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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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Elkuch M, Greiff V, Berger CT, Bouchenaki M, Daikeler T, Bircher A, Navarini AA, Heijnen I, Recher M. Low immunoglobulin E flags two distinct types of immune dysregulation. Clin Exp Immunol 2017; 187:345-352. [PMID: 28078662 DOI: 10.1111/cei.12885] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2016] [Indexed: 10/20/2022] Open
Abstract
During the last two decades, hyper-immunoglobulin (Ig)E syndromes have been characterized clinically and molecularly in patients with genetically determined primary immunodeficiencies. However, the detection of low IgE levels, defined here as below detection limit in the routine clinical immunology laboratory, has received little attention. We analysed the association of serum IgA, IgM and IgG levels (including IgG subclasses) with low, normal or high serum IgE levels in patients evaluated in a single-centre out-patient immunodeficiency and allergy clinic. The correlation of serum IgE levels with IgG subclasses depended on the clinical phenotype. In patients with immunodeficiencies, IgE correlated with IgG2 and IgG4 but not with IgG3. In contrast, in patients referred for signs of allergy, IgE correlated with IgG3 but not with IgG2. A low IgE result was associated with low IgG3 and IgG4 in allergy referrals, while immunodeficiency referrals with a low IgE result had significantly lower IgG1, IgG2 and IgG4 levels. Hierarchical clustering of non-IgE immunoglobulin profiles (IgM, IgA, IgG, IgG1-4) validated that non-IgE immunoglobulin levels predict the clinic referral, i.e. phenotype, of low-IgE patients. These results suggesto guide the clinical management of patients with low serum IgE levels.
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Affiliation(s)
- M Elkuch
- Immunodeficiency Clinic, Medical Outpatient Unit and Immunodeficiency Laboratory, Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - V Greiff
- Department of Biosystems Science and Engineering, ETH Zürich, Basel, Switzerland
| | - C T Berger
- Medical Outpatient Unit and Translational Immunology Laboratory, Department of Biomedicine, Basel, Switzerland
| | - M Bouchenaki
- Division of Medical Immunology, Laboratory Medicine, University Hospital Basel, Basel, Switzerland
| | - T Daikeler
- Rheumatology Clinic, University Hospital Basel, Basel, Switzerland
| | - A Bircher
- Allergy and Dermatology Clinic, University Hospital Basel, Basel
| | - A A Navarini
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - I Heijnen
- Division of Medical Immunology, Laboratory Medicine, University Hospital Basel, Basel, Switzerland
| | - M Recher
- Immunodeficiency Clinic, Medical Outpatient Unit and Immunodeficiency Laboratory, Department of Biomedicine, University Hospital Basel, Basel, Switzerland
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Brockow K, Aberer W, Atanaskovic-Markovic M, Bavbek S, Bircher A, Bilo B, Blanca M, Bonadonna P, Burbach G, Calogiuri G, Caruso C, Celik G, Cernadas J, Chiriac A, Demoly P, Oude Elberink JNG, Fernandez J, Gomes E, Garvey LH, Gooi J, Gotua M, Grosber M, Kauppi P, Kvedariene V, Laguna JJ, Makowska J, Mosbech H, Nakonechna A, Papadopolous NG, Ring J, Romano A, Rockmann H, Sargur R, Sedlackova L, Sigurdardottir S, Schnyder B, Storaas T, Torres M, Zidarn M, Terreehorst I. Drug allergy passport and other documentation for patients with drug hypersensitivity - An ENDA/EAACI Drug Allergy Interest Group Position Paper. Allergy 2016; 71:1533-1539. [PMID: 27145347 DOI: 10.1111/all.12929] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [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: 05/02/2016] [Indexed: 12/27/2022]
Abstract
The strongest and best-documented risk factor for drug hypersensitivity (DH) is the history of a previous reaction. Accidental exposures to drugs may lead to severe or even fatal reactions in sensitized patients. Preventable prescription errors are common. They are often due to inadequate medical history or poor risk assessment of recurrence of drug reaction. Proper documentation is essential information for the doctor to make sound therapeutic decision. The European Network on Drug Allergy and Drug Allergy Interest Group of the European Academy of Allergy and Clinical Immunology have formed a task force and developed a drug allergy passport as well as general guidelines of drug allergy documentation. A drug allergy passport, a drug allergy alert card, a certificate, and a discharge letter after medical evaluation are adequate means to document DH in a patient. They are to be handed to the patient who is advised to carry the documentation at all times especially when away from home. A drug allergy passport should at least contain information on the culprit drug(s) including international nonproprietary name, clinical manifestations including severity, diagnostic measures, potential cross-reactivity, alternative drugs to prescribe, and where more detailed information can be obtained from the issuer. It should be given to patients only after full allergy workup. In the future, electronic prescription systems with alert functions will become more common and should include the same information as in paper-based documentation.
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Oussalah A, Mayorga C, Blanca M, Barbaud A, Nakonechna A, Cernadas J, Gotua M, Brockow K, Caubet JC, Bircher A, Atanaskovic M, Demoly P, K. Tanno L, Terreehorst I, Laguna JJ, Romano A, Guéant JL. Genetic variants associated with drugs-induced immediate hypersensitivity reactions: a PRISMA-compliant systematic review. Allergy 2016; 71:443-62. [PMID: 26678823 DOI: 10.1111/all.12821] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2015] [Indexed: 12/31/2022]
Abstract
Drug hypersensitivity includes allergic (AR) and nonallergic reactions (NARs) influenced by genetic predisposition. We performed a systematic review of genetic predictors of IgE-mediated AR and NAR with MEDLINE and PubMed search engine between January 1966 and December 2014. Among 3110 citations, the search selected 53 studies, 42 of which remained eligible. These eligible studies have evaluated genetic determinants of immediate reactions (IR) to beta-lactams (n = 19), NAR against aspirin (n = 12) and other nonsteroidal anti-inflammatory drugs (NSAIDs) (n = 8), and IR to biologics (n = 3). We reported two genomewide association studies and four case-control studies on candidate genes validated by replication. Genes involved in IR to beta-lactams belonged to HLA type 2 antigen processing, IgE production, atopy, and inflammation, including 4 genes validated by replications, HLA-DRA, ILR4, NOD2, and LGALS3. Genes involved in NAR to aspirin belonged to arachidonic acid pathway, membrane-spanning 4A gene family, histamine production pathway, and pro-inflammatory cytokines, while those involved in NAR to all NSAIDs belonged to arachidonic acid pathway and HLA antigen processing pathway. ALOX5 was a common predictor of studies on NAR to both aspirin and NSAIDs. Although these first conclusions could be drawn, this review highlights also the lack of reliable data and the need for replicating studies in contrasted populations, taking into account worldwide allele frequencies, gene-gene interactions, and contrasted situations of environmental exposure.
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Affiliation(s)
- A. Oussalah
- Faculty of Medicine of Nancy; NGERE - Nutrition, Genetics and Environmental Risk Exposure; INSERM U954; University of Lorraine; Vandoeuvre-lès-Nancy France
- Department of Molecular Medicine and Personalized Therapeutics; Department of Biochemistry, Molecular Biology, Nutrition and Metabolism; University Hospital of Nancy; Vandoeuvre-lès-Nancy France
| | - C. Mayorga
- Research Laboratory; IBIMA; Regional University Hospital of Malaga; UMA; Malaga Spain
- Allergy Unit; IBIMA; Regional University Hospital of Malaga; UMA; Malaga Spain
| | - M. Blanca
- Allergy Unit; IBIMA; Regional University Hospital of Malaga; UMA; Malaga Spain
| | - A. Barbaud
- Department of Dermatology and Allergology; University Hospital of Nancy; Vandoeuvre-lès-Nancy France
| | - A. Nakonechna
- Allergy and Immunology; Clinic Royal Liverpool and Broadgreen University Hospital; Thomas Drive Liverpool UK
| | - J. Cernadas
- Immunoallergy Department; Centro Hospitalar Sao Joao; Porto Portugal
| | - M. Gotua
- Center for Allergy and Immunology Research; Tbilisi Georgia
| | - K. Brockow
- Klinik für Dermatologie und Allergologie am Biederstein; Technische Universität München; München Germany
| | - J.-C. Caubet
- Division of Paediatrics; University Hospital of Geneva; Geneva Switzerland
| | - A. Bircher
- Dermatologie/Allergologie; Universitätsspital Basel; Basel Switzerland
| | - M. Atanaskovic
- Department of Allergology and Pulmonology; University Children's Hospital; Belgrade Serbia
| | - P. Demoly
- Department of Pulmonology; Division of Allergy; Hôpital Arnaud de Villeneuve; University Hospital of Montpellier; Montpellier France
| | | | - I. Terreehorst
- Academisch Medisch Centrum; University of Amsterdam; Amsterdam Netherlands
| | - J. J. Laguna
- Allergy Unit; Hospital de la Cruz Roja and Department of Immunology Alfonso X el Sabio University; Madrid Spain
| | - A. Romano
- Allergy Unit; Complesso Integrato Columbus, Rome and IRCCS Oasi Maria S.S.; Troina Italy
| | - J.-L. Guéant
- Faculty of Medicine of Nancy; NGERE - Nutrition, Genetics and Environmental Risk Exposure; INSERM U954; University of Lorraine; Vandoeuvre-lès-Nancy France
- Department of Molecular Medicine and Personalized Therapeutics; Department of Biochemistry, Molecular Biology, Nutrition and Metabolism; University Hospital of Nancy; Vandoeuvre-lès-Nancy France
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Cazzaniga S, Ballmer-Weber B, Gräni N, Spring P, Bircher A, Anliker M, Sonntag A, Piletta P, Huber C, Borradori L, Diepgen T, Apfelbacher C, Simon D. Medical, psychological and socio-economic implications of chronic hand eczema: a cross-sectional study. J Eur Acad Dermatol Venereol 2015; 30:628-37. [DOI: 10.1111/jdv.13479] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 09/07/2015] [Indexed: 11/28/2022]
Affiliation(s)
- S. Cazzaniga
- Department of Dermatology, Inselspital; Bern University Hospital; Bern Switzerland
- Centro Studi GISED; Bergamo Italy
| | - B.K. Ballmer-Weber
- Department of Dermatology; University Hospital Zurich; Zurich Switzerland
| | - N. Gräni
- Department of Dermatology; University Hospital Zurich; Zurich Switzerland
| | - P. Spring
- Department of Dermatology; University Hospital of Lausanne CHUV; Lausanne Switzerland
| | - A. Bircher
- Department of Dermatology; University Hospital Basel; Basel Switzerland
| | - M. Anliker
- Department of Dermatology; Cantonal Hospital St. Gallen; St. Gallen Switzerland
| | - A.K. Sonntag
- Department of Dermatology; Cantonal Hospital Aarau; Aarau Switzerland
| | - P. Piletta
- Department of Dermatology; Geneva University Hospitals (HUG); Geneva Switzerland
| | - C. Huber
- Department of Dermatology; Geneva University Hospitals (HUG); Geneva Switzerland
| | - L. Borradori
- Department of Dermatology, Inselspital; Bern University Hospital; Bern Switzerland
| | - T. Diepgen
- Department of Clinical Social Medicine, Occupational and Environmental Dermatology; University Hospital; Ruprecht Karls University; Heidelberg Germany
| | - C. Apfelbacher
- Institute of Epidemiology and Preventive Medicine; University of Regensburg; Regensburg Germany
| | - D. Simon
- Department of Dermatology, Inselspital; Bern University Hospital; Bern Switzerland
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6
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Wüthrich B, Frei P, Bircher A, Hauser C, Pichler W, Schmid-Grendelmeier P, Spertini F, Olgiati D, Müller U. Bioresonanz – diagnostischer und therapeutischer Unsinn. Akt Dermatol 2014. [DOI: 10.1055/s-0034-1367626] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | | | - A. Bircher
- Allergologische Poliklinik, Dermatologische Universitätsklinik Basel/Schweiz
| | | | - W. Pichler
- Scientific director bei ADR-AC GmbH, Bern/Schweiz
| | | | - F. Spertini
- Service d’immunologie et d’allergologie, CHUV, Lausanne/Schweiz
| | | | - U. Müller
- Spital Netz Bern Ziegler, Allergiestation Medizinische Klinik, Bern/Schweiz
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7
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Abstract
BACKGROUND Monitoring after complete resolution of anaphylactic reactions is recommended. The aim of this study was to define the occurrence of biphasic - and clinically important biphasic - anaphylactic reactions, the number of transfers to intensive care units (ICU) because of anaphylaxis, and the number of deaths within 10 days of presentation to the emergency department (ED). METHODS Clinical records of patients visiting the ED of a tertiary care hospital were analysed retrospectively. Hospital databases, direct contact with patients and caregivers, and the Internet were used to obtain mortality rates. RESULTS Of 259 557 ED presentations from February 2001 through to August 2013, 1334 (0.51%) episodes of allergic reactions were detected, and 532 (0.20%) episodes in 495 patients fulfilled the definition of anaphylaxis. In 227 (44.8%) episodes, the length of hospital stay was ≥8 h (median 22 h, IQR 16-24). There were 507 uniphasic and 25 (4.5%) biphasic anaphylactic reactions. Twelve (2.3%) were clinically important, including 2 (0.36%) that occurred during hospital stay, one of whom (0.19%) was transferred to ICU for shock. No risk factors for biphasic reactions could be found. Eight patients were lost to follow-up. There were no deaths during the 10-day follow-up. CONCLUSION Biphasic anaphylactic reactions, especially clinically important ones, occurred rarely, and no mortality was found, whether the monitoring was for ≥8 h or for <8 h. Our study could motivate physicians to consider discharging patients after complete resolution of an anaphylactic reaction and to dispense with prolonged monitoring.
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Affiliation(s)
- M. Rohacek
- Department of Emergency Medicine; University Hospital Basel; Basel Switzerland
| | - H. Edenhofer
- Department of Emergency Medicine; University Hospital Basel; Basel Switzerland
| | - A. Bircher
- Allergology Unit; Department of Dermatology; University Hospital Basel; Basel Switzerland
| | - R. Bingisser
- Department of Emergency Medicine; University Hospital Basel; Basel Switzerland
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8
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Brockow K, Garvey LH, Aberer W, Atanaskovic-Markovic M, Barbaud A, Bilo MB, Bircher A, Blanca M, Bonadonna B, Campi P, Castro E, Cernadas JR, Chiriac AM, Demoly P, Grosber M, Gooi J, Lombardo C, Mertes PM, Mosbech H, Nasser S, Pagani M, Ring J, Romano A, Scherer K, Schnyder B, Testi S, Torres M, Trautmann A, Terreehorst I. Skin test concentrations for systemically administered drugs -- an ENDA/EAACI Drug Allergy Interest Group position paper. Allergy 2013; 68:702-12. [PMID: 23617635 DOI: 10.1111/all.12142] [Citation(s) in RCA: 541] [Impact Index Per Article: 49.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2013] [Indexed: 12/15/2022]
Abstract
Skin tests are of paramount importance for the evaluation of drug hypersensitivity reactions. Drug skin tests are often not carried out because of lack of concise information on specific test concentrations. The diagnosis of drug allergy is often based on history alone, which is an unreliable indicator of true hypersensitivity.To promote and standardize reproducible skin testing with safe and nonirritant drug concentrations in the clinical practice, the European Network and European Academy of Allergy and Clinical Immunology (EAACI) Interest Group on Drug Allergy has performed a literature search on skin test drug concentration in MEDLINE and EMBASE, reviewed and evaluated the literature in five languages using the GRADE system for quality of evidence and strength of recommendation. Where the literature is poor, we have taken into consideration the collective experience of the group.We recommend drug concentration for skin testing aiming to achieve a specificity of at least 95%. It has been possible to recommend specific drug concentration for betalactam antibiotics, perioperative drugs, heparins, platinum salts and radiocontrast media. For many other drugs, there is insufficient evidence to recommend appropriate drug concentration. There is urgent need for multicentre studies designed to establish and validate drug skin test concentration using standard protocols. For most drugs, sensitivity of skin testing is higher in immediate hypersensitivity compared to nonimmediate hypersensitivity.
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Affiliation(s)
- K. Brockow
- Department of Dermatology und Allergology Biederstein; Division Environmental Dermatology and Allergology Helmholtz Zentrum München/TUM; Technical University Munich; Munich; Germany
| | - L. H. Garvey
- Allergy Clinic; Copenhagen University Hospital; Gentofte; Denmark
| | - W. Aberer
- Department of Dermatology; Medical University of Graz; Graz; Austria
| | | | - A. Barbaud
- Dermatology Department and EA 72-98 INGRES; Brabois Hospital; University Hospital of Nancy; Lorraine University; Vandoeuvre les Nancy; France
| | - M. B. Bilo
- Department of Immunology, Allergy and Respiratory Diseases; Allergy Unit; University Hospital Ospedali Riuniti; Ancona; Italy
| | - A. Bircher
- Dermatologische Universitätsklinik Kantonsspital; Basel; Switzerland
| | - M. Blanca
- Allergy Service; Carlos Haya Hospital; Malaga; Spain
| | - B. Bonadonna
- Allergy Unit; Verona University Hospital; Verona; Italy
| | - P. Campi
- Allergy and Clinical Immunology Unit; San Giovanni di Dio Hospital; Florence; Italy
| | - E. Castro
- Department of Allergy and Clinical Immunology; Medical University; H. S. Joao; Porto; Portugal
| | - J. R. Cernadas
- Department of Allergy and Clinical Immunology; Medical University; H. S. Joao; Porto; Portugal
| | - A. M. Chiriac
- Allergy Department; University Hospital of Montpellier and INSERM U657; Montpellier; France
| | - P. Demoly
- Allergy Department; University Hospital of Montpellier and INSERM U657; Montpellier; France
| | - M. Grosber
- Department of Dermatology und Allergology Biederstein; Division Environmental Dermatology and Allergology Helmholtz Zentrum München/TUM; Technical University Munich; Munich; Germany
| | - J. Gooi
- Department of Immunology; Beaumont Hospital; Dublin; Ireland
| | - C. Lombardo
- Allergy Unit; Verona University Hospital; Verona; Italy
| | - P. M. Mertes
- Service d'anesthésie-réanimation chirurgicale; Hôpitaux Universitaires de Strasbourg; Strasbourg; France
| | - H. Mosbech
- Allergy Clinic; Copenhagen University Hospital; Gentofte; Denmark
| | - S. Nasser
- Department of Allergy; Addenbrooke's Hospital; Cambridge; UK
| | - M. Pagani
- Allergology and Oncology Service; Civil Hospital of Asola; Mantova; Italy
| | - J. Ring
- Department of Dermatology und Allergology Biederstein; Division Environmental Dermatology and Allergology Helmholtz Zentrum München/TUM; Technical University Munich; Munich; Germany
| | - A. Romano
- Allergy Unit; C. I. Columbus; Rome and IRCCS Oasi Maria S. S.; Troina; Italy
| | - K. Scherer
- Dermatologische Universitätsklinik Kantonsspital; Basel; Switzerland
| | - B. Schnyder
- Department of Rheumatology; Clinical Immunology and Allergology; Bern; Switzerland
| | - S. Testi
- Allergy and Clinical Immunology Unit; San Giovanni di Dio Hospital; Florence; Italy
| | - M. Torres
- Allergy Service; Carlos Haya Hospital; Malaga; Spain
| | - A. Trautmann
- Department of Dermatology and Allergology; University of Würzburg; Würzburg; Germany
| | - I. Terreehorst
- Department of ENT and Pediatrics; AMC; Amsterdam; The Netherlands
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Abstract
Allergic rhinoconjunctivits and asthma are frequent diseases. About one in ten asthma cases is caused by an occupational hazard, either by an allergic or a non-immunologic mechanism. Primary or secondary preventive measures should be able to prevent these cases. Often, occupational rhinitis precedes the development of occupational asthma. Important causative agents are flours, plant and enzyme powders, laboratory animals, latex, isocyanates and hardeners, epoxy resins, acrylates, formaldehyde and welding fumes. Early diagnosis and the installation of protective measures are decisive for the prognosis of occupational respiratory disease.
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Affiliation(s)
- K Scherer Hofmeier
- Dermatologische Klinik, Allergologische Poliklinik, Universitätsspital Basel.
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10
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Gerbase MW, Keidel D, Imboden M, Gemperli A, Bircher A, Schmid-Grendelmeier P, Bridevaux PO, Berger W, Schindler C, Rochat T, Probst-Hensch N. Effect modification of immunoglobulin E-mediated atopy and rhinitis by glutathione S-transferase genotypes in passive smokers. Clin Exp Allergy 2011; 41:1579-86. [PMID: 21729179 DOI: 10.1111/j.1365-2222.2011.03807.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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 Experimental studies suggest that glutathione S-transferase (GST) genotypes modify nasal allergen responses induced by secondhand smoke (SHS) exposure. OBJECTIVE We aimed to investigate whether GSTs affected systemic IgE and allergic rhinitis (AR) in SHS-exposed individuals from a population-based cohort. METHODS Analyses comprised 2309 never-smokers from the Swiss study on air pollution and health in adults cohort, reporting SHS status at baseline and 11 years later. Outcomes were defined by total serum IgE≥100 kU/L, specific serum IgE determined by Phadiatop® ≥0.35 kU/L and self-reported AR. GSTP1 Ile105Val, GSTM1 and GSTT1 gene deletion genotypes were identified at the follow-up survey. RESULTS After adjustment for relevant covariates, the homozygous GSTP1 105-Val genotype was negatively associated with high total IgE and high-specific IgE by Phadiatop®, notably in subjects persistently exposed to SHS (OR: 0.20, 95% CI 0.05-0.75; P=0.02, for high total IgE and OR: 0.29, 95% CI 0.10-0.89; P=0.03, for high specific IgE by Phadiatop®). Carrying at least one copy of the GSTM1 gene (non-null) showed a similar association for high specific IgE by Phadiatop® (OR: 0.41, 95% CI 0.22-0.76; P=0.004). No significant associations were found between GSTs and rhinitis. CONCLUSION AND CLINICAL RELEVANCE In this large cohort, homozygosity for GSTP1 105-Val or carrying the GSTM1 non-null genotype decreased the risk of high total IgE or high specific IgE using Phadiatop® by nearly half in subjects exposed to SHS, as compared with subjects carrying opposite alleles. These findings underline the value of genetic susceptibility when evaluating the effects of environmental exposure on allergic illness. The potential long-term effects of persistent SHS exposure in genetically vulnerable individuals may be of public health relevance.
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Affiliation(s)
- M W Gerbase
- Division of Pulmonary Medicine, University Hospitals of Geneva, Geneva, Switzerland.
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Bonadonna P, Pagani M, Bircher A, Scherer K, Caruso B, Cocco C, Schiappoli M, Senna G, Lombardo C. Skin Test Predictive Value On The Proton Pump Inhibitors Allergy. J Allergy Clin Immunol 2011. [DOI: 10.1016/j.jaci.2010.12.749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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12
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Cernadas JR, Brockow K, Romano A, Aberer W, Torres MJ, Bircher A, Campi P, Sanz ML, Castells M, Demoly P, Pichler WJ. General considerations on rapid desensitization for drug hypersensitivity - a consensus statement. Allergy 2010; 65:1357-66. [PMID: 20716314 DOI: 10.1111/j.1398-9995.2010.02441.x] [Citation(s) in RCA: 236] [Impact Index Per Article: 16.9] [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: 02/06/2023]
Abstract
Drug hypersensitivity reactions can occur with most drugs, are unpredictable, may affect any organ or system, and range widely in clinical severity from mild pruritus to anaphylaxis. In most cases, the suspected drug is avoided in the future. However, for certain patients, the particular drug may be essential for optimal therapy. Under these circumstances, desensitization may be performed. Drug desensitization is defined as the induction of a temporary state of tolerance of a compound responsible for a hypersensitivity reaction. It is performed by administering increasing doses of the medication concerned over a short period of time (from several hours to a few days) until the total cumulative therapeutic dose is achieved and tolerated. It is a high-risk procedure used only in patients in whom alternatives are less effective or not available after a positive risk/benefit analysis. Desensitization protocols have been developed and are used in patients with allergic reactions to antibiotics (mainly penicillin), insulins, sulfonamides, chemotherapeutic and biologic agents, and many other drugs. Desensitization is mainly performed in IgE-mediated reactions, but also in reactions where drug-specific IgE have not been demonstrated. Desensitization induces a temporary tolerant state, which can only be maintained by continuous administration of the medication. Thus, for treatments like chemotherapy, which have an average interval of 4 weeks between cycles, the procedure must be repeated for every new course. In this paper, some background information on rapid desensitization procedures is provided. We define the drugs and drug reactions indicated for such procedures, describe the possible mechanism of action, and discuss the indications and contraindications. The data should serve as background information for a database (accessible via the EAACI-homepage) with standardized protocols for rapid desensitization for antibiotics, chemotherapeutic agents, monoclonal antibodies/fusion proteins, and other drugs.
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Affiliation(s)
- J R Cernadas
- Department of Allergy and Clinical Immunology, Medical University, H. S. João, Porto, Portugal.
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13
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Bousquet PJ, Demoly P, Romano A, Aberer W, Bircher A, Blanca M, Brockow K, Pichler W, Torres MJ, Terreehorst I, Arnoux B, Atanaskovic-Markovic M, Barbaud A, Bijl A, Bonadonna P, Burney PG, Caimmi S, Canonica GW, Cernadas J, Dahlen B, Daures JP, Fernandez J, Gomes E, Gueant JL, Kowalski ML, Kvedariene V, Mertes PM, Martins P, Nizankowska-Mogilnicka E, Papadopoulos N, Ponvert C, Pirmohamed M, Ring J, Salapatas M, Sanz ML, Szczeklik A, Van Ganse E, De Weck AL, Zuberbier T, Merk HF, Sachs B, Sidoroff A. Pharmacovigilance of drug allergy and hypersensitivity using the ENDA-DAHD database and the GALEN platform. The Galenda project. Allergy 2009; 64:194-203. [PMID: 19178398 DOI: 10.1111/j.1398-9995.2008.01944.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Nonallergic hypersensitivity and allergic reactions are part of the many different types of adverse drug reactions (ADRs). Databases exist for the collection of ADRs. Spontaneous reporting makes up the core data-generating system of pharmacovigilance, but there is a large under-estimation of allergy/hypersensitivity drug reactions. A specific database is therefore required for drug allergy and hypersensitivity using standard operating procedures (SOPs), as the diagnosis of drug allergy/hypersensitivity is difficult and current pharmacovigilance algorithms are insufficient. Although difficult, the diagnosis of drug allergy/hypersensitivity has been standardized by the European Network for Drug Allergy (ENDA) under the aegis of the European Academy of Allergology and Clinical Immunology and SOPs have been published. Based on ENDA and Global Allergy and Asthma European Network (GA(2)LEN, EU Framework Programme 6) SOPs, a Drug Allergy and Hypersensitivity Database (DAHD((R))) has been established under FileMaker((R)) Pro 9. It is already available online in many different languages and can be accessed using a personal login. GA(2)LEN is a European network of 27 partners (16 countries) and 59 collaborating centres (26 countries), which can coordinate and implement the DAHD across Europe. The GA(2)LEN-ENDA-DAHD platform interacting with a pharmacovigilance network appears to be of great interest for the reporting of allergy/hypersensitivity ADRs in conjunction with other pharmacovigilance instruments.
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Affiliation(s)
- P-J Bousquet
- Département de Biostatistique Epidémiologie Clinique, Santé Publique et Information Médicale, GHU Carémeau, CHU Nîmes, Nîmes cedex 9, France
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14
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Uter W, Hegewald J, Aberer W, Bircher A, Brasch J, Coenraads PJ, Elsner P, Fartasch M, Frosch P, Fuchs T, Menné T, Jolanki R, Krêcisz B, Orton D, Perrenoud D, Schnuch A. FS05.5
The European Standard Series in 8 European countries - first results of the ESSCA network. Contact Dermatitis 2008. [DOI: 10.1111/j.0105-1873.2004.0309bh.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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15
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Le Coz CJ, Jelen G, Goossens A, Vigan M, Ducombs G, Bircher A, Giordano-Labadie F, Pons-Guiraud A, Milpied-Homsi, Castelain M, Tennstedt D, Bourrain JL, Bernard G. FS01.3
Disperse (yes), orange (yes), 3 (no): what do we test in textile dye dermatitis? Contact Dermatitis 2008. [DOI: 10.1111/j.0105-1873.2004.0309m.x] [Citation(s) in RCA: 7] [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: 11/27/2022]
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16
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Abstract
Isolated allergy to the common housefly (Musca domestica) has only been described in four cases. Predisposing factors include high concentrations of allergens and prolonged exposure time. Two pharmaceutical industry workers, 59 and 34 years of age, both without atopy, presented with recent onset of allergic rhinitis. Their symptoms appeared about 30 minutes after exposure to Musca domestica in the closed breeding rooms. They were symptom-free with other insects, on weekends and on vacation. Skin prick tests with common inhalant allergens were negative. Prick testing with crushed Musca domestica adults, hatched eggs, contaminated nets and sand, as well as fly feces were all positive. One patient had specific IGE antibodies against Musca domestica. Both patients lacked specific IgE antibodies against other insect species and common aeroallergens. In these two patients there was a species-specific sensitization without relevant cross reactions to other arthropods. The patients were transferred to new work sites where they had no contact with Musca domestica and became symptom-free. Thus this common insect can be a relevant occupational aeroallergen.
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Affiliation(s)
- E Tas
- Allergologische Poliklinik der Universitäts-Hautklinik Heidelberg, Vossstrasse 2, 69115 Heidelberg
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17
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Abstract
Urticaria is one of the most prevalent disorders in dermatological practice. The disease can be incapacitating. There are clear pathophysiological and epidemiological hints that helminths and protozoa are rare but treatable causes of acute and chronic urticaria. Doctors and patients are often not aware that parasitic diseases are increasingly common even in industrialized countries due to a steep rise in migration and international travel. This review presents the most important parasitic causes of urticaria and provides relevant details regarding personal history, clinical presentation, diagnosis and therapy.
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Affiliation(s)
- U Ronellenfitsch
- Abteilung für Medizin und Diagnostik, Schweizerisches Tropeninstitut, Socinstrasse 57, 4002 Basel
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18
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Hruz P, Stöckli R, Bircher A. [Urticaria after subcutaneous administration of Insulatard]. Praxis (Bern 1994) 2007; 96:781-2. [PMID: 17571635 DOI: 10.1024/1661-8157.96.19.781] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Ein 60-jähriger Patient mit einem insulinabhängigen Diabetes Typ II beschreibt nach einer subkutanen Injektion von Insulatard am Abdomen massive Nausea und Erbrechen, nach wenigen Minuten vom Auftreten eines generalisierten Juckreizes mit einem urtikariellen Aufflammphänomen an früheren Injektionsstellen gefolgt. In der allergologischen Abklärung liegt eine Sensibilisierung vom Soforttyp auf verschiedene Insuline, insbesondere tierischer, aber auch humaner Herkunft, vor. Bei einem negativen Pricktest und einem schwach positiven Intradermaltest wird Levemir zum aktuellen Zeitpunkt ausgezeichnet toleriert und kann als Ersatz für Insulatard verwendet werden.
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MESH Headings
- Delayed-Action Preparations
- Diabetes Mellitus, Type 2/drug therapy
- Diagnosis, Differential
- Drug Eruptions/diagnosis
- Drug Eruptions/etiology
- Humans
- Hypersensitivity, Immediate/diagnosis
- Hypersensitivity, Immediate/etiology
- Immunoglobulin E/blood
- Injections, Subcutaneous
- Insulin/administration & dosage
- Insulin/analogs & derivatives
- Insulin Detemir
- Insulin, Isophane
- Insulin, Long-Acting/adverse effects
- Insulin, Long-Acting/therapeutic use
- Insulin, Regular, Human
- Intradermal Tests
- Isophane Insulin, Human
- Male
- Middle Aged
- Urticaria/chemically induced
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Affiliation(s)
- P Hruz
- Medizinische Poliklinik, Universitätsspital Basel
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19
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Abstract
Die Wahl der Arzneiform für die Anwendung auf der Haut ist mitentscheidend für den Erfolg einer topischen Pharmakotherapie. Die Akuität der Effloreszenz, die Lokalisation und Ausdehnung der Affektion, der Hauttyp, die kosmetischen Ansprüche des Patienten, sowie die Abwaschbarkeit, der Kühl- und Okklusiveffekt der Arzneiform müssen bei der Wahl berücksichtigt werden. Angepasste Therapie- und Anwendungsmodalitäten unterstützen die Therapie und fördern die Compliance.
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Affiliation(s)
- C Surber
- Institut für Spital-Pharmazie, Universitätsspital Basel.
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20
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Wüthrich B, Frei PC, Bircher A, Hauser C, Pichler W, Schmid-Grendelmeier P, Spertini F, Olgiati D, Müller U. Bioresonanz - diagnostischer und therapeutischer Unsinn. Akt Dermatol 2006. [DOI: 10.1055/s-2006-925055] [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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21
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Brockow K, Christiansen C, Aberer W, Barbaud A, Bircher A, Kanny G, Pichler W, Ring J, Romano A, von Radnoth IS. CMR 2005: 11.06: European multicenter study on contrast media hypersensitivity. Contrast Media Mol Imaging 2006. [DOI: 10.1002/cmmi.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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22
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Schnuch A, Kelterer D, Bauer A, Schuster C, Aberer W, Mahler V, Katzer K, Rakoski J, Jappe U, Krautheim A, Bircher A, Koch P, Worm M, Löffler H, Hillen U, Frosch PJ, Uter W. Quantitative patch and repeated open application testing in methyldibromo glutaronitrile-sensitive patients. Contact Dermatitis 2005; 52:197-206. [PMID: 15859992 DOI: 10.1111/j.0105-1873.2005.00529.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Contact allergy to methyldibromo glutaronitrile (MDBGN), often combined with phenoxyethanol (PE) (e.g., Euxyl K 400), increased throughout the 1990s in Europe. Consequently, in 2003, the European Commission banned its use in leave-on products, where its use concentration was considered too high and the non-sensitizing use concentration as yet unknown. The 2 objectives of the study are (a) to find a maximum non-eliciting concentration in a leave-on product in MDBGN/PE-sensitized patients, which could possibly also be considered safe regarding induction and (b) to find the best patch test concentration for MDBGN. We, therefore, performed a use-related test (ROAT) in patients sensitized to MDBGN/PE (n = 39) with 3 concentrations of MDBGN/PE (50, 100 and 250 p.p.m. MDBGN, respectively). A subset of these patients (n = 24) was later patch-tested with various concentrations (0.1, 0.2, 0.3 and 0.5% MDBGN, respectively). 15 patients (38%, 95% confidence interval (CI) = 23-55%) had a negative and 24 (62%; 95% CI = 45-77%) a positive overall repeated open application test (ROAT) result. 13 reacted to the lowest (50 p.p.m.), 8 to the middle (100 p.p.m.) and 3 to the highest concentration (250 p.p.m.) only. In those 13 reacting to the lowest ROAT concentration, dermatitis developed within a few days (1-7). The strength of the initial and the confirmatory patch test result, respectively, and the outcome of the ROAT were positively associated. Of the 24 patients with a use and confirmatory patch test, 15 reacted to 0.1% MDBGN, 16 to 0.2%, 17 to 0.3% and 22 to 0.5%. With the patch test concentration of 0.5%, the number of ROAT-negative patients but patch-test-positive patients increases considerably, particularly due to + reactions. A maximum sensitivity of 94% (95% CI = 70-100%) is reached with a patch test concentration of 0.2%, and is not further improved by increasing the concentration. However, the specificity decreases dramatically from 88 (95% CI = 47-100%) with 0.2% to a mere 12.5% (95% CI = 0-53%) with 0.5%. It can be concluded (a) that for MDBGN 0.2% is very likely the best patch test concentration and (b) that 50 p.p.m. in a leave-on product can elicit contact dermatitis in sensitized persons. We were, therefore, unable to find a safe, still microbicidal, concentration for leave-on products. By contrast, with other contact allergens, dose-response use tests may be able to identify a non-eliciting concentration, which could give valuable clues to a non-inducing (i.e., safe) concentration in products.
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Affiliation(s)
- A Schnuch
- Information Network of Department of Dermatology (IVDK), University of Göttingen, Germany.
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23
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Brockow K, Christiansen C, Kanny G, Clément O, Barbaud A, Bircher A, Dewachter P, Guéant JL, Rodriguez Guéant RM, Mouton-Faivre C, Ring J, Romano A, Sainte-Laudy J, Demoly P, Pichler WJ. Management of hypersensitivity reactions to iodinated contrast media. Allergy 2005; 60:150-8. [PMID: 15647034 DOI: 10.1111/j.1398-9995.2005.00745.x] [Citation(s) in RCA: 205] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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24
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Brand S, Heller P, Huss A, Bircher A, Braun-Fahrländer C, Niederer M, Schwarzenbach S, Waeber R, Wegmann L, Küchenhoff J. Seelische Belastung bei Menschen mit umweltbezogenen St�rungen. Nervenarzt 2005; 76:36-42. [PMID: 15654647 DOI: 10.1007/s00115-004-1755-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Environmental illnesses raise diagnostic and therapeutic conflicts in scientific discussions and clinical practice. When a patient's health-belief model, based on environmental origins, does not match that of the expert, the therapeutic relationship can be endangered. Our study investigates this discrepancy, which has not been empirically evaluated so far. Patient (n=61) and expert disease concepts were systematically investigated. Our results indicate that in cases in which both concepts are favourable, the patient suffered minor psychiatric disorders with stable psychic structures and the symptoms were associated with medical or environmental causes. If both concepts were unfavourable, a higher proportion of psychiatric disorders with unstable psychic structures were present. In the case of incongruent concepts, the expert evaluations allow a more accurate assessment of the psychiatric diagnoses, psychic states and the psychic attribution of somatic and psychic burden.
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Affiliation(s)
- S Brand
- Psychiatrische Universitätsklinik, Basel, Schweiz
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25
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26
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Abstract
Nonimmediate manifestations (i.e. occurring more than 1 h after drug administration), particularly maculopapular and urticarial eruptions, are common during beta-lactam treatment. The mechanisms involved in most nonimmediate reactions seem to be heterogeneous and are not yet completely understood. However, clinical and immunohistological studies, as well as analysis of drug-specific T-cell clones obtained from the circulating blood and the skin, suggest that a type-IV (cell-mediated) pathogenic mechanism may be involved in some nonimmediate reactions such as maculopapular or bullous rashes and acute generalized exanthematous pustulosis. In the diagnostic work-up, the patient's history is fundamental; patch testing is useful, together with delayed-reading intradermal testing. The latter appears to be somewhat more sensitive than patch testing, but also less specific. In case of negative allergologic tests, consideration should be given to provocation tests, and the careful administration of the suspect agents. With regard to in vitro tests, the lymphocyte transformation test may contribute to the identification of the responsible drug. Under the aegis of the European Academy of Allergology and Clinical Immunology (EAACI) interest group on drug hypersensitivity and the European Network for Drug Allergy (ENDA), in this review we describe the general guidelines for evaluating subjects with nonimmediate reactions to beta-lactams.
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Affiliation(s)
- A Romano
- Oasi Maria SS, Troina, and C. I. Columbus, Rome, Italy
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27
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Aberer W, Bircher A, Romano A, Blanca M, Campi P, Fernandez J, Brockow K, Pichler WJ, Demoly P. Drug provocation testing in the diagnosis of drug hypersensitivity reactions: general considerations. Allergy 2003; 58:854-63. [PMID: 12911412 DOI: 10.1034/j.1398-9995.2003.00279.x] [Citation(s) in RCA: 513] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- W Aberer
- Department of Environmental Dermatology, University of Graz, Auenbruggerplatz 8, A-8036 Graz, Austria.
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28
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Aberer W, Bircher A, Romano A, Blanca M, Campi P, Fernandez J, Brockow K, Pichler WJ, Demoly P. Drug provocation testing in the diagnosis of drug hypersensitivity reactions: general considerations. Allergy 2003. [PMID: 12911412 DOI: 10.1034/j.1398-9995.2003.00279.x)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- W Aberer
- Department of Environmental Dermatology, University of Graz, Auenbruggerplatz 8, A-8036 Graz, Austria.
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29
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Wüthrich B, Bucher C, Jörg W, Bircher A, Eng P, Schneider Y, Schnyder F, Eigenmann P, Senti G. Double-blind, placebo-controlled study with sublingual immunotherapy in children with seasonal allergic rhinitis to grass pollen. J Investig Allergol Clin Immunol 2003; 13:145-8. [PMID: 14635462] [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: 04/27/2023] Open
Abstract
UNLABELLED Sublingual immunotherapy (SLIT) has been recognized as a viable alternative to subcutaneous immunotherapy for respiratory allergies both in adults and children, but clinical documentation about safety and efficacy in children is still poor. The purpose of this study was to assess the efficacy and tolerance of SLIT in children who are sensitized to grass pollen. METHODS Children with a clinical history of intermittent rhinoconjunctivitis, with or without mild asthma and positive skin prick tests to grass pollen, were selected to participate in a 2-year double-blind, placebo-controlled study with SLIT, using a grass extract (ALK-Abellò). RESULTS 22 children were analyzed at the end of the study. No relevant side effects occurred in the active group. A statistically significant difference (p = 0.05; Mann-Whitney test) in favor of the active group (n = 10) could be shown for drug consumption during the second year, as well as a significant improvement as compared to the first year of SLIT (p = 0.05; Wilcoxon test). CONCLUSIONS Despite the small number of patients, our data suggest that SLIT with a grass pollen extract is well tolerated in children and is able to significantly reduce drug consumption during the second year of treatment. Studies in larger groups of children sensitized to both grass and tree pollens are needed to definitively assess the role of SLIT in intermittent, seasonal rhinitis and pollen asthma.
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MESH Headings
- Administration, Sublingual
- Allergens/adverse effects
- Child
- Child, Preschool
- Conjunctivitis, Allergic/diagnosis
- Conjunctivitis, Allergic/drug therapy
- Desensitization, Immunologic/methods
- Double-Blind Method
- Female
- Follow-Up Studies
- Humans
- Immunotherapy/methods
- Male
- Patch Tests
- Plant Extracts/therapeutic use
- Poaceae/immunology
- Pollen/immunology
- Reference Values
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/drug therapy
- Severity of Illness Index
- Statistics, Nonparametric
- Treatment Outcome
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Affiliation(s)
- B Wüthrich
- Allergy Unit, Department of Dermatology, University Hospital, Zurich, Switzerland.
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30
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Degonda M, Pichler WJ, Bircher A, Helbling A. [Chronic idiopathic urticaria: effectiveness of fexofenadine. A double-blind, placebo controlled study with 21 patients]. Praxis (Bern 1994) 2002; 91:637-643. [PMID: 12014063 DOI: 10.1024/0369-8394.91.15.637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Chronic urticaria defined as repeated or daily eruptions of wheals within a week over a period of at least 1 1/2 months is a frustrating problem not only for the patient but also for the physician. Since a cause will seldom be identified, therapy is symptomatic. In this study the effect of fexofenadine the active metabolite of terfenadine on pruritus, wheal formation and subjective feedbacks has been investigated in 21 patients with chronic urticaria. The study was double-blind, placebo-controlled designed. Following a 1-week washout period all study subjects received fexofenadine 180 mg OD for 3 weeks; thereafter the subjects were randomized for another 3 weeks in a placebo and fexofenadine arm. This study showed that fexofenadine had a beneficial effect on urticaria, particularly pruritus, and the patient-reported symptoms. Reports on side effects were non characteristic and not different between fexofenadine and placebo. Prolongation of QTc intervals or other cardiac side effects have not been observed. Fexofenadine 180 mg is a new antihistamine that is effective in the treatment of chronic urticaria and that has a profile of side effects similar to placebo.
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Affiliation(s)
- M Degonda
- Allergologisch-Immunologische Poliklinik, Klinik für Rheumatologie, klinische Immunologie/Allergologie, Inselspital Bern
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31
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Abstract
Skin testing with a suspected drug has been reported to be helpful in determining the cause of cutaneous adverse drug reactions (CADR). Many isolated reports of positive drug skin tests are published, but without detailed information concerning the clinical features of the CADR and the method used in performing drug skin tests, such data are not very informative. A working party of the European Society of Contact Dermatitis (ESCD) for the study of skin testing in investigating cutaneous adverse drug reactions, has proposed the herein-reported guidelines for performing skin testing in CADR in order to standardize these procedures. In each reported case, the imputability of each drug taken at the onset of the CADR and a highly detailed description and characterization of the dermatitis need to be given. Drug skin tests are performed 6 weeks to 6 months after complete healing of the CADR. Drug patch tests are performed according to the methods used in patch testing in studying contact dermatitis. The commercialized form of the drug used by the patient is tested diluted at 30% pet. (pet.) and/or water (aq.). The pure drug is tested diluted at 10% in pet. or aq. In severe CADR, drug patch tests are performed at lower concentrations. It is also of value to test on the most affected site of the initial CADR. Drug prick tests are performed on the volar forearm skin with the commercialized form of the drug, but with sequential dilutions in cases of urticaria. Intradermal tests (IDT) are performed with sterile sequential dilutions (10-4, 10-3, 10-2, 10-1) of a pure sterile or an injectable form of the suspected drug with a small volume of 0.04 ml. Drug skin tests need to be read at 20 min and also later at D2 and D4 for patch tests, at D1 for prick tests and IDT. All these tests also need to be read at 1 week. The success of skin tests varies with the drug tested, with a high % of positive results, for example, with betalactam antibiotics, pristinamycin, carbamazepine and tetrazepam on patch testing, or with betalactam antibiotics and heparins on delayed readings of IDT. The results of drug skin tests also depend on the clinical features of the CADR. The use of appropriate control patients is necessary to avoid false-positive results.
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Affiliation(s)
- A Barbaud
- Dermatology Department, Hopital Fournier, 54000 Nancy, France
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Britschgi M, Steiner UC, Schmid S, Depta JP, Senti G, Bircher A, Burkhart C, Yawalkar N, Pichler WJ. T-cell involvement in drug-induced acute generalized exanthematous pustulosis. J Clin Invest 2001; 107:1433-41. [PMID: 11390425 PMCID: PMC209321 DOI: 10.1172/jci12118] [Citation(s) in RCA: 240] [Impact Index Per Article: 10.4] [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: 11/17/2022] Open
Abstract
Acute generalized exanthematous pustulosis (AGEP) is an uncommon eruption most often provoked by drugs, by acute infections with enteroviruses, or by mercury. It is characterized by acute, extensive formation of nonfollicular sterile pustules on erythematous background, fever, and peripheral blood leukocytosis. We present clinical and immunological data on four patients with this disease, which is caused by different drugs. An involvement of T cells could be implied by positive skin patch tests and lymphocyte transformation tests. Immunohistochemistry revealed a massive cell infiltrate consisting of neutrophils in pustules and T cells in the dermis and epidermis. Expression of the potent neutrophil-attracting chemokine IL-8 was elevated in keratinocytes and infiltrating mononuclear cells. Drug-specific T cells were generated from the blood and skin of three patients, and phenotypic characterization showed a heterogeneous distribution of CD4/CD8 phenotype and of T-cell receptor Vbeta-expression. Analysis of cytokine/chemokine profiles revealed that IL-8 is produced significantly more by drug-specific T cells from patients with AGEP compared with drug-specific T cells from patients that had non-AGEP exanthemas. In conclusion, our data demonstrate the involvement of drug-specific T cells in the pathomechanism of this rather rare and peculiar form of drug allergy. In addition, they indicate that even in some neutrophil-rich inflammatory responses specific T cells are engaged and might orchestrate the immune reaction.
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Affiliation(s)
- M Britschgi
- Clinic of Rheumatology and Clinical Immunology/Allergology, Inselspital, Bern, Switzerland
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Affiliation(s)
- P Demoly
- Maladies Respiratoires-INSERM U454, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, France
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Affiliation(s)
- P Demoly
- Maladies Respiratoires-INSERM U454, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, France
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Bircher A. [Effect of self-hypnosis in patients with pollinosis]. Forsch Komplementarmed 1999; 6 Suppl 1:47-9. [PMID: 10077719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The aim of this study in hypnosis was the exemplary verification of a regulatory intervention in patients with pollinosis. Hypnosis and self-hypnosis are established methods in medicine. 52 patients with pollinosis participated in this clinical study. It lasted over two pollen seasons. Self-hypnosis was learned quite easily. It resulted in a clear yet statistically weak beneficial effect on the subjective assessment of the pollinosis symptoms, on the consumption of drugs and on other objective findings. From a methodological point of view this study might suggest that the classical comparison of experimental groups in clinical research could hide some larger therapeutic effects in individual patients. Therefore, it would be desirable to consider also individual data analysis in all future studies dealing with psychological or psychosomatic mechanisms and in all studies which capture parameters interactive at different levels. The beneficial effect of hypnosis on the swelling of the nasal mucous membrane in a provocation test initiated a subsequent small project on the possible mode of action of hypnosis in this pollinosis study. However, the results were inconclusive.
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Pichler CE, Marquardsen A, Sparholt S, Løwenstein H, Bircher A, Bischof M, Pichler WJ. Specific immunotherapy with Dermatophagoides pteronyssinus and D. farinae results in decreased bronchial hyperreactivity. Allergy 1997. [PMID: 9140517 DOI: 10.1111/j.1398-9995.1997.tb00991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
To evaluate the tolerability and efficacy of specific immunotherapy with mite extracts, we performed a double-blind, placebo-controlled immunotherapy study in 30 patients with proven allergy to mite allergens. The specific immunotherapy with standardized extracts of Dermatophagoides pteronyssinus and D. farinae by a clustered rush protocol was well tolerated. After 1 year of treatment, the actively treated group showed a significant improvement compared to their starting value as well as to the placebo-treated patients with regard to skin prick test, conjunctival provocation test, and subjective rhinitis score. The subjective asthma score and bronchial hyperreactivity, measured by the methacholine provocation test, was improved in comparison to the starting value, but not to the placebo group, after 12 months. However, a further, open comparison of the placebo- and verum-treated groups at 18 months revealed a significant reduction. The drug intake was not increased in the verum-treated group. Exposure to mite levels was constant throughout this time period, as revealed by antigen measurement. We conclude that specific immunotherapy in perennial, mite-allergen-induced asthma may reduce not only immediate, IgE-mediated symptoms but, after a rather long time period of 12-18 months, also the inflammatory component of bronchial asthma, thus leading to a reduction of unspecific hyperreactivity.
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Affiliation(s)
- C E Pichler
- Institute of Immunology and Allergology, Inselspital, Bern, Switzerland
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37
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Pichler CE, Marquardsen A, Sparholt S, Løwenstein H, Bircher A, Bischof M, Pichler WJ. Specific immunotherapy with Dermatophagoides pteronyssinus and D. farinae results in decreased bronchial hyperreactivity. Allergy 1997; 52:274-83. [PMID: 9140517 DOI: 10.1111/j.1398-9995.1997.tb00991.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.1] [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: 02/04/2023]
Abstract
To evaluate the tolerability and efficacy of specific immunotherapy with mite extracts, we performed a double-blind, placebo-controlled immunotherapy study in 30 patients with proven allergy to mite allergens. The specific immunotherapy with standardized extracts of Dermatophagoides pteronyssinus and D. farinae by a clustered rush protocol was well tolerated. After 1 year of treatment, the actively treated group showed a significant improvement compared to their starting value as well as to the placebo-treated patients with regard to skin prick test, conjunctival provocation test, and subjective rhinitis score. The subjective asthma score and bronchial hyperreactivity, measured by the methacholine provocation test, was improved in comparison to the starting value, but not to the placebo group, after 12 months. However, a further, open comparison of the placebo- and verum-treated groups at 18 months revealed a significant reduction. The drug intake was not increased in the verum-treated group. Exposure to mite levels was constant throughout this time period, as revealed by antigen measurement. We conclude that specific immunotherapy in perennial, mite-allergen-induced asthma may reduce not only immediate, IgE-mediated symptoms but, after a rather long time period of 12-18 months, also the inflammatory component of bronchial asthma, thus leading to a reduction of unspecific hyperreactivity.
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Affiliation(s)
- C E Pichler
- Institute of Immunology and Allergology, Inselspital, Bern, Switzerland
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38
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Zanni MP, Mauri-Hellweg D, Brander C, Wendland T, Schnyder B, Frei E, von Greyerz S, Bircher A, Pichler WJ. Characterization of lidocaine-specific T cells. J Immunol 1997; 158:1139-48. [PMID: 9013953] [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] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
To investigate the cellular immune response to the drug lidocaine, we generated T cell lines and clones from the peripheral blood of four patients with proven allergy to lidocaine. The patients had contact dermatitis after topical application of lidocaine, and local swelling or generalized erythema exudativum multiforme after submucosal/subcutaneous injection of lidocaine. Two of three lidocaine-specific T cell lines were oligoclonal and one even became monoclonal, while the simultaneously analyzed immune response to tetanus toxoid was polyclonal. The lidocaine-specific T cell lines cross-reacted to mepivacaine, but not to other local anesthetics (bupivacaine, procaine, oxybuprocaine, and tetracaine). The majority of reactive T cells belonged to the CD4 cell lineage and were MHC class II restricted, but cloning also revealed some MHC class I-restricted CD8+ clones. A total of 2 of 56 lidocaine-specific T cell clones were CD4-CD8- and expressed TCR-gammadelta. The majority of 13 analyzed CD4 clones produced a rather polarized cytokine pattern, with a dominance of Th2-like cytokines showing a high IL-5 production. In addition, three CD4+ and all CD8+ (n = 7) clones secreted high IFN-gamma and low levels of IL-5/IL-4 (Th1-like). The data illustrate that a drug that sensitizes via the skin elicits a heterogeneous T cell response. The high IL-5 production and the participation of specific CD4+CD8+ and even gammadelta+ T cells appear to be distinguishing features of this hapten-specific immune response.
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Affiliation(s)
- M P Zanni
- Institute of Immunology and Allergology, Inselspital, Bern, Switzerland
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39
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Zanni MP, Mauri-Hellweg D, Brander C, Wendland T, Schnyder B, Frei E, von Greyerz S, Bircher A, Pichler WJ. Characterization of lidocaine-specific T cells. The Journal of Immunology 1997. [DOI: 10.4049/jimmunol.158.3.1139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Abstract
To investigate the cellular immune response to the drug lidocaine, we generated T cell lines and clones from the peripheral blood of four patients with proven allergy to lidocaine. The patients had contact dermatitis after topical application of lidocaine, and local swelling or generalized erythema exudativum multiforme after submucosal/subcutaneous injection of lidocaine. Two of three lidocaine-specific T cell lines were oligoclonal and one even became monoclonal, while the simultaneously analyzed immune response to tetanus toxoid was polyclonal. The lidocaine-specific T cell lines cross-reacted to mepivacaine, but not to other local anesthetics (bupivacaine, procaine, oxybuprocaine, and tetracaine). The majority of reactive T cells belonged to the CD4 cell lineage and were MHC class II restricted, but cloning also revealed some MHC class I-restricted CD8+ clones. A total of 2 of 56 lidocaine-specific T cell clones were CD4-CD8- and expressed TCR-gammadelta. The majority of 13 analyzed CD4 clones produced a rather polarized cytokine pattern, with a dominance of Th2-like cytokines showing a high IL-5 production. In addition, three CD4+ and all CD8+ (n = 7) clones secreted high IFN-gamma and low levels of IL-5/IL-4 (Th1-like). The data illustrate that a drug that sensitizes via the skin elicits a heterogeneous T cell response. The high IL-5 production and the participation of specific CD4+CD8+ and even gammadelta+ T cells appear to be distinguishing features of this hapten-specific immune response.
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Affiliation(s)
- M P Zanni
- Institute of Immunology and Allergology, Inselspital, Bern, Switzerland
| | - D Mauri-Hellweg
- Institute of Immunology and Allergology, Inselspital, Bern, Switzerland
| | - C Brander
- Institute of Immunology and Allergology, Inselspital, Bern, Switzerland
| | - T Wendland
- Institute of Immunology and Allergology, Inselspital, Bern, Switzerland
| | - B Schnyder
- Institute of Immunology and Allergology, Inselspital, Bern, Switzerland
| | - E Frei
- Institute of Immunology and Allergology, Inselspital, Bern, Switzerland
| | - S von Greyerz
- Institute of Immunology and Allergology, Inselspital, Bern, Switzerland
| | - A Bircher
- Institute of Immunology and Allergology, Inselspital, Bern, Switzerland
| | - W J Pichler
- Institute of Immunology and Allergology, Inselspital, Bern, Switzerland
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40
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Abstract
Although fulminating non-cardiogenic pulmonary edema following cardiopulmonary bypass is not a new phenomenon, the exact cause and pathogenesis are still unknown. The causative agent of this potentially lethal syndrome was hypothesized to be either protamine or blood products. There was no evidence that an antibody-mediated reaction plays a role and patients were reported to have negative skin tests. We report, for the first time, a patient who presented with fulminating non-cardiogenic pulmonary edema after repeated protamine administration with a subsequent positive skin test to protamine. Specific IgG antibodies to protamine were also found; however, the level was in the range of that of exposed non-reacting controls. IgE antibodies could not be detected.
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Affiliation(s)
- C Kindler
- Department of Anesthesia, University of Basel, Kantonsspital, Switzerland
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Buechner SA, Lautenschlager S, Itin P, Bircher A, Erb P. Lymphoproliferative responses to Borrelia burgdorferi in patients with erythema migrans, acrodermatitis chronica atrophicans, lymphadenosis benigna cutis, and morphea. Arch Dermatol 1995; 131:673-677. [PMID: 7778918] [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] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
BACKGROUND AND DESIGN Specific humoral and cell-mediated immune responses play an important role in the pathogenesis of Lyme borreliosis. Several previous studies demonstrated that a specific cellular immune response to Borrelia burgdorferi can occur independently of a diagnostic humoral response. Little is known about T-cell reactivities against B burgdorferi in early and late cutaneous manifestations of Lyme borreliosis. We studied the lymphoproliferative response of peripheral blood mononuclear cells to B burgdorferi antigen from 99 patients (25 with erythema migrans, 16 with acrodermatitis chronica atrophicans, 13 with lymphadenosis benigna cutis, and 45 with localized scleroderma) and 21 control subjects. The results are expressed as a stimulation index (SI) (mean count per minute of triplicate cultures with stimulant divided by mean count per minute without stimulant). The serum samples from all patients and control subjects were tested for antibodies to B burgdorferi by indirect immunofluorescence assay. RESULTS The 21 healthy seronegative controls had an SI of 3.3 +/- 2.0 (mean +/- SD). Compared with that of control subjects, the SIs were significantly elevated in patients with erythema migrans (9.8 +/- 9.1), acrodermatitis chronica atrophicans (11.8 +/- 8.2), and lymphadenosis benigna cutis (7.2 +/- 6.2). The 45 patients with localized scleroderma had elevated proliferative responses, with an SI of 6.5 +/- 7.3, but these responses did not significantly differ from those of controls. Elevated titers of antibodies to B burgdorferi were present in six (24%) of 25 patients with erythema migrans, five (38%) of 13 patients with lymphadenosis benigna cutis, and 13 (29%) of 45 patients with localized scleroderma. All 16 patients with acrodermatitis chronica atrophicans had markedly elevated antibody titers. CONCLUSIONS Our findings show that a significant lymphoproliferative response to B burgdorferi occurs in the majority of patients with cutaneous manifestations of Lyme borreliosis. The lymphocyte proliferation assay may be of diagnostic value in patients in whom Lyme borreliosis is strongly clinically suspected and who have nondiagnostic levels of antibodies against B burgdorferi.
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Affiliation(s)
- S A Buechner
- Department of Dermatology, Kantonsspital, University of Basel, Switzerland
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42
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Perrenoud D, Bircher A, Hunziker T, Suter H, Bruckner-Tuderman L, Stäger J, Thürlimann W, Schmid P, Suard A, Hunziker N. Frequency of sensitization to 13 common preservatives in Switzerland. Swiss Contact Dermatitis Research Group. Contact Dermatitis 1994; 30:276-9. [PMID: 8088140 DOI: 10.1111/j.1600-0536.1994.tb00597.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
From February 1989 to January 1990, the Swiss Contact Dermatitis Research Group conducted a 1-year study to examine the frequency of sensitization to a series of 13 common preservatives. A group of 2295 consecutive outpatients with suspected allergic contact dermatitis (age range 7-90 years, with a mean age of 42; 911 males, 1384 females) was tested. The %s of positive reactions to the preservatives studied are as follows, in descending order: formaldehyde 5.7%, benzalkonium chloride 5.5%, Kathon CG 5.5%, thimerosal 4.2%, chlorhexidine digluconate 2.0%, DMDM hydantoin 1.7%, paraben mix 1.7%, chloroacetamide 1.5%, Bronopol 1.2%, imidazolidinyl urea 1.0%, quaternium 15 1.0%, triclosan 0.8%, 2,4-dichlorobenzyl alcohol 0.4%. These relatively high values suggest a heavy exposure of the Swiss population to topical preservatives. Compared to previous studies, the sensitization rate to Kathon CG has stabilized in Switzerland over the last 2 years. Sensitization to formaldehyde portrayed impressive geographical variation, with sensitization rates up to 9% in western and only 3% in eastern Switzerland. The low sensitization rate to parabens argues for their inclusion in a medicament or preservative series, rather than in the standard series.
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Affiliation(s)
- D Perrenoud
- Service de Dermatologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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43
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Bircher A, de Boer EM, Agner T, Wahlberg JE, Serup J. Guidelines for measurement of cutaneous blood flow by laser Doppler flowmetry. A report from the Standardization Group of the European Society of Contact Dermatitis. Contact Dermatitis 1994; 30:65-72. [PMID: 8187504 DOI: 10.1111/j.1600-0536.1994.tb00565.x] [Citation(s) in RCA: 182] [Impact Index Per Article: 6.1] [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: 01/29/2023]
Abstract
The report reviews individual-related variables (age, sex, race, anatomical site), intra- and inter-individual variation (temporal, physical and mental activity, food and drugs), and environment-related variables (air convection, temperature). Technical variation, instrument validation including a standard reactive hyperemia experiment, and a standard operating procedure are discussed and included in the guidelines.
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Affiliation(s)
- A Bircher
- Department of Dermatological Research, Leo Pharmaceutical Products, Ballerup, Denmark
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44
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Levy F, Bircher A. [Allergic reactions of the respiratory tract]. Ther Umsch 1994; 51:24-30. [PMID: 8146810] [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: 01/29/2023]
Abstract
Allergic rhinoconjunctivitis and allergic asthma bronchiale are immunologically mediated diseases of the respiratory tract. Dependent on the allergen, they occur seasonally or perennially. Allergens can cause a specific reaction of the immune system, mediated by IgE-antibodies in individuals with a genetic predisposition. Different mediators are released from mast cells, and complex immunopathological mechanisms lead to inflammatory changes of the mucosa. A significant increase of allergies has been observed in the last decades. Indoor and outdoor allergens can be differentiated. Mites and animal dander are the most important indoor allergens. The pollens of birch, alder, hazel, different grasses and mugwort are the most important outdoor allergens. For diagnostic purposes skin tests, laboratory analyses and provocation tests are used. The best therapy is elimination of the offending allergen. As pharmacological agents histamine-receptor antagonists, topical corticosteroids and topical cromoglycate are currently used. Immune therapy is the most specific form of treatment.
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MESH Headings
- Allergens
- Asthma/diagnosis
- Asthma/etiology
- Asthma/therapy
- Conjunctivitis, Allergic/diagnosis
- Conjunctivitis, Allergic/etiology
- Conjunctivitis, Allergic/therapy
- Desensitization, Immunologic
- Humans
- Respiratory Hypersensitivity/diagnosis
- Respiratory Hypersensitivity/etiology
- Respiratory Hypersensitivity/therapy
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/etiology
- Rhinitis, Allergic, Perennial/therapy
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/etiology
- Rhinitis, Allergic, Seasonal/therapy
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Affiliation(s)
- F Levy
- Allergologische Poliklinik, Dermatologische Universitätsklinik, Kantonsspital Basel
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Schlienger RG, Haefeli WE, Bircher A, Leib SL, Lüscher TF. [Drug-induced Stevens-Johnson syndrome in a patient with AIDS]. Schweiz Rundsch Med Prax 1993; 82:888-92. [PMID: 8372290] [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] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The Stevens-Johnson syndrome is a severe potentially life-threatening form of the erythema multiforme, affecting both skin and mucous membranes. We present a case of a 49-year-old male patient with AIDS who developed a Stevens-Johnson syndrome while being treated with pyrimethamine, sulfadiazine and phenytoin for cerebral toxoplasmosis. Further diagnostic evaluation of this dangerous cutaneous affection may prove difficult for several reasons. In particular, in patients with AIDS who are more susceptible for adverse drug reactions and who are simultaneously receiving a variety of drugs with a considerable potential of cutaneous side effects, therapy cannot be withhold for lack of therapeutic alternatives. Moreover, the low lymphocyte count in this case may have made reliable testing with lymphocyte transformation studies impossible. The evaluation and the differential diagnosis of the drug-induced Stevens-Johnson syndrome are discussed. Especially long- and moderately long-acting sulfonamides belong to the most important agents that can cause a drug-induced Stevens-Johnson syndrome. The pathogenesis and the risk factors for cutaneous hypersensitivity reactions in HIV-infected patients are only poorly understood. These kind of reactions, however, seem to occur more often in patients with a more advanced immunodeficiency.
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46
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Levy F, Bircher A. [What is your diagnosis? Herpetic eczema]. Schweiz Rundsch Med Prax 1992; 81:1375-6. [PMID: 1439421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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47
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Glauser T, Bircher A, Wüthrich B. [Allergic rhinoconjunctivitis caused by the dust of green coffee beans]. Schweiz Med Wochenschr 1992; 122:1279-81. [PMID: 1529315] [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] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In a 37-year-old worker employed in a coffee roastery who suffered from work-related rhinoconjunctivitis, allergologic investigations demonstrated sensitization to the dust of the green, unroasted coffee bean. This particular allergy is uncommon in Switzerland. The case is discussed and the literature on the subject is reviewed.
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Affiliation(s)
- T Glauser
- Dermatologische Universitätsklinik Zürich
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48
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Hunziker N, Pasche F, Bircher A, Bruckner-Tuderman L, Hunziker T, Schmid P, Suard A, Suter H, Perrenoud D, Stäger J. Sensitization to the isothiazolinone biocide. Report of the Swiss Contact Dermatitis Research Group 1988-1990. Dermatology 1992; 184:94-7. [PMID: 1498387 DOI: 10.1159/000247512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 12/27/2022] Open
Abstract
The rate of sensitization to isothiazolinones (Kathon CG) detected in Switzerland rose from 3.5% (out of 2,491 patients) in 1987 to 6.3% (out of 982 patients) in 1988 and 5.6% (out of 2,295 patients) in 1989-90. This rate of sensitization appears to be related to the more and more widespread use of isothiazolinone biocide in cosmetics, domestic products and in industry.
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Affiliation(s)
- N Hunziker
- Clinique de Dermatologie, Hôpital cantonal, Genève, Switzerland
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49
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Hölzle E, Neumann N, Hausen B, Przybilla B, Schauder S, Hönigsmann H, Bircher A, Plewig G. Photopatch testing: the 5-year experience of the German, Austrian, and Swiss Photopatch Test Group. J Am Acad Dermatol 1991; 25:59-68. [PMID: 1880256 DOI: 10.1016/0190-9622(91)70175-2] [Citation(s) in RCA: 121] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A cooperative photopatch test study was conducted by 45 dermatologic centers in Austria, Germany, and Switzerland. Results obtained from 1985 to 1990 are presented. A standard photopatch test tray of 32 substances was applied to the back of patients with suspected photosensivity. After applications for 24 hours, test sites were irradiated with 10 joules/cm2UVA. Unirradiated controls were included. Readings were performed immediately and 24, 48, and 72 hours after irradiation; responses were qualitatively graded on a 4-point scale. All data were stored and processed by a computer. With computer-assisted analysis of reaction patterns photoallergic reactions were identified and distinguished from phototoxic reactions. Data of 1129 patients were evaluated. Among a total of 2859 positive test reactions in 870 patients, 2041 in 778 patients were found to be photoinduced and 818 in 413 patients were contact reactions; 108 reactions in 83 patients were classified as photoallergic. Nonsteroidal anti-inflammatory drugs, disinfectants, sunscreens, phenothiazines, and fragrances caused most often photoallergic reactions. Many unspecific phototoxic reactions were induced by tiaprofenic acid, promethazine, carprofen, chlorpromazine, fenticolar, wood balsam of Peru, and perfumes. Despite the distinction between photoallergic and phototoxic responses, many test reactions lacked relevance for the patients' dermatoses.
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Affiliation(s)
- E Hölzle
- Heinrich-Heine-Universität Düsseldorf, F.R.G
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50
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Itin P, Bircher A, Gudat F. [Eccrine hidrocystoma]. Hautarzt 1989; 40:647-9. [PMID: 2613520] [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] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Most eccrine hidrocystomas are solitary, asymptomatic lesions. Multiple hidrocystomas are very rare and are probably caused by dilatation of eccrine ducts. Immunohistochemical investigations are helpful in distinguishing whether a solitary or multiple form is present. An isolated hidrocystoma can be treated by surgery or electrocautery. Multiple eccrine hidrocystomas are more difficult to treat. Topical atropine may be successful for multiple lesions. We observed a patient with more than 100 lesions associated with significant hyperhidrosis. Although several systemic drugs were used, no relief of the hyperhidrosis could be achieved. During topical administration of atropine some shrinkage of cysts was seen.
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Affiliation(s)
- P Itin
- Dermatologische Universitätsklinik Basel
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