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Geier J, Ballmer-Weber B, Buhl T, Rieker-Schwienbacher J, Mahler V, Dickel H, Schubert S. Is benzyl alcohol a significant contact sensitizer? J Eur Acad Dermatol Venereol 2022; 36:866-872. [PMID: 35080274 DOI: 10.1111/jdv.17968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/07/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Benzyl alcohol is a widely used preservative, solvent, and fragrance material. According to published data, it is a rare sensitizer in humans. OBJECTIVES To identify characteristics and sensitization patterns of patients with positive patch test reactions to benzyl alcohol and to check the reliability of the patch test preparation benzyl alcohol 1% pet. PATIENTS AND METHODS Retrospective analysis of data from the Information Network of Departments of Dermatology (IVDK), 2010-2019. RESULTS Of 70,867 patients patch tested with benzyl alcohol 1% pet., 146 (0.21%) showed a positive reaction, most of them (89%) only weak positive. The number of doubtful and irritant reactions significantly exceeded the number of positive reactions. Reproducibility of positive test reactions was low. Among benzyl alcohol-positive patients, compared to benzyl alcohol negative patients, there were significantly more patients with leg dermatitis (17.8% vs. 8.6%), more patients aged 40 years or more (81.5% vs. 70.5%), and more patients who were tested because of a suspected intolerance reaction to topical medications (34.9% vs. 16.6%). Concomitant positive reactions were mainly seen to fragrances, preservatives, and ointment bases. CONCLUSIONS Sensitization to benzyl alcohol occurs very rarely, mainly in patients with stasis dermatitis. In view of our results, benzyl alcohol cannot be regarded as a significant contact allergen, and therefore marking it as skin sensitizer 1B and labelling it with H 317 is not helpful.
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Affiliation(s)
- J Geier
- Information Network of Departments of Dermatology (IVDK), Institute at the University Medical Center Göttingen, Göttingen, Germany
| | - B Ballmer-Weber
- Clinic of Dermatology and Allergology, Cantonal Hospital St, Gallen, St. Gallen, Switzerland
| | - T Buhl
- Department of Dermatology, Venereology and Allergy, University Medical Center Göttingen, Göttingen, Germany
| | - J Rieker-Schwienbacher
- Center for Dermatology, Phlebology and Allergology, Klinikum Stuttgart, Stuttgart, Germany
| | - V Mahler
- Department of Dermatology, University Hospital Erlangen, Erlangen, Germany.,current address Paul-Ehrlich-Institut, Langen, Germany
| | - H Dickel
- Department of Dermatology, Venereology and Allergology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - S Schubert
- Information Network of Departments of Dermatology (IVDK), Institute at the University Medical Center Göttingen, Göttingen, Germany
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Herman A, Uter W, Rustemeyer T, Matura M, Aalto-Korte K, Duus Johansen J, Gonçalo M, White IR, Balato A, Giménez Arnau AM, Brockow K, Mortz CG, Mahler V, Goossens A. Position statement: The need for EU legislation to require disclosure and labelling of the composition of medical devices. J Eur Acad Dermatol Venereol 2021; 35:1444-1448. [PMID: 33955077 PMCID: PMC8251888 DOI: 10.1111/jdv.17238] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND In recent years, skin reactions secondary to the use of medical devices (MD), such as allergic contact dermatitis have increasingly been observed (e.g. to continuous blood sugar monitoring systems, insulin pumps, wound dressings, medical gloves, etc.): this is regarded as a developing epidemic. Lack of labelling of the composition of MD, as well as frequent lack of cooperation of manufacturers to disclose this relevant information, even when contacted by the clinician for the individual case of an established adverse reaction, significantly impede patient care. OBJECTIVES To advocate for full ingredient labelling in the implementation of EU regulation for MD. METHODS This position paper reviews the scientific literature, the current regulatory framework adopted for MD to date, and the likely impact, including some costs data in case of the absence of such labelling. RESULTS Efforts made by several scientific teams, who are trying to identify the culprit of such adverse effects, either via asking for cooperation from companies, or using costly chemical analyses of MD, can only partly, and with considerable delay, compensate for the absence of meaningful information on the composition of MD; hence, patient management is compromised. Indeed, without knowing the chemical substances present, physicians are unable to inform patients about which substances they should avoid, and which alternative MD may be suitable/tolerated. CONCLUSION There is an urgent need for full and accurate labelling of the chemical composition of MD in contact with the human body.
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Affiliation(s)
- A Herman
- Department of Dermatology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - W Uter
- Department of Medical Informatics, Biometry and Epidemiology, Univ. Erlangen/Nürnberg, Erlangen, Germany
| | - T Rustemeyer
- Department of Dermatology and Allergology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - M Matura
- Dermatology Unit, Skaraborgs Hospital Skövde, Skövde, Sweden
| | - K Aalto-Korte
- Occupational Health Unit, Finnish Institute of Occupational Heath, Helsinki, Finland
| | - J Duus Johansen
- Department of Dermatology and Allergy, National Allergy Research Centre, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M Gonçalo
- Department of Dermatology, Coimbra University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - I R White
- Cutaneous Allergy Team, St. John's Institute of Dermatology, Guy's Hospital, London, UK
| | - A Balato
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Napoli, Italy
| | - A M Giménez Arnau
- Department of Dermatology, Hospital del Mar. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - K Brockow
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
| | - C G Mortz
- Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
| | - V Mahler
- Med. Faculty, Univ. Erlangen/Nuremberg, Erlangen, Germany
| | - A Goossens
- Contact Allergy Unit, Department of Dermatology, University Hospital KU Leuven, Leuven, Belgium
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3
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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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Mahler V, Mentzer D, Bonertz A, Muraro A, Eigenmann P, Bousquet J, Halken S, Pfaar O, Jutel M, Wahn U, Vieths S, Kaul S. Allergen Immunotherapy (AIT) in children: a vulnerable population with its own rights and legislation - summary of EMA-initiated multi-stakeholder meeting on Allergen Immunotherapy (AIT) for children, held at Paul-Ehrlich-Institut, Langen, Germany, 16.1.2019. Clin Transl Allergy 2020; 10:28. [PMID: 32612805 PMCID: PMC7325268 DOI: 10.1186/s13601-020-00327-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/30/2020] [Indexed: 12/15/2022] Open
Abstract
Concerning development of medicinal products, children belong to a so-called "special population" for which additional legislation applies: Regulation (EC) No 1901/2006 on medicinal products for paediatric use sets up a system of requirements, rewards and incentives to ensure that medicinal products are researched, developed and authorized to meet the therapeutic needs of children. Allergen Immunotherapy (AIT) is believed to contain a strong potential for immunomodulatory effects inducing sustained clinical efficacy after cessation of treatment (disease modifying effect) and thereby may prevent the progression of the atopic march towards asthma manifestation. However, to this day only few data on long-term effects in general exist and even fewer in children. These are predominantly data from open studies, which are strongly influenced in their validity by the known placebo effect of AIT. Furthermore, there are no studies allowing for the conclusion that efficacy in adults are mirrored by a similar efficacy in children and thus, up to now, it is not possible to extrapolate data from adults to children. The Paediatric Committee (PDCO)-European Medicines Agency's (EMA) scientific committee responsible for activities on medicines for children-initiated a Multi-Stakeholder Meeting on AIT for Children held at the Paul-Ehrlich-Institut in Langen, Germany, to provide a platform for discussion and exchange of thoughts to this topic between allergy experts from academia, regulators and AIT-manufacturers. The consented meeting minutes, conclusions and participants are presented.
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Affiliation(s)
- V Mahler
- Paul-Ehrlich-Institut, Paul-Ehrlich-Str. 51-59, 63225 Langen, Germany
| | - D Mentzer
- Paul-Ehrlich-Institut, Paul-Ehrlich-Str. 51-59, 63225 Langen, Germany
| | - A Bonertz
- Paul-Ehrlich-Institut, Paul-Ehrlich-Str. 51-59, 63225 Langen, Germany
| | - A Muraro
- Food Allergy Referral Centre Veneto Region, Department of Women and Child Health, Padua General University Hospital, Padua, Italy
| | - P Eigenmann
- Pediatric Allergy Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - J Bousquet
- Charité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Comprehensive Allergy Center, Department of Dermatology and Allergy, Berlin, Germany.,University Hospital Montpellier, Montpellier, France.,MACVIA-France, Montpellier, France
| | - S Halken
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - O Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Phillipps-Universität Marburg, Marburg, Germany
| | - M Jutel
- Department of Clinical Immunology, Wrocław Medical University, Wrocław, Poland.,ALL-MED Medical Research Institute, Wrocław, Poland
| | - U Wahn
- Pediatric Department, Charité, Berlin, Germany
| | - S Vieths
- Paul-Ehrlich-Institut, Paul-Ehrlich-Str. 51-59, 63225 Langen, Germany
| | - S Kaul
- Paul-Ehrlich-Institut, Paul-Ehrlich-Str. 51-59, 63225 Langen, Germany
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Uter W, Gefeller O, Mahler V, Geier J. Trends and current spectrum of contact allergy in Central Europe: results of the Information Network of Departments of Dermatology (IVDK) 2007–2018*. Br J Dermatol 2020; 183:857-865. [DOI: 10.1111/bjd.18946] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2020] [Indexed: 12/30/2022]
Affiliation(s)
- W. Uter
- Department of Medical Informatics, Biometry and Epidemiology University of Erlangen/Nürnberg Erlangen Germany
| | - O. Gefeller
- Department of Medical Informatics, Biometry and Epidemiology University of Erlangen/Nürnberg Erlangen Germany
| | - V. Mahler
- Paul Ehrlich Institut Langen Germany
| | - J. Geier
- Information Network of Departments of Dermatology University Medical Center Göttingen Germany
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Dickel H, Kuhlmann L, Bauer A, Bircher AJ, Breuer K, Fuchs T, Grabbe J, Mahler V, Pföhler C, Przybilla B, Rieker-Schwienbacher J, Schröder-Kraft C, Simon D, Treudler R, Weisshaar E, Worm M, Trinder E, Geier J. Atopy patch testing with aeroallergens in a large clinical population of dermatitis patients in Germany and Switzerland, 2000-2015: a retrospective multicentre study. J Eur Acad Dermatol Venereol 2020; 34:2086-2095. [PMID: 32003071 DOI: 10.1111/jdv.16250] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 01/22/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND The diagnostic significance of the atopy patch test for the management of dermatitis possibly triggered by aeroallergens is still controversial. However, sufficiently large studies with routinely tested standardized aeroallergen patch test preparations in dermatitis patients are lacking. OBJECTIVE To evaluate the reaction frequency and the reaction profiles of 10 until mid-2015 commercially available, standardized aeroallergen patch test preparations of the 'Stallerpatch' test series (Stallergenes, Antony Cedex, France) in a large multicentre patient cohort. METHODS A retrospective data analysis of patients with suspected aeroallergen-dependent eczematous skin lesions was performed, who were patch tested in 15 Information Network of Departments of Dermatology-associated clinics between 2000 and 2015. Patients were stratified according to their atopic dermatitis (AD) status. RESULTS The study group included 3676 patients (median age 41 years, 34.8% males, 54.5% AD). The most common aeroallergens causing positive patch test reactions were Dermatophagoides pteronyssinus (19.6%), Dermatophagoides farinae (16.9%), birch (6.2%), timothy grass (6.0%), cat dander (5.4%), mugwort (4.9%) and dog dander (4.6%). Reactions to other pollen allergen preparations, that is 5 grasses (3.2%), cocksfoot (2.1%) and plantain (1.6%), were less common. Positive patch test reactions to aeroallergens were consistently more frequent in patients with AD. These patients showed proportionally less dubious, follicular, irritant and weak positive reactions. Independent of AD status, a patient history of past or present allergic rhinitis was associated with an increased chance of a positive aeroallergen patch test reaction to pollen allergens. CONCLUSION The aeroallergen patch test is a useful add-on tool in clinical routine, especially in patients with AD and/or respiratory allergy. A patch test series comprising Dermatophagoides pteronyssinus, Dermatophagoides farinae, birch, timothy grass, cat dander and mugwort seems to be suitable. Controlled studies with specific provocation and elimination procedures are required to further evaluate the diagnostic significance of the proposed screening series.
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Affiliation(s)
- H Dickel
- Department of Dermatology, Venereology and Allergology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - L Kuhlmann
- Department of Gynaecology and Obstetrics, St. Vincenz Hospital, Vestische Caritas Clinics GmbH, Datteln, Germany
| | - A Bauer
- Department of Dermatology, University Allergy Centre, University of Dresden, Dresden, Germany
| | - A J Bircher
- Allergy Unit, Dermatology Clinic, University Hospital Basel, University of Basel, Basel, Switzerland
| | - K Breuer
- Department of Allergology, Dermatologikum Hamburg, Hamburg, Germany
| | - T Fuchs
- Department of Dermatology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - J Grabbe
- Department of Dermatology and Allergology, Kantonsspital Aarau, Aarau, Switzerland
| | - V Mahler
- Department of Dermatology, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - C Pföhler
- Department of Dermatology, Saarland University Medical Center, Homburg/Saar, Germany
| | - B Przybilla
- Department of Dermatology and Allergology, Ludwig Maximilians University of Munich, Munich, Germany
| | - J Rieker-Schwienbacher
- Centre for Dermatology, Phlebology and Allergology, Hospital Stuttgart, Stuttgart, Germany
| | - C Schröder-Kraft
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), BG Hospital Hamburg, Hamburg, Germany
| | - D Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - R Treudler
- Department of Dermatology, Venerology and Allergology, University of Leipzig, Leipzig, Germany
| | - E Weisshaar
- Occupational Dermatology, Department of Dermatology, Ruprecht Karls University of Heidelberg, Heidelberg, Germany
| | - M Worm
- Division of Allergy and Immunology, Department of Dermatology, Allergy and Venerology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - E Trinder
- Department of Medicine I, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - J Geier
- Information Network of Departments of Dermatology (IVDK), University Medical Center Göttingen, Göttingen, Germany
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8
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Mahler V, Becker D. The German Baseline Series: Evolution and History of a National BLS. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_65-1] [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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Heetfeld AB, Schill T, Schröder SS, Forkel S, Mahler V, Pfützner W, Schön MP, Geier J, Buhl T. Challenging a paradigm: skin sensitivity to sodium lauryl sulfate is independent of atopic diathesis. Br J Dermatol 2019; 183:139-145. [PMID: 31562780 DOI: 10.1111/bjd.18564] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Sodium lauryl sulfate (SLS) is the best-studied detergent in irritant contact dermatitis. In atopic dermatitis, the two major pathophysiological abnormalities concern skin barrier function and regulation of cutaneous immune responses. The probability of atopic skin diathesis can be assessed by comprehensive analysis of patient history, as well as clinical and laboratory findings, resulting in the Erlangen Atopy Score (EAS). OBJECTIVES To investigate the impacts of (i) atopic skin diathesis according to the EAS and (ii) the physician-assessed diagnoses 'atopic dermatitis', 'allergic rhinitis' and 'allergic asthma' on SLS skin reactions. METHODS This is a retrospective analysis of data from 2030 consecutive patients patch tested with SLS (0·25% aqueous) from two tertiary referral centres in Germany, from 2008 to 2014. RESULTS Patients with a high probability of atopic skin diathesis showed no significant increase in positive SLS reactions compared with patients without atopic skin diathesis (14·2% vs. 16·8%). The grading of positive SLS skin reactions (1-4) revealed no differences in patients with or without atopic skin diathesis. Furthermore, diagnoses of atopic dermatitis, allergic rhinitis or allergic asthma had no impact on positive SLS skin reactions in multivariate logistic regression analysis. CONCLUSIONS We found no association of increased skin irritability to SLS with atopic skin diathesis, atopic dermatitis, allergic rhinitis or allergic asthma in a large patient cohort. It therefore seems that the test of skin irritability with SLS, which is currently common practice in many centres, does not allow prediction of susceptibility to irritant eczematous inflammation in atopic vs. nonatopic individuals. What's already known about this topic? Irritant contact dermatitis and atopic skin diathesis share impaired skin barrier function as a pathophysiological pattern. Sodium lauryl sulfate (SLS) is tested at 0·25% aqueous as an irritant control in patch testing, and hence the results might be affected by atopic skin diathesis. What does this study add? Challenging a long-standing paradigm, we found no association of increased reactivity to SLS patch tests in individuals with atopic skin diathesis, atopic dermatitis, allergic rhinitis or allergic asthma in a large patient cohort. Thus, irritant control testing with SLS, which is useful in interpreting doubtful allergen patch test results, does not depend on individual atopy status.
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Affiliation(s)
- A B Heetfeld
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37099, Göttingen, Germany
| | - T Schill
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37099, Göttingen, Germany
| | - S S Schröder
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37099, Göttingen, Germany
| | - S Forkel
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37099, Göttingen, Germany
| | - V Mahler
- Paul-Ehrlich-Institut, Langen, Germany.,Department of Dermatology and Allergology, University Medical Center Erlangen, Erlangen, Germany
| | - W Pfützner
- Department of Dermatology and Allergology, Allergy Center Hessen, University Medical Center Marburg, Marburg, Germany
| | - M P Schön
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37099, Göttingen, Germany.,Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37099, Göttingen, Germany
| | - J Geier
- Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37099, Göttingen, Germany.,Information Network of Departments of Dermatology (IVDK), University Medical Center Göttingen, Robert-Koch-Straße 40, 37099, Göttingen, Germany
| | - T Buhl
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37099, Göttingen, Germany.,Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37099, Göttingen, Germany
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10
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Worm M, Bauer A, Elsner P, Mahler V, Molin S, Nielsen T. Efficacy and safety of topical delgocitinib in patients with chronic hand eczema: data from a randomized, double‐blind, vehicle‐controlled phase
II
a study. Br J Dermatol 2019; 182:1103-1110. [DOI: 10.1111/bjd.18469] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2019] [Indexed: 12/31/2022]
Affiliation(s)
- M. Worm
- Division of Allergy and Immunology Department of Dermatology and Allergy Charité Universitätsmedizin Berlin Berlin Germany
| | - A. Bauer
- Department of Dermatology University Allergy Center University Hospital Carl Gustav Carus Technical University Dresden Germany
| | - P. Elsner
- Department of Dermatology University Hospital Jena Jena Germany
| | - V. Mahler
- Department of Dermatology University Hospital Erlangen Erlangen Germany
| | - S. Molin
- Division of Dermatology Queen's University Kingston ON Canada
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11
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Abstract
BACKGROUND The food sector is one of the high-risk areas for occupational irritative and allergic contact eczema. OBJECTIVES The present work provides an overview of the main allergens as well as sensitization frequencies and risk in various food industry occupations. METHODS The literature on type IV sensitization in the food sector is summarized. RESULTS The relative risk of developing a work-related eczema in food processing is increased by more than 3 times. The comparison group was calculated on the basis of the proportion of documented cases in the IVDK (Informationsverbund Dermatologischer Kliniken) network per 100,000 working persons in relation to the average of the years 2005 and 2010. For this purpose, the average risk of all patients was set as reference to 1. Bakers, pastry chefs, cooks and meat and fish processors are mainly affected. In addition to irritant contact eczema, allergic contact eczema and protein contact dermatitis often occur. Leading haptens (main allergens) are rubber ingredients, but also disinfectants and compositae. CONCLUSION Only a few contact allergens are responsible for the majority of job-relevant sensitizations in the food industry.
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Affiliation(s)
- A Bauer
- Klinik und Poliklinik für Dermatologie, Universitäts AllergieCentrum, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - S Schubert
- Informationsverbund Dermatologischer Kliniken (IVDK), Universitätsmedizin Göttingen, Georg-August Universität Göttingen, Göttingen, Deutschland
| | - J Geier
- Informationsverbund Dermatologischer Kliniken (IVDK), Universitätsmedizin Göttingen, Georg-August Universität Göttingen, Göttingen, Deutschland
| | - V Mahler
- Paul-Ehrlich-Institut, Langen, Deutschland.,Med. Fakultät, Universität Erlangen-Nürnberg, Erlangen, Deutschland
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12
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Erfurt-Berge C, Mahler V. Contact Sensitization in Patients With Lower Leg Dermatitis, Chronic Venous Insufficiency, and/or Chronic Leg Ulcer: Assessment of the Clinical Relevance of Contact Allergens. J Investig Allergol Clin Immunol 2019; 27:378-380. [PMID: 29199962 DOI: 10.18176/jiaci.0188] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- C Erfurt-Berge
- Department of Dermatology, University Hospital Erlangen, Erlangen, Germany
| | - V Mahler
- Department of Dermatology, University Hospital Erlangen, Erlangen, Germany
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13
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Aurich S, Spiric J, Engin A, Simon JC, Mahler V, Treudler R. Report of a Case of IgE-Mediated Anaphylaxis to Fenugreek. J Investig Allergol Clin Immunol 2019; 29:56-58. [DOI: 10.18176/jiaci.0328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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14
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Worm M, Francuzik W, Renaudin J, Bilo MB, Cardona V, Scherer Hofmeier K, Köhli A, Bauer A, Christoff G, Cichocka‐Jarosz E, Hawranek T, Hourihane JO, Lange L, Mahler V, Muraro A, Papadopoulos NG, Pföhler C, Poziomkowska‐Gęsicka I, Ruëff F, Spindler T, Treudler R, Fernandez‐Rivas M, Dölle S. Factors increasing the risk for a severe reaction in anaphylaxis: An analysis of data from The European Anaphylaxis Registry. Allergy 2018; 73:1322-1330. [PMID: 29318637 DOI: 10.1111/all.13380] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Preventive measures to decrease the frequency and intensity of anaphylactic events are essential to provide optimal care for allergic patients. Aggravating factors may trigger or increase the severity of anaphylaxis and therefore need to be recognized and avoided. OBJECTIVE To identify and prioritize factors associated with an increased risk of developing severe anaphylaxis. METHODS Data from the Anaphylaxis Registry (122 centers in 11 European countries) were used in logistic regression models considering existing severity grading systems, elicitors, and symptoms to identify the relative risk of factors on the severity of anaphylaxis. RESULTS We identified higher age and concomitant mastocytosis (OR: 3.1, CI: 2.6-3.7) as the most important predictors for an increased risk of severe anaphylaxis. Vigorous physical exercise (OR: 1.5, CI: 1.3-1.7), male sex (OR: 1.2, CI: 1.1-1.3), and psychological burden (OR: 1.4, CI: 1.2-1.6) were more often associated with severe reactions. Additionally, intake of beta-blockers (OR: 1.9, CI: 1.5-2.2) and ACE-I (OR: 1.28, CI: 1.05, 1.51) in temporal proximity to allergen exposition was identified as an important factor in logistic regression analysis. CONCLUSION Our data suggest it may be possible to identify patients who require intensified preventive measures due to their relatively higher risk for severe anaphylaxis by considering endogenous and exogenous factors.
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Affiliation(s)
- M. Worm
- Department of Dermatology and Allergology Charite‐Universitätsmedizin Berlin Berlin Germany
| | - W. Francuzik
- Department of Dermatology and Allergology Charite‐Universitätsmedizin Berlin Berlin Germany
| | - J.‐M. Renaudin
- Allergy Vigilance Network University Hospital Nancy Nancy France
| | - M. B. Bilo
- Department of Internal Medicine/Allergy Unit University Hospital Ospedali Riuniti Ancona Italy
| | - V. Cardona
- Allergy Section, Department of Internal Medicine Hospital Universitari Vall d'Hebron Barcelona Spain
| | | | - A. Köhli
- Division of Allergology University Children's Hospital Zurich Switzerland
| | - A. Bauer
- Department of Dermatology University Allergy Center University Hospital Carl Gustav Carus Technical University Dresden Dresden Germany
| | - G. Christoff
- Faculty of Public Health Medical University‐Sofia Sofia Bulgaria
- Tokuda Medical Centre Allergy Out‐patient Clinic Sofia Bulgaria
| | - E. Cichocka‐Jarosz
- Department of Pediatrics Jagiellonian University Medical College Krakow Poland
| | - T. Hawranek
- Department of Dermatology Paracelsus Private Medical University Salzburg Salzburg Austria
| | | | - L. Lange
- Department of Pediatrics St. Marien‐Hospital Bonn Germany
| | - V. Mahler
- Department of Dermatology University Hospital of Erlangen Friedrich‐Alexander‐University Erlangen Erlangen Germany
| | - A. Muraro
- Department of Mother and Child Health Padua General University Hospital Padua Italy
| | | | - C. Pföhler
- Department of Dermatology Saarland University Hospital Homburg/Saar Germany
| | | | - F. Ruëff
- Department of Dermatology and Allergology Klinikum der Universität München München Germany
| | - T. Spindler
- Department of Pediatric Pneumology and Allergology Lung Centre South‐West Wangen Germany
| | - R. Treudler
- Department of Dermatology, Venerology and Allergology LICA‐Comprehensive Allergy Center Universität Leipzig Leipzig Germany
| | | | - S. Dölle
- Department of Dermatology and Allergology Charite‐Universitätsmedizin Berlin Berlin Germany
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15
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Abstract
Summary
Objectives: The aim of this study is to objectify user critique rendering it usable for quality assurance. Based on formative and summative evaluation results we strive to promote software improvements; in our case, the physician discharge letter composition process at the Department of Dermatology, University Hospital Erlangen, Germany.
Methods: We developed a novel six-step approach to objectify user critique: 1) acquisition of user critique using subjectivist methods, 2) creation of a workflow model, 3) definition of hypothesis and indicators, 4) measuring of indicators, 5) analyzing results, 6) optimization of the system regarding both subjectivist and objectivist evaluation results. In particular, we derived indicators and workflows directly from user critique/narratives. The identified indicators were mapped onto work-flow activities, creating a link between user critique and the evaluated system.
Results: Users criticized a new discharge letter system as “too slow” and “too labor-intensive” in comparison with the previously used system. In a stepwise approach we collected subjective user critique, derived a comprehensive process model including deviations and deduced a set of five indicators for objectivist evaluation: processing time, system-related waiting time, number of mouse clicks, number of keyboard inputs, and throughput time. About 3500 measurements have been performed to compare the work-flow-steps of both systems, regarding 20 discharge letters.Although the difference of the mean total processing time between both systems was statistically insignificant (2011.7 s vs. 1971.5 s; p = 0.457), we detected a significant difference in waiting times (101.8 s vs. 37.2 s; p < 0.001) and number of user interactions (77 vs. 69; p < 0.001) in favor of the old system, thus objectifying user critique.
Conclusions: Our six-step approach enables objectification of user critique, resulting in objective values for continuous quality assurance. To our knowledge no previous study in medical informatics mapped user critique onto workflow steps. Subjectivist analysis prompted us to use the indicator system-related waiting time for the objectivist study, which was rarely done before. We consider combining subjectivist and objectivist methods as a key point of our approach. Future work will concentrate on automated measurement of indicators.
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Cazzaniga S, Apfelbacher C, Diepgen T, Ofenloch R, Weisshaar E, Molin S, Bauer A, Mahler V, Elsner P, Schmitt J, Ballmer‐Weber B, Spring P, Naldi L, Borradori L, Simon D. Patterns of chronic hand eczema: a semantic map analysis of the
CARPE
registry data. Br J Dermatol 2017; 178:229-237. [DOI: 10.1111/bjd.15660] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2017] [Indexed: 11/30/2022]
Affiliation(s)
- S. Cazzaniga
- Department of Dermatology, Inselspital Bern University Hospital Bern Switzerland
- Centro Studi GISED Bergamo Italy
| | - C. Apfelbacher
- Institute of Epidemiology and Preventive Medicine University of Regensburg Regensburg Germany
| | - T. Diepgen
- Department of Clinical Social Medicine Occupational and Environmental Dermatology University Hospital Ruprecht Karls University Heidelberg Germany
| | - R.F. Ofenloch
- Department of Clinical Social Medicine Occupational and Environmental Dermatology University Hospital Ruprecht Karls University Heidelberg Germany
| | - E. Weisshaar
- Department of Clinical Social Medicine Occupational and Environmental Dermatology University Hospital Ruprecht Karls University Heidelberg Germany
| | - S. Molin
- Department of Dermatology and Allergy Ludwig Maximilian University Munich Germany
| | - A. Bauer
- Department of Dermatology University Hospital Carl Gustav Carus Technical University Dresden Dresden Germany
| | - V. Mahler
- Department of Dermatology University Hospital of Erlangen Friedrich Alexander University Erlangen‐Nuremberg Erlangen Germany
| | - P. Elsner
- Department of Dermatology and Dermatological Allergy Friedrich Schiller University Jena Jena Germany
| | - J. Schmitt
- Centre for Evidence‐based Healthcare Medical Faculty Carl Gustav Carus Technical University Dresden Dresden Germany
| | - B.K. Ballmer‐Weber
- Allergy Unit Department of Dermatology University Hospital Zürich Zurich Switzerland
| | - P. Spring
- Department of Dermatology University Hospital of Lausanne CHUV Lausanne Switzerland
| | - L. Naldi
- Centro Studi GISED Bergamo Italy
- Department of Dermatology Papa Giovanni XXIII Hospital Bergamo Italy
| | - L. Borradori
- Department of Dermatology, Inselspital Bern University Hospital Bern Switzerland
| | - D. Simon
- Department of Dermatology, Inselspital Bern University Hospital Bern Switzerland
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17
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Uter W, Amario-Hita J, Balato A, Ballmer-Weber B, Bauer A, Belloni Fortina A, Bircher A, Chowdhury M, Cooper S, Czarnecka-Operacz M, Dugonik A, Gallo R, Giménez-Arnau A, Johansen J, John S, Kieć-Świerczyńska M, Kmecl T, Kręcisz B, Larese Filon F, Mahler V, Pesonen M, Rustemeyer T, Sadowska-Przytocka A, Sánchez-Pérez J, Schliemann S, Schuttelaar M, Simon D, Spiewak R, Valiukevičienė S, Weisshaar E, White I, Wilkinson S. European Surveillance System on Contact Allergies (ESSCA): results with the European baseline series, 2013/14. J Eur Acad Dermatol Venereol 2017. [DOI: 10.1111/jdv.14423] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- W. Uter
- Department of Medical Informatics; Biometry and Epidemiology; Friedrich-Alexander-University Erlangen/Nürnberg; Erlangen Germany
| | - J.C. Amario-Hita
- Department of Dermatology; University Hospital of Puerto Real; Cádiz Spain
| | - A. Balato
- Department of Advanced Biomedical Sciences; University of Naples Federico II; Napoli Italy
| | - B. Ballmer-Weber
- Department of Dermatology; University Hospital Zürich; Zürich Switzerland
- Centre for Dermatology and Allergology; Kantonsspital Luzern; Luzern Switzerland
| | - A. Bauer
- Department of Dermatology; University Hospital Carl Gustav Carus; Technical University of Dresden; Dresden Germany
| | - A. Belloni Fortina
- Pediatric Dermatology Unit; Department of Medicine DIMED; University of Padova; Padova Italy
| | - A. Bircher
- Allergology Unit; Department of Dermatology; University Hospital Basel; Basel Switzerland
| | - M.M.U. Chowdhury
- The Welsh Institute of Dermatology; University Hospital of Wales; Cardiff UK
| | | | | | - A. Dugonik
- Department of Dermatology; University Medical Center Maribor; Maribor Slovenia
| | - R. Gallo
- Clinica Dermatologica; IRCCS - AOU San Martino - IST and Department of Health Sciences; University of Genoa; Genoa Italy
| | - A. Giménez-Arnau
- Department of Dermatology; Hospital del Mar; Universitat Autónoma; Barcelona Spain
| | - J.D. Johansen
- National Allergy Centre/Department of Dermatology; Gentofte Hospital; University of Copenhagen; Hellerup Denmark
| | - S.M. John
- Department of Dermatology; Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm); University of Osnabrück; Lower Saxony Institute for Occupational Dermatology (NIB); Osnabrück Germany
| | - M. Kieć-Świerczyńska
- Department of Dermatology; Nofer Institute of Occupational Medicine; Łodz Poland
| | - T. Kmecl
- Department of Dermatology; General Hospital Celje; Celje Slovenia
| | - B. Kręcisz
- Department of Dermatology; Nofer Institute of Occupational Medicine; Łodz Poland
- Faculty of Medicine and Health Science; Institute of Medical Science; Jan Kochanowski University; Kielce Poland
| | - F. Larese Filon
- Department of Public Health, Occupational Medicine; University of Trieste; Trieste Italy
| | - V. Mahler
- Department of Dermatology; University Hospital Erlangen; Friedrich-Alexander-University Erlangen-Nürnberg; Erlangen Germany
| | - M. Pesonen
- Occupational Medicine; Finnish Institute of Occupational Health (FIOH); Helsinki Finland
| | - T. Rustemeyer
- Department of Dermatology; Free University of Amsterdam; Amsterdam The Netherlands
| | | | - J. Sánchez-Pérez
- Department of Dermatology; Hospital Universitario la Princesa; Madrid Spain
| | - S. Schliemann
- Department of Dermatology and Allergology; University Hospital Jena; Jena Germany
| | - M.L. Schuttelaar
- Department of Dermatology; University Medical Centre Groningen; University of Groningen; Groningen The Netherlands
| | - D. Simon
- Department of Dermatology; Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
| | - R. Spiewak
- Department of Experimental Dermatology and Cosmetology; Faculty of Pharmacy; Jagiellonian University Medical College; Krakow Poland
| | - S. Valiukevičienė
- Department of Skin and Venereal Diseases; Lithuanian University of Health Sciences; Kaunas Lithuania
| | - E. Weisshaar
- Department of Clinical Social Medicine; University Hospital Heidelberg; Heidelberg Germany
| | - I.R. White
- St. John's Institute of Dermatology; Guy's Hospital; London UK
| | - S.M. Wilkinson
- Dermatology; Leeds Teaching Hospitals NHS Trust; Leeds UK
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18
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Mahler V, Drexler H, Bauer A, Diepgen T, Skudlik C. 14. Tagung der Arbeitsgemeinschaft für Berufs- und Umweltdermatologie (ABD), 7. – 9. September 2017, Erlangen. DB 2017; 65:99-132. [DOI: 10.5414/dbx00302] [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: 09/02/2023]
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Mahler V, Aalto-Korte K, Alfonso J, Bakker J, Bauer A, Bensefa-Colas L, Boman A, Bourke J, Bubaš M, Bulat P, Chaloupka J, Constandt L, Danielsen T, Darlenski R, Dugonik A, Ettler K, Gimenez-Arnau A, Gonçalo M, Johansen J, John S, Kiec-Swierczynska M, Koch P, Kohánka V, Krecisz B, Larese Filon F, Ljubojević S, Macan J, Marinović B, Matura M, Mihatsch P, Mijakoski D, Minov J, Pace J, Pesonen M, Ramada Rodilla J, Rast H, Reljic V, Salavastru C, Schuster C, Schuttelaar M, Simon D, Spiewak R, Jurakic Tončić R, Urbanček S, Valiukevičienė S, Weinert P, Wilkinson M, Uter W. Occupational skin diseases: actual state analysis of patient management pathways in 28 European countries. J Eur Acad Dermatol Venereol 2017; 31 Suppl 4:12-30. [DOI: 10.1111/jdv.14316] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 03/24/2017] [Indexed: 11/27/2022]
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20
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Alfonso J, Bauer A, Bensefa-Colas L, Boman A, Bubas M, Constandt L, Crepy M, Goncalo M, Macan J, Mahler V, Mijakoski D, Ramada Rodilla J, Rustemeyer T, Spring P, John S, Uter W, Wilkinson M, Giménez-Arnau A. Minimum standards on prevention, diagnosis and treatment of occupational and work-related skin diseases in Europe - position paper of the COST Action StanDerm (TD 1206). J Eur Acad Dermatol Venereol 2017; 31 Suppl 4:31-43. [DOI: 10.1111/jdv.14319] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2017] [Indexed: 12/23/2022]
Affiliation(s)
- J.H. Alfonso
- Department of Occupational Medicine and Epidemiology; National Institute of Occupational Health; Oslo Norway
| | - A. Bauer
- Department of Dermatology; University Allergy Center; University Hospital Carl Gustav Carus; Technical University Dresden; Dresden Germany
| | - L. Bensefa-Colas
- Department of Occupational and Environmental Diseases; AP-HP; Paris Descartes University; Sorbonne Paris Cité; Paris France
- Laboratoire Santé Publique et Environnement; Paris France
| | - A. Boman
- Institute of Environmental Medicine; Occupational and Environmental Dermatology; Stockholm Sweden
| | - M. Bubas
- Department for Education and Information; Croatian Institute for Health Protection and Safety at Work; Zagreb Croatia
| | - L. Constandt
- Fedris, Agence Fédérale des risques professionnels; Brussels Belgium
| | - M.N. Crepy
- Department of Occupational and Environmental Diseases; AP-HP; Paris Descartes University; Sorbonne Paris Cité; Paris France
| | - M. Goncalo
- Clinic of Dermatology; University Hospital and Faculty of Medicine; University of Coimbra; Coimbra Portugal
| | - J. Macan
- Unit for Occupational and Environmental Health; Institute for Medical Research and Occupational Health; Zagreb Croatia
| | - V. Mahler
- Department of Dermatology; University Hospital of Erlangen; Erlangen Germany
| | - D. Mijakoski
- Institute for Occupational Health of Republic of Macedonia; Skopje Macedonia
| | - J.M. Ramada Rodilla
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM); CIBER de Epidemiología y Salud Pública (CIBERESP); Barcelona Spain
| | - T. Rustemeyer
- Department of Dermatology and Allergology; VU University Medical Centre; Amsterdam The Netherlands
| | - P. Spring
- Department of Dermatology; University of Lausanne; Lausanne Switzerland
| | - S.M. John
- Department of Dermatology, Environmental Medicine; University of Osnabrück; Osnabrück Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück; Lower-Saxony Institute of Occupational Dermatology (NIB); Osnabrück Germany
| | - W. Uter
- Department of Medical Informatics, Biometry and Epidemiology; Friedrich-Alexander Universität Erlangen/Nürnberg; Erlangen Germany
| | | | - A.M. Giménez-Arnau
- Department of Dermatology; Hospital del Mar; Institut Mar d´Investigacions Mèdiques (IMIM); Universitat Autònoma de Barcelona; Barcelona Spain
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21
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Maurer M, Staubach P, Raap U, Richter-Huhn G, Bauer A, Ruëff F, Jakob T, Yazdi AS, Mahler V, Wagner N, Lippert U, Hillen U, Schwinn A, Pawlak M, Behnke N, Chaouche K, Chapman-Rothe N. H1-antihistamine-refractory chronic spontaneous urticaria: it's worse than we thought - first results of the multicenter real-life AWARE study. Clin Exp Allergy 2017; 47:684-692. [PMID: 28160338 DOI: 10.1111/cea.12900] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 10/05/2016] [Accepted: 01/12/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Most data on chronic spontaneous urticaria (CSU) originate from highly selected patient populations treated at specialized centres. Little is known about CSU patient characteristics and the burden of CSU in routine clinical practice. AWARE (A World-wide Antihistamine-Refractory chronic urticaria patient Evaluation) is an ongoing global study designed to assess chronic urticaria in the real-life setting. OBJECTIVE To describe the baseline characteristics of the first 1539 German AWARE patients with H1-antihistamine-refractory CSU. METHODS This prospective non-interventional study included patients (18-75 years) with a diagnosis of H1-antihistamine-refractory CSU for > 2 months. Baseline demographic and disease characteristics, comorbidities, and pharmacological treatments were recorded. Quality of life (QoL) was assessed using the dermatology life quality index (DLQI), chronic urticaria QoL questionnaire (CU-Q2 oL), and angioedema QoL questionnaire (AE-QoL, in cases of angioedema). Previous healthcare resource utilization and sick leave data were collected retrospectively. RESULTS Between March and December 2014, 1539 patients were assessed in 256 sites across Germany. The percentage of females, mean age, and mean body mass index were 70%, 46.3 years, and 27 kg/m2 , respectively. The mean urticaria control test score was 7.9, one in two patients had angioedema, and the most frequent comorbidities were chronic inducible urticaria (CIndU; 24%), allergic rhinitis (18.2%), hypertension (18.1%), asthma (12%), and depression (9.5%). Overall, 57.6% of patients were receiving at least one pharmacological treatment including second-generation H1-antihistamines (46.3%), first-generation H1-antihistamines (9.1%), and corticosteroids (15.8%). The mean DLQI, total CU-Q2 oL, and total AE-QoL scores were 8.3, 36.2, and 46.8, respectively. CSU patients reported frequent use of healthcare resources, including emergency services (29.7%), general practitioners (71.9%), and additional allergists or dermatologists (50.7%). CONCLUSIONS AND CLINICAL RELEVANCE This study reveals that German H1-antihistamine-refractory CSU patients have high rates of uncontrolled disease, angioedema, and comorbid CIndU, are undertreated, have impaired QoL, and rely heavily on healthcare resources.
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Affiliation(s)
- M Maurer
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - P Staubach
- Department of Dermatology, University Hospital Mainz, Mainz, Germany
| | - U Raap
- Department of Dermatology and Allergy, Klinikum Oldenburg AöR, University of Oldenburg, Oldenburg, Germany
| | | | - A Bauer
- Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - F Ruëff
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
| | - T Jakob
- Department of Dermatology and Allergology, Justus Liebig University, University Medical Center Gießen and Marburg, Gießen, Germany.,Department of Dermatology, Medical Center - University of Freiburg, Freiburg, Germany
| | - A S Yazdi
- Department of Dermatology, University of Tübingen, Tübingen, Germany
| | - V Mahler
- Department of Dermatology, University Hospital Erlangen, Erlangen, Germany
| | - N Wagner
- Department of Dermatology, Clinical Centre Darmstadt, Darmstadt, Germany
| | - U Lippert
- Department of Dermatology, Venereology and Allergology, University Medical Center, Georg-August-University, Göttingen, Germany
| | - U Hillen
- Department of Dermatology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - A Schwinn
- Praxis für Dermatologie, Memmingen, Germany
| | - M Pawlak
- Hautarztpraxis, Heilbad Heiligenstadt, Germany
| | - N Behnke
- Hautarztpraxis, Panketal, Germany
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Giménez-Arnau A, Deza G, Bauer A, Johnston G, Mahler V, Schuttelaar ML, Sanchez-Perez J, Silvestre J, Wilkinson M, Uter W. Contact allergy to preservatives: ESSCA* results with the baseline series, 2009-2012. J Eur Acad Dermatol Venereol 2017; 31:664-671. [DOI: 10.1111/jdv.14063] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 10/26/2016] [Indexed: 11/30/2022]
Affiliation(s)
- A.M. Giménez-Arnau
- Department of Dermatology; Hospital del Mar; Universitat Autònoma de Barcelona (UAB); Barcelona Spain
| | - G. Deza
- Department of Dermatology; Hospital del Mar; Universitat Autònoma de Barcelona (UAB); Barcelona Spain
| | - A. Bauer
- Department of Dermatology; University Hospital Carl Gustav Carus; Technical University Dresden; Dresden Germany
| | - G.A. Johnston
- Department of Dermatology; Leicester Royal Infirmary; Leicester UK
| | - V. Mahler
- Department of Dermatology; University Hospital Erlangen; Erlangen Germany
| | - M.-L. Schuttelaar
- Department of Dermatology; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - J. Sanchez-Perez
- Department of Dermatology; Hospital Universitario La Princesa; Madrid Spain
| | - J.F. Silvestre
- Department of Dermatology; Hospital General Universitario de Alicante; Alicante Spain
| | - M. Wilkinson
- Department of Dermatology; Chapel Allerton Hospital; Leeds UK
| | - W. Uter
- Department of Medical Informatics, Biometry and Epidemiology; University of Erlangen-Nuremberg; Erlangen Germany
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Ofenloch R, Apfelbacher C, Weisshaar E, Molin S, Bauer A, Mahler V, Elsner P, Diepgen T. Determinanten der Lebensqualität von Patienten mit chronischem Handekzem im 2-Jahres Verlauf. Gesundheitswesen 2016. [DOI: 10.1055/s-0036-1586659] [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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Mihatsch P, Boyd P, Krzyzak L, Lechmann M, Nicolas J, Mahler V, Steinkasserer A, Vocanson M. 370 Soluble CD83 inhibits skin inflammation to chemical sensitizers. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.06.390] [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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Abstract
BACKGROUND In Germany, occupational skin diseases rank first in the occupational skin disease statistics for many years. Especially, occupationally acquired contact allergies as well as multi-sensitization are the most important predictors for a poor prognosis and persistent eczema. OBJECTIVES To update the spectrum and sensitization frequencies of most frequent allergens from the standard series in Germany in patients with occupationally acquired type IV sensitizations in general and within different occupational groups. METHODS Data of all employed patients (age range: 16-68 years, n = 14234) patch tested between 2003 and 2013 in the German Departments of the Information Network of Departments of Dermatology (IVDK) and diagnosed occupationally acquired contact dermatitis after patch testing were analyzed. The control group was composed of all other patients (n = 31706) within the same time frame, in which occupationally acquired allergic contact dermatitis was negated explicitly. RESULTS The prevalence Ratio (PR; indicating risk) was significantly increased for: Thiuram-mix (PR 5.63 95 %CI 4.97-6.4), zinkdiethyldithiocarbamate (PR 6.22 95 %CI 4.76-8.22), mercaptobenzothiazole (MBT) (PR 3.88 95 %CI 3.09-4.89), mercapto-mix without MBT (PR 3.23 95 %CI 2.59-4.03), N-isopropyl-N'-phenyl-p-phenylene diamine (IPPD) (PR 2.3195 %CI 1.87-2.86), epoxy resin (PR 2.82 95 %CI 2.45-3.25), chloromethylisothiazolinone/methylisothiazolinone (MCI/MI) (PR 2.19 95 %CI 1.97-2.42) and compositae mix II (PR 2.05 95 %CI 1.45-2.89). They were the predominant occupational allergens and were at least associated with a doubled risk (PR ≥ 2.0) for acquiring occupationally allergic contact dermatitis. The highest risk increase was identified in employees in the health services, in agriculture, metal industry, food and service industry as well as building trades CONCLUSIONS A limited number of occupationally relevant allergens cause the majority of sensitizations in the workforce, if standard series allergens are concerned. Data analysis of national and international contact allergy data bases provide valuable information on sensitization rates and profiles in skin risk occupations to implement targeted prevention strategies. To diagnose occupational allergic contact dermatitis in individual cases additional testing of occupation related patch test series as well as patients' own products is commonly inevitable.
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Affiliation(s)
- A Bauer
- Klinik und Poliklinik für Dermatologie, UniversitätsAllergieZentrum, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - J Geier
- Informationsverbund Dermatologischer Kliniken (IVDK), Universitätsmedizin Göttingen, Georg-August Universität Göttingen, Göttingen, Deutschland
| | - V Mahler
- Hautklinik, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen/Nürnberg, Erlangen, Deutschland
| | - W Uter
- Institut für Medizininformatik, Biometrie und Epidemiologie, Friedrich-Alexander Universität Erlangen/Nürnberg, Erlangen, Deutschland
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Apfelbacher C, Weiß M, Molin S, Bauer A, Mahler V, Schmitt J, Elsner P, Diepgen T, Weisshaar E. Which factors are associated with the use of systemic antihistamines in patients with chronic hand eczema? Results from the CARPE registry. J Eur Acad Dermatol Venereol 2015; 30:50-6. [DOI: 10.1111/jdv.13398] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 08/04/2015] [Indexed: 01/27/2023]
Affiliation(s)
- C. Apfelbacher
- Medical Sociology; Institute of Epidemiology and Preventive Medicine; University of Regensburg; Regensburg Germany
| | - M. Weiß
- Department of Clinical Social Medicine, Occupational and Environmental Dermatology; University Hospital, Ruprecht Karls University Heidelberg; Heidelberg Germany
| | - S. Molin
- Department of Dermatology and Allergy; Ludwig Maximilian University; Munich Germany
| | - A. Bauer
- Department of Dermatology; University Hospital Carl Gustav Carus, Technical University Dresden; Dresden Germany
- University Allergy Center (UAC); University Hospital Carl Gustav Carus, Technical University Dresden; Dresden Germany
| | - V. Mahler
- Department of Dermatology; University Hospital of Erlangen, Friedrich-Alexander-University Erlangen; Erlangen Germany
| | - J. Schmitt
- University Allergy Center (UAC); University Hospital Carl Gustav Carus, Technical University Dresden; Dresden Germany
- Centre for Evidence-based Healthcare; Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden; Dresden Germany
| | - P. Elsner
- Department of Dermatology and Dermatological Allergy; Friedrich-Schiller-University Jena; Jena Germany
| | - T.L. Diepgen
- Department of Clinical Social Medicine, Occupational and Environmental Dermatology; University Hospital, Ruprecht Karls University Heidelberg; Heidelberg Germany
| | - E. Weisshaar
- Department of Clinical Social Medicine, Occupational and Environmental Dermatology; University Hospital, Ruprecht Karls University Heidelberg; Heidelberg Germany
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Breuer K, Lipperheide C, Lipke U, Zapf T, Dickel H, Treudler R, Molin S, Mahler V, Pföhler C, Löffler H, Schwantes H, Schnuch A. Contact allergy induced by bisphenol A diglycidyl ether leachables from aluminium tubes for pharmaceutical use. Allergy 2015; 70:220-6. [PMID: 25582652 DOI: 10.1111/all.12538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Aluminium tubes for pharmaceutical use are internally lacquered with epoxy resins (ER) based on bisphenol A diglycidyl ether (BADGE). Recently, it was shown that remnants of ER polymerization like BADGE are extractable from epoxy-based coatings of commercially available tubes and may leach into semi-solid drug preparations. We aimed to evaluate the safety of BADGE-contaminated macrogol ointments in individuals sensitized to ER based on BADGE by use tests. METHODS Repeated open application testing (ROAT) in 11 patients sensitized to ER based on BADGE with BADGE in macrogol ointments (3 mg/kg; 30 mg/kg, equivalent to BADGE concentration determined in macrogol ointment after storage in a commercially available tube; 300 mg/kg). RESULTS The 30 mg/kg BADGE ointment elicited reactions in three patients, and another three patients reacted to 300 mg/kg BADGE ointment. No reactions to the vehicle control and 3 mg/kg BADGE were observed. CONCLUSIONS Elevated BADGE concentrations in ER-coated aluminium tubes pose a risk of developing contact dermatitis to patients sensitized to ER based on BADGE. Quality standards are deemed necessary for the production of ER-coated aluminium tubes intended for pharmaceutical use and should consider the results of the present ROAT study.
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Affiliation(s)
- K. Breuer
- Department of Allergology and Occupational Dermatology; Dermatologikum Hamburg; Hamburg Germany
| | - C. Lipperheide
- Federal Institute for Drugs and Medical Devices (BfArM); Bonn Germany
| | - U. Lipke
- Federal Institute for Drugs and Medical Devices (BfArM); Bonn Germany
| | - T. Zapf
- Federal Institute for Drugs and Medical Devices (BfArM); Bonn Germany
| | - H. Dickel
- Department of Dermatology, Venereology and Allergology; St. Josef-Hospital; Ruhr-University Bochum; Bochum Germany
| | - R. Treudler
- Department of Dermatology, Venereology and Allergology; University of Leipzig; Leipzig Germany
| | - S. Molin
- Department of Dermatology and Allergology; Ludwig Maximilians University; Munich Germany
| | - V. Mahler
- Department of Dermatology; University Hospital of Erlangen; Erlangen Germany
| | - C. Pföhler
- Department of Dermatology; Saarland University Medical School; Homburg/Saar Germany
| | - H. Löffler
- Department of Dermatology; SLK-Kliniken; Heilbronn Germany
| | - H. Schwantes
- Department of Occupational Dermatology; Berufsgenossenschaftliche-Klinik Falkenstein; Falkenstein Germany
| | - A. Schnuch
- Information Network of Departments of Dermatology; University of Göttingen; Göttingen Germany
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Van Hemelen D, Mahler V, Fischer G, Fae I, Reichl-Leb V, Pickl W, Jutel M, Smolinska S, Ebner C, Bohle B, Jahn-Schmid B. HLA class II peptide tetramers vs allergen-induced proliferation for identification of allergen-specific CD4 T cells. Allergy 2015; 70:49-58. [PMID: 25236500 DOI: 10.1111/all.12524] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Fluorescence-labeled MHC class II/peptide tetramer complexes are considered as optimal tools to characterize allergen-specific CD4(+) T cells, but this technique is restricted to frequently expressed HLA class II molecules and knowledge of immunodominant epitopes. In contrast, allergen-stimulated proliferation assessed by CFSE dilution is less sophisticated and widely applicable. The major mugwort allergen, Art v 1, contains only one single, immunodominant, HLA-DR1-restricted epitope (Art v 125-36 ). Thus, essentially all Art v 1-reactive cells should be identified by a HLA-DRB1*01:01/Art v 119-36 tetramer. METHODS We compared specificity and sensitivity of tetramer(+) and allergen-induced proliferating (CFSE(lo) ) CD4(+) T cells by flow cytometry. RESULTS The frequency of tetramer(+) CD4(+) T cells determined ex vivo in PBMC of mugwort-allergic individuals ranged from 0 to 0.029%. After 2-3 weeks of in vitro expansion, sufficient tetramer(+) T cells for phenotyping were detected in 83% of Art v 125-36 -reactive T-cell lines (TCL) from mugwort-allergic individuals, but not in TCL from healthy individuals. The tetramers defined bona fide Th2 cells. Notably, Art v 125-36 -reactive TCL depleted of tetramer(+) T cells still reacted to the peptide, and only 44% of Art v 125-36 -specific T-cell clones were detected by the tetramer. CFSE(lo) CD4(+) T cells contained only 0.3-10.7% of tetramer(+) T cells and very low proportions of Th2 cells. CONCLUSION Allergen-specific T cells can be identified by HLA class II tetramers with high specificity, but unexpected low sensitivity. In contrast, allergen-stimulated CFSE(lo) CD4(+) T cells contain extremely high fractions of bystander cells. Therefore, for T-cell monitoring, either method should be interpreted with caution.
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Affiliation(s)
- D. Van Hemelen
- Department of Pathophysiology and Allergy Research; Center for Pathophysiology; Infectiology and Immunology; Medical University of Vienna; Vienna Austria
| | - V. Mahler
- Department of Dermatology; University of Erlangen; Erlangen Germany
| | - G. Fischer
- Department of Blood Group Serology; Medical University of Vienna; Vienna Austria
| | - I. Fae
- Department of Blood Group Serology; Medical University of Vienna; Vienna Austria
| | - V. Reichl-Leb
- Institute of Immunology; Medical University of Vienna; Vienna Austria
- Christian Doppler Laboratory for Immunomodulation; Medical University of Vienna; Vienna Austria
| | - W. Pickl
- Institute of Immunology; Medical University of Vienna; Vienna Austria
- Christian Doppler Laboratory for Immunomodulation; Medical University of Vienna; Vienna Austria
| | - M. Jutel
- Department of Clinical Immunology; Wroclaw Medical University and ‘ALL-MED’ Medical Research Institute; Wroclaw Poland
| | - S. Smolinska
- Department of Clinical Immunology; Wroclaw Medical University and ‘ALL-MED’ Medical Research Institute; Wroclaw Poland
| | - C. Ebner
- Allergieambulatorium Reumannplatz; Vienna Austria
| | - B. Bohle
- Department of Pathophysiology and Allergy Research; Center for Pathophysiology; Infectiology and Immunology; Medical University of Vienna; Vienna Austria
- Christian Doppler Laboratory for Immunomodulation; Medical University of Vienna; Vienna Austria
| | - B. Jahn-Schmid
- Department of Pathophysiology and Allergy Research; Center for Pathophysiology; Infectiology and Immunology; Medical University of Vienna; Vienna Austria
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Apfelbacher C, Popielnicki A, Bauer A, Diepgen TL, Elsner P, Dawsey R, Mahler V, Molin S, Schmitt J, Weisshaar E, Ofenloch RF. Severity And Functional Disability Of Patients With Occupational Contact Dermatitis: Validation Of The German Version Of The Occupational Contact Dermatitis Disease Severity Index (ODDI). Value Health 2014; 17:A567. [PMID: 27201885 DOI: 10.1016/j.jval.2014.08.1889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | | | - A Bauer
- University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | | | - P Elsner
- University Hospital Jena, Jena, Germany
| | | | - V Mahler
- University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - S Molin
- Ludwig-Maximilians-University Munich, München, Germany
| | - J Schmitt
- Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - E Weisshaar
- University Hospital Heidelberg, Heidelberg, Germany
| | - R F Ofenloch
- University Hospital Heidelberg, Heidelberg, Germany
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Ofenloch R, Diepgen T, Molin S, Weisshaar E, Bauer A, Mahler V, Elsner P, Apfelbacher C. Validität und Reliabilität der deutschen Version des Occupational Contact Dermatitis Disease Severity Index (ODDI). Gesundheitswesen 2014. [DOI: 10.1055/s-0034-1386982] [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: 10/24/2022]
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Affiliation(s)
- V. Mahler
- Hautklinik am Universitätsklinikum Erlangen
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Thomas P, Stauner K, Schraml A, Mahler V, Banke IJ, Gollwitzer H, Burgkart R, Prodinger PM, Schneider S, Pritschet M, Mazoochian F, Schopf C, Steinmann A, Summer B. [Characteristics of 200 patients with suspected implant allergy compared to 100 symptom-free arthroplasty patients]. Orthopade 2014; 42:607-13. [PMID: 23907451 DOI: 10.1007/s00132-012-2038-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Data on implant allergies are incomplete; therefore, we compared the data on allergy history, patch test (PT) and lymphocyte transformation test (LTT) results in a patient series from the Munich implant allergy outpatient department with symptom-free arthroplasty patients. PATIENTS AND METHODS In this study 200 arthroplasty patients with complaints involving the prosthesis (130 female, 187 knee and 13 hip prostheses) and in parallel 100 symptom-free patients (75 female, 47 knee and 53 hip prostheses) were investigated. A questionnaire-aided history including implant type, cementing, intolerance of dental materials, atopy, cutaneous metal intolerance (CMI) and PT, including a standard series with Ni, Co, Cr, seven bone cement components, including gentamicin and benzoyl peroxide and LTT for Ni, Co and Cr. RESULTS In the knee arthroplasty patients with complaints 9.1% showed dental material intolerance, 23.5% atopy, 25.7% CMI, 18.2% metal allergies, 7.4% gentamicin allergy and 27.8% positive metal LTT (mostly to Ni). In symptom-free patients 0% showed dental material intolerance, 19.1% atopy, 12.8% CMI, 12.8% metal allergy, 0% gentamicin allergy and 17% positive metal LTT. CONCLUSIONS Characteristics of the patients with complaints were increased intolerance of dental materials, higher rates of atopy, CMI, metal and gentamicin allergy and LTT reactivity.
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Affiliation(s)
- P Thomas
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Ludwig-Maximilians-Universität München, Frauenlobstr. 9-11, 80337, München, Deutschland.
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Zimmermann S, Achenbach S, Wolf M, Janka R, Marwan M, Mahler V. Recurrent shock and pulmonary edema due to acetazolamide medication after cataract surgery. Heart Lung 2013; 43:124-6. [PMID: 24388201 DOI: 10.1016/j.hrtlng.2013.11.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 11/25/2013] [Accepted: 11/27/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVE We report a patient with recurrent shock and transient non-cardiogenic pulmonary edema within a period of two months - every time occurring after cataract surgery and a single oral dose of standard post-operative medication with acetazolamide. DATA SOURCES Records of the intensive care unit, review of the literature. CONCLUSIONS This case demonstrates a rare but severe side effect of acetazolamide. We also present a review of the literature to raise the awareness of health care providers for this special form of non-cardiogenic pulmonary edema.
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Affiliation(s)
- S Zimmermann
- Department of Cardiology, University-Hospital of Erlangen-Nuremberg, Germany.
| | - S Achenbach
- Department of Cardiology, University-Hospital of Erlangen-Nuremberg, Germany
| | - M Wolf
- Department of Pneumology, University-Hospital of Erlangen-Nuremberg, Germany
| | - R Janka
- Department of Radiology, University-Hospital of Erlangen-Nuremberg, Germany
| | - M Marwan
- Department of Cardiology, University-Hospital of Erlangen-Nuremberg, Germany
| | - V Mahler
- Department of Dermatology, University-Hospital of Erlangen-Nuremberg, Germany
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Jamin A, Wangorsch A, Mahler V, Malczyk AH, Bartel D, Foetisch K, Lidholm J, Vieths S, Scheurer S. Identification and characterization of Lyc e 4, a Bet v 1 homologous PR-10 protein, in tomato fruits. Clin Transl Allergy 2013. [PMCID: PMC3723464 DOI: 10.1186/2045-7022-3-s3-p87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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van Kampen V, de Blay F, Folletti I, Kobierski P, Moscato G, Olivieri M, Quirce S, Sastre J, Walusiak-Skorupa J, Kotschy-Lang N, Müsken H, Mahler V, Schliemann S, Ochmann U, Sültz J, Worm M, Sander I, Zahradnik E, Brüning T, Merget R, Raulf-Heimsoth M. Evaluation of commercial skin prick test solutions for selected occupational allergens. Allergy 2013; 68:651-8. [PMID: 23421494 DOI: 10.1111/all.12116] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Skin prick testing (SPT) is an important step in the diagnosis of IgE-mediated occupational allergic diseases. The outcome of SPT is related to the quality of allergen extracts. Thus, the aim of the study was to assess different commercially available SPT solutions for selected occupational allergens. METHODS SPT was performed in 116 bakers, 47 farmers and 33 subjects exposed to natural rubber latex (NRL), all with work-related allergic symptoms. The SPT solutions from different manufacturers (n = 3-5) for wheat flour, rye flour, soy, cow hair/dander, storage mites (Tyrophagus putrescentiae, Lepidoglyphus destructor, Acarus siro) and NRL were analysed with respect to their protein and antigen contents. SPT was carried out in 16 allergy centres in six European countries using standardized procedures. Specific IgE values were used as the gold standard to calculate the sensitivity and specificity of SPT solutions. The optimal cut-point for each SPT solution was determined by Youden Index. RESULTS Protein and antigen contents and patterns of the SPT solutions varied remarkably depending on the manufacturer. While SPT solutions for wheat flour and soy reached overall low sensitivities, sensitivities of other tested SPT solutions depended on the manufacturer. As a rule, solutions with higher protein and antigen content showed higher sensitivities and test efficiencies. CONCLUSIONS There is a wide variability of SPT solutions for occupational allergens, and the sensitivity of several solutions is low. Thus, improvement and standardization of SPT solutions for occupational allergens is essential.
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Affiliation(s)
- V. van Kampen
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance Ruhr-University Bochum (IPA); Bochum; Germany
| | - F. de Blay
- Department of Chest Diseases; University Hospital Strasbourg; Strasbourg; France
| | - I. Folletti
- Occupational Medicine; Terni Hospital; University of Perugia; Perugia; Italy
| | - P. Kobierski
- Rehabilitation Clinic Tobelbad; Austrian workers compensation board; Tobelbad; Austria
| | - G. Moscato
- Allergy and Immunology Unit; Fondazione ‘Salvatore Maugeri’; Institute of Research and Care; Scientific Institute of Pavia; Pavia
| | - M. Olivieri
- Unit of Occupational Medicine; University Hospital of Verona; Verona; Italy
| | - S. Quirce
- Department of Allergy; Hospital La Paz (IdiPAZ) and CIBER of Respiratory Diseases CIBERES; Madrid
| | - J. Sastre
- Department of Allergy; Fundación Jiménez Díaz and CIBER of Respiratory Diseases CIBERES; Madrid; Spain
| | | | | | - H. Müsken
- Institute for Pneumological and Allergological Expertises; Bad Lippspringe
| | - V. Mahler
- Department of Dermatology; University Hospital; Erlangen
| | - S. Schliemann
- Department of Dermatology and Allergology; Friedrich Schiller University Jena; Jena
| | - U. Ochmann
- Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Ludwig-Maximilians-Universität
| | - J. Sültz
- Occupational Physician; Neusaess
| | - M. Worm
- Allergy Centre - Department of Dermatology; Charité; University Berlin; Berlin; Germany
| | - I. Sander
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance Ruhr-University Bochum (IPA); Bochum; Germany
| | - E. Zahradnik
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance Ruhr-University Bochum (IPA); Bochum; Germany
| | - T. Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance Ruhr-University Bochum (IPA); Bochum; Germany
| | - R. Merget
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance Ruhr-University Bochum (IPA); Bochum; Germany
| | - M. Raulf-Heimsoth
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance Ruhr-University Bochum (IPA); Bochum; Germany
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Magerl M, Rother M, Bieber T, Biedermann T, Brasch J, Dominicus R, Hunzelmann N, Jakob T, Mahler V, Popp G, Schäkel K, Schlingensiepen R, Schmitt J, Siebenhaar F, Simon JC, Staubach P, Wedi B, Weidner C, Maurer M. Randomized, double-blind, placebo-controlled study of safety and efficacy of miltefosine in antihistamine-resistant chronic spontaneous urticaria. J Eur Acad Dermatol Venereol 2012; 27:e363-9. [PMID: 22928719 DOI: 10.1111/j.1468-3083.2012.04689.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU), a mast cell-driven condition, is debilitating, common, and hard to treat. Miltefosine, a lipid raft modulator, can inhibit mast cell responses in vivo. OBJECTIVE To study the safety and efficacy of systemic miltefosine treatment in CSU patients resistant to standard-dosed antihistamines. METHODS In this investigator-initiated multicentre, randomized, double-blind, placebo-controlled study, CSU patients were treated for 4 weeks with daily doses of up to 150-mg miltefosine (n = 47) or placebo (n = 26). Disease activity was assessed using the urticaria activity score. Safety and tolerability of miltefosine were also assessed. RESULTS After 4 weeks of treatment, Urticaria Activity Score (UAS7) levels were substantially more reduced in miltefosine-treated patients (-6.3 vs. -3.5 in placebo-treated patients; P = 0.05). Also, the number of weals, but not the intensity of pruritus, was significantly reduced in miltefosine-treated patients vs. placebo-treated patients (P = 0.02). In general, adverse events were frequent in both groups (miltefosine: 88%, placebo: 65% of patients) but mostly mild to moderate in severity. We did not observe any serious adverse events. CONCLUSIONS The results of this study indicate that miltefosine is an effective and safe treatment option for CSU patients who do not respond to standard-dosed antihistamines.
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Affiliation(s)
- M Magerl
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité- Universitätsmedizin Berlin, Berlin, Germany Department Clinical Operations, X-pert Med GmbH, Gräfelfing, Germany Department of Dermatology and Allergy, University of Bonn, Bonn, Germany Department of Dermatology, Eberhard Karls University Tübingen, Tübingen, Germany Department of Dermatology and Allergy, UK-SH, Campus Kiel, Kiel, Germany Praxisklinik und Gemeinschaftspraxis, Dülmen, Germany Department of Dermatology and Allergy, Universitätsklinikum Köln, Cologne, Germany Department of Dermatology and Allergy, Universitäts-Hautklinik Freiburg, Freiburg, Germany Department of Dermatology, University Hospital Erlangen, Erlangen, Germany Licca Clinical Research Institute, Augsburg, Germany Department of Dermatology, Universitätsklinikum Heidelberg, Heidelberg, Germany Jado Technologies GmbH, Dresden, Germany Department of Occupational and Social Medicine, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Germany Department of Dermatology, Venerology and Allergy, Universitätklinikum Leipzig, Leipzig, Germany Department of Dermatology and Allergy, Universitätsmedizin Mainz, Mainz, Germany Department of Dermatology and Allergy, Medizinische Hochschule Hannover, Hannover, Germany X-pert Med GmbH, Jena, Germany
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Worm M, Edenharter G, Ruëff F, Scherer K, Pföhler C, Mahler V, Treudler R, Lang R, Nemat K, Koehli A, Niggemann B, Hompes S. Symptom profile and risk factors of anaphylaxis in Central Europe. Allergy 2012; 67:691-8. [PMID: 22335765 DOI: 10.1111/j.1398-9995.2012.02795.x] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anaphylaxis is the most severe manifestation of an IgE-dependent allergy. Standardized acquired clinical data from large cohorts of well-defined cases are not available. The aim of this study was to analyse the symptom profile and risk factors of anaphylaxis in a large Central European cohort. METHODS We acquired data from patients in Germany, Austria and Switzerland who experienced a severe allergic reaction defined by the onset of severe pulmonary and/or severe cardiovascular symptoms. The data were gained via an online questionnaire from 83 medical centres specialized in allergy. Data were collected from 2006 to 2010 and analysed by using a multinomial regression model. RESULTS A total of 2012 paediatric and adult patients were included into the present analysis. The skin (84%) was the most frequently affected organ followed by the cardiovascular (72%) and the respiratory (68%) system. The regression model analysing the onset of cardiovascular versus respiratory symptoms revealed a strong impact of age (adjusted OR = 6.08; 95% CI, 3.35-11.01; P < 0.001). Furthermore, the elicitor food (adjusted OR = 0.29; 95% CI, 0.21-0.41, P < 0.001) and the presence of atopic diseases (adjusted OR = 0.54; 95% CI, 0.40-0.73, P < 0.001) were significantly associated with the onset of respiratory symptoms. CONCLUSION Data from individuals who experienced anaphylaxis can support the identification of risk factors. The present study indicates that age, the elicitor itself and the presence of atopic diseases have an impact on the symptom profile of anaphylaxis. Identifying further risk factors of anaphylaxis is of significant importance for clinical practice in the future.
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Affiliation(s)
- M. Worm
- Department of Dermatology and Allergy; University Hospital Charité; Berlin; Germany
| | | | - F. Ruëff
- Department of Dermatology and Allergology; Ludwig-Maximilian-University; Munich; Germany
| | - K. Scherer
- Allergy Unit; Department of Dermatology; University Hospital; Basel; Switzerland
| | - C. Pföhler
- Department of Dermatology; Saarland University Hospital; Homburg/Saar; Germany
| | - V. Mahler
- Department of Dermatology; University Hospital; Erlangen; Germany
| | - R. Treudler
- Department of Dermatology; Venerology and Allergology, Universität Leipzig; Germany
| | - R. Lang
- Department of Dermatology; University Hospital; Paracelsus Medical University; Salzburg; Austria
| | - K. Nemat
- Department of Paediatrics; University Hospital Carl Gustav Carus; Technical University of Dresden; Dresden; Germany
| | - A. Koehli
- Division of Allergy; University Children's Hospital; Zurich; Switzerland
| | - B. Niggemann
- Paediatric Allergology and Pneumology; German Red Cross Hospital Westend; Berlin; Germany
| | - S. Hompes
- Department of Dermatology and Allergy; University Hospital Charité; Berlin; Germany
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Wangorsch A, Weigand D, Peters S, Mahler V, Fötisch K, Reuter A, Imani J, Dewitt AM, Kogel KH, Lidholm J, Vieths S, Scheurer S. Identification of a Dau c PRPlike protein (Dau c 1.03) as a new allergenic isoform in carrots (cultivar Rodelika). Clin Exp Allergy 2011; 42:156-66. [PMID: 22093066 DOI: 10.1111/j.1365-2222.2011.03900.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 09/14/2011] [Accepted: 09/16/2011] [Indexed: 01/17/2023]
Abstract
BACKGROUND Up to 25% of food allergic subjects in central Europe suffer from carrot allergy. Until now, two isoforms of the major carrot (Daucus carota) allergen Dau c 1 have been described: Dau c 1.01, comprising five variants (Dau c 1.0101-Dau c 1.0105) and Dau c 1.02. OBJECTIVE To investigate potential allergenic properties of a Dau c PRPlike protein, a novel isoform of the PR-10 protein family in carrot. METHODS Dau c PRPlike cDNA from carrot roots (cv Rodelika) was cloned after RT-PCR and 5'RACE. Dau c PRPlike protein was expressed in E. coli, purified under native conditions by Ni-NTA chromatography and analysed by CD spectroscopy. Immuno-reactivity of the rDau c PRPlike protein was compared with rDau c 1.0104 and rDau c 1.0201 in terms of IgE binding (immunoblotting, ImmunoCAP), IgE cross-reactivity (ELISA inhibition) and in vitro mediator release with sera from carrot allergic patients. mRNA expression of Dau c PRPlike protein in wild-type and transgenic carrot roots was analysed by qRT-PCR. RESULTS The Dau c PRPlike protein was identified as a new allergenic isoform, Dau c 1.03, in carrot roots. 68% of carrot allergic patients were sensitized to rDau c 1.03. The IgE-reactivity of rDau c 1.03 strongly correlated with reactivity to rDau c 1.0104, but not to rDau c 1.0201. The extent of IgE cross-reactivity and allergenic potency of Dau c 1 isoforms varied between the individual sera tested. Dau c 1.03 mRNA transcripts were up-regulated in Dau c 1.01 and Dau c 1.02 gene-silenced carrot roots. CONCLUSION AND CLINICAL RELEVANCE Dau c 1 isoforms display distinct IgE epitope heterogeneity. Dau c 1.03 appears to contribute to the allergenicity of carrots and the manifestation of carrot allergy. The epitope diversity of different Dau c 1 isoforms should be considered for component-resolved diagnosis and gene silencing of carrot allergens.
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Affiliation(s)
- A Wangorsch
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
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Colsman A, Kunzmann U, Seggewies C, Mahler V. [Preparing dermatological discharge reports within an electronic clinical information systems. A pilot investigation regarding medical and economical aspects]. Hautarzt 2010; 60:821-5. [PMID: 19533069 DOI: 10.1007/s00105-009-1781-6] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The insertion of all patient details in one clinical information system (CIS) provides an enormous potential to rationalize and accelerate the administrative procedures in primary patient care. A successful data management system has to record not only the entire spectrum of the patient's medical data, but also the patient's personal data like name, address, date of birth, as well as names and addresses of other involved physicians. In addition, all aspects of the database gathered from varying sources must be compatible. The program has to be user-friendly enough that many different workers with varying backgrounds can effectively employ it. We investigated the effective saving of time in preparing a patient's discharge report based on conventional dictation using the clinical information system (Soarian) compared to a conventional, isolated word-processing program (Word). Existing potentials and limitations concerning the use of the CIS are presented. The objective analysis of measured processing times demonstrated a reduction for the typist, but no benefit for the physician dictating the discharge report. In the subjective perception of all users, the processing time appeared to have increased due to awkward editing and navigation functions. Improvements are required to increase the acceptance of the program by the users.
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Affiliation(s)
- A Colsman
- Hautklinik, Universitätsklinikum Erlangen
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Ott H, Schröder C, Raulf-Heimsoth M, Mahler V, Ocklenburg C, Merk HF, Baron JM. Microarrays of recombinant Hevea brasiliensis proteins: a novel tool for the component-resolved diagnosis of natural rubber latex allergy. J Investig Allergol Clin Immunol 2010; 20:129-138. [PMID: 20461967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Component-resolved diagnosis using microarray technology has recently been introduced in clinical allergology, but its applicability in patients with natural rubber latex (NRL) allergy has not been investigated. OBJECTIVES To evaluate the utility of microarray-based immunoglobulin (Ig) E detection in the diagnostic workup of NRL allergy and to compare this new diagnostic tool with established methods of NRL-specific IgE detection. METHODS We investigated 52 adults with immediate-type NRL allergy and 50 control patients. Determination of specific serum IgE against 8 recombinant Hevea brasiliensis allergen components was performed using a customized allergen microarray and a conventional fluorescence enzyme immunoassay (FEIA). RESULTS The panel of microarrayed allergen components was shown to represent a comprehensive repertoire of clinically relevant NRL proteins. NRL-specific IgE recognition patterns and sensitization rates determined by microarray analysis were similar to those obtained by conventional FEIA. The diagnostic sensitivity rates of combined single-component data were not significantly different for the respective recombinant test system, whereas the sensitivity level of extract-based FEIA analysis was markedly higher. CONCLUSION The current study provides evidence that microarrays of recombinant NRL allergen components are a suitable new tool for the diagnosis of NRL-specific sensitization.They show performance characteristics comparable to those of current diagnostic tests and could be indicated in small children in whom only limited blood volumes are obtainable. Further large-scale studies in unselected patient populations and in high-risk groups are warranted before the microarray can be introduced into routine management of patients with NRL allergy.
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Affiliation(s)
- H Ott
- Department of Dermatology and Allergology, University Hospital Aachen, Aachen, Germany.
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Mahler V, Erfurt-Berge C, Schiemann S, Michael S, Egloffstein A, Kuss O. Dirt-binding particles consisting of hydrogenated castor oil beads constitute a nonirritating alternative for abrasive cleaning of recalcitrant oily skin contamination in a three-step programme of occupational skin protection. Br J Dermatol 2009; 162:812-8. [DOI: 10.1111/j.1365-2133.2009.09602.x] [Citation(s) in RCA: 9] [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: 11/29/2022]
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Pfoch L, Mahler V, Sticherling M. Drug-eluting coronary stents: hypersensitivity reactions to paclitaxel. A case report. Dermatology 2008; 218:52-5. [PMID: 18987464 DOI: 10.1159/000171817] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Accepted: 05/23/2008] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Drug-eluting stents become increasingly popular for the treatment of coronary artery disease. Consequently, side effects including hypersensitivity reactions have to be anticipated. CASE REPORT Here we report on a patient with an anaphylactic reaction 2 weeks after implantation of a polymer-based paclitaxel-eluting stent (Taxus, Boston Scientific). The patient presented with disseminated wheals, pruritus, bronchial asthma and acute synovitis. The reaction was successfully treated with initial intravenous injection followed by oral antihistamine treatment for 1 month until all stent-bound paclitaxel was assumed to be eluted. Thereafter no further anaphylactic reaction occurred. CONCLUSION This sequence of events points towards a causal relation of the stent implantation and hypersensitivity reaction with a central role of paclitaxel. The increasing use of this type of stent should therefore be carefully monitored for such adverse reactions.
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Affiliation(s)
- L Pfoch
- Department of Dermatology, University Hospital of Erlangen, Erlangen, Germany
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Thumann P, Topf S, Feser A, Erfurt C, Schuler G, Mahler V. [Digital speech recognition in dermatology: a pilot study with regard to medical and economic aspects]. Hautarzt 2008; 59:131-4. [PMID: 18210002 DOI: 10.1007/s00105-007-1450-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Economic factors dominate more and more the healthcare systems; modern technologies advance every day and offer opportunities for savings. MATERIAL AND METHODS In a pilot study, digital speech recognition based on Dragon NaturallySpeaking, Version 7 was compared with common dictation in dermatology. RESULTS The conventional method took 24.1 minutes per page and reports could be sent out after 16.8 days; in sharp contrast, the reports dictated by digital speech recognition took 15.8 minutes per page and were sent out after 3.2 days. CONCLUSION Digital Speech recognition in dermatology has advantages compared to ordinary dictation, if the dictating person is trained with the software and it is implemented in a digital patient documentation system.
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Affiliation(s)
- P Thumann
- Hautklinik des Universitätsklinikums Erlangen, Hartmannstrasse 14, 91052, Erlangen
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Mahler V, Gutgesell C, Valenta R, Fuchs T. Natural rubber latex and hymenoptera venoms share ImmunoglobinE-epitopes accounting for cross-reactive carbohydrate determinants. Clin Exp Allergy 2007; 36:1446-56. [PMID: 17083355 DOI: 10.1111/j.1365-2222.2006.02587.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [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: 11/30/2022]
Abstract
BACKGROUND Epidemiological data on the prevalence and risk factors of latex sensitization have suggested a significant association between latex sensitization and the presence of one or more positive skin prick test responses to aeroallergens, food allergens and to one or more insect venoms. Xylose and core 3-fucose are typical complex glycans in plants and are foreign to mammals. Plant N-glycans and insect N-glycans may cross-react in humans. OBJECTIVE The aim of our study was to investigate whether there are cross-reactive IgE-binding structures in natural rubber latex (NRL) and hymenoptera venoms and to examine their nature. METHODS Hundred and twenty-five consecutive patients with insect venom allergy were screened for coincidental latex-specific IgE. IgE-binding components in the venoms from Apis mellifera and/or vespula species and in NRL extracts were characterized by IgE-immunoblotting to the natural allergen sources and determination of specific IgE to recombinant allergens. Cross-reactive components were investigated by inhibition experiments. The involvement of carbohydrates in the constitution of cross-reactive IgE-epitopes was further examined by specific IgE-binding to cross-reactive carbohydrate determinants (CCD) in bromelain and horseradish peroxidase as well as by periodate treatment. RESULTS NRL glove extracts inhibited patients' serum IgE-binding to venom allergens. Vice versa, the IgE-binding to latex glove extracts could be inhibited by pre-incubation with the insect venoms. Specific IgE-binding to recombinant latex allergens was absent, whereas the cross-reactive IgE-epitopes were sensitive to periodate treatment and specific IgE to CCD (MMXF and MUXF type) could be detected. CONCLUSION Insect venoms and NRL share IgE-binding CCD that may be responsible for positive serological test results to NRL in patients with insect venom allergy. This copositivity occurs frequently (13.6%) among venom-allergic individuals and did not elicit clinical symptoms upon contact to latex in the patients examined. In contrast, true cosensitization to insect venoms and NRL allergens can occur and may not be missed.
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Affiliation(s)
- V Mahler
- Department of Dermatology, University of Erlangen-Nuremberg, Erlangen, Germany
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Schuh A, Thomas P, Reinhold R, Holzwarth U, Zeiler G, Mahler V. [Allergic reaction to components of bone cement after total knee arthroplasty]. Zentralbl Chir 2007; 131:429-31. [PMID: 17089297 DOI: 10.1055/s-2006-949533] [Citation(s) in RCA: 15] [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: 10/24/2022]
Abstract
There are many reports about allergic reactions in association with total hip or knee arthroplasty. While most studies focus on allergic reactions to metallic components, only few reports exist about reactions to bone cement or its ingredients. We report about a patient who developed eczema at the knee and the lower leg one year after cemented TKR. Patch testing showed as potential causes contact allergic reactions to nickel and benzoylperoxide, an ingredient of the here used bone cement. The local and temporal association between onset of eczema and knee arthroplasty suggests a causal link. Benzoylperoxide as potential contact allergen in bone cement is so far almost neglected. The development of extended testing procedures and data collection should provide further information and better care of these patients. The development of special bone cements for patients with allergic diathesis is requested.
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Affiliation(s)
- A Schuh
- Orthopädische Klinik Rummelsberg, Schwarzenbruck.
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Abstract
BACKGROUND The treatment of inflammatory skin diseases is at present often empirical as causal therapeutic approaches, based on an incomplete knowledge of the immune pathogenesis, are mostly unavailable. The currently applied treatments can in fact lead to remission of the disease; however, under certain circumstances undesirable side-effects must be expected. On the basis of experience gained in cytokine modulation therapy of chronic inflammatory diseases such as rheumatoid arthritis and psoriasis, the application of TNF-alpha inhibitors represents a novel, more specific, and effective therapeutic option for distinct chronic inflammatory diseases. PATIENTS AND METHODS The current status of the therapeutic effect of TNF-alpha blockers is discussed based on our own observations and a review of the current literature. Also discussed are potential undesirable side-effects and possible contraindications of this therapy. RESULTS AND CONCLUSIONS Based on recent findings, the use of TNF-alpha blockers seems to be promising in the treatment of therapy-resistant inflammatory dermatoses. At present, guidelines for indications and contraindications of anti-TNF-alpha treatment of inflammatory skin disorders are rare. Such guidelines are necessary to improve the efficacy of anticytokine treatment and the reduction of side-effects.
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Affiliation(s)
- A Jacobi
- Department of Dermatology, University of Erlangen, Erlangen, Germany.
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Schroeder C, Ott H, Stanzel S, Mahler V, Raulf-Heimsoth M, Merk H, Baron J. Comparison of Microarray-Based IgE Profiling with Established Diagnostic Methods in Patients with Latex Allergy. J Allergy Clin Immunol 2006. [DOI: 10.1016/j.jaci.2005.12.527] [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: 10/24/2022]
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Uter W, Hegewald J, Aberer W, Ayala F, Bircher AJ, Brasch J, Coenraads PJ, Schuttelaar MLA, Elsner P, Fartasch M, Mahler V, Belloni Fortina A, Frosch PJ, Fuchs T, Johansen JD, Menné T, Jolanki R, Krêcisz B, Kiec-Swierczynska M, Larese F, Orton D, Peserico A, Rantanen T, Schnuch A. The European standard series in 9 European countries, 2002/2003 - First results of the European Surveillance System on Contact Allergies. Contact Dermatitis 2005; 53:136-45. [PMID: 16128752 DOI: 10.1111/j.0105-1873.2005.00673.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.2] [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: 11/26/2022]
Abstract
Since January 2001, the European Surveillance System on Contact Allergies (ESSCA), supported by European Union funding (contract QLK4-CT-2001-00343), has started to collect patch-test data. This comprises a standardized clinical history and the patch-test results using the European standard series, from 17 centres in 9 European countries listed above. In 2002 and 2003, 10 511 patients' test results have been pooled and analysed. The anamnestic data partly reflect the subspecialties of some centres. The most common allergen was nickel sulfate (17.3%); however, large international variations were observed. The prevalence of contact allergy to Myroxylon pereirae resin (balsam of Peru) (5.8%) is coming close to the frequency found with the fragrance mix (6.4%). Regarding contact allergy to chromium compounds, different frequencies were noted in the 2 centres focused on occupational dermatitis (2.3% in the FIOH versus 7.4% in the Nofer Institute). These most likely reflect the beneficial effect of addition of ferrous sulfate in one, but not the other country. As differences may partly be due to different patch-test reading, standardization may need to be refined further. By providing post-marketing surveillance in the field of contact allergy, ESSCA will meet its objective of increased consumer safety across Europe.
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Affiliation(s)
- W Uter
- Department of Medical Informatics, Biometry & Epidemiology, University of Erlangen-Nürnberg, Erlangen, Germany.
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Bruynzeel DP, Diepgen TL, Andersen KE, Brandão FM, Bruze M, Frosch PJ, Goossens A, Lahti A, Mahler V, Maibach HI, Menné T, Wilkinson JD. Monitoring the European standard series in 10 centres 1996-2000. Contact Dermatitis 2005; 53:146-9. [PMID: 16128753 DOI: 10.1111/j.0105-1873.2005.00541.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.8] [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
A 5-year retrospective study of the frequency of sensitization to the 25 allergens of the European standard series (ESS) was conducted in 10 centres in 8 European countries. Included were the results of 26 210 patients. The range in sensitivities differed moderately between the centres. Combining results of different centres and drawing conclusions on incidences can be done only with great care. The information on the ranking of the allergens and their sensitization incidence in the clinics are useful for decisions on the future composition of the standard series. The ESS is still a valid screening tool, and no substances should be deleted.
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Affiliation(s)
- D P Bruynzeel
- Department of Occupational Dermatology, VU University Medical Centre, Amsterdam, the Netherlands.
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