, Reske-Kunz AB, Sudowe S, Darcan Y, Galle J, Ahmed J, Seitzer U, Sel S, Wegmann M, Nassenstein C, Pollock K, Dawbarn D, Allen SJ, Gupta S, Schulz-Maronde S, Kutzleb C, Kapp A, Forssmann WG, Forssmann U, Elsner J, Fuchs B, Bälder R, Escher SE, Heitland A, Borelli C, Scharrer E, Oppel T, Przybilla B, Ludwig R, Schindewolf M, Hirsch K, Lindhoff-Last E, Kaufmann R, Boehncke WH, Ruäff F, Albert K, Bauer C, Weimer G, Tas E, Bircher A, Kleine-Tebbe J, Herold DA, Ribel M, Hartz C, Miguel-Moncin MMS, Cistero-Bahima A, Conti A, Scheurer S, Fiedler EM, Illner AK, Lee H, Ernst D, Backhaus B, Raithel M, Hahn EG, Nabe A, Straube S, Weidenhiller M, Konturek P, Simon K, Kressel J, Wildner S, Simon D, Mart H, Heer P, Simon HU, Braathen LR, Straumann A, Brockow K, Huss-Marp J, Braun-Falco M, Schmelz M, Darsow U, Preussner LM, Ristau T, Sotlar K, Hartmann K, Gerbaulet A, Baldus SE, Magerl M, Siebenhaar F, Maurer M, Wittmann M, Purwar R, Hartmann C, Stünkel T, Werfel T, Mrabet-Dahbi S, Ahmad-Nejad P, Breuer K, Klotz M, Herz U, Heeg K, Neumaier M, Langer K, Wollenberg A, Soost S, Zuberbier T, Biedermann T, Günther C, Tangemann K, Schwärzler C, Lametschwandtner G, Rot A, Carballido JM, Gibbs BF, Zillikens D, Grabbe J, Zahradnik E, Fleischer C, Dorn I, Eberhardt F, Hartwig D, Rueff F, Hipler UC, Vetter M, Heitmann M, Bauer A, Elsner P, Herzinger T, Summer B, Maier S, Ghoreschi K, Roider G, Thomas P, Freising C, Glaser S, Schäfer T. 17. Mainzer Allergie-Workshop. Allergo J 2005. [DOI: 10.1007/bf03370389] [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: 11/28/2022]
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Affiliation(s)
- C Jaeger
- Department of Dermatology, University of Heidelberg, Vosstrasse. 2, D-69115 Heidelberg, Germany.
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Witte W, Braulke C, Cuny C, Strommenger B, Werner G, Heuck D, Jappe U, Wendt C, Linde HJ, Harmsen D. Emergence of methicillin-resistant Staphylococcus aureus with Panton?Valentine leukocidin genes in central Europe. Eur J Clin Microbiol Infect Dis 2004; 24:1-5. [PMID: 15599784 DOI: 10.1007/s10096-004-1262-x] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The aim of the present study was to investigate strains of methicillin-resistant Staphylococcus aureus (MRSA) for the presence of the lukS-lukF determinant of Panton-Valentine leukocidin and to further characterize strains found to contain the genes. During the past 2 years, MRSA containing the lukS-lukF genes for Panton-Valentine leukocidin, particularly those emerging outside of hospitals, have become of interest. MRSA strains sent to the national reference center in Germany were investigated for lukS-lukF by polymerase chain reaction (PCR). If the presence of lukS-lukF was demonstrated, strains were further characterized by molecular typing (determination of SmaI pattern, spa sequence, and multilocus sequence type), PCR demonstration of resistance genes, and characterization of the SCCmec element. Since the end of 2002, MRSA containing Panton-Valentine leukocidin genes have been demonstrated as the causative agent of 28 cases of infection (9 community-acquired cases, 19 sporadic nosocomial cases) in different areas of Germany. Twenty-seven of these 28 isolates exhibited a unique pattern of genomic typing: all exhibited multilocus sequence type 80, spa sequence type 44, and a SmaI macrorestriction pattern that corresponds to a community-acquired strain of MRSA from France and Switzerland. In addition to resistance to oxacillin, the strains exhibited resistance to ciprofloxacin, tetracycline (tetM), and fusidic acid, the last of which is encoded by the far-1 gene. The far-1 gene was shown to be located on the plasmid. One isolate corresponded to community MRSA (cMRSA) of multilocus sequence type 1 from the USA.
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Affiliation(s)
- W Witte
- Robert Koch Institute, Wernigerode Branch, Burgstrasse 37, 38855 Wernigerode, Germany.
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Jappe U, Boit R, Farrar MD, Ingham E, Sandoe J, Holland KT. Evidence for diversity within Propionibacterium acnes: a comparison of the T-cell stimulatory activity of isolates from inflammatory acne, endocarditis and the laboratory. J Eur Acad Dermatol Venereol 2004; 18:450-4. [PMID: 15196160 DOI: 10.1111/j.1468-3083.2004.00950.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Propionibacterium acnes is primarily associated with the pathogenesis of acne vulgaris but reports are increasing in number implicating P. acnes in other diseases such as abscess formation, meningitis and endocarditis. The pathogenicity of P. acnes is thought to be partly due to the interaction of the bacterium with the immune system. Historically, investigations have focused on humoral and cell-mediated immune responses to P. acnes antigens without attention to the possibility that different antigens may be expressed by different isolates. OBJECTIVE Investigations were performed to determine whether there were differences between a laboratory strain of P. acnes (P-37) and fresh clinical isolates in their ability to stimulate naive and adult lymphocytes. MATERIAL AND METHODS The fresh isolates were collected from a patient with inflammatory acne and a patient with P. acnes-induced prosthetic valve endocarditis. The lymphocyte transformation assay was used to detect responses to whole-cell suspensions of stationary phase P. acnes isolates during 7 days of incubation. RESULTS The acne isolate was significantly more stimulatory for cord blood mononuclear cells (CBMNCs) than the laboratory isolate (P. acnes P-37) at day 4 of incubation. There were no significant differences between the three strains at any other time points. However, the isolate cultivated from inflammatory acne was significantly more stimulatory for peripheral blood mononuclear cells (PBMNCs) from acne donors than the endocarditis isolate or the laboratory strain at most time points. There were no significant differences between the endocarditis strain and the laboratory strain. CONCLUSION It can be hypothesized that in case of P. acnes-induced endocarditis lymphocyte stimulation is a disadvantage for the microorganism and therefore a lack of lymphocyte stimulation may be relevant to the pathogenesis of endocarditis.
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Affiliation(s)
- U Jappe
- Department of Dermatology, University of Heidelberg, Vosstrasse 2, D-69115 Heidelberg, Germany.
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