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Voth V, Merk DR, Roser D, Hemmer W, Seeburger J, Liebrich M. Isolated Aortic Valve Cusp Reconstruction in the Adult Population: Long-Term Single-Center Experience. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Liebrich M, Merk DR, Roser D, Hemmer W, Seeburger J, Voth V. Comparison of Bicuspid and Tricuspid Aortic Valve Cusp Reconstruction: Single-Center Experience. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Voth V, Liebrich M, Trabold T, Hemmer W, Seeburger J. Complete-Island/Partial-Island Technique and Types of Complex Transposition for Surgical Management of Supra-Aortic Vessel Involvement during the Frozen Elephant Trunk Procedure in Acute/Chronic Type-A Aortic Dissection: Midterm Results from 158 Patients. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Aboud A, Fujita B, Stierle U, Hemmer W, Lange R, Franke U, Leyh R, Laufer G, Sievers HH, Ensminger S. Long-Term Outcomes for Patients Undergoing the Ross Procedure in 10 European Heart Centers: An Update from the Ross Registry. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Liebrich M, Schlereth S, Roser D, Strauss H, Merk DR, Hupp T, Doll N, Voth V, Hemmer W. Hans Georg Borst Preis: Midterm Results with the Frozen-Elephant Trunk Technique (E-vita Open) in Thoracic Aortic Disease: A Single-Center Experience in 199 Patients. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Liebrich M, Stadler C, Voth V, Roser D, Merk R, Doll N, Hemmer W. Freedom from Aortic Valve–Related Reoperation and Long-Term Survival after the David Procedure: A Single-Center Experience in 500 Patients. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Pecha S, Burger H, Möller V, Madej T, Osswald B, Maali A, De Simone R, Monsefi N, Ziaukas V, Erler S, Elfarra H, Perthel M, Hemmer W, Ghaffari N, Sandhaus T, Busk H, Schmitto J, Bärsch V, Easo J, Treede H, Albert M, Nägele H, Zenker D, Hegazy Y, Ahmadi D, Ehrlich W, Knaut M, Reichenspurner H, Butter C, Hakmi S. The German Laser Lead Extraction Registry: GALLERY. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Curin M, Garmatiuk T, Resch-Marat Y, Chen KW, Hofer G, Fauland K, Keller W, Hemmer W, Vrtala S, Focke-Tejkl M, Valenta R. Similar localization of conformational IgE epitopes on the house dust mite allergens Der p 5 and Der p 21 despite limited IgE cross-reactivity. Allergy 2018; 73:1653-1661. [PMID: 29319884 PMCID: PMC6055609 DOI: 10.1111/all.13398] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Due to high IgE recognition frequency and high allergenic activity, Der p 5 and Der p 21 are clinically important house dust mite (HDM) allergens. The objective of this study was to characterize the immunodominant IgE epitopes of Der p 5 and Der p 21 responsible for their high allergenic activity. METHODS A panel of 12 overlapping peptides spanning the Der p 5 and Der p 21 sequence were synthesized to search for sequential IgE epitopes by direct testing for allergic patients' IgE reactivity. Peptide-specific antibodies raised in rabbits were used in inhibition studies for localizing conformational IgE epitopes which were visualized on the surfaces of the allergen structures by molecular modelling. IgE cross-reactivity between the allergens was investigated by IgE inhibition studies. RESULTS Immunodominant IgE epitopes defined by allergic patients' IgE on Der p 5 and Der p 21 were primarily of the conformational, discontinuous type including N- and C-terminal portions of the protein. They could be located on each allergen on one area with similar localization, but despite similar structure of the allergens, no relevant IgE cross-reactivity could be detected. CONCLUSION Our study shows that Der p 5 and Der p 21 contain a major conformational IgE epitope-containing area located on similar portions of their structure, but they lack relevant IgE cross-reactivity. These data are important for the development of modern allergy vaccines based on defined molecules for allergen-specific immunotherapy of HDM allergy.
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Palladino C, Narzt MS, Bublin M, Schreiner M, Humeniuk P, Gschwandtner M, Hafner C, Hemmer W, Hoffmann-Sommergruber K, Mildner M, Palomares O, Gruber F, Breiteneder H. Peanut lipids display potential adjuvanticity by triggering a pro-inflammatory response in human keratinocytes. Allergy 2018; 73:1746-1749. [PMID: 29747215 PMCID: PMC6095042 DOI: 10.1111/all.13475] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Liebrich M, Voth V, Tzanavaros I, Hemmer W. Endokarditis nach Aorta-ascendens-Ersatz. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2017. [DOI: 10.1007/s00398-017-0149-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kari F, Richardt D, Beyersdorf F, Doll N, Hemmer W, Liebrich M, Reichenspurner H, Detter C, Sievers H. Bicuspid Aortic Valve-Sparing Root Surgery: What Is the Fate of Residual Aortic Regurgitation? Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Merz C, Böthig D, Liebrich M, Scheid M, Hemmer W, Doll N, Horke A, Haverich A, Tzanavaros I. 25 Years of Experience in Pediatric Pacing: Is There an Achilles Heel? Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Liebrich M, Voth V, Hupp T, Richter GM, Doll KN, Hemmer W. Aortenbogenchirurgie. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2016. [DOI: 10.1007/s00398-016-0084-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hemmer W. [Cross reactions between Hymenoptera venoms from different families, genera and species]. Hautarzt 2015; 65:775-9. [PMID: 25234625 DOI: 10.1007/s00105-014-2776-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Simultaneous reactivity with the venoms of different Hymenoptera is commonly seen in patients allergic to insect venoms. Strong, though individually variable, cross-reactivity occurs between the venoms of different Vespinae species (Vespula, Dolichovespula, Vespa). In Middle Europe, anaphylaxis after European hornet stings is nearly always due to cross-reactivity with Vespula venom. The identification of the primary venom in patients testing positive for Vespula and Polistes (paper wasps) is particularly important in Mediterranean areas. Component-resolved diagnosis with the marker allergens Ves v 5 and Pol d 5 may directly identify the causative venom in the majority of patients. There is substantial cross-reactivity between honeybee and bumblebee venom, sometimes causing allergic symptoms in patients allergic to honeybee venom after accidental bumblebee stings. However, subjects strongly exposed to bumblebees may show bumblebee-specific sensitization and require immunotherapy with bumblebee venom. More than half of all venom-allergic patients show double-positive test results to honeybee and vespid venoms. This may be due to true double sensitization or due to cross-reactivity between homologous allergens present in both venoms and sharing around 50 % sequence identity, i.e. hyaluronidases (Api m 2/Ves v 2), dipeptidyl peptidases (Api m 5/Ves v 3), and vitellogenins (Api m 12/Ves v 6). The clinical relevance of these cross-reactions is unknown. In up to 50 % the double-positivity is caused by clinically irrelevant IgE antibodies against CCDs. Many (though not all) patients with true double sensitization may be identified by means of the species-specific marker allergens Api m 1 and Ves v 1/5. Some Vespula venom-allergic patients may clinically cross-react to fire ant stings (Solenopsis), but otherwise allergen relationships with other ant species are not well studied.
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Sievers HH, Charitos E, Takkenberg J, Stierle U, Franke U, Hörer J, Albert M, Lange R, Hemmer W. An Update on the Adult Patients of the German Ross Registry. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Charitos E, Takkenberg J, Stierle U, Franke U, Hörer J, Albert M, Lange R, Hemmer W, Sievers HH. Estimation of the Lifetime Risk for Reoperation after the Ross Procedure According to the Patient's Age at the Initial Procedure: A Simulation Study Based on Data from the German Ross Registry. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Guhsl EE, Hofstetter G, Lengger N, Hemmer W, Ebner C, Fröschl R, Bublin M, Lupinek C, Breiteneder H, Radauer C. IgE, IgG4 and IgA specific to Bet v 1-related food allergens do not predict oral allergy syndrome. Allergy 2015; 70:59-66. [PMID: 25327982 PMCID: PMC4283702 DOI: 10.1111/all.12534] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Birch pollen-associated plant food allergy is caused by Bet v 1-specific IgE, but presence of cross-reactive IgE to related allergens does not predict food allergy. The role of other immunoglobulin isotypes in the birch pollen-plant food syndrome has not been investigated in detail. METHODS Bet v 1-sensitized birch pollen-allergic patients (n = 35) were diagnosed for food allergy by standardized interviews, skin prick tests, prick-to-prick tests and ImmunoCAP. Concentrations of allergen-specific IgE, IgG1, IgG4 and IgA to seven Bet v 1-related food allergens were determined by ELISA. RESULTS Bet v 1, Cor a 1, Mal d 1 and Pru p 1 bound IgE from all and IgG4 and IgA from the majority of sera. Immunoglobulins to Gly m 4, Vig r 1 and Api g 1.01 were detected in <65% of the sera. No significant correlation was observed between plant food allergy and increased or reduced levels of IgE, IgG1, IgG4 or IgA specific to most Bet v 1-related allergens. Api g 1-specific IgE was significantly (P = 0.01) elevated in celeriac-allergic compared with celeriac-tolerant patients. Likewise, frequencies of IgE (71% vs 15%; P = 0.01) and IgA (86% vs 38%; P = 0.04) binding to Api g 1.01 were increased. CONCLUSION Measurements of allergen-specific immunoglobulins are not suitable for diagnosing Bet v 1-mediated plant food allergy to hazelnut and Rosaceae fruits. In contrast, IgE and IgA to the distantly related allergen Api g 1 correlate with allergy to celeriac.
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Fellinger C, Hemmer W, Wöhrl S, Sesztak-Greinecker G, Jarisch R, Wantke F. Clinical characteristics and risk profile of patients with elevated baseline serum tryptase. Allergol Immunopathol (Madr) 2014; 42:544-52. [PMID: 25224360 DOI: 10.1016/j.aller.2014.05.002] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 04/28/2014] [Accepted: 05/25/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND The clinical relevance of elevated basal serum tryptase (eBST ≥ 11.4 ng/ml) often remains unclear. METHODS BST was assessed in 15,298 patients attending our outpatient clinic. Frequency and severity of anaphylaxis was compared in 900 patients with eBST and 900 patients with normal BST. The prevalence of eBST was evaluated in patients with drug reactions, urticaria, gastrointestinal symptoms or venom allergy. Mast cell-associated symptoms were recorded prospectively in 100 patients with eBST and 100 controls using a standardised questionnaire. RESULTS 5.9% (n=900) of 15,298 patients had eBST ≥11.4 ng/ml (mean 20 ± 21 ng/ml, 11.4-390 ng/ml). In 47% of them BST was <15.0 and in 78% <20.0 ng/ml. In patients with normal BST (4.5 ± 2.1 ng/ml), mean levels increased continuously with age (0.28 ng/ml per decade; p<0.001). Fatigue, meteorism, muscle/bone ache, vertigo, tachycardia, flush, palpitations, diarrhoea and oedema were associated with eBST (p<0.05 to <0.0001) without significant differences between slightly (11.4-20 ng/ml) or strongly (>20 ng/ml) eBST. eBST was significantly associated with adverse reactions to drugs (34%), radio contrast media (15%) and insect stings (24%) (p<0.05). Anaphylaxis was more common in patients with eBST (21% vs. 14%, p<0.001). The relative role of insect stings, drugs and food as the most important triggers was similar in patients with elevated and normal BST. Severe reactions (grade 3/4) occurred most often in subjects with BST >20 ng/ml (BST <11.4 mg/ml: 2.8%; 11.5-20 ng/ml: 5.9%; >20 ng/ml: 12.4%). CONCLUSIONS In clinical practice it appears reasonable to assess BST, besides after anaphylactic reactions also in patients suffering repeatedly from vertigo, flush, tachycardia, palpitations, oedema and nausea. Even patients with slightly eBST have a higher risk of anaphylaxis and experience more severe reactions.
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Sievers H, Charitos E, Albert M, Franke UF, Stierle U, Horer J, Lange R, Hemmer W. 181 * A MULTICENTRE EVALUATION OF THE AUTOGRAFT PROCEDURE FOR YOUNG PATIENTS UNDERGOING AORTIC VALVE REPLACEMENT: RESULTS FROM THE GERMAN ROSS REGISTRY. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Hemmer W, Morawetz W. Karyological Differentiation in Sapindaceae with Special Reference toSerjaniaandCardiospermum. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/j.1438-8677.1990.tb00177.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Horke A, Hemmer W, Sandica E, Rüffer A, Cesnjevar R, Ciubotaru A, Boethig D. The RVOT conduit registry: Freedom from explantation of various conduit types. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Bokanovic D, Aberer W, Hemmer W, Heinemann A, Komericki P, Scheffel J, Sturm GJ. Determination of sIgE to rPhl p 1 is sufficient to diagnose grass pollen allergy. Allergy 2013; 68:1403-9. [PMID: 24117513 DOI: 10.1111/all.12263] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2013] [Indexed: 12/30/2022]
Abstract
BACKGROUND New diagnostic tools such as the basophil activation test (BAT) and component-resolved diagnosis (CRD) are promising for Hymenoptera venom or food allergy. A clear benefit for inhalant allergens has not yet been shown. Our aim was to compare new and established tests for grass pollen allergy. METHODS Forty-nine patients with grass pollen allergy and 47 controls were prospectively enrolled in the study. A symptom score was calculated for each patient. Conjunctival provocation tests (CPT), skin prick tests (SPT), BAT, and sIgE determination including CRD were performed. Sensitivity and specificity were compared and results were correlated with the symptom score. RESULTS Single determination of sIgE to rPhl p 1 showed the best balance between sensitivity (98%) and specificity (92%). Use of additional components, such as rPhl p 2 and 5, did not increase sensitivity. Generally, sensitivity of tests was high: SPT 100%, ISAC-112 100%, sIgE to timothy grass 98%, BAT 98%, ISAC-103 84%, and CPT 83%. Specificity ranged from 79% (SPT) to 96% (CPT). All test results and calculated values (e.g. ratio sIgE/tIgE) did not correlate with symptom severity. Asymptomatic sensitization to timothy grass in controls was rare in the CAP (11%) and predominantly due to Phl p 1 sensitization. CONCLUSION rPhl p 1 was sufficient to diagnose grass pollen allergy, and sIgE patterns were the same in symptomatically and asymptomatically sensitized subjects. The testing of multiple components was of minor importance, and no test correlated with symptom severity.
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Horke A, Hemmer W, Botha CA, Bruker C, Boethig D. Autograft Durability after Ross Operation: Gender Is More Important Than Aortic Valve Cusp Number According to 17-Years Results after 621 Operations of a Single Center. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0033-1354463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Holzweber F, Svehla E, Fellner W, Dalik T, Stubler S, Hemmer W, Altmann F. Inhibition of IgE binding to cross-reactive carbohydrate determinants enhances diagnostic selectivity. Allergy 2013; 68:1269-77. [PMID: 24107260 PMCID: PMC4223978 DOI: 10.1111/all.12229] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2013] [Indexed: 11/28/2022]
Abstract
Background Allergy diagnosis by determination of allergen-specific IgE is complicated by clinically irrelevant IgE, of which the most prominent example is IgE against cross-reactive carbohydrate determinants (CCDs) that occur on allergens from plants and insects. Therefore, CCDs cause numerous false-positive results. Inhibition of CCDs has been proposed as a remedy, but has not yet found its way into the routine diagnostic laboratory. We sought to provide a simple and affordable procedure to overcome the CCD problem. Methods Serum samples from allergic patients were analysed for allergen-specific IgEs by different commercial tests (from Mediwiss, Phadia and Siemens) with and without a semisynthetic CCD blocker with minimized potential for nonspecific interactions that was prepared from purified bromelain glycopeptides and human serum albumin. Results Twenty two per cent of about 6000 serum samples reacted with CCD reporter proteins. The incidence of anti-CCD IgE reached 35% in the teenage group. In patients with anti-CCD IgE, application of the CCD blocker led to a clear reduction in read-out values, often below the threshold level. A much better correlation between laboratory results and anamnesis and skin tests was achieved in many cases. The CCD blocker did not affect test results where CCDs were not involved. Conclusion Eliminating the effect of IgEs directed against CCDs by inhibition leads to a significant reduction in false-positive in vitro test results without lowering sensitivity towards relevant sensitizations. Application of the CCD blocker may be worthwhile wherever natural allergen extracts or components are used.
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Klug C, Focke M, Hemmer W, Wank H, Swoboda I. Identification and characterization of meat allergens for improved diagnosis of meat allergy. Clin Transl Allergy 2013. [PMCID: PMC3723525 DOI: 10.1186/2045-7022-3-s3-p174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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