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Helbling A, Hausmann O, Jutel M, Akdis CA, Pichler WJ. In Memoriam: Ulrich R. Müller. Allergy 2023; 78:3291-3292. [PMID: 37925600 DOI: 10.1111/all.15937] [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] [Received: 10/19/2023] [Accepted: 10/21/2023] [Indexed: 11/06/2023]
Affiliation(s)
| | - Oliver Hausmann
- Loewenpraxis and Klinik St. Anna Lucerne, Lucerne, Switzerland
- ADR-AC GmbH, Bern, Switzerland
| | - Marek Jutel
- Department of Immunology, Wrocław Medical University, Wrocław, Poland
- ALL-MED Medical Research Institute, Wrocław, Poland
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
- Christine Kühne Center for Allergy Research and Education (CK- CARE), Davos, Switzerland
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El Rahal A, Beck J, Ahlborn P, Bernasconi C, Marbacher S, Wanderer S, Burkhardt JK, Daniel RT, Ferrari A, Hausmann O, Kamenova M, Kothbauer K, Lutz K, Mariani L, Alfieri A, Schöni D, Schucht P, Raabe A, Regli L, Kuhlen D, Seule M, Soleman J, Starnoni D, Zaldivar J, Zweifel C, Schaller K, Fung C. Incidence, therapy, and outcome in the management of chronic subdural hematoma in Switzerland: a population-based multicenter cohort study. Front Neurol 2023; 14:1206996. [PMID: 37780710 PMCID: PMC10540067 DOI: 10.3389/fneur.2023.1206996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 06/19/2023] [Indexed: 10/03/2023] Open
Abstract
Background Chronic subdural hematoma (cSDH) is a disease affecting mainly elderly individuals. The reported incidence ranges from 2.0/100,000 to 58 per 100,000 person-years when only considering patients who are over 70 years old, with an overall incidence of 8.2-14.0 per 100,000 persons. Due to an estimated doubling of the population above 65 years old between 2000 and 2030, cSDH will become an even more significant concern. To gain an overview of cSDH hospital admission rates, treatment, and outcome, we performed this multicenter national cohort study of patients requiring surgical treatment of cSDH. Methods A multicenter cohort study included patients treated in 2013 in a Swiss center accredited for residency. Demographics, medical history, symptoms, and medication were recorded. Imaging at admission was evaluated, and therapy was divided into burr hole craniostomy (BHC), twist drill craniostomy (TDC), and craniotomy. Patients' outcomes were dichotomized into good (mRS, 0-3) and poor (mRS, 4-6) outcomes. A two-sided t-test for unpaired variables was performed, while a chi-square test was performed for categorical variables, and a p-value of <0.05 was considered to be statistically significant. Results A total of 663 patients were included. The median age was 76 years, and the overall incidence rate was 8.2/100,000. With age, the incidence rate increased to 64.2/100,000 in patients aged 80-89 years. The most prevalent symptoms were gait disturbance in 362 (58.6%) of patients, headache in 286 (46.4%), and focal neurological deficits in 252 (40.7%). CSDH distribution was unilateral in 478 (72.1%) patients, while 185 presented a bilateral hematoma with no difference in the outcome. BHC was the most performed procedure for 758 (97.3%) evacuations. CSDH recurrence was noted in 104 patients (20.1%). A good outcome was seen in almost 81% of patients. Factors associated with poor outcomes were age, GCS and mRS on admission, and the occurrence of multiple deficits present at the diagnosis of the cSDH. Conclusion As the first multicenter national cohort-based study analyzing the disease burden of cSDH, our study reveals that the hospital admission rate of cSDH was 8.2/100,000, while with age, it rose to 64.2/100,000. A good outcome was seen in 81% of patients, who maintained the same quality of life as before the surgery. However, the mortality rate was 4%.
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Affiliation(s)
- Amir El Rahal
- Department of Neurosurgery, University Hospital of Geneva, Faculty of Medicine, Geneva, Switzerland
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany
| | - Peter Ahlborn
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Corrado Bernasconi
- Department of Neurosurgery, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Stefan Wanderer
- Department of Neurosurgery, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Roy Thomas Daniel
- Department of Neurosurgery, University Hospital Center of Lausanne, Lausanne, Switzerland
| | - Andrea Ferrari
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Oliver Hausmann
- Department of Neurosurgery, Hirslanden Klinik St. Anna, Luzern, Switzerland
| | - Maria Kamenova
- Department of Neurosurgery, University Hospital Basel, Faculty of Medicine, Basel, Switzerland
| | - Karl Kothbauer
- Department of Neurosurgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Katharina Lutz
- Department of Neurosurgery, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Luigi Mariani
- Department of Neurosurgery, University Hospital Basel, Faculty of Medicine, Basel, Switzerland
| | - Alex Alfieri
- Department of Neurosurgery, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Daniel Schöni
- Department of Neurosurgery, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Philippe Schucht
- Department of Neurosurgery, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Andreas Raabe
- Department of Neurosurgery, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Dominique Kuhlen
- Department of Neurosurgery, Regional Hospital Lugano (EOC), Lugano, Switzerland
| | - Martin Seule
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany
| | - Jehuda Soleman
- Department of Neurosurgery, University Hospital Basel, Faculty of Medicine, Basel, Switzerland
| | - Daniele Starnoni
- Department of Neurosurgery, University Hospital Center of Lausanne, Lausanne, Switzerland
| | - Julien Zaldivar
- Department of Neurosurgery, University Hospital Center of Lausanne, Lausanne, Switzerland
| | - Christian Zweifel
- Department of Neurosurgery, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Karl Schaller
- Department of Neurosurgery, University Hospital of Geneva, Faculty of Medicine, Geneva, Switzerland
| | - Christian Fung
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany
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Berberat J, Andereggen L, Gruber P, Hausmann O, Reza Fathi A, Remonda L. A Diagnostic Biomarker for Cervical Myelopathy Based on Dynamic MRI. Spine (Phila Pa 1976) 2023:00007632-990000000-00296. [PMID: 37018513 DOI: 10.1097/brs.0000000000004667] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/16/2023] [Indexed: 04/07/2023]
Abstract
STUDY DESIGN Multicenter prospective observational study. OBJECTIVE Diffusion tensor imaging (DTI) in flexion-extension improves the diagnosis of degenerative cervical myelopathy (DCM). We aimed to provide an imaging biomarker for the detection of DCM. SUMMARY OF BACKGROUND DATA DCM is the most common form of spinal cord dysfunction in adults; however, imaging surveillance for myelopathy remains poorly characterized. METHODS Symptomatic DCM patients were examined in maximum neck flexion-extension and neutral positions in a 3T-MRI scanner and allocated to two groups: i) patients with visible intramedullary hyperintensity (IHIS) on T2-weighted imaging (IHIS+, n=10); and ii) patients without IHIS (IHIS-, n=11). Range of motion, space available for the spinal cord, apparent diffusion coefficient (ADC), axial diffusivity (AD), radial diffusivity (RD), and fractional anisotropy (FA) were measured and compared between the neck positions and between the groups as well as between control (C2/3) and pathological segments. RESULTS Significant differences between the control level (C2/3) and pathological segments were appreciated for the IHIS+group at neutral neck position in AD; at flexion in ADC and AD; and at neck extension in ADC, AD, and FA values. For the IHIS- group, significant differences between the control level (C2/3) and pathological segments were found only for ADC values in neck extension. When comparing diffusion parameters between groups, RD was significantly different in all three neck positions. CONCLUSION Significant increases in ADC values between the control and pathological segments were found for both groups in neck extension only. This may serve as a diagnostic tool to identify early changes in the spinal cord related to myelopathy and to indicate potentially reversible spinal cord injury and support the indication for surgery in select circumstances.
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Affiliation(s)
- Jatta Berberat
- Institute of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland
- Geriatric Psychiatry, Department of Psychiatry, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
| | - Lukas Andereggen
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
- Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Philipp Gruber
- Institute of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Oliver Hausmann
- Faculty of Medicine, University of Bern, Bern, Switzerland
- Department of Neuro and Spine Surgery, Hirslanden Klinik St. Anna, Luzern, Switzerland
| | - Ali Reza Fathi
- Faculty of Medicine, University of Bern, Bern, Switzerland
- Neurochirurgie Fathi AG, Aarau, Switzerland
| | - Luca Remonda
- Institute of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland
- Faculty of Medicine, University of Bern, Bern, Switzerland
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van Schouwenburg P, Unger S, Payne KJ, Kaiser FMP, Pico-Knijnenburg I, Pfeiffer J, Hausmann O, Friedmann D, Erbel M, Seidl M, van Zessen D, Stubbs AP, van der Burg M, Warnatz K. Deciphering imprints of impaired memory B-cell maturation in germinal centers of three patients with common variable immunodeficiency. Front Immunol 2022; 13:959002. [PMID: 36275744 PMCID: PMC9582261 DOI: 10.3389/fimmu.2022.959002] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/02/2022] [Indexed: 11/13/2022] Open
Abstract
Common variable immunodeficiency (CVID), characterized by recurrent infections, low serum class-switched immunoglobulin isotypes, and poor antigen-specific antibody responses, comprises a heterogeneous patient population in terms of clinical presentation and underlying etiology. The diagnosis is regularly associated with a severe decrease of germinal center (GC)-derived B-cell populations in peripheral blood. However, data from B-cell differentiation within GC is limited. We present a multiplex approach combining histology, flow cytometry, and B-cell receptor repertoire analysis of sorted GC B-cell populations allowing the modeling of distinct disturbances in GCs of three CVID patients. Our results reflect pathophysiological heterogeneity underlying the reduced circulating pool of post-GC memory B cells and plasmablasts in the three patients. In patient 1, quantitative and qualitative B-cell development in GCs is relatively normal. In patient 2, irregularly shaped GCs are associated with reduced somatic hypermutation (SHM), antigen selection, and class-switching, while in patient 3, high SHM, impaired antigen selection, and class-switching with large single clones imply increased re-cycling of cells within the irregularly shaped GCs. In the lymph nodes of patients 2 and 3, only limited numbers of memory B cells and plasma cells are formed. While reduced numbers of circulating post GC B cells are a general phenomenon in CVID, the integrated approach exemplified distinct defects during GC maturation ranging from near normal morphology and function to severe disturbances with different facets of impaired maturation of memory B cells and/or plasma cells. Integrated dissection of disturbed GC B-cell maturation by histology, flow cytometry, and BCR repertoire analysis contributes to unraveling defects in the essential steps during memory formation.
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Affiliation(s)
- Pauline van Schouwenburg
- Laboratory for Pediatric Immunology, Department of Pediatrics, Willem-Alexander Children’s Hospital, Leiden University Medical Center (LUMC), Leiden, Netherlands
- Department of Immunology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Susanne Unger
- Department of Rheumatology and Clinical Immunology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Chronic Immunodeficiency (CCI), Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Kathryn J. Payne
- Department of Rheumatology and Clinical Immunology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Chronic Immunodeficiency (CCI), Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Fabian M. P. Kaiser
- Department of Immunology, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Pediatrics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ingrid Pico-Knijnenburg
- Laboratory for Pediatric Immunology, Department of Pediatrics, Willem-Alexander Children’s Hospital, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Jens Pfeiffer
- Department of Otorhinolaryngology- Head and Neck Surgery, University of Freiburg, Freiburg, Germany
| | | | - David Friedmann
- Department of Rheumatology and Clinical Immunology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Chronic Immunodeficiency (CCI), Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Michelle Erbel
- Institute of Surgical Pathology, Department of Pathology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maximilian Seidl
- Institute of Surgical Pathology, Department of Pathology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Institute of Pathology, Heinrich Heine University and University Hospital of Duesseldorf, Duesseldorf, Germany
| | - David van Zessen
- Clinical Bioinformatics Unit, Department of Pathology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Andrew P. Stubbs
- Clinical Bioinformatics Unit, Department of Pathology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Mirjam van der Burg
- Laboratory for Pediatric Immunology, Department of Pediatrics, Willem-Alexander Children’s Hospital, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Klaus Warnatz
- Department of Rheumatology and Clinical Immunology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Chronic Immunodeficiency (CCI), Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- *Correspondence: Klaus Warnatz,
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Thoo L, Gumowski PI, Kammermann K, Nussli S, Grabscheid B, Hausmann O, Axius U, Pichler WJ, Yerly D. Highly specific and reliable in vitro diagnostic analysis of memory T and B lymphocytes in a Swiss cohort of COVID-19 patients. Swiss Med Wkly 2021; 151:w30005. [PMID: 34519459 DOI: 10.4414/smw.2021.w30005] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The SARS-CoV-2 pandemic has claimed many lives and disrupted the quality of life of most individuals. Diagnostic tests not only serve to confirm past exposure but can provide information crucial for guiding healthcare options for patients. Current diagnostic tests for the presence of the SARS-CoV-2 virus or anti-spike protein antibodies do not address the question whether longer lasting cellular immunity is mounted in most individuals. Using an activation marker flow cytometric immunoassay (SARS-CoV-2 lymphocytes analysis), we showed that both CD4+/CD8+ T cell and B cell activation differ between naïve and infected individuals up to 11 months after infection. On the basis of the specificity of this diagnostic tool for detecting both SARS-CoV-2-experienced T and B cells, we propose that this assay could benefit immunocompromised individuals who are unable to mount sustained antibody responses, by determining cellular immunity as possible partial protection, and for studying immune correlates of protection - thereby increasing knowledge of COVID-19 in a wider range of patient groups.
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Affiliation(s)
- Lester Thoo
- ADR-AC GmbH, Adverse Drug Reactions - Analysis and Consulting, Bern, Switzerland
| | - Pierre I Gumowski
- INRAAIC, Meyrin, Geneva, Switzerland.,Clinical Immunology, Hôpital de la Tour, Meyrin, Switzerland
| | - Kevin Kammermann
- ADR-AC GmbH, Adverse Drug Reactions - Analysis and Consulting, Bern, Switzerland
| | - Swelia Nussli
- ADR-AC GmbH, Adverse Drug Reactions - Analysis and Consulting, Bern, Switzerland
| | - Benno Grabscheid
- ADR-AC GmbH, Adverse Drug Reactions - Analysis and Consulting, Bern, Switzerland
| | - Oliver Hausmann
- ADR-AC GmbH, Adverse Drug Reactions - Analysis and Consulting, Bern, Switzerland.,Löwenpraxis Luzern, Lucerne, Switzerland.,Klinik St. Anna, Lucerne, Switzerland
| | - Ulrika Axius
- ADR-AC GmbH, Adverse Drug Reactions - Analysis and Consulting, Bern, Switzerland
| | - Werner J Pichler
- ADR-AC GmbH, Adverse Drug Reactions - Analysis and Consulting, Bern, Switzerland
| | - Daniel Yerly
- ADR-AC GmbH, Adverse Drug Reactions - Analysis and Consulting, Bern, Switzerland
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Mueller‐Wirth N, Buenter A, Jörg L, Ebo DG, Glatz M, Fernando SL, Spoerl D, Helbling A, Hausmann O, Gupta N, Pichler WJ. IgE-mediated chlorhexidine allergy-Cross-reactivity with other biguanide disinfectants. Allergy 2020; 75:3237-3247. [PMID: 32678912 DOI: 10.1111/all.14497] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/30/2020] [Accepted: 05/05/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Chlorhexidine (CHX) is a widely utilized disinfectant that can cause IgE-mediated urticaria/anaphylaxis. The cross-reactivity of patients with IgE-mediated CHX allergy with other disinfectants, which share structural similarities with CHX like polyhexanide (polyhexamethylene biguanide; PHMB), alexidine (ALX), or octenidine (OCT), is unknown. METHODS Forty-four patients with anaphylaxis or urticaria upon CHX exposure and positive skin prick test (SPT) and/or positive CHX ImmunoCAP test (Phadia TFS, Uppsala, Sweden) were recruited. IgE to the biguanide and/or hexamethylene structure was investigated with PHMB ImmunoCAP (n = 32) and by basophil activation tests (BAT) with CHX and ALX (n = 37). Inhibition tests of CHX and PHMB ImmunoCAPs by CHX, ALX, PHMB, and OCT were performed. RESULTS IgE reactivity to PHMB as surrogate marker for biguanide/hexamethylene reactivity was detected in 5/32 sera. Seven of 37 patients showed a positive BAT with ALX, but only under optimized conditions. Binding to CHX ImmunoCAP was inhibited by ALX in 1/32 sera, and binding to PHMB was blocked by ALX (1/5) and by OCT in another (1/5). In SPT, 9/10 patients were positive for CHX and 3 of them with ALX (only at highest concentration at 5 mg/mL). A further patient reacted primarily with OCT and showed IgE cross-reactivity with CHX, ALX, and PHMB. CONCLUSION The IgE response to CHX seems polyclonal. The chloroguanide ending of CHX is the main epitope for the IgE and is suitable as screening assay to detect CHX reactivity. IgE-reactivities with the biguanide or hexamethylene components of other disinfectants (ALX, PHMB) can be detected by SPT, PHMB ImmunoCAP, and ALX-BAT in 15%-33% of CHX-allergic patients.
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Affiliation(s)
| | - Antonia Buenter
- ADR‐AC GmbH Bern Switzerland
- Dep. of Rheumatology, Immunology and Allergology, Inselspital University of Bern Bern Switzerland
| | - Lukas Jörg
- Dep. of Rheumatology, Immunology and Allergology, Inselspital University of Bern Bern Switzerland
| | - Didier G. Ebo
- Department of Immunology ‐ Allergology – Rheumatology and the Infla‐Med Centre of Excellence University AntwerpAntwerp University Hospital Antwerpen Belgium
| | - Martin Glatz
- Allergiestation University of Zurich Zurich Switzerland
| | - Suran L. Fernando
- Faculty of Medicine and Health (Immunology and Infectious Diseases) University of Sydney Sydney NSW Australia
| | - David Spoerl
- Department of Clinical Immunology and Allergy HUG Geneva Geneva Switzerland
| | - Arthur Helbling
- Dep. of Rheumatology, Immunology and Allergology, Inselspital University of Bern Bern Switzerland
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Bergmann-Hug K, Fricker M, Hausmann O, Helbling A, Jörg L. Sensitization to Hymenoptera venom in pollen allergic patients: Frequency and involvement of cross-reacting carbohydrate determinants (CCD). PLoS One 2020; 15:e0238740. [PMID: 32898145 PMCID: PMC7478646 DOI: 10.1371/journal.pone.0238740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/21/2020] [Indexed: 01/26/2023] Open
Abstract
Sensitization to Hymenoptera venom in patients without a history of systemic allergic reactions to Hymenoptera stings is frequently found and can be due to the presence of specific IgE to cross-reactive carbohydrate determinants (CCD). This study investigates 105 pollen allergic subjects for the presence of specific IgE to honeybee or wasp venom, pollen, the MUXF3 carbohydrate epitope from bromelain and recombinant Hymenoptera venom components. In addition, in a subgroup of patients (n = 10) a basophil activation test (BAT) using bee and wasp venom was performed. Specific IgE to Hymenoptera venom was detected in 45.7% of the pollen allergic subjects and in 26.7% of the non-atopic controls, both without a history of systemic allergic reactions to Hymenoptera stings. The high sensitization rate in atopic patients could partially be explained by cross-sensitization between pollen and Hymenoptera venom due to specific IgE to CCDs. In our study population, only 20% showed a sensitization to CCDs. Primary sensitization due to sting exposure, high total IgE values or unspecific binding and detection of low affinity antibodies in the test procedure could be reasons. Thus, determination of specific IgE to Hymenoptera venom in patients without a history of systemic allergic reactions as screening test is not recommended.
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Affiliation(s)
- Katrin Bergmann-Hug
- Allergy Unit, Zieglerspital, Clinic of Internal Medicine, Spital Netz Bern AG, Bern, Switzerland
- Department of Rheumatology, Immunology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Fricker
- Department of Rheumatology, Immunology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Praxisgemeinschaft Mörigen, Mörigen, Switzerland
| | - Oliver Hausmann
- Department of Rheumatology, Immunology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- ADR-AC GmbH, Adverse Drug Reactions, Analysis and Consulting, Bern, Switzerland
- Löwenpraxis Luzern, Lucerne, Switzerland
| | - Arthur Helbling
- Allergy Unit, Zieglerspital, Clinic of Internal Medicine, Spital Netz Bern AG, Bern, Switzerland
- Department of Rheumatology, Immunology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Jörg
- Department of Rheumatology, Immunology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- * E-mail:
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Schmid B, Hausmann O, Hitzl W, Achermann Y, Wuertz-Kozak K. The Role of Cutibacterium acnes in Intervertebral Disc Inflammation. Biomedicines 2020; 8:biomedicines8070186. [PMID: 32629986 PMCID: PMC7400222 DOI: 10.3390/biomedicines8070186] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 12/19/2022] Open
Abstract
Recently, the role of infection of the intervertebral disc (IVD) with Cutibacterium acnes (C. acnes) as a contributor to disc-related low back pain (LBP) has been discussed. The aim of this study was to investigate whether and how C. acnes contributes to the inflammatory processes during IVD disease. The prevalence of C. acnes infection in human IVD tissue was determined by aerobic and anaerobic culture. Thereafter, primary human IVD cells were infected with a reference and a clinical C. acnes strain and analyzed for pro-inflammatory markers (gene/protein level). In a subsequent experiment, the involvement of the Toll-like receptor (TLR) pathway was investigated by co-treatment with sparstolonin B, a TLR2/4 inhibitor. We detected C. acnes in 10% of IVD biopsies (with either herniation or degeneration). Stimulating IVD cells with both C. acnes strains strongly and significantly upregulated expression of Interleukin (IL)-1β, IL-6, IL-8, and inducible nitric oxide synthase (iNOS). IL-6, cyclooxygenase (COX)-2, and iNOS expression was reduced upon TLR2/4 inhibition in 3 out of 5 donors, whereby responders and non-responders could not be differentiated by their basal TLR2 or TLR4 expression levels. We demonstrate that exposure of IVD cells to C. acnes induces an inflammatory response that may contribute to the development of discogenic LBP by involving TLR2/4 activation, yet only in a subgroup of patients. Whether the same response will be observed in vivo and where lower inoculums are present remains to be proven in future studies.
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Affiliation(s)
- Bettina Schmid
- Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091 Zurich, Switzerland;
- Faculty of Science, University of Zurich, Gloriastrasse 31, 8091 Zurich, Switzerland
| | - Oliver Hausmann
- Neuro- and Spine Centre, Klinik St. Anna, St. Anna Street 32, 6006 Lucerne, Switzerland;
- Department of Neurosurgery, Inselspital Berne, University of Berne, Murtenstrasse 11, 3010 Berne, Switzerland
- CABMM Center for Applied Biotechnology and Molecular Medicine, University of Zurich, 8057 Zurich, Switzerland;
| | - Wolfgang Hitzl
- Research Office (Biostatistics), Paracelsus Medical University, Strubergasse 20, 5020 Salzburg, Austria;
- Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Müllner Hauptstr. 48, 5020 Salzburg, Austria
- Department of Ophthalmology and Optometry, Paracelsus Medical University Salzburg, 2020 Salzburg, Austria
| | - Yvonne Achermann
- CABMM Center for Applied Biotechnology and Molecular Medicine, University of Zurich, 8057 Zurich, Switzerland;
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Karin Wuertz-Kozak
- CABMM Center for Applied Biotechnology and Molecular Medicine, University of Zurich, 8057 Zurich, Switzerland;
- Department of Biomedical Engineering, Rochester Institute of Technology (RIT), 106 Lomb Memorial Dr., Rochester, NY 14623, USA
- Institute for Biomechanics, D-HEST, ETH Zurich, Hönggerbergring 64, 8093 Zurich, Switzerland
- Spine Center, Schön Clinic Munich Harlaching (Academic Teaching Hospital and Spine Research Institute of the Paracelsus Medical University Salzburg), Harlachinger Str. 51, 81547 Munich, Germany
- Correspondence: or ; Tel.: +1585-475-7355
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Jörg L, Mueller-Wirth N, Pecaric-Petkovic T, Diaz C, Pichler W, Hausmann O. The Fcε receptor I pathway is crucial but not exclusive for basophil activation in patients with autoimmune forms of chronic spontaneous urticaria. J Eur Acad Dermatol Venereol 2020; 34:e825-e827. [PMID: 32491222 DOI: 10.1111/jdv.16703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- L Jörg
- Department of Rheumatology, Immunology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - N Mueller-Wirth
- ADR-AC GmbH, Adverse Drug Reactions, Analysis and Consulting, Bern, Switzerland
| | - T Pecaric-Petkovic
- ADR-AC GmbH, Adverse Drug Reactions, Analysis and Consulting, Bern, Switzerland
| | - C Diaz
- ADR-AC GmbH, Adverse Drug Reactions, Analysis and Consulting, Bern, Switzerland
| | - W Pichler
- ADR-AC GmbH, Adverse Drug Reactions, Analysis and Consulting, Bern, Switzerland
| | - O Hausmann
- ADR-AC GmbH, Adverse Drug Reactions, Analysis and Consulting, Bern, Switzerland.,Löwenpraxis Luzern, Lucerne, Switzerland
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Hausmann O. Commentary on “Degenerative Cervical Myelopathy: A 7-Letter Coding System That Supports Decision-Making for the Surgical Approach”. Neurospine 2020; 17:172-173. [PMID: 32252166 PMCID: PMC7136099 DOI: 10.14245/ns.2040100.050] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Oliver Hausmann
- Neuro- and Spine Center, Hirslanden Klinik St. Anna Lucerne, Lucerne, Switzerland; University of Berne, Berne, Switzerland
- Corresponding Author Oliver Hausmann E-mail: https://orcid.org/0000-0002-6599-841X Neuro- and Spine Center, Hirslanden Klinik St. Anna Lucerne, Lucerne, Switzerland; University of Berne, Berne, Switzerland
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11
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Hausmann O, Daha M, Longo N, Knol E, Müller I, Northrup H, Brockow K. Pegvaliase: Immunological profile and recommendations for the clinical management of hypersensitivity reactions in patients with phenylketonuria treated with this enzyme substitution therapy. Mol Genet Metab 2019; 128:84-91. [PMID: 31375398 DOI: 10.1016/j.ymgme.2019.05.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/13/2019] [Accepted: 05/13/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To provide recommendations for managing hypersensitivity adverse events (HAEs) to an injectable enzyme substitution therapy (pegvaliase, a PEGylated phenylalanine ammonia lyase enzyme) in adult patients with phenylketonuria (PKU). METHODS Eight European academic immunology experts with a broad range of experience in hypersensitivity, anaphylaxis, and/or drug reactions, and two geneticists from the USA with pegvaliase experience convened for two advisory board meetings. Efficacy, safety, and immunological profile of pegvaliase were discussed with the objective of developing recommendations for the clinical management of HAEs associated with pegvaliase treatment. RESULTS Based on available immunogenicity data, it was concluded that pegvaliase induces a Type III hypersensitivity reaction, causing HAEs with peak event rates during induction/titration and a decline over time during maintenance therapy. The decline in HAEs with longer duration of therapy was considered to likely be driven by anti-drug antibody affinity maturation, reduced immune complex formation, and decreased complement activation over time. Immunology and PKU experts unanimously supported that the use of an induction, titration, and maintenance dosing regimen and implementation of several risk mitigation strategies contributed to the improvement of tolerability over time. Key risk mitigation strategies utilized in the Phase 3 clinical trials such as premedication with H1-receptor antagonists, allowance for a longer titration period after an HAE, patient education, and requirement to carry auto-injectable adrenaline (epinephrine) should be continued in clinical practice. A tool for administration of auto-injectable adrenaline in patients using pegvaliase was suggested. It was added that after the occurrence of a severe HAE a temporary dose reduction is more likely to improve tolerability than treatment interruption. CONCLUSIONS Overall, it was agreed that pegvaliase has a generally tolerable safety profile in adults with PKU. Importantly, the risk mitigation strategies utilized in the clinical trials were considered to support the continued use of key strategies for management in the commercial setting, such as a slow induction/titration dosing paradigm and premedication with H1-receptor antagonists. However, physicians and patients need to be aware of the risk of HAEs associated with pegvaliase; presence of a trained observer during early treatment may be beneficial in certain circumstances, and a requirement to carry auto-injectable adrenaline is recommended. Because pegvaliase offers the possibility to normalize diet, while maintaining blood phenylalanine within the recommended therapeutic range, safe use of this medication in the clinical setting is important. Ongoing monitoring of long-term clinical safety of patients on pegvaliase treatment in the commercial setting was recommended.
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Affiliation(s)
- Oliver Hausmann
- Adverse Drug Reactions, Analysis & Consulting (ADR-AC) GmbH, Bern, and Research Affiliate, Department of Rheumatology, Immunology and Allergology Inselspital, University of Bern, Switzerland
| | - Mohamed Daha
- Department of Nephrology, Leiden University Medical Center, Leiden, the Netherlands
| | - Nicola Longo
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Edward Knol
- Department of Immunology and Dermatology, Department of Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ingo Müller
- Division of Pediatric Stem Cell Transplantation and Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hope Northrup
- Department of Pediatrics, The McGovern Medical School, Houston, TX, USA
| | - Knut Brockow
- Department of Dermatology and Allergy, School of Medicine Technical University of Munich, Munich, Germany.
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12
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Abstract
The diagnosis of drug allergy is essentially based on a detailed anamnesis, involving the doctors who first treated the patient, and skin testing (prick, intradermal and epicutaneous / patch tests). In the allergological practice / clinic, provocation tests with the presumed trigger are only carried out if the indication is very clear (see articles in this issue on drug allergy children, allergies to betalactam and other antibiotics as well as analgesic intolerance). The provocation with a probably tolerable alternative is in the foreground. Unfortunately, the skin tests of certain drug groups have a low sensitivity even under optimal conditions, but very good specificity. Accordingly, positive skin tests are mostly relevant, but negative skin tests cannot rule out an allergy. In recent years, it has therefore proved successful to carry out supplementary laboratory tests in the clarification of drug allergies. The serological tests (IgE) are of little help. In contrast, the test forms based on the analysis of leukocytes (basophil activation test, BAT, and lymphocyte transformation test, LTT) have gained in importance and complement the diagnostic repertoire. In the combination of all test methods (skin test, LTT, BAT, sometimes provocation test) the trigger of a drug allergy can be defined in a good 70 % of cases and in most cases a safe therapeutic alternative can be found. In the following, we will discuss the importance of laboratory diagnostics in drug allergy.
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Affiliation(s)
| | | | - Oliver Hausmann
- 1 ADR-AC GmbH, Bern.,2 Löwenpraxis, Luzern.,3 Klinik St. Anna, Luzern
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13
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Franco-Obregón A, Cambria E, Greutert H, Wernas T, Hitzl W, Egli M, Sekiguchi M, Boos N, Hausmann O, Ferguson SJ, Kobayashi H, Wuertz-Kozak K. TRPC6 in simulated microgravity of intervertebral disc cells. Eur Spine J 2018; 27:2621-2630. [PMID: 29968164 DOI: 10.1007/s00586-018-5688-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 06/25/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE Prolonged bed rest and microgravity in space cause intervertebral disc (IVD) degeneration. However, the underlying molecular mechanisms are not completely understood. Transient receptor potential canonical (TRPC) channels are implicated in mechanosensing of several tissues, but are poorly explored in IVDs. METHODS Primary human IVD cells from surgical biopsies composed of both annulus fibrosus and nucleus pulposus (passage 1-2) were exposed to simulated microgravity and to the TRPC channel inhibitor SKF-96365 (SKF) for up to 5 days. Proliferative capacity, cell cycle distribution, senescence and TRPC channel expression were analyzed. RESULTS Both simulated microgravity and TRPC channel antagonism reduced the proliferative capacity of IVD cells and induced senescence. While significant changes in cell cycle distributions (reduction in G1 and accumulation in G2/M) were observed upon SKF treatment, the effect was small upon 3 days of simulated microgravity. Finally, downregulation of TRPC6 was shown under simulated microgravity. CONCLUSIONS Simulated microgravity and TRPC channel inhibition both led to reduced proliferation and increased senescence. Furthermore, simulated microgravity reduced TRPC6 expression. IVD cell senescence and mechanotransduction may hence potentially be regulated by TRPC6 expression. This study thus reveals promising targets for future studies. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Alfredo Franco-Obregón
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- BioIonic Currents Electromagnetic Pulsing Systems Laboratory, BICEPS, National University of Singapore, Singapore, Singapore
| | - Elena Cambria
- Institute for Biomechanics, D-HEST, ETH Zurich, Hönggerbergring 64, 8093, Zurich, Switzerland
| | - Helen Greutert
- Institute for Biomechanics, D-HEST, ETH Zurich, Hönggerbergring 64, 8093, Zurich, Switzerland
| | - Timon Wernas
- School of Engineering and Architecture, Lucerne University of Applied Sciences and Arts, Lucerne, Switzerland
| | - Wolfgang Hitzl
- Research Office (Biostatistics), Paracelsus Private Medical University, Salzburg, Austria
- Department of Ophthalmology and Optometry, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Marcel Egli
- School of Engineering and Architecture, Lucerne University of Applied Sciences and Arts, Lucerne, Switzerland
| | - Miho Sekiguchi
- Department of Orthopaedic Surgery, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Norbert Boos
- Prodorso Center for Spinal Medicine, Zurich, Switzerland
| | - Oliver Hausmann
- Neuro- and Spine Center, Hirslanden Klinik St. Anna, Lucerne, Switzerland
| | - Stephen J Ferguson
- Institute for Biomechanics, D-HEST, ETH Zurich, Hönggerbergring 64, 8093, Zurich, Switzerland
| | - Hiroshi Kobayashi
- Institute for Biomechanics, D-HEST, ETH Zurich, Hönggerbergring 64, 8093, Zurich, Switzerland
- Department of Orthopaedic Surgery, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Karin Wuertz-Kozak
- Institute for Biomechanics, D-HEST, ETH Zurich, Hönggerbergring 64, 8093, Zurich, Switzerland.
- Spine Center, Schön Klinik München Harlaching, 81547, Munich, Germany.
- Academic Teaching Hospital and Spine Research Institute, Paracelsus Private Medical University, Salzburg, Austria.
- Department of Health Science, University of Potsdam, Potsdam, Germany.
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Jörg L, Pecaric-Petkovic T, Reichenbach S, Coslovsky M, Stalder O, Pichler W, Hausmann O. Double-blind placebo-controlled trial of the effect of omalizumab on basophils in chronic urticaria patients. Clin Exp Allergy 2017; 48:196-204. [DOI: 10.1111/cea.13066] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 10/20/2017] [Accepted: 11/05/2017] [Indexed: 12/01/2022]
Affiliation(s)
- L. Jörg
- Department of Rheumatology, Immunology and Allergology, Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
| | - T. Pecaric-Petkovic
- Adverse Drug Reactions, Analysis and Consulting; ADR-AC GmbH; Bern Switzerland
| | - S. Reichenbach
- Department of Rheumatology, Immunology and Allergology, Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
- Clinical Trial Unit; University of Bern; Bern Switzerland
| | - M. Coslovsky
- Clinical Trial Unit; University of Bern; Bern Switzerland
| | - O. Stalder
- Clinical Trial Unit; University of Bern; Bern Switzerland
| | - W. Pichler
- Adverse Drug Reactions, Analysis and Consulting; ADR-AC GmbH; Bern Switzerland
| | - O. Hausmann
- Department of Rheumatology, Immunology and Allergology, Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
- Adverse Drug Reactions, Analysis and Consulting; ADR-AC GmbH; Bern Switzerland
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Pichler WJ, Buenter A, Fernando S, Wirth N, Helbling A, Glatz M, Spoerl D, Gupta N, Hausmann O. P20: DOES CHLORHEXIDINE SPECIFIC IgE CROSS-REACT WITH ALEXIDINE? Intern Med J 2017. [DOI: 10.1111/imj.20_13578] [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: 11/29/2022]
Affiliation(s)
| | - A Buenter
- ADR-AC GmbH; Bern Switzerland
- Department of Rheumatology, Immunology and Allergology; University of IS Bern; Switzerland
| | - S Fernando
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital; Sydney Australia
| | - N Wirth
- ADR-AC GmbH; Bern Switzerland
| | - A Helbling
- Department of Rheumatology, Immunology and Allergology; University of IS Bern; Switzerland
| | - M Glatz
- Allergiestation; University of Zurich; Switzerland
| | - D Spoerl
- Department of Clinical Immunology and Allergy, HUG; Geneva Switzerland
| | - N Gupta
- Teleflex Inc.; Reading PA USA
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Unger S, Seidl M, van Schouwenburg P, Rakhmanov M, Bulashevska A, Frede N, Grimbacher B, Pfeiffer J, Schrenk K, Munoz L, Hanitsch L, Stumpf I, Kaiser F, Hausmann O, Kollert F, Goldacker S, van der Burg M, Keller B, Warnatz K. The T H1 phenotype of follicular helper T cells indicates an IFN-γ-associated immune dysregulation in patients with CD21low common variable immunodeficiency. J Allergy Clin Immunol 2017; 141:730-740. [PMID: 28554560 DOI: 10.1016/j.jaci.2017.04.041] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/31/2017] [Accepted: 04/12/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND A subgroup of patients with common variable immunodeficiency (CVID) experience immune dysregulation manifesting as autoimmunity, lymphoproliferation, and organ inflammation and thereby increasing morbidity and mortality. Therefore treatment of these complications demands a deeper comprehension of their cause and pathophysiology. OBJECTIVES On the basis of the identification of an interferon signature in patients with CVID with secondary complications and a skewed follicular helper T-cell differentiation in defined monogenic immunodeficiencies, we sought to determine the profile of CD4 memory T cells in blood and secondary lymphatic tissues of these patients. METHODS We quantified TH1/TH2/TH17 CD4 memory T cells in blood and lymph nodes of patients with CVID using flow cytometry, analyzed their function, and correlated all findings to the burden of immune dysregulation. RESULTS Patients with CVID with immune dysregulation had a skewed memory CD4 T-cell differentiation toward a CXCR3+CCR6- TH1 phenotype both in blood and lymph nodes. Consistent with our phenotypic findings, we observed a higher IFN-γ production in peripheral CD4 memory T cells and lymph node-derived follicular helper T cells of patients with CVID compared with those of healthy control subjects. Increased IFN-γ production was accompanied by a poor germinal center output, an accumulation of T-box transcription factor (T-bet)+ B cells in lymph nodes, and an accumulation of T-bet+CD21low B cells in peripheral blood of affected patients. CONCLUSION Identification of excessive IFN-γ production by blood and lymph node-derived T cells of patients with CVID with immune dysregulation will offer new therapeutic avenues for this subgroup. CD21low B cells might serve as a marker of this IFN-γ-associated dysregulation.
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Affiliation(s)
- Susanne Unger
- Center for Chronic Immunodeficiency (CCI), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Maximilian Seidl
- Center for Chronic Immunodeficiency (CCI), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Institute for Surgical Pathology, University Medical Center Freiburg, Freiburg, Germany
| | - Pauline van Schouwenburg
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mirzokhid Rakhmanov
- Center for Human Genetics and Laboratory Diagnostics (AHC), Martinsried, Germany
| | - Alla Bulashevska
- Center for Chronic Immunodeficiency (CCI), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Natalie Frede
- Center for Chronic Immunodeficiency (CCI), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bodo Grimbacher
- Center for Chronic Immunodeficiency (CCI), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jens Pfeiffer
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Freiburg, Freiburg, Germany
| | - Klaudia Schrenk
- Center for Chronic Immunodeficiency (CCI), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Institute for Surgical Pathology, University Medical Center Freiburg, Freiburg, Germany
| | - Luis Munoz
- Department of Internal Medicine 3-Rheumatology and Immunology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Leif Hanitsch
- Institute of Medical Immunology, Charité University Medicine Berlin, Campus Virchow, Berlin, Germany
| | - Ina Stumpf
- Center for Chronic Immunodeficiency (CCI), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Fabian Kaiser
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Florian Kollert
- Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Freiburg, Germany
| | - Sigune Goldacker
- Center for Chronic Immunodeficiency (CCI), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mirjam van der Burg
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Baerbel Keller
- Center for Chronic Immunodeficiency (CCI), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Klaus Warnatz
- Center for Chronic Immunodeficiency (CCI), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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Abstract
Multiple drug hypersensitivity (MDH) is a syndrome that develops as a consequence of massive T-cell stimulations and is characterized by long-lasting drug hypersensitivity reactions (DHR) to different drugs. The initial symptoms are mostly severe exanthems or drug rash with eosinophilia and systemic symptoms (DRESS). Subsequent symptoms due to another drug often appear in the following weeks, overlapping with the first DHR, or months to years later after resolution of the initial presentation. The second DHR includes exanthema, erythroderma, DRESS, Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), hepatitis, and agranulocytosis. The eliciting drugs can be identified by positive skin or in vitro tests. The drugs involved in starting the MDH are the same as for DRESS, and they are usually given in rather high doses. Fixed drug combination therapies like sulfamethoxazole/trimethoprim or piperacillin/tazobactam are frequently involved in MDH, and 30-40% of patients with severe DHR to combination therapy show T-cell reactions to both components. The drug-induced T-cell stimulation appears to be due to the p-i mechanism. Importantly, a permanent T-cell activation characterized by PD-1+/CD38+ expression on CD4+/CD25low T cells can be found in the circulation of patients with MDH for many years. In conclusion, MDH is a drug-elicited syndrome characterized by a long-lasting hyperresponsiveness to multiple, structurally unrelated drugs with clinically diverse symptoms.
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Affiliation(s)
- Werner J. Pichler
- Department of Immunology, ADR-AC, Bern, Siriraj Hospital, Mahidol University, NSW, Australia
| | - Yuttana Srinoulprasert
- Department of Immunology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - James Yun
- Department of Clinical Immunology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Oliver Hausmann
- Department of Immunology, ADR-AC, Bern, Siriraj Hospital, Mahidol University, NSW, Australia
- Department of Immunology, Löwenpraxis, Luzern, Switzerland, NSW, Australia
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18
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Hausmann O. [Not Available]. Rev Med Suisse 2017; 13:261. [PMID: 28704001] [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: 06/07/2023]
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19
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Pichler WJ, Hausmann O. Classification of Drug Hypersensitivity into Allergic, p-i, and Pseudo-Allergic Forms. Int Arch Allergy Immunol 2016; 171:166-179. [PMID: 27960170 DOI: 10.1159/000453265] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Drug hypersensitivity reactions (DHR) are clinically and functionally heterogeneous. Different subclassifications based on timing of symptom appearance or type of immune mechanism have been proposed. Here, we show that the mode of action of drugs leading to immune/inflammatory cell stimulation is a further decisive factor in understanding and managing DHR. Three mechanisms can be delineated: (a) some drugs have or gain the ability to bind covalently to proteins, form new antigens, and thus elicit immune reactions to hapten-carrier complexes (allergic/immune reaction); (b) a substantial part of immune-mediated DHR is due to a typical off-target activity of drugs on immune receptors like HLA and TCR (pharmacological interaction with immune receptors, p-i reactions); such p-i reactions are linked to severe DHR; and (c) symptoms of DHR can also appear if the drug stimulates or inhibits receptors or enzymes of inflammatory cells (pseudo-allergy). These three distinct ways of stimulations of immune or inflammatory cells differ substantially in clinical manifestations, time of appearance, dose dependence, predictability, and cross-reactivity, and thus need to be differentiated.
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20
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Carr DF, Chung WH, Jenkiins RE, Chaponda M, Nwikue G, Cornejo Castro EM, Antoine DJ, Pirmohamed M, Wuillemin N, Dina D, Eriksson KK, Yerly D, Pavlos R, Mckinnin E, Ostrov D, Peters B, Buus S, Koelle D, Chopra A, Rive C, Redwood A, Restrepo S, Bracey A, Yuan J, Gaudieri S, Carrington M, Haas D, Mallal S, Phillips E, De Boer D, Menheere P, Nieuwhof C, Bons J, Jonsson F, De Chaisemartin L, Granger V, Gillis C, Gouel A, Neukirch C, Dib F, Nicaise PR, Longrois D, Tubach F, Martin S, Bruhns P, Chen KL, Liao SL, Sheen YS, Cho YT, Yang CW, Liau JY, Chu CY, Aguiar R, Lopes A, Fernandes N, Viegas L, Pereira-Barbosa MA, Bünter A, Gupta N, Petkovic TP, Wirth N, Pichler WJ, Hausmann O, Yazicioglu M, Ozdemir PG, Ciplak G, Kaya O, Cooke PJ, Mota I, Gaspar Â, Benito-Garcia F, Chambel M, Morais-Almeida M, Marques L, Alcoceba E, Lara S, Carneiro-Leão L, Botelho C, Dias-Castro E, Cernadas JR, Nicholls K, Lay W, Smith O, Collins C, Unglik G, Spriggs K, Auyeung P, McComish J, Douglass JA, Peter JG, Potter P, Carolino F, De Castro ED, Moreira AS, Abreu C, Gomes E, Cardoso BK, Tomaz E, Correia S, Inácio F, Arnold A, Bear N, Rueter K, Gong G, O’Sullivan M, Muthusamy S, Noble V, Lucas M, Buterleviciute N, Rudzeviciene O, Abreu C, May S, Pongdee T, Park M, Griguola L, Vinikovas A, Kašinskaite S, Kvedariene V, Aktas A, Rahman S, Elbi H, Ozyurt BC, Cavkaytar O, Karaatmaca B, Cetinkaya PG, Esenboga S, Sahiner UM, Sekerel BE, Soyer O, Zubrinich C, Tong B, Patel M, Giles M, O’Hehir R, Puy R, Amaral L, Demir S, Gelincik A, Olgac M, Caskun R, Unal D, Colakoglu B, Buyukozturk S, Matute OV, Bernad A, Gastaminza G, Madamba R, Lacasa C, Goikoetxea MJ, D’Amelio C, Rifón J, Martínez N, Ferrer M, Ribeiro C, Faria E, Frutuoso C, Barros A, Lebre R, Pego A, Bom AT, Ensina LF, Aranda C, Nunes IC, Martins AM, Solé D, Bavbek S, Kendirlinan R, Çerçi P, Tutluer S, Soyyigit S, Sözener ZÇ, Aydin Ö, Gümüsburun R, Almeida M, Sai K, Imatoh T, Nakamura R, Fukazawa C, Hinomura Y, Saito Y, Sousa-Pinto B, Correia C, Gomes L, Gil-Mata S, Araújo L, Delgado L, Sai K, Okamoto-Uchida Y, Kajinami K, Matsunaga K, Aihara M, Wang CW, Su SC, Hung SI, Ho HC, Yang CH, Paulmann M, Dunant A, Mockenhaupt M, Sekula P, Schumacher M, Kardaun S, Naldi L, Bellón T, Creamer D, Haddad C, Sassolas B, Lebrun-Vignes B, Valeyrie-Allanore L, Roujeau JC, Paulmann M, Kremmler C, Mockenhaupt M, Dodiuk-Gad RP, Olteanu C, Feinstein A, Hashimoto R, Alhusayen R, Whyte-Croasdaile S, Finkelstein Y, Burnett M, Sade S, Cartotto R, Jeschke M, Shear NH, Takamura N, Yamane Y, Matsukura S, Nakamura K, Watanabe Y, Yamaguchi Y, Kambara T, Ikezawa Z, Aihara M, Hashimoto R, Chew H, Burnett M, Jeschke M, Knezevic B, Ionmhain UN, Barraclough A, Anstey M, Usui T, Meng X, Farrell J, Whitaker P, Watson J, French N, Park K, Naisbitt D, Neves AC, Cadinha S, Moreira A, Da Silva JPM, Drvar DL, Gulin SJ, Hadzavdic SL, Ceovic R, De Francisco AM, De Vicente Jiménez T, Luque AG, David NR, Galván JMM, Darlenski R, Gulin D, Sikic J, Habek JC, Galic E, Specht P, Staab D, Mayer B, Roehmel J, Solovan C, Chiriac A, Djurinec P, Kostovic K, Bradamante M, Almeida JP, Caiado J, Pedro E, Da Silva PC, Barbosa MP, Bogas G, Blanca-López N, Pérez-Alzate D, Doña I, Agúndez JA, García-Martín E, Cornejo-García JA, Mayorga C, Torres MJ, Canto MG, Blanca M, Aksakal S, Sin AZ, Koç ZP, Günsen FD, Ardeniz Ö, Gökmen ENM, Gülbahar O, Kokuludag A, Pérez-Sánchez N, Salas M, Salas M, Gomez F, Barrionuevo E, Andreu I, Miranda MÁ, Didžiokaite G, Gaidej O, Kašinskaite S, Garcimartin MI, Somoza ML, Bojas G, Cornejo-Garcia JA, Perez FJR, Miranda MA, Jerschow E, Pelletier T, Ren Z, Hudes G, Sanak M, Morales E, Schuster V, Spivack SD, Rosenstreich D, Erzen R, Silar M, Bajrovic N, Rijavec M, Zidarn M, Korosec P, Castro E, Al-Ahmad M, Rodriguez T, Azevedo JP, Tavares B, Regateiro F, Todo-Bom A, Miranda PA, De La Cruz Hoyos B, Abuzeid W, Akbar N, Gibber M, Fried M, Han W, Keskin T, Tamayev R, Spivack SD, Rosenstreich D, Jerschow E, Boni E, Russello M, Mauro M, Neto MF, Brosseron L, Malheiro D, Barreira P, Sprigg D, Trevenen M, Seet J, Trubiano J, Smith W, Jeelall Y, Vale S, Loh R, Mclean-Tooke A, Müller S, Amstutz U, Jörg L, Yawalkar N, Krähenbühl S, Leblanc A, Ribeiro L, Vega A, Rivas RG, Alonso A, Beitia JM, Mateo B, Cárdenas R, Garcia-Dominguez JJ, Pavlos R, Strautins K, James I, Mallal S, Redwood A, Aguiar R, Lopes A, Neves A, Do Céu Machado M, Dalgiç CT, Gökmen ENM, Bulut G, Ardeniz FÖ, Gülbahar O, Sin AZ, Hsu SH, Yang CW, Ye YM, Hur GY, Park HS, Kim SH, Ali S, Hollingsworth PN, Mclean-Tooke APC, Chadly Z, Fredj NB, Aouam K, Romdhane HB, Boughattas NA, Chaabane A, Salazar ML, Pola B, Fiandor A, Ramírez E, Ortega JD, Quirce S, Cabañas R, Baynova K, Labella M, Prados M, Ramonaite A, Bajoriuniene I, Sitkauskiene B, Sakalauskas R, Kwon JW, Park S, Silva D, Leão LC, Castro E, Garcimartin M, De La Torre MV, Pérez FJR, Haroun E, Diez GC, Ónodi-Nagy K, Kinyó Á, Kemény L, Bata-Csörgo Z, Pita JS, Fernandes RA, Moura A, Sousa N, Loureiro C, Pfützner W, Marrouche N, Grattan C, Chen YE, Chen CB, Hsiao YP, Garcimartin MI, Ruano FJ. 7th drug hypersensitivity meeting: part one. Clin Transl Allergy 2016. [PMCID: PMC5009634 DOI: 10.1186/s13601-016-0121-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Oral Abstracts O1 Functionally distinct HMGB1 isoforms correlate with physiological processes in drug-induced SJS/TEN Daniel F. Carr, Wen-Hung Chung, Rosalind E. Jenkiins, Mas Chaponda, Gospel Nwikue, Elena M. Cornejo Castro, Daniel J. Antoine, Munir Pirmohamed O2 Hypersensitivity reactions to beta-lactams, does the t cell recognition pattern influence the clinical picture? Natascha Wuillemin, Dolores Dina, Klara K. Eriksson, Daniel Yerly O3 Specific binding characteristics of HLA alleles associated with nevirapine hypersensitivity Rebecca Pavlos, Elizabeth Mckinnin, David Ostrov, Bjoern Peters, Soren Buus, David Koelle, Abha Chopra, Craig Rive, Alec Redwood, Susana Restrepo, Austin Bracey, Jing Yuan, Silvana Gaudieri, Mary Carrington, David Haas, Simon Mallal, Elizabeth Phillips O4 Do we need to measure total ige for the interpretation of analytical results of ImmunoCAP dnd 3gAllergy specific IgE? Douwe De Boer, Paul Menheere, Chris Nieuwhof, Judith Bons O5 Neutrophil activation in systemic anaphylaxis: results from the multicentric NASA study Friederike Jonsson, Luc De Chaisemartin, Vanessa Granger, Caitlin Gillis, Aurelie Gouel, Catherine Neukirch, Fadia Dib, Pascale Roland Nicaise, Dan Longrois, Florence Tubach, Sylvie Martin, Pierre Bruhns, NASA Study Group O6 Purpuric drug eruptions due to epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) for non-small-cell lung cancer (NSCLC): a clinic-pathological study of 32 cases Kai-Lung Chen, Shu-Ling Liao, Yi-Shuan Sheen, Yung-Tsu Cho, Che-Wen Yang, Jau-Yu Liau, Chia-Yu Chu Poster presentations: Poster Walk 1—Anaphylaxis (P01–P09) P1 Anaphylactic reactions during anaesthesia and the perioperative period Rita Aguiar, Anabela Lopes, Natália Fernandes, Leonor Viegas, M. A. Pereira-Barbosa P2 Anaphylaxis to chlorhexidine: is there a cross-reactivity to alexidine? Antonia Bünter, Nisha Gupta, Tatjana Pecaric Petkovic, Nicole Wirth, Werner J. Pichler, Oliver Hausmann P3 Cefotaxime-induced severe anaphylaxis in a neonate Mehtap Yazicioglu, Pinar G. Ozdemir, Gokce Ciplak, Ozkan Kaya P4 Clinical features and diagnosis of anaphylaxis resulting from exposure to chlorhexidine Peter John Cooke P5 Drug-induced anaphylaxis: five-year single-center survey Inês Mota, Ângela Gaspar, Filipe Benito-Garcia, Marta Chambel, Mário Morais-Almeida P6 Intraoperative severe anaphylactic reaction due to patent blue v dye Luis Marques, Eva Alcoceba, Silvia Lara P7 Kounis syndrome in the setting of anaphylaxis to diclofenac Leonor Carneiro-Leão, Carmen Botelho, Eunice Dias-Castro, Josefina Cernadas P8 Perioperative anaphylaxis audit: Royal Melbourne Hospital Katherine Nicholls, William Lay, Olivia Smith, Christine Collins, Gary Unglik, Kymble Spriggs, Priscilla Auyeung, Jeremy McComish, Jo A. Douglass P9 Recurrent peri-operative anaphylaxis: a perfect storm Jonny G. Peter, Paul Potter Poster Walk 2: DH regions and patient groups (P10–P19) P10 A rare presentation of amoxicillin allergy in a young child Fabrícia Carolino, Eunice Dias De Castro, Josefina R. Cernadas P11 Adverse drug reactions in children: antibiotics or virus? Ana Sofia Moreira, Carmo Abreu, Eva Gomes P12 Allergic reactions in invasive medical procedures Bárbara Kong Cardoso, Elza Tomaz, Sara Correia, Filipe Inácio P13 Antibiotic allergy in children: room for improvement Annabelle Arnold, Natasha Bear, Kristina Rueter, Grace Gong, Michael O’Sullivan, Saravanan Muthusamy, Valerie Noble, Michaela Lucas P14 Drug hypersensitivity reactions in children and results of diagnostic evaluation Neringa Buterleviciute, Odilija Rudzeviciene P15 Nonimmediate cutaneous drug reactions in children: are skin tests required? Ana Sofia Moreira, Carmo Abreu, Eva Gomes P16 Pediatric patients with a history of penicillin allergy and a positive penicillin skin test may not be at an increased risk for multiple drug allergies Sara May, Thanai Pongdee, Miguel Park P17 Proved hypersensitivity to drugs according data of Vilnius University Hospital Santariskiu Klinikos Linas Griguola, Arturas Vinikovas, Simona Kašinskaite, Violeta Kvedariene P18 Self-reported prevalence of drug hypersensitivity reactions among students in Celal Bayar University, Turkey Ayse Aktas, Suheyla Rahman, Huseyin Elbi, Beyhan Cengiz Ozyurt P19 Severe drug hypersensitivity reactions in pediatric age Ozlem Cavkaytar, Betul Karaatmaca, Pinar Gur Cetinkaya, Saliha Esenboga, Umit M. Sahiner, Bulent E. Sekerel, Ozge Soyer Poster Walk 3: Desensitisation (P20–P28) P20 A protocol for desensitisation to valaciclovir Celia Zubrinich, Bianca Tong, Mittal Patel, Michelle Giles, Robyn O’Hehir, Robert Puy P21 A rare case of desensitization to modafinil Josefina Cernadas, Luís Amaral, Fabrícia Carolino P22 A sixteen-day desensitization protocol in delayed type hypersensitivity reactions to oral drugs Semra Demir, Asli Gelincik, Muge Olgac, Raif Caskun, Derya Unal, Bahauddin Colakoglu, Suna Buyukozturk P23 Desensitization to intravenous etoposide using a 12 and a 13-step protocol. Two cases report Olga Vega Matute, Amalia Bernad, Gabriel Gastaminza, Roselle Madamba, Carlos Lacasa, M. J. Goikoetxea, Carmen D’Amelio, Jose Rifón, Nicolas Martínez, Marta Ferrer P24 Drug desensitisation in oncology: the experience of an immunoallergology department for 5 years Carmelita Ribeiro, Emília Faria, Cristina Frutuoso, Anabela Barros, Rosário Lebre, Alice Pego, Ana Todo Bom P25 Filgrastim anaphylaxis: a successful desensitization protocol Luis Amaral, Josefina Cernadas P26 Galsulfase hypersensitivity and desensitization of a mucopolysaccharidosis VI patient Luis Felipe Ensina, Carolina Aranda, Ines Camelo Nunes, Ana Maria Martins, Dirceu Solé P27 Rapid drug desensitization with biologicals: one-center experience with four biologicals Sevim Bavbek, Resat Kendirlinan, Pamir Çerçi, Seda Tutluer, Sadan Soyyigit, Zeynep Çelebi Sözener, Ömür Aydin, Reyhan Gümüsburun P28 Successful desensitization to a high dose of methotrexate in a delayed type hypersensitivity reaction Josefina Cernadas, Leonor Carneiro-Leão, Fabrícia Carolino, Marta Almeida Poster Walk 4: SJS (P29–P38) P29 Assessment of impact of infection on drug-induced severe cutaneous adverse reactions and rhabdomyolysis using the Japanese adverse drug event report database Kimie Sai, Takuya Imatoh, Ryosuke Nakamura, Chisato Fukazawa, Yasushi Hinomura, Yoshiro Saito P30 Characterization of erythema multiforme and severe cutaneous adverse reactions hospitalizations Bernardo Sousa-Pinto, Cláudia Correia, Lídia Gomes, Sara Gil-Mata, Luís Araújo, Luís Delgado P31 Effects of infection on incidence/severity of SJS/TEN and myopathy in Japanese cases analyzed by voluntary case reports Ryosuke Nakamura, Kimie Sai, Takuya Imatoh, Yoshimi Okamoto-Uchida, Koji Kajinami, Kayoko Matsunaga, Michiko Aihara, Yoshiro Saito P32 Efficacy of tumor necrosis factor—a antagonists in Stevens–Johnson syndrome and toxic epidermal necrolysis: a randomized controlled trial and immunosuppressive effects evaluation Chuang-Wei Wang, Shih-Chi Su, Shuen-Iu Hung, Hsin-Chun Ho, Chih-Hsun Yang, Wen-Hung Chung P33 Evolution of drug causality in Stevens–Johnson syndrome and toxic epidermal necrolysis in Europe: analysis of 10 years RegiSCAR-Study Maren Paulmann, Ariane Dunant, Maja Mockenhaupt, Peggy Sekula, Martin Schumacher, Sylvia Kardaun, Luigi Naldi, Teresa Bellón, Daniel Creamer, Cynthia Haddad, Bruno Sassolas, Bénédicte Lebrun-Vignes, Laurence Valeyrie-Allanore, Jean-Claude Roujeau P34 Long-term sequelae in patients with Stevens–Johnson syndrome and toxic epidermal necrolysis: a 5-year analysis Maren Paulmann, Carmen Kremmler, Peggy Sekula, Laurence Valeyrie-Allanore, Luigi Naldi, Sylvia Kardaun, Maja Mockenhaupt P35 Major emotional complications and decreased health related quality of life among survivors of Stevens–Johnson syndrome and toxic epidermal necrolysis Roni P. Dodiuk-Gad, Cristina Olteanu, Anthony Feinstein, Rena Hashimoto, Raed Alhusayen, Sonia Whyte-Croasdaile, Yaron Finkelstein, Marjorie Burnett, Shachar Sade, Robert Cartotto, Marc Jeschke, Neil H. Shear P36 Retrospective analysis of Stevens–Johnson syndrome and toxic epidermal necrolysis in Japanese patients: treatment and outcome Naoko Takamura, Yumiko Yamane, Setsuko Matsukura, Kazuko Nakamura, Yuko Watanabe, Yukie Yamaguchi, Takeshi Kambara, Zenro Ikezawa, Michiko Aihara P37 Severe physical complications among survivors of Stevens–Johnson syndrome and toxic epidermal necrolysis Roni P. Dodiuk-Gad, Cristina Olteanu, Rena Hashimoto, Hall Chew, Raed Alhusayen, Sonia Whyte-Croasdaile, Yaron Finkelstein, Marjorie Burnett, Shachar Sade, Robert Cartotto, Marc Jeschke, Neil H. Shear P38 Stevens–Johnson syndrome/toxic epidermal necrolysis combined with haemophagocytic lymphohistiocytosis: a case report Brittany Knezevic, Una Nic Ionmhain, Allison Barraclough, Michaela Lucas, Matthew Anstey Poster Walk 5: Other organs/unexpected immune reactions (P39–P47) P39 A case report of patient with anti-tuberculosis drug-related severe liver failure Toru Usui, Xiaoli Meng, John Farrell, Paul Whitaker, John Watson, Neil French, Kevin Park, Dean Naisbitt P40 Acute interstitial nephritis induced by ibuprofen Ana Castro Neves, Susana Cadinha, Ana Moreira, J. P. Moreira Da Silva P41 Cetuximab induced acneiform rash—two case reports Daniela Ledic Drvar, Sandra Jerkovic Gulin, Suzana Ljubojevic Hadzavdic, Romana Ceovic P42 Enteropathy associated with losartan Ana Montoro De Francisco, Talía De Vicente Jiménez, Amelia García Luque, Natalia Rosado David, José Mª Mateos Galván P43 Granuloma annulare after therapy with canakinumab Razvigor Darlenski P44 Hypersensitivity eosinophilic myocarditis or acute coronary syndrome? Case report Dario Gulin, Jozica Sikic, Jasna Cerkez Habek, Sandra Jerkovic Gulin, Edvard Galic P45 Piperacillin-induced immune haemolytic anaemia: a severe and frequent complication of antibiotic treatment in patients with cystic fibrosis Philip Specht, Doris Staab, Beate Mayer, Jobst Roehmel P46 Progesterone triggered pemphigus foliaceus: case report Sandra Jerkovic Gulin, Caius Solovan, Anca Chiriac P47 Ramipril: triggered generalized pustular psoriasis Paola Djurinec, Kresimir Kostovic, Mirna Bradamante, Sandra Jerkovic Gulin, Romana Ceovic Poster Walk 6: NSAIDs (P48–P56) P48 Aspirin desensitization in cardiovascular disease—Portuguese experience Jose Pedro Almeida, Joana Caiado, Elisa Pedro, Pedro Canas Da Silva, Manuel Pereira Barbosa P49 Asthma and/or rhinitis to NSAIDs with good tolerance to ASA Gador Bogas, Natalia Blanca-López, Diana Pérez-Alzate, Inmaculada Doña, José Augusto Agúndez, Elena García-Martín, José Antonio Cornejo-García, Cristobalina Mayorga, María José Torres, Gabriela Canto, Miguel Blanca P50 Clinical characteristics of 196 patients with non-steroidal anti-inflammatory drug (NSAIDs) hypersensitivity Sengül Aksakal, Aytül Zerrin Sin, Zeynep Peker Koç, Fatma Düsünür Günsen, Ömür Ardeniz, Emine Nihal Mete Gökmen, Okan Gülbahar, Ali Kokuludag P51 Development of immediate hypersensitivity to several NSAIDs maintaining good tolerance to ASA Natalia Pérez-Sánchez, Natalia Blanca-López, Diana Pérez-Alzate, Gador Bogas, Inmaculada Doña, María Salas, María José Torres, Miguel Blanca, Gabriela Canto P52 Diagnosis of hypersensitivity reactions to paracetamol in a large series of cases Inmaculada Doña, Maria Salas, Francisca Gomez, Natalia Blanca-Lopez, Diana Perez-Alzate, Gador Bogas, Esther Barrionuevo, Maria Jose Torres, Inmaculada Andreu, Miguel Ángel Miranda, Gabriela Canto, Miguel Blanca P53 Hypersensitivity to paracetamol according to the new classification of hypersensitivity to NSAIDs Gabija Didžiokaite, Olesia Gaidej, Simona Kašinskaite, Violeta Kvedariene P54 Ibuprofen and other aryl propionic derivates can induce immediate selective hypersensitivity responses Diana Perez-Alzate, Natalia Blanca-López, Maria Isabel Garcimartin, Inmaculada Doña, Maria Luisa Somoza, Cristobalina Mayorga, Maria Jose Torres, Gador Bojas, Jose Antonio Cornejo-Garcia, Maria Gabriela Canto, Miguel Blanca P55 Subjects developing immediate responses to several NSAIDs can be selective with good tolerance to ASA Natalia Blanca-Lopez, Diana Pérez-Alzate, Francisco Javier Ruano Perez, Inmaculada Doña, Maria Luisa Somoza, Inmaculada Andreu, Miguel Angel Miranda, Cristobalina Mayorga, Maria Jose Torres, Jose Antonio Cornejo-Garcia, Miguel Blanca, Maria Gabriela Canto P56 Utility of low-dose oral aspirin challenges for diagnosis of aspirin exacerbated respiratory disease Elina Jerschow, Teresa Pelletier, Zhen Ren, Golda Hudes, Marek Sanak, Esperanza Morales, Victor Schuster, Simon D. Spivack, David Rosenstreich Poster Walk 7: NSAID 2 (P57–P65) P57 Alternate regulation of cyclooxygenase-2 (COX-2) MRNA expression may predispose patients to aspirin-induced exacerbations Renato Erzen, Mira Silar, Nissera Bajrovic, Matija Rijavec, Mihaela Zidarn, Peter Korosec P58 Anaphylaxis to diclofenac: what about the underlying mechanism? Leonor Carneiro-Leão, Fabrícia Carolino, Luís Amaral, Carmen Botelho, Eunice Dias-Castro, Josefina Cernadas P59 COX-2 inhibitors: are they always a safe alternative in hypersensitivity to nonsteroidal anti-inflammatory drugs? Luis Amaral, Fabricia Carolino, Eunice Castro, Josefina Cernadas P60 Management of patients with history of NSAIDs reactions prior to coronary angioplasty Mona Al-Ahmad, Tito Rodriguez P61 Oral drug challenge with non-steroidal anti-inflammatory drug under spirometric control: clinical series of 110 patients João Pedro Azevedo, Emília Faria, Beatriz Tavares, Frederico Regateiro, Ana Todo-Bom P62 Prevalence and incidence of analgesic hypersensitivity reactions in Colombia Pablo Andrés Miranda, Bautista De La Cruz Hoyos P63 Recent endoscopic sinus surgery lessens reactions during aspirin challenge in patients with aspirin exacerbated respiratory disease Teresa Pelletier, Waleed Abuzeid, Nadeem Akbar, Marc Gibber, Marvin Fried, Weiguo Han, Taha Keskin, Robert Tamayev, Golda Hudes, Simon D. Spivack, David Rosenstreich, Elina Jerschow P64 Safe use of imidazole salycilate in a case of multiple NSAIDs induced urticaria-angioedema Elisa Boni, Marina Russello, Marina Mauro P65 Selective hypersensitivity reactions to ibuprofen—seven years experience Marta Ferreira Neto Poster Walk 8: Epidemiological methods (P66–P72) P66 Allopurinol hypersensitivity: a 7-year review Lise Brosseron, Daniela Malheiro, Susana Cadinha, Patrícia Barreira, J. P. Moreira Da Silva P67 Antibiotic allergy labelling is associated with increased hospital readmission rates in Australia Brittany Knezevic, Dustin Sprigg, Michelle Trevenen, Jason Seet, Jason Trubiano, William Smith, Yogesh Jeelall, Sandra Vale, Richard Loh, Andrew Mclean-Tooke, Michaela Lucas P68 Experts’ opinions on severe cutaneous adverse drug reactions-report of a survey from the 9th international congress on cutaneous adverse drug reactions 2015 Roni P. Dodiuk-Gad, Cristina Olteanu, Wen-Hung Chung, Neil H. Shear P69 HLA-A*31-positive AGEP with carbamazepine use and other severe cutaneous adverse drug reactions (SCARs) detected by electronic medical records screening Sabine Müller, Ursula Amstutz, Lukas Jörg, Nikhil Yawalkar, Stephan Krähenbühl P70 Patients with suspected drug allergy: a specific psychological profile? Eunice Dias-Castro, Ana Leblanc, Laura Ribeiro, Josefina R. Cernadas P71 Use of an electronic device and a computerized mathematic algorithm to detect the allergic drug reactions through the analysis of heart rate variability Arantza Vega, Raquel Gutierrez Rivas, Ana Alonso, Juan Maria Beitia, Belén Mateo, Remedios Cárdenas, Juan Jesus Garcia-Dominguez P72 Variation in ERAP influences risk for HLA-B*57:01 positive abacavir hypersensitivity Rebecca Pavlos, Kaija Strautins, Ian James, Simon Mallal, Alec Redwood, Elizabeth Phillips Poster Walk 9: DRESS/AGEP (P73–P81) P73 A clinical case of DRESS syndrome in a child after administration of amoxicillin-clavulanic acid Rita Aguiar, Anabela Lopes, Ana Neves, Maria Do Céu Machado, M. A. Pereira-Barbosa P74 Acute generalized exanthematous pustulosis (AGEP) induced by mesalazine, reliable and oftenly used drug to treat inflammatory bowel disease Ceyda Tunakan Dalgiç, Emine Nihal Mete Gökmen, Fatma Düsünür Günsen, Gökten Bulut, Fatma Ömür Ardeniz, Okan Gülbahar, Ali Kokuludag, Aytül Zerrin Sin P75 Changes of blood plasmacytoid dendritic cells, myeloid dendritic cells, and basophils during the acute stage of drug reaction with eosinophilia and systemic symptoms (DRESS) and other drug eruptions Shao-Hsuan Hsu, Yung-Tsu Cho, Che-Wen Yang, Kai-Lung Chen, Chia-Yu Chu P76 Characterization of isoniazid/rifampicin-specific t-cell responses in patients with DRESS syndrome Young-Min Ye, Gyu-Young Hur, Hae-Sim Park, Seung-Hyun Kim P77 DRESS syndrome secondary to sulfasalazine with delayed TEN: a case presentation Syed Ali, Michaela Lucas, Peter N. Hollingsworth, Andrew P. C. Mclean-Tooke P78 Drug rash with eosinophilia and systemic symptoms (DRESS) features according to the culprit drug Zohra Chadly, Nadia Ben Fredj, Karim Aouam, Haifa Ben Romdhane, Naceur A. Boughattas, Amel Chaabane P79 Drug reaction with eosinophilia and systemic symptoms induced by allopurinol: not always easy to diagnose Marina Lluncor Salazar, Beatriz Pola, Ana Fiandor, Teresa Bellón, Elena Ramírez, Javier Domínguez Ortega, Santiago Quirce, Rosario Cabañas P80 Drug reaction with eosinophilia and systemic symptoms syndrome induced by two drugs simultaneously: a case report Krasimira Baynova, Marina Labella, Manuel Prados P81 The drug reaction with eosinophilia and systemic symptoms (DRESS) induced by the second-line antituberculosis drugs and Epstein–Barr virus infection Agne Ramonaite, Ieva Bajoriuniene, Brigita Sitkauskiene, Raimundas Sakalauskas Poster Walk 10: Miscellaneous drug hypersensitivity (P82–P91) P82 A case of cycloserine-induced lichenoid drug eruption confirmed with a lymphocatye transformation test Jae-Woo Kwon, Shinyoung Park P83 Allergic reaction to topical eye drops: 5 years’ retrospective study in a drug allergy unit Diana Silva, Leonor Carneiro Leão, Fabricia Carolino, Eunice Castro, Josefina Cernadas P84 Allergy to heparins Diana Perez-Alzate, Natalia Blanca-López, Maria Luisa Somoza Alvarez, Maria Garcimartin, Maria Vazquez De La Torre, Francisco Javier Ruano Pérez, Elisa Haroun, Gabriela Canto Diez P85 Allopurinol-induced adverse drug reactions Katinka Ónodi-Nagy, Ágnes Kinyó, Lajos Kemény, Zsuzsanna Bata-Csörgo P86 Analysis of a population with immediate hypersensitivity to corticosteroids: an 11 year review Joana Sofia Pita, Emília Faria, Rosa Anita Fernandes, Ana Moura, Nuno Sousa, Carmelita Ribeiro, Carlos Loureiro, Ana Todo Bom P87 Anaphylaxis against mivacurium in a 12-months old boy at first-time exposure Wolfgang Pfützner P88 Antihistamine-exacerbated chronic spontaneous urticaria: a paradox? Nadine Marrouche, Clive Grattan P89 Anti-osteoporotic agents-induced cutaneous adverse drug reactions in Asians Yu-En Chen, Chun-Bing Chen, Wen-Hung Chung, Yu-Ping Hsiao, Chia-Yu Chu P90 Diagnosis of allergic reactions to eye drops Maria Vazquez De La Torre, Natalia Blanca-Lopez, Diana Perez-Alzate, Maria Isabel Garcimartin, Francisco Javier Ruano, Maria Luisa Somoza, Elisa Haroun, Gabriela Canto P91 Diagnostic approach in suspected hypersensitivity reactions to corticosteroids Fabrícia Carolino, Eunice Dias De Castro, Josefina R. Cernadas
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Krupkova O, Sekiguchi M, Klasen J, Hausmann O, Konno S, Ferguson SJ, Wuertz-Kozak K. Epigallocatechin 3-gallate suppresses interleukin-1β-induced inflammatory responses in intervertebral disc cells in vitro and reduces radiculopathic pain in rats. Eur Cell Mater 2014; 28:372-86. [PMID: 25422948 DOI: 10.22203/ecm.v028a26] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Intervertebral disc (IVD) disease, which is characterised by age-related changes in the adult disc, is the most common cause of disc failure and low back pain. The purpose of this study was to analyse the potential of the biologically active polyphenol epigallocatechin 3-gallate (EGCG) for the treatment of painful IVD disease by identifying and explaining its anti-inflammatory and anti-catabolic activity. Human IVD cells were isolated from patients undergoing surgery due to degenerative disc disease (n = 34) and cultured in 2D or 3D. An inflammatory response was activated by IL-1β, EGCG was added, and the expression/activity of inflammatory mediators and pathways was measured by qRT-PCR, western blotting, ELISA, immunofluorescence and transcription factor assay. The small molecule inhibitor SB203580 was used to investigate the involvement of the p38 pathway in the observed effects. The analgesic properties of EGCG were analysed by the von Frey filament test in Sprague-Dawley rats (n = 60). EGCG significantly inhibited the expression of pro-inflammatory mediators and matrix metalloproteinases in vitro, as well as radiculopathic pain in vivo, most probably by modulation of the activity of IRAK-1 and its downstream effectors p38, JNK and NF-κB.
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Affiliation(s)
- O Krupkova
- Institute for Biomechanics (D-HEST), ETH Zurich, Hönggerbergring 64, HPP O13, 8093 Zurich,
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Abstract
Knowing the clinical warning signs of immunodeficiency (ID) in adulthood is crucial for early detection of the over 200 forms of primary ID known to date. Many of these congenital diseases with a genetic background already manifest in childhood. Antibody deficiency diseases represent an important exception, with common variable immunodeficiency (CVID) being the most common form of ID. The median age of onset of CVID is 24 years. Unfortunately, the delay in diagnosis is still in excess of 4 years. General practitioners as well as allergists play a particularly important role in early detection. ID patients who present primarily with signs of immune dysregulation pose an even greater diagnostic challenge. Thus, autoimmune cytopenia, inflammatory bowel diseases, or sarcoid-like granulomatous inflammation can be the first manifestation in up to 20 % of ID patients. Secondary forms of ID [e. g., due to long-term corticosteroid treatment, HIV-infection, leukemia, lymphoma, nephrotic syndrome, malabsorption syndrome] need to be differentiated from primary antibody deficiency. Considering the overlap with allergic symptoms [ID accompanied by a susceptibility to eczema, elevated total IgE, blood eosinophilia], the present article discusses, the clinical warning signs of ID, the first diagnostic steps required and the option of further diagnostic work up at specialist centers for complex cases, as well as the treatment options for such cases.
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Affiliation(s)
- Oliver Hausmann
- Allergological-Immunological Polyclinic, University Clinic for Rheumatology, Clinical Immunology and Allergology, Bern University Hospital, 3010 Bern, Switzerland ; Lucerne, Switzerland
| | - Klaus Warnatz
- Center for Chronic Immunodeficiency (CCI), Freiburg University Clinic, Freiburg, Germany
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Hausmann O, Warnatz K. Immundefizienz im Erwachsenenalter — ein Leitfaden für die allergologische Praxis. Allergo J 2014. [DOI: 10.1007/s15007-014-0669-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Affiliation(s)
| | - Werner J Pichler
- Department of RheumatologyAllergology and ImmunologyInselspitalUniversity Hospital of BernBerneSwitzerland
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Klawitter M, Hakozaki M, Kobayashi H, Krupkova O, Quero L, Ospelt C, Gay S, Hausmann O, Liebscher T, Meier U, Sekiguchi M, Konno SI, Boos N, Ferguson SJ, Wuertz K. Expression and regulation of toll-like receptors (TLRs) in human intervertebral disc cells. Eur Spine J 2014; 23:1878-91. [PMID: 24997157 DOI: 10.1007/s00586-014-3442-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 06/10/2014] [Accepted: 06/25/2014] [Indexed: 12/15/2022]
Abstract
PURPOSE Although inflammatory processes play an essential role in painful intervertebral disc (IVD) degeneration, the underlying regulatory mechanisms are not well understood. This study was designed to investigate the expression, regulation and importance of specific toll-like receptors (TLRs)--which have been shown to play an essential role e.g. in osteoarthritis--during degenerative disc disease. METHODS The expression of TLRs in human IVDs was measured in isolated cells as well as in normal or degenerated IVD tissue. The role of IL-1β or TNF-α in regulating TLRs (expression/activation) as well as in regulating activity of down-stream pathways (NF-κB) and expression of inflammation-related genes (IL-6, IL-8, HSP60, HSP70, HMGB1) was analyzed. RESULTS Expression of TLR1/2/3/4/5/6/9/10 was detected in isolated human IVD cells, with TLR1/2/4/6 being dependent on the degree of IVD degeneration. Stimulation with IL-1β or TNF-α moderately increased TLR1/TLR4 mRNA expression (TNF-α only), and strongly increased TLR2 mRNA expression (IL-1β/TNF-α), with the latter being confirmed on the protein level. Stimulation with IL-1β, TNF-α or Pam3CSK4 (a TLR2-ligand) stimulated IL-6 and IL-8, which was inhibited by a TLR2 neutralizing antibody for Pam3CSK4; IL-1β and TNF-α caused NF-κB activation. HSP60, HSP70 and HMGB1 did not increase IL-6 or IL-8 and were not regulated by IL-1β/TNF-α. CONCLUSION We provide evidence that several TLRs are expressed in human IVD cells, with TLR2 possibly playing the most crucial role. As TLRs mediate catabolic and inflammatory processes, increased levels of TLRs may lead to aggravated disc degeneration, chronic inflammation and pain development. Especially with the identification of more endogenous TLR ligands, targeting these receptors may hold therapeutic promise.
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Affiliation(s)
- Marina Klawitter
- Competence Center for Applied Biotechnology and Molecular Medicine, University of Zurich, Zurich, Switzerland,
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Aghayev E, Etter C, Bärlocher C, Sgier F, Otten P, Heini P, Hausmann O, Maestretti G, Baur M, Porchet F, Markwalder TM, Schären S, Neukamp M, Röder C. Five-year results of lumbar disc prostheses in the SWISSspine registry. Eur Spine J 2014; 23:2114-26. [PMID: 24947182 DOI: 10.1007/s00586-014-3418-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 06/11/2014] [Accepted: 06/11/2014] [Indexed: 12/22/2022]
Abstract
PURPOSE The Swiss Federal Office of Public Health demanded a nationwide HTA registry for lumbar total disc arthroplasty (TDA), to decide about its reimbursement. The goal of the SWISS spine registry is to generate evidence about the safety and efficiency of lumbar TDA. METHODS Two hundred forty-eight cases treated between 3-2005 and 6-2006, who were eligible for the 5-year follow-up were included in the study. Follow-up rates for 3-6 months, 1, 2 and 5 years were 85.9, 77.0, 44.0 and 51.2 %, respectively. Outcome measures were back and leg pain, medication consumption, quality of life, intraoperative and postoperative complication and revision rates. Additionally, segmental mobility, ossification, adjacent and distant segment degeneration were analysed at the 5-year follow-up. RESULTS There was a significant, clinically relevant and lasting reduction of back (preop/postop 73/29 VAS points) and leg pain (preop/postop VAS 55/22) and a consequently decreased analgesics consumption and quality of life improvement (preop/postop 0.30/0.76 EQ-5D score points) until 5 years after surgery. The rates for intraoperative and early postoperative complications were 4.4 and 3.2 %, respectively. The overall complication rate during five postoperative years was 23.4 %, and the adjacent segment degeneration rate was 10.7 %. In 4.4 % of patients, a revision surgery was performed. Cumulative survivorship probability for a revision/re-intervention-free 5-year postoperative course was 90.4 %. At the 5-year follow-up, the average range of motion of the mobile segments (86.8 %) was 9.7°. In 43.9 % of patients, osteophytes at least potentially affecting the range of motion were seen. CONCLUSIONS Lumbar TDA appeared as efficient in long-term pain alleviation, consequent reduction of pain medication consumption and improvement of quality of life. The procedure also appeared sufficiently safe, but surgeons have to be aware of a list of potential adverse events. The outcome is stable over the 5-year postoperative period. The vast majority of treated segments remained mobile after 5 years, although almost half of patients showed osteophytes.
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Affiliation(s)
- Emin Aghayev
- Institute for Evaluative Research in Medicine, Stauffacherstrasse 78, 3014, Bern, Switzerland,
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Aghayev E, Bärlocher C, Sgier F, Hasdemir M, Steinsiepe KF, Wernli F, Porchet F, Hausmann O, Ramadan A, Maestretti G, Ebeling U, Neukamp M, Röder C. Five-year results of cervical disc prostheses in the SWISSspine registry. Eur Spine J 2013; 22:1723-30. [PMID: 23584163 DOI: 10.1007/s00586-013-2770-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 03/18/2013] [Accepted: 04/01/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND The Swiss Federal Office of Public Health demanded a nationwide HTA-registry for cervical total disc arthroplasty (TDA), to decide about its reimbursement. The goal of the SWISSspine registry is to generate evidence about the safety and efficiency of cervical TDA. MATERIALS AND METHODS Three hundred thirty-two cases treated between 3.2005 and 6.2006 who were eligible for 5 years follow-ups were included in the study. Follow-up rates for 3-6 months, 1, 2 and 5 years were 84.6, 74.4, 50.6 and 64.8 %, respectively. Outcome measures were neck and arm pain, medication, quality of life, intraoperative and postoperative complication and revision rates. In addition, segmental mobility, ossification, adjacent and distant segment degeneration were analyzed at the 5-year follow-up. RESULTS There was significant, clinically relevant and lasting reduction of neck (preop/postop 60/21 VAS points) and arm pain (preop/postop VAS 67/17) and a consequently decreased analgesics consumption and quality of life improvement (preop/postop 0.39/0.82 EQ-5D points) until the 5-year follow-up. The rates for intraoperative and early postoperative complications were 0.6 and 7.2 %, respectively. In 0.6 % an early and in 3.9 % a late revision surgery was performed. At the 5-year follow-up, the average range of motion of the mobile segments (88.2 %) was 10.2°. In 40.7 % of the patients osteophytes at least potentially affecting range of motion were seen. CONCLUSIONS Cervical TDA appeared as safe and efficient in long-term pain alleviation, consequent reduction of pain killer consumption and in improvement of quality of life. The improvement is stable over the 5 years postoperative period. The vast majority of treated segments remained mobile after 5 years, although 40.7 % of patients showed osteophytes.
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Affiliation(s)
- Emin Aghayev
- Institute for Evaluative Research in Orthopedic Surgery, University of Bern, Stauffacherstrasse 78, 3014 Bern, Switzerland.
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Tomasi SO, Ghani I, Waldvogel D, Hausmann O. Radicular pain from lumbar canal stenosis in addition to pre-existing phantom limb pain. J Neurol Surg A Cent Eur Neurosurg 2013; 74 Suppl 1:e92-5. [PMID: 23427034 DOI: 10.1055/s-0032-1328952] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Phantom limb (PL) is a term used to designate the sensation of the presence of an extremity following amputation, and it may be seen immediately after injury or years later in the part of the body that is deafferented or amputated. Phantom limb pain (PLP) is the term used to describe painful sensations referred to the absent limb. We present a case of a 71-year-old male with spinal claudication from discoligamentous lumbar canal stenosis L3-L4 and L4-L5 with L5 radicular pain in the left PL 13 years after the amputation. The patient had a disappearance of his radicular pain in the left PL following microsurgical lumbar decompression of L3-L4 and L4-L5. This is one of the rare cases reported in the literature in which a radicular pain in the PL disappeared following surgical decompression of the spinal canal.
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Affiliation(s)
- S O Tomasi
- Department of Neurosurgery, Hirslanden Klinik St. Anna, Luzern, Switzerland
| | - I Ghani
- Department of Neurosurgery, Hirslanden Klinik St. Anna, Luzern, Switzerland
| | - D Waldvogel
- Department of Neurology, Hirslanden Klinik St. Anna, Luzern, Switzerland
| | - O Hausmann
- Department of Neurosurgery, Hirslanden Klinik St. Anna, Luzern, Switzerland
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Jandus P, Hausmann O, Pichler WJ, Helbling A. Intravenous immunoglobulin in urticaria. J Investig Allergol Clin Immunol 2013; 23:71-73. [PMID: 23653985] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Affiliation(s)
- P Jandus
- Division of Allergology, Department of Rheumatology, Clinical Immunology and Allergology, University Hospital, Bern, Switzerland.
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Klawitter M, Quero L, Klasen J, Gloess AN, Klopprogge B, Hausmann O, Boos N, Wuertz K. Curcuma DMSO extracts and curcumin exhibit an anti-inflammatory and anti-catabolic effect on human intervertebral disc cells, possibly by influencing TLR2 expression and JNK activity. J Inflamm (Lond) 2012; 9:29. [PMID: 22909087 PMCID: PMC3506446 DOI: 10.1186/1476-9255-9-29] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Accepted: 07/15/2012] [Indexed: 01/21/2023]
Abstract
Background As proinflammatory cytokines seem to play a role in discogenic back pain, substances exhibiting anti-inflammatory effects on intervertebral disc cells may be used as minimal-invasive therapeutics for intradiscal/epidural injection. The purpose of this study was to investigate the anti-inflammatory and anti-catabolic potential of curcuma, which has been used in the Indian Ayurvedic medicine to treat multiple ailments for a long time. Methods Human disc cells were treated with IL-1β to induce an inflammatory/catabolic cascade. Different extracts of curcuma as well as curcumin (= a component selected based on results with curcuma extracts and HPLC/MS analysis) were tested for their ability to reduce mRNA expression of proinflammatory cytokines and matrix degrading enzymes after 6 hours (real-time RT-PCR), followed by analysis of typical inflammatory signaling mechanisms such as NF-κB (Western Blot, Transcription Factor Assay), MAP kinases (Western Blot) and Toll-like receptors (real-time RT-PCR). Quantitative data was statistically analyzed using a Mann Whitney U test with a significance level of p < 0.05 (two-tailed). Results Results indicate that the curcuma DMSO extract significantly reduced levels of IL-6, MMP1, MMP3 and MMP13. The DMSO-soluble component curcumin, whose occurrence within the DMSO extract was verified by HPLC/MS, reduced levels of IL-1β, IL-6, IL-8, MMP1, MMP3 and MMP13 and both caused an up-regulation of TNF-α. Pathway analysis indicated that curcumin did not show involvement of NF-κB, but down-regulated TLR2 expression and inhibited the MAP kinase JNK while activating p38 and ERK. Conclusions Based on its anti-inflammatory and anti-catabolic effects, intradiscal injection of curcumin may be an attractive treatment alternative. However, whether the anti-inflammatory properties in vitro lead to analgesia in vivo will need to be confirmed in an appropriate animal model.
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Affiliation(s)
- Marina Klawitter
- Spine Research Group, Competence Center for Applied Biotechnology and Molecular Medicine, University of Zurich, Zurich, Switzerland.
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Müller U, Schmid-Grendelmeier P, Hausmann O, Helbling A. IgE to recombinant allergens Api m 1, Ves v 1, and Ves v 5 distinguish double sensitization from crossreaction in venom allergy. Allergy 2012; 67:1069-73. [PMID: 22676144 DOI: 10.1111/j.1398-9995.2012.02847.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Diagnostic tests in patients with Hymenoptera venom allergy are frequently positive to venoms of both honey bee and wasp (Vespula). Component-resolved analysis with recombinant species-specific major allergens (rSSMA) may help to distinguish true double sensitization from crossreactivity. METHODS Included were 121 patients with systemic allergic reactions to Hymenoptera stings, 76 with double positivity of serum-specific IgE (sIgE) to both venoms, 45 with single positivity to bee or wasp venom, and 32 controls without history of systemic reactions to Hymenoptera stings and no sIgE to whole venoms. In venom-allergic patients and controls, sIgE to rSSMA Api m 1 of bee venom and to Ves v 1 and Ves v 5 of wasp venom were tested by ImmunoCAP. RESULTS Only 47% of 76 patients with double positivity to whole venoms reacted also to rSSMA of both species. Specificity of sIgE to the 3 rSSMA was very high, with no sIgE to rSSMA of the other species in single-positive venom-allergic patients and only one control with low sIgE to Ves v 1. All wasp-allergic single-positive patients had sIgE to Ves v 5 and/or Ves v 1, and 78.3% of single-positive bee venom-allergic patients had sIgE to Api m 1. CONCLUSION Specificity of sIgE to rSSMA of both species is excellent. Sensitivity of sIgE to rSSMA was optimal for wasp venom. Sensitivity of bee venom Api m 1 could be increased by adding rSSMA of other important bee venom allergens.
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Affiliation(s)
- U. Müller
- Division of Allergy, Department of Medicine; Spital Ziegler; Bern; Switzerland
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Singeisen H, Hodel D, Hausmann O. A Comparison of Spinal and General Anaesthesia for Lumbar Spine Surgery: Patients' Characteristics and Economic Aspects. J Neurol Surg A Cent Eur Neurosurg 2012. [DOI: 10.1055/s-0032-1316185] [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: 10/28/2022]
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Kopac P, Rudin M, Gentinetta T, Gerber R, Pichler C, Hausmann O, Schnyder B, Pichler WJ. Continuous apple consumption induces oral tolerance in birch-pollen-associated apple allergy. Allergy 2012; 67:280-5. [PMID: 22070352 DOI: 10.1111/j.1398-9995.2011.02744.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [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: 12/16/2022]
Abstract
BACKGROUND Patients with birch pollen allergy (major allergen: Bet v 1) have often an associated oral allergy syndrome (OAS) to apple, which contains the cross-reactive allergen Mal d 1. As successful birch pollen immunotherapy does not consistently improve apple related OAS symptoms, we evaluated whether regular apple consumption has an effect on OAS and immune parameters of Mal d 1 or Bet v 1 allergy. METHODS A total of 40 patients with a clear history of birch pollen rhinoconjunctivitis and associated OAS to apple were included in an open, randomized, controlled clinical trial: 27 patients consumed daily defined amount of apple (1-128 g), doubling the amount every two to three weeks, while 13 patients remained untreated. Primary endpoint was the proportion of patients that achieved tolerance to at least 128 g of apple at the end of the study after 8 months. Exploratory endpoints were questionnaire about cross-reactive food and pollen allergy symptoms, conjunctival provocation test with birch pollen and Bet v 1, and in vitro tests (tIgE, sIgE, and IgG4 to Mal d 1 and Bet v 1; basophil activation test with both allergens). RESULTS Seventeen of 27 patients in active group and none of 13 patients in control group (P = 0.0001) could tolerate a whole apple after the intervention. However, differences in endpoints reflecting systemic immune reactivity did not reach statistical significance. CONCLUSION In patients with OAS to apple, tolerance can be safely induced with slowly, gradually increasing consumption of apple. However, the observation of a relapse after discounting of apple consumption and absence of immunologic changes suggest that induced tolerance is only transient.
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Affiliation(s)
- P Kopac
- Division of Allergology, Department of Rheumatology, Clinical Immunology and Allergology, Inselspital, University of Bern, Switzerland
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Hausmann O, Schnyder B, Pichler W. Etiology and Pathogenesis of Adverse Drug Reactions. Chemical Immunology and Allergy 2012; 97:32-46. [DOI: 10.1159/000335614] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Pichler WJ, Wendland T, Hausmann O, Schnyder B, Fricker M, Pichler C, Helbling A. Syndrome DRESS (Drug Rash with Eosinophilia and Systemic Symptoms). ACTA ACUST UNITED AC 2011. [DOI: 10.4414/fms.2011.07693] [Citation(s) in RCA: 5] [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: 11/19/2022]
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Graumann U, Ritz MF, Hausmann O. Necessity for Re-Vascularization after Spinal Cord Injury and the Search for Potential Therapeutic Options. Curr Neurovasc Res 2011; 8:334-41. [DOI: 10.2174/156720211798121007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 09/26/2011] [Accepted: 09/27/2011] [Indexed: 11/22/2022]
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Borer-Reinhold M, Haeberli G, Bitzenhofer M, Jandus P, Hausmann O, Fricker M, Helbling A, Müller U. An increase in serum tryptase even below 11.4 ng/mL may indicate a mast cell-mediated hypersensitivity reaction: a prospective study in Hymenoptera venom allergic patients. Clin Exp Allergy 2011; 41:1777-83. [PMID: 22092437 DOI: 10.1111/j.1365-2222.2011.03848.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 07/11/2011] [Accepted: 07/15/2011] [Indexed: 12/28/2022]
Abstract
BACKGROUND During a systemic hypersensitivity reaction (SR), an increase in serum tryptase compared to the baseline value is an indicator of mast cell activation, most often due to an IgE-mediated mechanism. OBJECTIVE To study the relevance of an increase in serum tryptase below the upper normal value of 11.4 ng/mL. METHODS Serum tryptase levels were measured in 35 patients with Hymenoptera venom hypersensitivity before and during venom exposure. Of these, 20 developed SR to stings or following venom injections during immunotherapy (reactors), while 15 tolerated reexposure to stings or venom injections during immunotherapy without SR (non-reactors). Serum tryptase was estimated at 2, 5 and 24 h after exposure and was compared to a baseline value obtained before or at least 72 h after exposure. RESULTS Considering circadian variation of serum tryptase, a relative increase to ≥135% of the baseline value (relative delta bound) was defined to indicate mast cell activation. Such an increase was observed in 17 of 20 reactors (85%), but none of 15 non-reactors. A serum tryptase of ≥11.4 ng/mL following venom exposure was observed in eight of the 20 reactors (40%) and 2 (13.3%) of the 15 non-reactors. Both these non-reactors also had an elevated baseline serum tryptase. CONCLUSIONS AND CLINICAL RELEVANCE Serum tryptase values obtained during a suspected hypersensitivity reaction must always be compared to a baseline value. A relative tryptase increase to ≥135% of the baseline value during a suspected hypersensitivity reaction indicates mast cell activation even below 11.4 ng/mL.
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Affiliation(s)
- M Borer-Reinhold
- Allergiestation, Medizinische Klinik, Spital Netz Bern Ziegler, Bern, Switzerland
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Hemmer W, Jarisch R, Wieczorek D, Kapp A, Wedi B, Müller U, Schmid-Grendelmeier P, Hausmann O, Helbling A, Varga R, Stretz E, Rolle M, Przybilla B, Ruëff F, Krischan L, Schneider M, Sonnenschein U, Darsow U, Ring J, Eberlein B, Friedl TK, Garaganova J, Arnold A. Klinische In-vitro-Diagnostik. Allergo J 2011. [DOI: 10.1007/bf03362489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Gentinetta T, Hausmann O, Kopac P, Colagiovanni A, Pichler WJ. Developing a passive sensitization procedure for basophils to diagnose IgE-mediated drug hypersensitivity (151.19). The Journal of Immunology 2011. [DOI: 10.4049/jimmunol.186.supp.151.19] [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: 01/02/2023]
Abstract
Abstract
Introduction: The basophil activation test is quite well established for protein allergens. It is normally done with the patients’ basophils and requires fresh cells and rapid processing. It would be a particularly interesting test for drug allergy, as only very few drug specific in vitro IgE assays exist and it seems to be a highly relevant read out system. Objective: To set up a passive sensitization protocol to test IgE-mediated drug hypersensitivity. Methods: PMBCs of basophil donors are incubated with lactic acid (pH=3.9) to remove surface bound IgE. Afterwards, re-sensitization with patient serum and subsequent stimulation with serial dilutions of drugs. Degranulation can be measured by flow cytometry (anti-CCR3-APC/anti-CD63-PE). Results: We were able to establish a well functional procedure for protein allergens and for some drug allergens (cephalosporines, NMBAs). Passive sensitization assays using serum of patients with well-documented IgE-mediated amoxicillin allergy were reproducibly false negative. Conclusion: Using defined donor basophils for passive sensitizations with serum would have several advantages over direct assays, as it would facilitate diagnosis, as patient’s sera is easy to store and as it would provide a direct proof of an IgE-mediated hypersensitivity reaction. However, a better understanding of how small drugs are actually able to cross-link cell surface bound IgE seems to be a prerequisite to improve this assay and to widen its application.
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Affiliation(s)
- Thomas Gentinetta
- 1Division of Allergology, Clinic for Rheumatology and Clinical Immunology/Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- 2Adverse Drug Reactions - Analysis and Consulting (ADR-AC) GmbH, Bern, Switzerland
| | - Oliver Hausmann
- 2Adverse Drug Reactions - Analysis and Consulting (ADR-AC) GmbH, Bern, Switzerland
| | - Peter Kopac
- 3University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
| | | | - Werner J. Pichler
- 1Division of Allergology, Clinic for Rheumatology and Clinical Immunology/Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- 2Adverse Drug Reactions - Analysis and Consulting (ADR-AC) GmbH, Bern, Switzerland
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Ritz MF, Graumann U, Gutierrez B, Hausmann O. Traumatic spinal cord injury alters angiogenic factors and TGF-beta1 that may affect vascular recovery. Curr Neurovasc Res 2011; 7:301-10. [PMID: 20860549 DOI: 10.2174/156720210793180756] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 09/01/2010] [Indexed: 12/22/2022]
Abstract
Traumatic spinal cord injury (SCI) disrupts the blood-spinal cord barrier and reduces the blood supply caused by microvascular changes. Vessel regression and neovascularization have been observed in the course of secondary injury contributing to microvascular remodeling after trauma. Spatio-temporal distribution of blood vessels and modulation of gene expression of several angiogenic factors have been investigated in rats after spinal cord compression injury. Rarefaction of vessels was detectable at the injury site 2 days after SCI before they disappeared in the developing cavity after 2 and 4 weeks, whereas no changes were observed in the penumbra. Investigation of the temporal expression of angiogenic genes using quantitative RT-PCR disclosed a constant down-regulation of the vascular endothelial growth factor (VEGF), and transient decreases of angiopoietin-1 (Ang-1), platelet-derived growth factor-BB (PDGF-BB), as well as placental growth factor (PlGF), with the lowest values obtained 3 days after injury, when compared to the expression levels obtained in sham-operated rats. Hepatocyte growth factor (HGF) was the only angiogenic factor with a constant increased gene expression when compared with controls, starting at day 3 post-SCI. mRNA levels of transforming growth factor-beta 1 (TGF-β1) were elevated at every time point following SCI, whereas those encoding for the cysteine-rich protein CCN1/CYR61 were upregulated after 2 h, 6 h, and 1 week only. Our data provide an overview of the temporal modulated expression of the major angiogenic factors, hampering revascularization in the lesion during the phase of secondary injury. These findings should be considered in order to improve therapeutic interventions.
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Affiliation(s)
- Marie-Françoise Ritz
- Department of Biomedicine, Brain Tumor Biology, Pharmacenter, Klingelbergstrasse 50, 4056 Basel, Switzerland.
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Jandus P, Hausmann O, Haeberli G, Gentinetta T, Mueller U, Helbling A. Unpredicted adverse reaction to omalizumab. J Investig Allergol Clin Immunol 2011; 21:563-566. [PMID: 22312942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Despite promising reports of the use of omalizumab as add-on therapy in patients with systemic mastocytosis and recurrent anaphylaxis during specific venom immunotherapy (VIT), unpredicted adverse effects may lead to therapy failure. We present the case of a patient with systemic mastocytosis and Hymenoptera venom allergy who was administered omalizumab as add-on therapy to improve VIT tolerability after repeated severe adverse reactions despite H1/H2-antihistamine prophylaxis. We describe an unexpected discontinuation of omalizumab following successful initiation of VIT in a patient with systemic mastocytosis, with subsequent lack of tolerability of VIT. An interesting aspect of this case is the correlation of basophil activation test results with both clinical tolerability and VIT intolerance.
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Affiliation(s)
- P Jandus
- Allergy Unit, Department of Internal Medicine, Spital Netz Bern Zieglerspital, Switzerland
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Helbling A, Müller UR, Hausmann O. Uterine contractions are known side effects of venom immunotherapy. J Investig Allergol Clin Immunol 2011; 21:330. [PMID: 21721389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
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Graumann U, Ritz MF, Rivero BG, Hausmann O. CD133 expressing pericytes and relationship to SDF-1 and CXCR4 in spinal cord injury. Curr Neurovasc Res 2010; 7:144-54. [PMID: 20374199 DOI: 10.2174/156720210791184907] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 03/30/2010] [Indexed: 11/22/2022]
Abstract
Compression injury to the spinal cord (SC) results in vascular changes affecting the severity of the primary damage of the spinal cord. The recruitment of bone marrow (BM)-derived cells contribute to revascularization and tissue regeneration in a wide range of ischemic pathologies. Involvement of these cells in the vascular repair process has been investigated in an animal model of spinal cord injury (SCI). Temporal gene and protein expression of the BM-derived stem cell markers CD133 and CD34, of the mobilization factor SDF-1 and its receptor CXCR4 were determined following SC compression injury in rats. CD133 was expressed in uninjured tissue by cells surrounding arterioles identified as pericytes by co-expression of alpha-SMA. These cells mostly disappeared 2 days after injury but repopulated the tissue after 2 weeks. CD34 was expressed by endothelial cells and CD11b+ macrophages/microglia invading the injured tissue as observed 2 weeks following injury. SDF-1 was induced in reactive astrocytes and endothelial cells not until 2 weeks post-SCI. Comparison of the variation between CD34, CD133, CXCR4, and SDF-1 revealed a corresponding trend of CD133 with the SDF-1 expression. This study showed that resident microvascular CD133+ pericytes with presumptive stem cell potential are sensitive to SCI. Their decline following SCI and the delayed induction of SDF-1 may contribute to vessel destabilisation and inefficient revascularization. In addition, none of the analyzed markers could be assigned clearly to BM-derived cells. Together, our findings suggest that effective recruitment of pericytes may serve as a therapeutic option to improve microcirculation after SCI.
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Affiliation(s)
- Ursula Graumann
- Spinal Injury Research, Swiss Paraplegic Research, Guido A. Zäch Strasse 4, 6207 Nottwil, Switzerland.
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Abstract
Immune reactions to drugs can cause a variety of diseases involving the skin, liver, kidney, lungs, and other organs. Beside immediate, IgE-mediated reactions of varying degrees (urticaria to anaphylactic shock), many drug hypersensitivity reactions appear delayed, namely hours to days after starting drug treatment, showing a variety of clinical manifestations from solely skin involvement to fulminant systemic diseases which may be fatal. Immunohistochemical and functional studies of drug-specific T cells in patients with delayed reactions confirmed a predominant role for T cells in the onset and maintenance of immune-mediated delayed drug hypersensitivity reactions (type IV reactions). In these reactions, drug-specific CD4+ and CD8+ T cells are stimulated by drugs through their T cell receptors (TCR). Drugs can stimulate T cells in two ways: they can act as haptens and bind covalently to larger protein structures (hapten-carrier model), inducing a specific immune response. In addition, they may accidentally bind in a labile, noncovalent way to a particular TCR of the whole TCR repertoire and possibly also major histocompatibility complex (MHC)-molecules - similar to their pharmacologic action. This seems to be sufficient to reactivate certain, probably in vivo preactivated T cells, if an additional interaction of the drug-stimulated TCR with MHC molecules occurs. The mechanism was named pharmacological interaction of a drug with (immune) receptor and thus termed the p-i concept. This new concept may explain the frequent skin symptoms in drug hypersensitivity to oral or parenteral drugs. Furthermore, the various clinical manifestations of T cell-mediated drug hypersensitivity may be explained by distinct T cell functions leading to different clinical phenotypes. These data allowed a subclassification of the delayed hypersensitivity reactions (type IV) into T cell reactions which, by releasing certain cytokines and chemokines, preferentially activate and recruit monocytes (type IVa), eosinophils (type IVb), or neutrophils (type IVd).
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Affiliation(s)
- Oliver Hausmann
- Division of Allergology, Department of Rheumatology, Clinical Immunology and Allergology, Inselspital, CH-3010 Bern, Switzerland
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Egli D, Hausmann O, Schmid M, Boos N, Dietz V, Curt A. Lumbar spinal stenosis: Assessment of cauda equina involvement by electrophysiological recordings. J Neurol 2007; 254:741-50. [PMID: 17426910 DOI: 10.1007/s00415-006-0427-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2006] [Revised: 09/20/2006] [Accepted: 09/28/2006] [Indexed: 11/29/2022]
Abstract
UNLABELLED The objective of this study was to investigate the relationship between electrophysiological recordings and clinical as well as radiological findings in patients suggestive to suffer from a lumbar spinal stenosis (LSS). We hypothesise that the electrophysiological recordings, especially SSEP, indicate a lumbar nerve involvement that is complementary to the neurological examination and can provide confirmatory information in less obvious clinical cases. In a prospective cohort study, 54 patients scheduled for surgery due to LSS were enrolled in an unmasked, uncontrolled trial. All patients were assessed by neurological examination, electrophysiological recordings, and magnetic resonance imaging (MRI) of the lumbar spine. The electrophysiological recordings focused on spinal lumbar nerve involvement. RESULTS About 88% suffered from a multisegmental LSS and 91% of patients respectively complained of chronic lower back pain and/or leg pain for more than 3 months, combined with a restriction in walking distance. The neurological examination revealed only a few patients with sensory and/or motor deficits while 87% of patients showed pathological electrophysiological recordings (abnormal tibial SSEP in 78% of patients, abnormal H-reflex in 52% of patients). CONCLUSIONS Whereas the clinical examination, even in severe LSS, showed no specific sensory-motor deficit, the electrophysiological recordings indicated that the majority of patients had a neurogenic disorder within the lumbar spine. By the pattern of bilateral pathological tibial SSEP and pathological reflexes associated with normal peripheral nerve conduction, LSS can be separated from a demyelinating polyneuropathy and mono-radiculopathy. The applied electrophysiological recordings, especially SSEP, can confirm a neurogenic claudication due to cauda equina involvement and help to differentiate neurogenic from vascular claudication or musculo-skeletal disorders of the lower limbs. Therefore, electro-physiological recordings provide additional information to the neurological examination when the clinical relevance of a radiologically-suspected LSS needs to be confirmed.
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Affiliation(s)
- D Egli
- Spinal Cord Injury Center, University Hospital Balgrist, Forchstrasse 340, 8008 Zürich, Switzerland.
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Hausmann O, Gerber A, Groneberg D, Lode H, Menz G. Verlaufsmessungen von exhaliertem Stickstoff-Monoxid (NO) bei allergischem und nichtallergischem (intrinsic) Asthma bronchiale unter Hochgebirgsbedingungen (Davos). Pneumologie 2005. [DOI: 10.1055/s-2005-864533] [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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Hausmann O. [Informed consent and quality management in neurosurgery]. Praxis (Bern 1994) 2004; 93:1918-1920. [PMID: 15580884 DOI: 10.1024/0369-8394.93.46.1918] [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: 05/24/2023]
Abstract
Die Mehrzahl der zunehmenden ärztlichen Haftpflichtfälle ist auf unterlassene oder unzureichende Aufklärung zurückzuführen. Von Seiten der FMH bestehen klare Richtlinien hinsichtlich der Aufklärungsmodalität. Das Bundesgericht verlangt eine optimale aber keine maximale Aufklärung. Die Aufklärung beinhaltet nebst der Einholung der Operationseinwilligung des Patienten auch die Möglichkeit eines Vertrauensaufbaus vom Patienten zum behandelnden Arzt.
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Affiliation(s)
- O Hausmann
- Neurochirurgische Universitätsklinik Basel, Klinik St. Anna Luzern.
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Hausmann O, Min K, Böni T, Erni T, Dietz V, Curt A. SSEP analysis in surgery of idiopathic scoliosis: the influence of spine deformity and surgical approach. Eur Spine J 2003; 12:117-23. [PMID: 12709848 PMCID: PMC3784845 DOI: 10.1007/s00586-002-0398-6] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2001] [Revised: 01/22/2002] [Accepted: 02/01/2002] [Indexed: 10/25/2022]
Abstract
The study was conducted to assess the possible impact of spine deformity in patients with idiopathic scoliosis (IS) on tibial nerve somatosensory evoked potentials (t-SSEPs) and the influence of spine correction upon postoperative SSEP recordings. In 61 consecutive patients undergoing 64 spinal instrumentations, 129 pre- and postoperative SSEPs were analyzed. The degree of spine deformity was assessed by the pre-operative Cobb angle of the major scoliotic curve. In a control group, reference values of t-SSEP latencies were established with respect to body height. In a cohort study, IS patients were compared with healthy controls with respect to t-SSEP latency, amplitude, configuration and interside difference. The results of the analysis showed that preoperative-body-height-corrected t-SSEP latencies were prolonged in 61% of patients, with a pathological interside difference in 23.4% of them. The impairment of t-SSEPs was not related to the extent of spine deformity as assessed by the Cobb angle. Even without occurrence of postoperative neurological deficits, postoperative t-SSEPs showed significantly increased latencies without changes in t-SSEP configuration. The prolongation of t-SSEP latencies was related to the surgical procedure (combined ventro-dorsal approach), but not to the extent of spine correction, level of instrumentation, or number of fused segments. The analysis of preoperative t-SSEPs was of no predictive value for intra- or postoperative neurological complications. t-SSEPs are significantly affected in IS patients, although these patients show no obvious clinical neurological deficits. The extent of t-SSEP impairment is not related to the severity of scoliosis. Even in clinically uneventful surgery, the postoperative t-SSEPs can be deteriorated depending on the surgical approach. This indicates a subclinical impact of spine surgery upon spinal cord function.
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Affiliation(s)
- Oliver Hausmann
- />ParaCare, Swiss Paraplegic Center, Institute for Rehabilitation and Research, University Hospital Balgrist, Forchstrasse 340, 8008 Zurich, Switzerland, , ,
| | - Kan Min
- />Department of Orthopedic Surgery, University Hospital Balgrist, University of Zürich, Switzerland, , ,
| | - Thomas Böni
- />Department of Orthopedic Surgery, University Hospital Balgrist, University of Zürich, Switzerland, , ,
| | - Thomas Erni
- />ParaCare, Swiss Paraplegic Center, Institute for Rehabilitation and Research, University Hospital Balgrist, Forchstrasse 340, 8008 Zurich, Switzerland, , ,
| | - Volker Dietz
- />ParaCare, Swiss Paraplegic Center, Institute for Rehabilitation and Research, University Hospital Balgrist, Forchstrasse 340, 8008 Zurich, Switzerland, , ,
| | - Armin Curt
- />ParaCare, Swiss Paraplegic Center, Institute for Rehabilitation and Research, University Hospital Balgrist, Forchstrasse 340, 8008 Zurich, Switzerland, , ,
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Roelcke U, Hausmann O, Merlo A, Missimer J, Maguire RP, Freitag P, Radü EW, Weinreich R, Gratzl O, Leenders KL. PET imaging drug distribution after intratumoral injection: the case for (124)I-iododeoxyuridine in malignant gliomas. J Nucl Med 2002; 43:1444-51. [PMID: 12411546] [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: 02/27/2023] Open
Abstract
UNLABELLED Locoregional administration may yield higher tumor drug concentrations compared with intravenous injection and may reduce the risk of systemic adverse effect. Furthermore, in the case of brain tumors, it may circumvent limited drug delivery imposed by the blood-brain barrier. We used PET to study the retention and spatial distribution of iododeoxyuridine (IUdR), which has been used as a DNA-targeting radiosensitizing drug and which can be charged with therapeutic nuclides. METHODS Locoregional (resection cavity, tumor) instillation of 5-19 MBq (124)I-IUdR was achieved in 7 postoperative patients with malignant gliomas through a reservoir implanted in the skull. Patients were scanned with PET during the first hour and at 2, 24, and 48 h after (124)I-IUdR instillation. (124)I-IUdR metabolism was measured in the reservoir fluid in the presence or absence of a degradation inhibitor (5'-butyryl-IUdR [butyryl-IUdR]). Region-of-interest analysis was applied to calculate intratumoral retention (K(local)) of (124)I-IUdR from the PET images after a 24-h washout phase using an autoradiographic method. RESULTS At 24 h, radioactivity concentration in the reservoir was approximately 1% of the concentration 5 min after tracer instillation. The major metabolite of (124)I-IUdR in the reservoir was (124)I-iodouracil. (124)I-IUdR degradation could be partially inhibited by butyryl-IUdR. In the plasma, radioactivity peaked between 2 and 6 h. The area of tissue radioactivity increased with time up to 3-fold compared with the initial distribution. Tumor (124)I-IUdR retention (K(local)) ranged from 0.006 to 0.017 micro L/g/min, which is substantially lower compared with the IUdR-DNA incorporation reported recently after intravenous injection of (124)I-IUdR (K(i), 3.9 +/- 2.3 micro L/g/min, where K(i) is the DNA incorporation rate of (124)I-IUdR after intravenous tracer injection). CONCLUSION Although a single injection of (124)I-IUdR resulted in radioactivity distribution over the tumor, retention at 24 h was substantially lower compared with intravenous injection of (124)I-IUdR. Slow diffusion after locoregional administration, in contrast to fast delivery via tumor capillaries after intravenous injection, may account for our findings, resulting in a low amount of drug incorporation into DNA before degradation and washout from tissue.
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Affiliation(s)
- Ulrich Roelcke
- PET Program, Paul Scherrer Institute, Villigen, Switzerland.
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Fulci G, Labuhn M, Maier D, Lachat Y, Hausmann O, Hegi ME, Janzer RC, Merlo A, Van Meir EG. p53 gene mutation and ink4a-arf deletion appear to be two mutually exclusive events in human glioblastoma. Oncogene 2000; 19:3816-22. [PMID: 10949938 DOI: 10.1038/sj.onc.1203700] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.4] [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: 11/08/2022]
Abstract
P16 and P14ARF are two tumor suppressors encoded by the locus ink4a-arf which is frequently deleted in human tumors. Recent experiments performed with mouse embryonic fibroblasts have shown that P14ARF is an upstream regulator of the P53 pathway. This raises the question as to whether in human tumors the loss of p14arf and mutation of p53 are mutually exclusive events which segregate with genetic alterations at other loci. To examine this question we performed a multigenic analysis on 29 gliomas. We analysed p53 and p14arf in relation with five other genetic loci encoding the most frequently mutated genes in human gliomas: cdkn2a, mdm2, egfr, pten and the chromosomal regions 10q23.3 and 10q25-26. Our study shows for the first time that p53 mutations and p14arf deletions appear mutually exclusive in human glioblastoma, suggesting that they may be functionally redundant in glioma tumorigenesis. The P53 pathway is, therefore, disrupted in 81.8% of malignant gliomas (WHO grades III and IV), either by mutation of the p53 gene (31.8%) or by p14arf deletion (54.5%). These tumors further showed MDM2 overexpression (9.1%), egfr oncogene amplification/egfr overexpression (50%), pten mutations (27.3%) and loss of heterozygosity (LOH) at the chromosomal regions 10q23.3 (86.4%) and 10q25-26 (100%). These alterations did not segregate with p53 mutations or p14arf deletions, while p14arf and cdkn2a were always deleted.
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Affiliation(s)
- G Fulci
- Department of Neurosurgery, University Hospital (CHUV), Lausanne, Switzerland
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