Volume 1 (2017)
Free open-access journal.
|
| Price of the complete print-issue: 0.00$ |
Add to Cart
|
Allergologie select
Systemic therapy of atopic dermatitis
C. Bußmann and N. Novak
Page No. 1
Abstract
Allergologie select, Volume 1, Nr. 1/2017 (1-8)
Systemic therapy of atopic dermatitis
C. Bußmann and N. Novak
Klinik und Poliklinik für Dermatologie und Allergologie, Universität Bonn
Therapy of severe atopic dermatitis, which is refractory to consistent treatment with topical steroids and topical calcineurin inhibitors is still a problem in many cases. The use of cyclosporine, which is the only approved systemic drug for the therapy of severe atopic dermatitis is often limited by contraindications or adverse reactions. In this context, results from controlled and open label studies with novel therapeutic approaches such as methotrexat, omalizumab or rituximab, which are in part very promising, are of great interest. In this work we would like to provide an overview of established and new therapeutic options for the treatment of severe atopic dermatitis.
*N. Novak is being supported by a DFG NO454/5-2 Heisenberg professorship.Correspondence to:
Prof. Dr. med. Natalija Novak, Klinik und Poliklinik für Dermatologie und Allergologie Universität Bonn, Sigmund-Freud-Straße 25, D–53105 Bonn
Email: [email protected]
Allergologie select
Ethylene oxide as an occupational contact allergen – an underestimated problem?
K. Breuer, M. Worm, C. Skudlik and S.M. John
Page No. 9
Abstract
Allergologie select, Volume 1, No. 1/2017 (9-13)
Ethylene oxide as an occupational contact allergen – an underestimated problem?
K. Breuer1, M. Worm2, C. Skudlik1#3 and S.M. John1,3,4
1Dermatologikum Hamburg, 2Klinik für Dermatologie, Venerologie und Allergologie, Allergie-Centrum-Charité, Campus Mitte, Universitätsmedizin Berlin, 3Institut für interdisziplinäre dermatologische Prävention und Rehabilitation (iDerm), Universität Osnabrück, 4Fachgebiet Dermatologie und Umweltmedizin, Universität Osnabrück
Background: Ethylene oxide (EtO) is a volatile epoxy compound which is used to sterilize medical devices. EtO may cause irritant contact dermatitis, but only few cases of allergic contact dermatitis have been reported yet. Objectives: About 20 employees of a department for surgery developed eczematous skin reactions at the contact areas to wrist bands of surgical gowns which had been sterilized with EtO. Patch tests were performed to exclude contact allergy. Methods: Due to the volatility of EtO, patch tests were done with epichlorohydrin (0.1% pet., 1% pet.) which is an epoxy compound chemically related to EtO. Results: 7/8 patients and 4 healthy control persons showed non-allergic irritant reactions to 1.0% epichlorohydrin. 1.0% epichlorohydrin may have induced an iatrogenic sensitization in one of the control persons. None of the control persons reacted to 0.1% epichlorohydrin. Allergic contact dermatitis to EtO and a cross sensitization to epichlorohydrin was diagnosed in a nurse who showed an allergic crescendo patch test reaction to 0.1% epichlorohydrin. Conclusions: EtO can act as an occupational contact allergen in health personnel, a problem that may have been underestimated in the past due to methodological difficulties in patch testing. When allergic contact dermatitis to EtO is suspected, a patch test to 0.1% epichlorohydrin should be performed.Correspondence to:
PD Dr. med. Kristine Breuer
Dermatologikum Hamburg
Drehbahn 1 – 3
D–20354 Hamburg
Email: [email protected]
Allergologie select
Elicitors of severe allergic reactions – reports from allergists and emergency doctors
M. Hohenadel, K. Beyer, S. Hompes and M. Worm
Page No. 14
Abstract
Allergologie select, Volume 1, No. 1/2017 (14-20)
Elicitors of severe allergic reactions – reports from allergists and emergency doctors
M. Hohenadel, K. Beyer, S. Hompes and M. Worm
Klinik für Dermatologie, Venerologie und Allergologie, Charité – Universitätsmedizin Berlin
Data from the anaphylaxis registry of German-speaking countries indicate that food is the most frequent elicitor of severe allergic reactions in children, venom is the most frequent elicitor in adults. The anaphylaxis registry considers data from patients of allergy centres. The aim of the present study was to collect data regarding elicitors, cofactors and the medical care of patients with severe allergic reactions seen in private practice allergists but also patients seen by emergency doctors. From June 2008 to December 2009 70 cases of severe allergic reactions from private practice allergists and 154 from the emergency doctors were registered. Our data show that the profiles of elicitors differs among the reporting groups. The reported causes from allergists were severe reactions to food, venom and subcutaneous immunotherapy, the emergency doctors gave venom as the most frequent elicitor. Our data show that a systematic evaluation of severe allergic reactions can provide important data about elicitors and circumstances of anaphylaxis. Through a comparison with data from the anaphylaxis register the analysis of the data from the emergency doctors will allow to determine how many patients with severe allergic reactions are seen by an allergist for further diagnostics and therapy later on.Correspondence to:
Prof. Dr. med. Margitta Worm
Klinik für Dermatologie, Venerologie und Allergologie
Charité – Universitätsmedizin Berlin
Charitéplatz 1
D–10117 Berlin
Email: [email protected]
Allergologie select
Food-induced anaphylaxis and cofactors – data from the anaphylaxis registry
M. Worm, K. Scherer, A. Köhli-Wiesner et al.
Page No. 21
Abstract
Allergologie select, Volume 1, No. 1/2017 (21-27)
Food-induced anaphylaxis and cofactors – data from the anaphylaxis registry
M. Worm1, K. Scherer2, A. Köhli-Wiesner3, F. Ruëff4, V. Mahler5, L. Lange6, R. Treudler7, E. Rietschel8, Z. Szepfalusi9, R. Lang10, U. Rabe11, T. Reese12, N. Schwerk13, K. Beyer14 and S. Hompes1
1Klinik für Dermatologie und Allergologie, Charité – Universitätsmedizin Berlin, 2Abteilung Allergologie, Klinik für Dermatologie, Universitätsspital Basel, Schweiz, 3Allergologie, Universitätskinderkliniken Zürich, Schweiz 4Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München, 5Hautklinik Universitätsklinikum Erlangen, 6Abteilung für Pädiatrie, St.-Marien-Hospital Bonn, 7Klinik für Dermatologie, Venerologie und Allergologie, Universität Leipzig, 8Klinik und Poliklinik für Kinderheilkunde, Uni-Klinik Köln, 9Klinik für Kinder und Jugendheilkunde, Medizinische Universität Wien, Österreich, 10Klinik für Dermatologie, Paracelsus Medizinische Privatuniversität Salzburg, Österreich, 11Fachklinik für Pneumologie, Johanniter-Krankenhaus, Treuenbrietzen, 12Klinik für Kinder- und Jugendmedizin, Mathias-Spital Rheine, 13Zentrum für Kinderheilkunde und Jugendmedizin, Medizinische Hochschule Hannover, 14Klinik für Pädiatrie mit Schwerpunkt Pneumologie und Immunologie, Charité – Universitätsmedizin Berlin
Food allergens are frequent causes of anaphylaxis. In particular in children and adults they are frequent elicitors of severe allergic reactions, whereas in adults food allergens range among venom and drugs. Since 2006 severe allergic reactions from Germany, Austria and Switzerland are collected in the anaphylaxis registry. Currently 78 hospitals and private practises are connected. From July 2006 until February 2009 1,156 severe allergic reactions were registered. Among children and adolescents (n = 187, age range from 3 months to 17 years) food allergens were with 58% the most frequent elicitors. In the adult group (n = 968, 18 – 85 years) food allergens were on the third position (16.3%) following venom and drugs. In children legumes (31%) and in particular peanuts were frequently responsible food allergens, followed by tree nuts (25%) where hazelnut was the most frequent elicitor. In adults fruits (13.4%) induced most often severe food dependent anaphylaxis, but also animal products (12.2%); among these most frequently crustaceans and mussels. Cofactors were often suspected in food dependent anaphylaxis, namely in 39% of the adult group and in 14% of the children and adolescence group. In adults drugs (22%) and physical activity (10%) were reported as the most frequent cofactors, in children physical activity was suspected in 8.7% and drugs in 2.6%. Concomitant diseases like atopic dermatitis, allergic asthma or allergic rhinoconjunctivitis were reported in 78% of children and adolescents and in 67% of the adults. In conclusion food-induced anaphylaxis, their cofactors and concomitant diseases in affected patients are age-dependent. The data offers to identify risk factors of anaphylaxis.Correspondence to:
Prof. Dr. med. Margitta Worm
Allergie-Centrum Charité
Klinik für Dermatologie und Allergologie
Charité – Universitätsmedizin Berlin
Charitéplatz 1
D–10117 Berlin
Email: [email protected]
Allergologie select
The German Infant Nutritional Intervention Study (GINI) for the preventive effect of hydrolysed infant formulas in infants at high risk for allergic diseases. Design and selected results
A. von Berg, B. Filipiak-Pittroff, U. Krämer, E. Link, J. Heinrich, S. Koletzko, A. Grübl, U. Hoffmann, C. Beckmann, D. Reinhardt, C.P. Bauer, E. Wichmann, and D. Berdel
Page No. 28
Abstract
Allergologie select, Volume 1, No. 1/2017 (28-38)
The German Infant Nutritional Intervention Study (GINI) for the preventive effect of hydrolysed infant formulas in infants at high risk for allergic diseases. Design and selected results
A. von Berg1, B. Filipiak-Pittroff1, U. Krämer2, E. Link2, J. Heinrich3, S. Koletzko4, A. Grübl5, U. Hoffmann5, C. Beckmann1, D. Reinhardt, C.P. Bauer5, E. Wichmann3, and D. Berdel1
1Forschungsinstitut, Klinik für Kinder- und Jugendmedizin, Marien-Hospital, Wesel, 2Leibniz-Institut für umweltmedizinische Forschung (IUF), Düsseldorf, 3Institut für Epidemiologie I, Helmholtz Zentrum München, Deutsches Forschungszentrum für Umwelt und Gesundheit, Neuherberg, 4Dr. von Hauner‘sches Kinderspital, Ludwig-Maximilian-Universität München, 5Kinderklinik der Technischen Universität München
In the complex interaction between certain environmental factors and genetic disposition, the early allergen exposure plays a major role in the development of allergic diseases. In aiming to reduce the allergen burden for the infant at risk during early infancy, cow milk protein hydrolysate infant formulas (hypoallergenic infant formulas) are appropriate alternatives to breastfeeding for primary allergy prevention. The German Infant Nutritional Intervention- Program (GINI) was supported for the first 3 years of the study by the German Ministry for Education and Research (BMBF) (FKZ 01 EE 9401-4). It is a birth cohort which was primarily scheduled until the children were 3 years old. The aim of the prospective, randomised, double-blind intervention study was to investigate the impact of different cow milk protein hydrolysate infant formulas in the first 4 – 6 months on the development of allergic diseases in children at risk due to at least one parent or biological sibling with a history of an allergic disease. The allocation to one of the 4 intervention formulas (partial whey hydrolysate, extensive whey hydrolysate, extensive casein hydrolysate or standard cow’s milk formula) was randomised and stratified by family history (single/biparental) and the respective obstetric clinic. Recruitment was carried out by the three clinical centers (Research Institute Marien-Hospital Wesel, Children’s Department, Ludwigs-Maximilians-University München and Children’s Department Technical University München) in 18 obstetric clinics between 01.09.1995 and 30.06.1998. Along with the intervention study a non-interventional, complementary observational cohort of children with or without allergy risk was recruited and followed by annual self-reporting parental questionnaires. The GINI intervention study (GINI-I, N = 2.252) and the non-interventional observation study (GINI-NI, N = 3.739) are combined in the population-based GINIplus study (see article J. Heinrich et al. in this journal). The results of the GINI intervention study confirm that, cow milk protein hydrolysate infant formulas have a preventive effect on allergic manifestation compared with a standard cow milk formula, until school age. However, the dimension of the effect is different between the formulas. This effect, which is mainly driven by the effect on atopic eczema, develops in the first months of life and persists without rebound. In the formula-groups the cumulative incidence of atopic eczema until school age is reduced between 26% and 45% compared with standard cow milk formula. A beneficial effect of the hydrolysate formulas on the respiratory manifestations asthma and rhinoconjunctivitis, however, could not be shown. By comparing the GINI-intervention and non-intervention arm of the GINIplus study it was demonstrated, that a family history for allergy doubles the risk for eczema in the offspring. Early intervention with cow milk protein hydrolysate infant formulas is able to substantially compensate this risk for eczema until the age of 6 years. In contrast, by randomisation to standard cow milk formula this risk showed a trend towards a higher incidence compared with children at risk from the non-intervention group. Thus, the results of the GINIplus study have contributed to answer some of the controversially discussed questions.Correspondence to:
Prof. Dr. med. D. Berdel
Forschungsinstitut
Klinik für Kinder- und Jugendmedizin
Marien-Hospital
Pastor-Janßen-Straße 8-38
D–46483 Wesel
Email: [email protected]
Allergologie select
The role of the innate immune system in allergic contact dermatitis
S.F. Martin
Page No. 39
Abstract
Allergologie select, Volume 1, No. 1/2017 (39-43)
The role of the innate immune system in allergic contact dermatitis*
S.F. Martin
Forschergruppe Allergologie, Hautklinik, Universitätsklinikum Freiburg
Allergic contact dermatitis is a T-cell mediated inflammatory skin disease that is caused by low molecular weight chemicals and metal ions. These contact allergens induce skin inflammation, an essential element of the sensitization process. Our understanding of the molecular mechanisms that underlie chemical-induced inflammation has improved significantly over the last years. The emerging picture shows that contact allergens activate known innate immune and stress responses that play a role in immune responses to infections. Contact allergens use innate immune receptors such as the Toll-like receptors TLR2 and TLR4 and the NOD-like receptor NLRP3 as part of the inflammasome as well as the induction of oxidative stress to induce skin inflammation. The detailed identification of the relevant signaling pathways and the mechanisms of their activation by contact allergens will most likely lead to more targeted therapeutic approaches by interference with these pathways. Moreover, this will help to refine existing, and to develop new in vitro assays for the identification of contact allergens, an important step to replace animal testing e.g. for ingredients of cosmetics which was prohibited now by EU legislation.
*According to a lecture on the occasion of the 4th German Allergy Congress, Berlin, September 3 – 6, 2009.Correspondence to:
Prof. Dr. rer. nat. S.F. Martin
Forschergruppe Allergologie
Hautklinik, Universitätsklinikum Freiburg
Hauptstraße 7
D–79104 Freiburg
Email: [email protected]
Allergologie select
Complementary alternative medicine (CAM) and atopic eczema
T. Schäfer
Page No. 44
Abstract
Allergologie select, Volume 1, No. 1/2017 (44-52)
Complementary alternative medicine (CAM) and atopic eczema
T. Schäfer
Ratekau
There is a substantial and growing interest in complementary alternative medicine (CAM) in the general population. This paper aims to answer in how far patients with atopic eczema use CAM and which techniques. Furthermore the evidence basis on the efficacy of CAM in the use for atopic eczema should be reviewed. For that purpose randomised controlled trials were searched systematically. In Germany about 46% of the general population and up to 51% of inpatients with eczema use CAM. Acupuncture, homeopathy, diets and supplements comprise the most popular techniques. Better educated, middle-aged women use CAM more frequently. In general the evidence basis concerning studies on the efficacy (and safety) of CAM for atopic eczema with appropriate size and quality is limited. Most studies were found on essential fatty acids and Chinese herbs, whereby the results remain conflicting. There was not enough evidence to assess the efficacy of acupuncture, homeopathy and salt baths. A single study on bioresonance should no superiority compared to a shame procedure. Single studies indicated beneficial effects for topical hypericum, autologous blood injection, massage therapy, Vitamin E and D, and topical Viatmin B12. These results must be confirmed by future studies. CAM are frequently used in atopic eczema, the evidence basis for that, however, is limited.Correspondence to:
Prof. Dr. med. T. Schäfer
Häven 6b
D–23626 Ratekau
Email: [email protected]
Allergologie select
Risk factors in Hymenoptera venom allergy
F. Ruëff, J. Kroth and B. Przybilla
Page No. 53
Abstract
Allergologie select, Volume 1, No. 1/2017 (53-58)
Risk factors in Hymenoptera venom allergy
F. Ruëff, J. Kroth and B. Przybilla
AllergieZentrum, Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität, München
Risk factors should be part of the decision, of which patient should be offered venom immunotherapy (VIT) and how VIT should be performed. Risk factors for a severe systemic anaphylactic reaction (SAR) after a Hymenoptera field sting include a preceding less severe sting reaction, a wasp sting, an increased baseline serum tryptase concentration (BSTC), mastocytosis, older age, ACE inhibitor medication, and male gender. During VIT, treatment with honey bee venom is the most important risk factor for a SAR. Further risk factors include a high BSTC (for vespid VIT only), presence of venom specific IgE in serum, any antihypertensive medication during therapy, and an ultra-rush protocol for build-up. Treatment failure is more common in patients suffering from honey bee venom allergy, high BSTC (for vespid VIT only) or mastocytosis, and in those who had experienced side effects during VIT. Besides discontinuing antihypertensive medication or switching to a moderate type of dose increase during build-up, little can be done to minimize the risks associated with VIT. Increasing the maintenance dose may improve the efficacy of VIT. In patients with a particularly high risk for treatment failure, or in case of treatment failure, VIT should include an increased maintenance dose right from the beginning. Usually, 200 mg will be sufficient.Correspondence to:
PD Dr. med. Franziska Ruëff
AllergieZentrum
Klinik und Poliklinik für Dermatologie und Allergologie
Ludwig-Maximilians-Universität
Frauenlobstraße 9 – 11
D–80337 München
Email: [email protected]
Allergologie select
Implant allergy
P. Thomas and B. Summer
Page No. 59
Abstract
Allergologie select, Volume 1, No. 1/2017 (59-64)
Implant allergy
P. Thomas and B. Summer
Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität, München
Osteosynthesis materials or artificial joint replacement make part of clinical routine. In case of complaints mostly mechanical causes or infections are found. Metals like nickel, chromium and cobalt or bone cement components like acrylates and gentamicine may however potentially cause intolerance reactions to implants. Correspondingly eczema, delayed wound / bone healing, recurrent effusion, pain or implant loosening have been described as manifestation of implant allergy. In contrast to the high incidence of cutaneous metal allergy, allergies associated with implants are rare. Diagnosis of metal implant allergy is based on excluding differential diagnoses – in particular infection – and on a combined approach of allergological diagnostics by patch test and histopathology of periimplant tissue. Risk factors for allergic sensitization to implants or triggering periimplant allergic reactions in the case of preexisting cutaneous metal allergy are unknown. Despite the risk of developing complications being unclear, titanium-based osteosynthesis materials are recommended for metal-allergic patients and the use of metal-metal couplings in arthroplasty is rather not recommended for such patients. If a regular, potentially applicable CoCr-polyethylene articulation is preferred, the patient has to be well informed and has to give his written consent.Correspondence to:
Prof. Dr. med. P. Thomas
Klinik und Poliklinik für Dermatologie und Allergologie
Ludwig-Maximilians-Universität
Frauenlobstrasse 9 – 11
D-80337 München
Email: [email protected]
Allergologie select
Rare and new occupational inhalation allergens
M. Raulf-Heimsoth, I. Sander, S. Kespohl, V. van Kampen and T. Brüning
Page No. 65
Abstract
Allergologie select, Volume 1, No. 1/2017 (65-70)
Rare and new occupational inhalation allergens
M. Raulf-Heimsoth, I. Sander, S. Kespohl, V. van Kampen and T. Brüning
Institut für Prävention und Arbeitsmedizin der Deutschen Gesetzlichen Unfallversicherung, Institut der Ruhr-Universität Bochum (IPA)
Occupational airway diseases induced by inhalation of allergens at workplaces have become common, but the inducers are diverse and their pathomechanisms are not clear in each case. Only few allergens were studied in detail (like wheat flour dust and natural rubber latex) and most of the occupational airway sensitizers were documented only as case reports. In this review more rare and exotic occupational Type I-aeroallergens according to their workplace application area (e.g. production of dough and bakery products, handling with decorative and economic plants, wood processing, fish-, shellfish-processing and fish breeding) were described.Correspondence to:
Prof. Dr. rer. nat. Monika Raulf-Heimsoth
Institut für Prävention und Arbeitsmedizin der Deutschen Gesetzlichen Unfallversicherung
Institut der Ruhr-Universität Bochum (IPA)
Bürkle-de-la-Camp-Platz 1
D–44789 Bochum
Email: [email protected]
Allergologie select
Novel key cytokines in allergy: IL-17, IL-22
S. Eyerich, C. Traidl-Hoffmann, H. Behrendt, A. Cavani, C.B. Schmidt-Weber, J. Ring and K. Eyerich
Page No. 71
Abstract
Allergologie select, Volume 1, No. 1/2017 (71-76)
Novel key cytokines in allergy: IL-17, IL-22*
S. Eyerich1, C. Traidl-Hoffmann1#2, H. Behrendt1, A. Cavani3, C.B. Schmidt-Weber1, J. Ring2 and K. Eyerich2
1ZAUM – Zentrum Allergie & Umwelt, Technische Universität und Helmholtz-Zentrum München, 2Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München, 3Laboratory of Immunology, Istituto Dermopatico DellImmacolata, Rome, Italy
The biology of the T cell cytokines Interleukin (IL-)17 and IL-22 has been a main focus in the field of clinical immunology in the last decade. This intensive interest in both cytokines resulted in almost 5,000 scientific publications (www.pubmed.com) dealing with the molecular structure, extra- and intracellular signaling pathways, specific transcription factors and the function of IL-17 and IL-22. This review article highlights the main findings concerning IL-17 and IL-22 in the last years.
*Based on a lecture on the occasion of the 5th German Allergy Congress 2010, Hannover, Germany.Correspondence to:
Dr. med. K. Eyerich
Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein
Technische Universität München
Biedersteiner Straße 29
D–80802 München
Email: [email protected]
Allergologie select
Avoiding contact allergens: from basic research to the in vitro identification of contact allergens
S.F. Martin and P.R. Esser
Page No. 77
Abstract
Allergologie select, Volume 1, No. 1/2017 (77-84)
Avoiding contact allergens: from basic research to the in vitro identification of contact allergens
S.F. Martin and P.R. Esser
Forschergruppe Allergologie, Hautklinik, Universitätsklinikum Freiburg
Allergic contact dermatitis (ACD) is a chemical-induced inflammatory skin disease. Contact allergens are low-molecular-weight chemicals that must react with proteins in order to become immunogenic. This interaction leads to the activation of innate immune and stress responses and to the formation of antigenic epitopes for T cells which are the effector cells of ACD. Due to the multitude of chemicals that surround us in our daily life and their potential sensitizing capacity, it is crucial to identify contact sensitizers before these chemicals are used in consumer products. Appropriate in vitro assays for hazard identification are urgently needed to replace animal-based assays. The EU-wide ban on sensitization testing of cosmetic ingredients in animals is in effect since March 2009 and the necessity to test more than 30,000 already marketed chemicals for their sensitizing potential under the EU regulation REACh has intensified the worldwide efforts to replace animal testing. We summarize here the current strategies to develop a battery of assays which allows the identification of contact allergens by in vitro alternatives to animal testing. Our main focus lies on the test systems recently developed within the EU project Sens-it-iv in which we participate.Correspondence to:
Prof. Dr. rer. nat. S.F. Martin
Forschergruppe Allergologie
Hautklinik
Universitätsklinikum Freiburg
Hauptstraße 7
D–79104 Freiburg
Email: [email protected]
Allergologie select
GINIplus and LISAplus. Design and selected results of two German birth cohorts about natural course of atopic diseases and its determinants
J. Heinrich, I. Brüske, C. Cramer, U. Hoffmann, M. Schnappinger, B. Schaaf, A. von Berg, D. Berdel, U. Krämer, I. Lehmann, O. Herbarth, M. Borte, A. Grübl, C.P. Bauer, C. Beckmann, H. Behrendt, J. Ring and S. Koletzko
Page No. 85
Abstract
Allergologie select, Volume 1, No. 1/2017 (85-95)
GINIplus and LISAplus. Design and selected results of two German birth cohorts about natural course of atopic diseases and its determinants
J. Heinrich1, I. Brüske1, C. Cramer2, U. Hoffmann3, M. Schnappinger1, B. Schaaf4, A. von Berg5, D. Berdel5, U. Krämer2, I. Lehmann6, O. Herbarth7, M. Borte8, A. Grübl2, C.P. Bauer2, C. Beckmann4, H. Behrendt9, J. Ring10 and S. Koletzko11
1Institut für Epidemiologie I, Helmholtz Zentrum München, Deutsches Forschungszentrum für Umwelt und Gesundheit, Neuherberg, 2Leibniz-Institut für Umweltmedizinische Forschung (IUF), Düsseldorf, 3Kinderklinik, Technische Universität München, 4Praxis für Kinder- und Jugendmedizin, Bad Honnef, 5Forschungsinstitut, Klinik für Kinder- und Jugendmedizin, Marien-Hospital, Wesel, 6Department Expositionsforschung und Epidemiologie, UFZ – Helmholtz Zentrum, Leipzig, 7Institut für Umweltmedizin und Hygiene, Medizinische Fakultät, Universität Leipzig, 8Kinderklinik, Städtisches Klinikum St. Georg, Leipzig, 9Zentrum Allergie und Umwelt (ZAUM), Technische Universität und Helmholtz Zentrum München, 10Christine Kühne Center of Allergy Research and Education (CK-CARE), Klinik und Poliklinik für Dermatologie und Allergologie, Technische Universität München, 11Dr. von Hauner‘sches Kinderspital, Ludwig-Maximilian-Universität München
The increasing prevalence of asthma, hay fever and allergic sensitization in Western Germany after division in 1949 and the rapid increase in East German children after re-unification in 1990 are strong indications for the role of life-style and/or environmental factors for development of atopic diseases. Obviously the perinatal period is crucial for priming the immune system. Therefore, explorations of determinants of atopic diseases need pregnancy or birth cohorts as most appropriate epidemiological study designs. This review presents the design and selected results of the two German birth cohorts GINIplus and LISAplus. GINIplus and LISAplus recruited 5.991 and 3.097 healthy, term newborns from Munich, Wesel, Leipzig and Bad Honnef. Approximatly 55% could be followed for the first 10 years. We analyzed the natural course of atopic diseases and the role of life-style, environmental and genetic factors for disease onset, intermediate phenotypes and for genes involved in detoxification and oxidative stress. The results of these two large birth cohorts contributed substantially to the understanding of atopic diseases and its determinants.Correspondence to:
Dr. J. Heinrich
Institut für Epidemiologie I
Helmholtz Zentrum München
Ingolstädter Landstraße 1
D–85764 Neuherberg
Email: [email protected]
Allergologie select
Epidemiology of cutaneous adverse drug reactions
M. Mockenhaupt
Page No. 96
Abstract
Allergologie select, Volume 1, No. 1/2017 (96-108)
Epidemiology of cutaneous adverse drug reactions
M. Mockenhaupt
Dokumentationszentrum schwerer Hautreaktionen (dZh), Universitäts-Hautklinik Freiburg
Epidemiologic investigations of cutaneous adverse drug reactions (cADR) are important to evaluate their impact in dermatology and health care in general as well as their burden for affected patients. Few epidemiologic studies have been performed on frequent non-life-threatening cADR including reactions of both delayed and immediate hypersensitivity, such as maculopapular exanthema (MPE), fixed drug eruption and urticaria. Concerning rare but life-threatening severe cutaneous adverse reactions, e.g., toxic epidermal necrolysis (TEN), Stevens- Johnson syndrome (SJS), acute generalized exanthematous pustulosis (AGEP) and drug reaction with eosinophilia and systemic symptoms (DRESS), several epidemiologic studies have been performed to date, some of which are still ongoing. Such studies enable the calculation of reliable incidence rates and demographic data, but also allowed to perform risk estimation for drugs. The spectrum of drugs causing cADR differs substantially when separating the various clinical conditions. Whereas antibiotics are by far the most frequent inducers of milder cADR like MPE, they have a much lower risk to induce SJS/ TEN, for which “high-risk” drugs are antiinfective sulfonamides, allopurinol, certain anti-epileptic drugs, nevirapine and nonsteroidal anti-inflammatory drugs (NSAIDs) of the oxicam-type. In contrast, AGEP is predominantly caused by the antibiotics pristinamycin and aminopenicillins, followed by quinolones, (hydroxy-)chloroquine and sulfonamides. DRESS can be induced by a number of drugs known to cause SJS/TEN, such as certain antiepileptics and allopurinol, but also other medications (e.g., minocyclin).Correspondence to:
Prof. Dr. med. Maja Mockenhaupt
Dokumentationszentrum schwerer Hautreaktionen (dZh)
Universitäts-Hautklinik Freiburg
Hauptstraße 7
D–79104 Freiburg
Email: [email protected]
