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Gultuna S, Basa Akdogan B, Gonul M, Aydin FN, Unal S, Erkek GN, Ozalp Ates FS, Yuceege MB, Ozdemir SAO. Sleep quality in patients with chronic spontaneous urticaria and relation with Orexin-A, leptin, and ghrelin. Allergy Asthma Proc 2024; 45:e38-e45. [PMID: 38982607 DOI: 10.2500/aap.2024.45.240023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
Background: Sleep can be affected in patients with chronic spontaneous urticaria (CSU). The mechanisms of sleep regulation remain poorly understood. Orexin-A, a neuroexcitatory peptide, plays a role in coordinating sleep-wake states. Ghrelin and leptin are involved in sleep regulation through the orexin system. Objective: The effects of orexin-A, ghrelin, and leptin on sleep quality in patients with CSU have not been investigated. We aimed to determine the effects of CSU on sleep quality and the association between serum orexin-A, ghrelin, and leptin levels, and sleep quality in patients with CSU. Methods: Thirty-three patients with CSU and 34 sex- and age-matched controls were included in the study. Serum orexin-A, leptin, and ghrelin levels, and the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS) scores were measured in patients with CSU and in the controls; also used were the chronic urticaria quality-of-life questionnaire score and the urticaria activity score used for 7 consecutive days. Results: Median (minimum-maximum) orexin-A, leptin, and ghrelin levels in patients were 385 pg/mL (90-495 pg/mL), 3.1 ng/mL (0-21.2 ng/mL), and 701.8 pg/mL (101.9-827.7 pg/mL), respectively. Median serum orexin-A and leptin levels were higher in the patients compared with the controls (p < 0.001 and p = 0.012, respectively), whereas the median serum ghrelin levels were similar to the controls (p = 0.616). The serum orexin-A level was positively correlated with ghrelin (r = 0.298, p = 0.014), PSQI sleep quality (r = 0.356, p = 0.003), and ESS (r = 0.357, p = 0.003). Conclusion: Serum orexin-A is associated with sleep quality in patients with CSU. Further studies are needed to elucidate the role of ghrelin and leptin on sleep quality in patients with CSU.
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Affiliation(s)
- Selcan Gultuna
- From the Department of Immunology and Allergy, University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Buket Basa Akdogan
- From the Department of Immunology and Allergy, University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Muzeyyen Gonul
- Department of Dermatology, University of Health Sciences Etlik City Hospital, Ankara, Turkey
| | - Fevzi Nuri Aydin
- Department of Biochemistry, University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital
| | - Simge Unal
- Department of Dermatology, University of Health Sciences Uşak Training and Research Hospital, Uşak, Turkey
| | | | - Funda Seher Ozalp Ates
- Department of Biostatics and Medical Informatics, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Melike Bagnu Yuceege
- Department of Chest Diseases, University of Health Sciences Etlik City Hospital, Ankara, Turkey; and
| | - Sinem Ayse Ornek Ozdemir
- Department of Dermatology, University of Health Sciences Ankara Training and Research Hospital, Ankara, Turkey
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Abdel-Meguid AM, Awad SM, Noaman M, Abdel Gawad AM, Abou-Taleb DAE. Does chronic urticaria affect quality of sleep and quality of life? J Public Health Res 2024; 13:22799036241243268. [PMID: 38638409 PMCID: PMC11025431 DOI: 10.1177/22799036241243268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 03/14/2024] [Indexed: 04/20/2024] Open
Abstract
Background Urticaria affects a wide range of daily activities and social relationships. It has a severe impact on quality of life (QOL) and causes psychological problems. Objective was to assess the impact of chronic urticaria (CU) on quality of sleep, the levels of depression, anxiety, QOL and their interaction with each other and their relation to disease related factors. Patients and methods The study included 25 patients with CU and 25 healthy controls. Urticaria Activity Score (UAS) was used for objective evaluation of the intensity of urticaria. Patients completed a 10-cm visual analogue score (VAS) indicating the overall severity of their itching over the previous 2 weeks. The Dermatology Life Quality Index (DLQI) was used to evaluate patients' QOL. Patients were also assessed for anxiety and depression with the Hospital Anxiety and Depression Scale (HADS). Pittsburgh Sleep Quality Index (PSQI) was used for evaluation of sleep quality and sleep disturbances. Results In our CU patients the mean of UAS7 score was 39.72 ± 2.76 and the mean of VAS score was 28 ± 1.34. The mean of DLQI score was 24.8 ± 4.37 indicating severe impact of QOL. CU patients had higher total HADS score when compared to controls; 72% of the patients had depression and 92% had anxiety. By using PSQI, CU patients had significantly longer sleep latency onset, shorter total sleep duration, lower sleep efficiency and higher PSQI scores compared to controls. Conclusion CU highly affects the QOL of patients and is associated with higher levels of anxiety, depression and poor sleep quality.
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Affiliation(s)
- Azza M Abdel-Meguid
- Faculty of Medicine, Department of Dermatology, Venereology, and Andrology, Assiut University Hospitals, Assiut, Egypt
| | - Sara M Awad
- Faculty of Medicine, Department of Dermatology, Venereology, and Andrology, Assiut University Hospitals, Assiut, Egypt
| | - Mostafa Noaman
- Faculty of Medicine, Neuropsychiatry Department, Assiut University Hospitals, Assiut, Egypt
| | - Asmaa M Abdel Gawad
- Faculty of Medicine, Department of Dermatology, Venereology, and Andrology, Assiut University Hospitals, Assiut, Egypt
| | - Doaa A E Abou-Taleb
- Faculty of Medicine, Department of Dermatology, Venereology, and Andrology, Assiut University Hospitals, Assiut, Egypt
- Department of Dermatology and Venereology, Hotat Sudir Hospital, Ministry of Health, Riyadh, Saudi Arabia
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Tomaszewska K, Słodka A, Tarkowski B, Zalewska-Janowska A. Neuro-Immuno-Psychological Aspects of Chronic Urticaria. J Clin Med 2023; 12:jcm12093134. [PMID: 37176575 PMCID: PMC10179371 DOI: 10.3390/jcm12093134] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/19/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023] Open
Abstract
Urticaria is a condition characterized by the development of itchy wheals (hives), angioedema, or both. The pathophysiology of chronic spontaneous urticaria (CSU) is still poorly understood. It is suggested that there is no dominant and independent mechanism of CSU; however, there are different immunological and non-immunological abnormalities that act simultaneously or/and follow each other resulting in clinical symptoms. The latest hypothesis points out that mast cells (MCs) to be activated via autoantibodies in autoallergic or autoimmune mechanism mediators released from degranulated MCs are responsible for the vasoactive and neurospecific effect in CSU. According to many clinical observations, it is suggested that psychological stress can be both a triggering factor in the onset of CSU and a modulating one in the course of the disease and therapy effectiveness. Of importance, the mechanistic background of the psychological stress response in the skin has not yet been fully elucidated. However, of note, a variety of inflammatory mediators, neuropeptides, and neurotransmitters facilitate this phenomenon. This review presents recent findings on the neuro-immuno-psychological aspects of CSU, highlighting an emerging role of neuro-immune interactions. It also points out the usefulness of psychological tools employment for the baseline diagnosis of perceived stress level and the presence of its symptoms. Furthermore, it proposes the implementation of non-invasive interventions to reduce psychological stress and anxiety. A bio-psycho-social approach including psychological support and patient education seems to be as important as traditional pharmacotherapy for CSU. It facilitates the effective control of active disease and a prolonged remission time in this disease.
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Affiliation(s)
- Katarzyna Tomaszewska
- Psychodermatology Department, Chair of Pulmonology, Rheumatology and Clinical Immunology, Medical University of Lodz, 92-213 Lodz, Poland
| | - Aleksandra Słodka
- Psychodermatology Department, Chair of Pulmonology, Rheumatology and Clinical Immunology, Medical University of Lodz, 92-213 Lodz, Poland
| | - Bartłomiej Tarkowski
- Psychodermatology Department, Chair of Pulmonology, Rheumatology and Clinical Immunology, Medical University of Lodz, 92-213 Lodz, Poland
| | - Anna Zalewska-Janowska
- Psychodermatology Department, Chair of Pulmonology, Rheumatology and Clinical Immunology, Medical University of Lodz, 92-213 Lodz, Poland
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Ates H, Firat S, Buhari GK, Keren M, Cifci B, Erkekol FÖ. Relationships between quality of life, sleep problems, and sleep quality in patients with chronic idiopathic urticaria. J Cosmet Dermatol 2022; 21:4072-4079. [PMID: 35166020 DOI: 10.1111/jocd.14851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 01/30/2022] [Accepted: 02/09/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND In this study, we aimed to evaluate the sleep quality among chronic urticaria patients using the Chronic Urticaria Quality-of-Life Questionnaire (CU-Q2oL), sleep quality assessment tools, and polysomnography and to investigate any relationships between the obtained results. METHODS The study included 21 patients diagnosed with chronic spontaneous urticaria and 19 healthy controls. We recorded the patients' sleep quality data, including CU-Q2 oL, Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and polysomnography results. RESULT Patients in the chronic urticaria group were more likely to have an ESS score of ≥10 (52.4% vs. 5.3%, p = 0.004) and an apnea-hypopnea index of ≥5 (44.4% vs. 5.3%, p = 0.017) compared to the control group. In the patient group, the CU-Q2 oL total score was positively correlated with sleep latency (r = 0.713, p = 0.004) and PSQI-C1 score (r = 0.726, p = 0.005), while it was negatively correlated with urticaria duration (r = -0.579, p = 0.015), apnea-hypopnea index (r = -0.607, p = 0.021), longest apnea duration (r = -0.583, p = 0.029), total number of respiratory events (r = -0.618, p = 0.018), and apnea count (r = -0.686, p = 0.007). CONCLUSION We conclude that sleep-related problems exist among a considerably large proportion of patients with chronic spontaneous urticaria.
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Affiliation(s)
- Hale Ates
- Department of Allergy and Immunology, Atatürk Chest Disease and Chest Surgery Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Selma Firat
- Sleep Disorders Center, Ataturk Chest Diseases and Thoracic Surgery Education and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Gozde Koycu Buhari
- Department of Allergy and Immunology, Atatürk Chest Disease and Chest Surgery Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Metin Keren
- Department of Pulmonary Diseases, Süreyyapaşa Pulmonary Diseases Education and Research Hospital, Istanbul, Turkey
| | - Bulent Cifci
- Department of Chest Diseases, Medical School, Turkiye Yuksek Ihtisas University, Ankara, Turkey
| | - Ferda Öner Erkekol
- Department of Allergy and Immunology, Atatürk Chest Disease and Chest Surgery Training and Research Hospital, Health Sciences University, Ankara, Turkey
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Giménez‐Arnau A, Maurer M, Bernstein J, Staubach P, Barbier N, Hua E, Severin T, Joubert Y, Janocha R, Balp M. Ligelizumab improves sleep interference and disease burden in patients with chronic spontaneous urticaria. Clin Transl Allergy 2022; 12:e12121. [PMID: 35218324 PMCID: PMC8848195 DOI: 10.1002/clt2.12121] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/27/2021] [Accepted: 01/25/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) negatively impacts patients' sleep, thereby reducing health-related quality of life (HRQoL). Half of patients with inadequately controlled CSU report sleep interference often or every night, which can lead to depression, anxiety, social, and work-related problems. METHODS This randomized, double-blind, placebo-controlled Phase 2b core study (NCT02477332) included adult patients ≥18 years with moderate to severe CSU inadequately controlled with H1 -antihistamines. The current analysis includes patients randomized to receive ligelizumab 72 or 240 mg, omalizumab 300 mg or placebo every 4 weeks (q4w) for five injections over 20 weeks with treatment-free follow-up for 24 weeks. Patients could enter the open-label extension study (NCT02649218) from Week 32 onwards if their weekly urticaria activity score was ≥12, which included an open-label treatment (52 weeks of ligelizumab 240 mg q4w) and a 48-week post-treatment follow-up. Weekly Sleep Interference Scores (SIS7, range 0 [no interference]-21 [substantial interference]), Weekly Activity Interference Score (AIS7), Dermatology Life Quality Index (DLQI) scores, and Overall Work Impairment were assessed. RESULTS Mean baseline SIS7 scores were balanced between the treatment arms for ligelizumab 72 mg (n = 84) and 240 mg (n = 85), omalizumab 300 mg (n = 85), and placebo (n = 43). By Week 12, patients experienced large improvements in sleep interference, with least square mean (standard error) changes from baseline (CFB) in SIS7 of -7.84 (0.58), -7.55 (0.61), -6.98 (0.60), and -5.85 (0.81), respectively. By Week 12, CFB in AIS7 were -8.25 (0.57), -8.25 (0.59), -7.30 (0.60), and -5.62 (0.79), DLQI scores were -9.79 (0.77), -9.93 (0.81), -8.35 (0.79), and -6.99 (1.11), and Overall Work Impairment scores were -28.96 (3.73), -30.76 (3.71), -25.74 (3.91), and -20.13 (5.10) for ligelizumab 72 and 240 mg, omalizumab 300 mg and placebo, respectively. Improvements in each patient-reported outcome were sustained with ligelizumab 240 mg treatment during the extension study. CONCLUSIONS Ligelizumab showed effective and sustained responses in managing sleep interference in patients with CSU, and numerically higher responses than with omalizumab and placebo. Treating the symptoms of CSU with ligelizumab improved disease burden, HRQoL, and markedly improved sleep quality.
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Affiliation(s)
- Ana Giménez‐Arnau
- Department of DermatologyHospital del MarInstitut Mar d´Investigacions MèdiquesUniversitat AutònomaBarcelonaSpain
| | - Marcus Maurer
- Department of Dermatology and AllergyDermatological AllergologyAllergie‐Centrum‐CharitéCharité ‐ Universitätsmedizin BerlinBerlinGermany
| | - Jonathan Bernstein
- Bernstein Allergy Group and Bernstein Clinical Research CenterCollege of MedicineCincinnatiOhioUSA
| | - Petra Staubach
- Department of DermatologyUniversity Medical Center MainzMainzGermany
| | | | - Eva Hua
- China Novartis Institutes for Biomedical Research Co. LtdShanghaiChina
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Cherrez-Ojeda I, Maurer M, Felix M, Bernstein JA, Ramon GD, Jardim Criado RF, Mata VL, Cherrez A, Morfin-Maciel BM, Larco JI, Tinoco IO, Chorzepa GF, Gómez RM, Raad RJ, Thomsen SF, Schmid-Grendelmeier P, Guillet C, Cherrez S, Vanegas E. "Chronic urticaria and obstructive sleep apnea: Is there a significant association?". World Allergy Organ J 2021; 14:100577. [PMID: 34471460 PMCID: PMC8387911 DOI: 10.1016/j.waojou.2021.100577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/07/2021] [Accepted: 08/03/2021] [Indexed: 11/28/2022] Open
Abstract
Background Few studies have explored the association between obstructive sleep apnea (OSA) and chronic urticaria (CU). Our study aims to fill this gap by determining the frequency of the risk categories for OSA and how they might correlate with the specific CU patient reported outcome measures urticaria activity score (UAS7), urticaria control test (UCT) and CU quality of life questionnaire (CU-Q2oL). Methods We conducted a cross-sectional study involving a cohort of 171 Latin American CU patients. Descriptive statistics were used to determine frequency and proportions for demographic and clinical variables, while a chi-squared test for association between STOP-Bang OSA questionnaire categories and both UAS7 and UCT categories was performed to analyze how such variables interact. To further assess the strength of the correlation a Cramer's V coefficient was reported. Finally, a Kendall-Tau b correlation coefficient was performed to measure the correlation between the STOP-Bang score and other independent continuous variables. Results The average STOP-Bang score was 2.5, with 24% and 21% of patients falling into the intermediate and high-risk category for moderate-to-severe OSA, respectively. There was a strong statistically significant association (Cramer's V = 0.263; p = .000) between UAS-7 categories and STOP-Bang risk categories. A similar pattern of strong significant association (Cramer's V = .269; p = .002) was observed between UCT categories and STOP-Bang risk categories. A weak positive correlation between the STOP-Bang score and the CU-Q2oL average score (τb = 0.188, p = .001) was identified. Overall, 72.5% patients reported limitations with respect to sleep in a varied degree according to the CU-Q2oL. Conclusions Our results suggest that a considerable proportion of patients with CU are at intermediate to high risk for OSA. Higher disease activity, poor CU control, and worse quality of life were all found to be associated with an increased risk. Additional studies are needed to determine the exact link between these conditions, and to determine whether screening and treatment for OSA might benefit patients with CU.
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Affiliation(s)
- Ivan Cherrez-Ojeda
- Universidad Espíritu Santo, Samborondón, Ecuador.,Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - Marcus Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Germany
| | - Miguel Felix
- Universidad Espíritu Santo, Samborondón, Ecuador.,Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - Jonathan A Bernstein
- University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology/Allergy Section, Cincinnati, OH, United States
| | - German D Ramon
- Instituto de Alergia e Inmunología del Sur, Bahía Blanca, Argentina
| | | | - Valeria L Mata
- Universidad Espíritu Santo, Samborondón, Ecuador.,Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - Annia Cherrez
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador.,Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, Rostock, Germany
| | | | | | | | | | | | - Rodolfo Jaller Raad
- Departamento de Alergias del Centro de Asma Alergia e Inmunología Barranquilla, Colombia
| | - Simon Francis Thomsen
- Department of Dermatology, Bispebjerg Hospital and Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Carole Guillet
- Allergy Unit, Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Department of Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sofia Cherrez
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador.,Department of Dermatology, SRH Zentralklinikum Suhl, Germany
| | - Emanuel Vanegas
- Universidad Espíritu Santo, Samborondón, Ecuador.,Respiralab, Respiralab Research Group, Guayaquil, Ecuador
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Spindler M, Przybyłowicz K, Hawro M, Weller K, Reidel U, Metz M, Maurer M, Hawro T. Sleep disturbance in adult dermatologic patients: A cross-sectional study on prevalence, burden, and associated factors. J Am Acad Dermatol 2021; 85:910-922. [PMID: 33864837 DOI: 10.1016/j.jaad.2021.04.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/26/2021] [Accepted: 04/02/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Sleep disturbance remains insufficiently characterized in many dermatoses. OBJECTIVE To investigate the prevalence, burden, and factors associated with sleep disturbance in dermatologic patients. METHODS We recruited 800 patients and recorded pruritus characteristics and sociodemographic and clinical parameters. Validated questionnaires were used to assess sleep disturbance, psychological distress, health-related quality of life, and work productivity. RESULTS Two thirds of patients met criteria of poor sleep, which was associated with psychological distress, diminished health-related quality of life, and lost work productivity. Patients with average and maximum pruritus on the visual analog scale exceeding 5 and 6.5 points, respectively, were at high risk of suffering pruritus-related sleep disturbance. Overall pruritus intensity and its nocturnal exacerbation contributed independently to sleep disturbance. Psychological distress was of even higher impact on sleep than pruritus and almost a third of the relationship between pruritus intensity and sleep was mediated by psychological distress. CONCLUSION Sleep disturbance is prevalent in dermatologic patients and constitutes a considerable burden. CLINICAL IMPLICATION Dermatologic patients with intense pruritus and psychological distress should be examined for sleep disorders. Adequate antipruritic therapy and complementary psychotherapy in affected patients may help them regain restorative sleep.
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Affiliation(s)
- Max Spindler
- Dermatological Allergology, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Katarzyna Przybyłowicz
- Dermatological Allergology, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marlena Hawro
- Dermatological Allergology, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Karsten Weller
- Dermatological Allergology, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrich Reidel
- Dermatological Allergology, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Metz
- Dermatological Allergology, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marcus Maurer
- Dermatological Allergology, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tomasz Hawro
- Dermatological Allergology, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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