Volume 2 (2018)
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Original paper
Stressful life events in childhood and allergic sensitization
G. Herberth, S. Röder, A. Bockelbrink, T. Schäfer, M. Borte, O. Herbarth, U. Krämer, H. Behrendt, S. Sausenthaler, J. Heinrich and I. Lehmann
Page No. 1
Abstract
Allergologie select, Volume 2, Nr. 1/2018 (1-9)
Stressful life events in childhood and allergic sensitization*
G. Herberth, S. Röder, A. Bockelbrink, T. Schäfer, M. Borte, O. Herbarth, U. Krämer, H. Behrendt, S. Sausenthaler, J. Heinrich and I. Lehmann
Environmental Immunology, Helmholtz Center for Environmental Research (UFZ), Leipzig, Germany
Stressful life events evidently have an impact on development of allergic diseases, but the mechanism linking stress to pathological changes of immune system function is still not fully understood. The aim of our study was to investigate the relationship between stressful life events, neuropeptide and cytokine concentrations in children as well as the association between early stressful life events and atopic eczema (AE). Within the LISA plus (Life style – Immune system – Allergy) study, blood samples from children of 6 years of age were analyzed for concentration of the neuropeptides vasoactive intestinal peptide (VIP), somatostatin (SOM), substance P (SP) and the Th1/Th2 cytokines IFN-γ and IL-4. Life events such as severe disease or death of a family member, unemployment or divorce of the parents were assessed with a questionnaire filled in by the parents. Furthermore, lifetime prevalence of AE and incidence after the assessment period of life events were compared. Our data suggest that separation/divorce of parents increase children’s risk of developing AE later in life. Children with separated/divorced parents showed high VIP levels and high concentrations of the Th2 cytokine IL-4 in their blood. Severe diseases and death of a family member were neither associated with neuropeptide levels nor with cytokine concentrations. Unemployment of the parents was associated with decreased IFN-γ concentrations in children’s blood but not with neuropeptide levels. Thus, the neuropeptide VIP might be a mediator between stressful life events and immune regulation contributing to the Th2 shifted immune response in children with separated/divorced parents.
*Based on a lecture on the occasion of the 3rd German Allergy Congress, Erfurt, September 10 – 13, 2008.
German version published in Allergologie, Vol. 33, No. 2/2010, pp. 55-65Correspondence to:
Dr. rer. nat. G. Herberth
Umweltimmunologie
Helmholtz-Zentrum für Umweltforschung – UFZ
Permoserstrasse 15
D-04318 Leipzig
Email: [email protected]
Review
Occurence and hygienic/allergological relevance of mould from point of view of the environmental medicine
T. Gabrio and U. Weidner
Page No. 10
Abstract
Allergologie select, Volume 2, Nr. 1/2018 (10-16)
Occurence and hygienic/allergological relevance of mould from point of view of the environmental medicine*
T. Gabrio and U. Weidner
Landesgesundheitsamt Baden-Württemberg im Regierungspräsidium Stuttgart (LGA)
Allergic skin and respiratory diseases range among the most frequent afflictions in industrialized countries. Due to this fact the importance of indoor mould pollution based on dampness is discussed. In a sentinel health study of the State Health Agency (LGA) children attending Class 4 of a primary school were tested by an in-vitro allergy screening (UniCap 100/Phadia) for the mould allergens mx1 (Penicillium chrysogenum m1, Cladosporium herbarum m2, Aspergillus fumigatus m3 und Alternaria alternata m6). Primarily about 5% of the children were sensitized against mould which are associated with the ambient air. The investigations showed that most of the children were sensitized against Alternaria alternata and concerning the IgE-concentration (kU/l) Alternaria alternata had the highest concentration among the tested allergens. Commonly children with sensitization against mould were polysensitized. It is unclear if the allergy screening against mould mx1 includes mould with indication for indoor mould pollution such as Acremonium spp., Aspergillus penicillioides, Aspergillus restrictus, Aspergillus versicolor, Chaetomium spp., Phialophora spp., Stachybotrys chartarum, Tritirachium (Engyodontium) album und Trichoderma spp. by means of crossreaction. Therefore such investigations do not admit any conclusion about health problems as a result of indoor mould pollution. At the present state of knowledge the exposure measurements of indoor mould pollutions are not possible, at most a semiquantitative assessment. Although it is generally accepted that dwellings with moisture and mould represent a health risk, knowledge about indoor mould pollution and the related health problems is lacking.
*Based on a lecture on the occasion of the 4th German Allergy Congress, Berlin, September 3 – 6, 2009.
German version published in Allergologie, Vol. 33, No. 3/2010, pp. 101-108Correspondence to:
Dr. rer. nat. T. Gabrio
Landesgesundheitsamt Baden-Württemberg im
Regierungspräsidium Stuttgart
Nordbahnhofstraße 135
D–70191 Stuttgart
Email: [email protected]
Original paper
Development of the BELANA questionnaire for the analysis of economic burdens of food allergy and intolerance
N. Rösch, S. Schnadt, R. Herbst, A. Arens-Volland, S. Kohler, F. Feidert, P. Schmalz, K. Hermann and R. Mösges
Page No. 17
Abstract
Allergologie select, Volume 2, Nr. 1/2018 (17-28)
Development of the BELANA questionnaire for the analysis of economic burdens of food allergy and intolerance
N. Rösch1, S. Schnadt2, R. Herbst1, A. Arens-Volland1, S. Kohler1, F. Feidert3, P. Schmalz4, K. Hermann4 and R. Mösges4
1Centre de Recherche Public Henri Tudor, Luxembourg, 2Deutscher Allergie- und Asthmabund e.V. (DAAB), Mönchengladbach, 3Clinique d’Eich, Centre Hospitalier de Luxembourg, 4Institut für Medizinische Statistik, Informatik und Epidemiologie der Universität zu Köln (IMSIE)
Introduction: Patients affected by food allergies and intolerances need to apply dedicated avoidance strategies and also prevent the consequences of unbalanced diets. In most countries, the health economic costs for these patients are unknown.
Methods: To measure temporal and financial burdens of the patients in multinational settings, the BELANA questionnaire (Burdens and Expenses of Living as an Adult with Nutrition based Allergy or Intolerance) has been developed. For the complementary measurement of Health Related Quality of Life (HR-QoL), a combined appliance of the disease-specific FAQLQ-AF (Food Allergy Quality of Life Questionnaire – Adult Form) and the generic SF-12v1 (Short Form-12 Health Survey) has been chosen.
Results: BELANA collects six economic items while avoiding questions, which are already included in the HR-QoL questionnaires or could lead to denial tendencies. In a web-based pilot survey with 51 patients, the practicability of using BELANA and the complementary quality of life instruments has been investigated. The electronic data collection offers real time plausibility checks and limits the workload for completion and data evaluation.
Discussion: The response rates at BELANA health-economic items (76 – 100%) and the high amount of completed questionnaires (50 of 51) confirm the patients acceptance of the chosen methodology. Within the web-based survey, the combination of BELANA, FAQLQ-AF and SF-12v1 has been completed in an average of 22 minutes. An age-related selection bias has not been confirmed in this pilot application. The median age in the pilot trial was 37.9 years (minimum age to participate was 18 years, range from 19 to 72 years, Standard Deviation (SD) = 12.4 years). Most of the participants were female (44 of 50). Conclusion: It is assumed that the BELANA questionnaire should be a useful tool for the evaluation of health economic burdens for patients with food allergy and intolerance.
German version published in Allergologie, Vol. 34, No. 4/2011, p. 177-190Correspondence to:
Dr. rer. medic. N. Rösch
Centre de Recherche Public Henri Tudor
29, avenue John F. Kennedy
L–1855 Luxembourg-Kirchberg
Email: [email protected]
Case report
Contact dermatitis of the lips due to late-type sensitization against dalbergiones in a wooden recorder
C. Pföhler and W. Tilgen
Page No. 29
Abstract
Allergologie select, Volume 2, Nr. 1/2018 (29-31)
Contact dermatitis of the lips due to late-type sensitization against dalbergiones in a wooden recorder
C. Pföhler and W. Tilgen
Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum des Saarlandes, Homburg/Saar
Background: Late-type sensitizations against wood are rare and are mostly seen in patients with occupational contact with saw dust. Generally, commercial wooden products only lead to sensitization or dermatitis in cases when contact to the unprotected skin is direct, intensive and of longer duration, i.e. by wearing wooden jewellery or by playing wooden instruments. Causative for the sensitization process are ingredients of the wood core such as alkaloids, glycosides, anthrachinones, saponines, phenols, catechols, flavonoids, cumarins, and benzo-, naphtho-, furano-, and phenanthrenquinones and their precursors.
Case report: We report the case of a 70-year-old patient who developed cheilitis after playing different wooden recorders made of African blackwood, rosewood, cedar, olive, and pear.
Methods: Patch testing with baseline series of contact allergens and saw dust of the recorders were performed as well as skin prick tests with common inhalant allergens and saw dust of the recorders.
Results: Patch testing showed sensitizations against African blackwood, rosewood, fragrance mix 2 and hydroxyisohexyl-3-cyclohexene carboxaldehyde. Skin prick testing was without pathological results.
Conclusion: African blackwood and rosewood contain(S)-4’-hydroxy-4-methoxydalbergione and (S)-4-methoxydalbergione. As a result of the chemical affinity between the dalbergiones, cross-reactions between different woods are observed. The case presented shall show the diagnostic procedure in cases in which sensitizations against wood components are suspected.
German version published in Allergologie, Vol. 33, No. 9/2010, pp. 410-412Correspondence to:
PD Dr. med. Claudia Pföhler
Klinik für Dermatologie, Venerologie und Allergologie
Universitätsklinikum des Saarlandes
Kirrbergerstraße 100
D–66421 Homburg/Saar
Email: [email protected]
Original paper
Monitoring of omalizumab therapy in children and adolescents
J.O. Steiß, A. Schmidt, H. Lindemann, S. Rudloff, A. Staatz, P. Strohner, G. Becher, L. Nährlich and K.P. Zimmer
Page No. 32
Abstract
Allergologie select, Volume 2, Nr. 1/2018 (32-38)
Monitoring of omalizumab therapy in children and adolescents
J.O. Steiß1, A. Schmidt1, H. Lindemann1, S. Rudloff1, A. Staatz2, P. Strohner2, G. Becher3, L. Nährlich1 and K.P. Zimmer1
1Zentrum für Kinderheilkunde und Jugendmedizin, Justus-Liebig-Universität Gießen, 2BioTeZ Berlin-Buch GmbH, 3BecherConsult GmbH Berlin
Background: Omalizumab is a successfully implemented supplementary therapy for improving asthma control in children aged 6 years and older with severe persistent allergic asthma. The dosage of omalizumab depends on body weight and IgE level, yet no parameter has been established to guide dosage changes during therapy. Clinical studies in patients with allergic asthma or allergic rhinitis revealed a clinically relevant improvement by using omalizumab leading to concentrations of free serum IgE reported to be lower than 50 ng/ml. Therefore, only the question concerning the concentrations of free IgE used in a therapy with omalizumab is regarded of clinical importance, while total IgE (free and omalizumab-bound IgE) increases during treatment.
Patients and methods: Ten patients, 8 to 17 years of age, received therapy with omalizumab due to severe allergic asthma. In addition, the patients had pronounced rhinoconjunctivitis, food allergy, insect sting allergy, and/or neurodermitis. The total IgE in the serum was measured in the patients 3 – 6 monthly before each omalizumab injection as a potential progress parameter (Sandwich-Immunoassay ADVIA Centaur).
Results: Six months after beginning of the therapy with omalizumab, a significant decrease of the total IgE concentration was found, in comparison to the baseline values (p < 0.003). In all patients the tolerability of omalizumab was very good: there was a reduction in the frequency of the asthma exacerbations and rescue medications. All patients reported a clearly improved quality of life.
Conclusions: A general increase in IgE was not observed in any of the children we treated with omalizumab. Apart from the development of routine assays to determine free serum IgE levels, the significance of the total serum IgE as a suitable control of an omalizumab therapy should be further investigated in controlled studies with regard to sensitivity and specificity. In order to only administer the lowest necessary dose of omalizumab especially in children and adolescents, the establishment of laboratory parameters (free IgE and/or total IgE) to adequately monitor the therapy is urgently needed. Patients undergoing an omalizumab therapy require medical supervision at close intervals.
German version published in Allergologie, Vol. 33, No. 10/2010, p. 421-428Correspondence to:
PD Dr. med. J.-O. Steiß
Pädiatrische Pneumologie und Allergologie
Zentrum für Kinderheilkunde und Jugendmedizin
Universitätsklinikum Gießen und Marburg GmbH
Justus-Liebig-Universität
Feulgenstraße 12
D–35385 Gießen
Email: [email protected]
Original paper
Patient characteristics in German allergological practices – a nationwide survey
T. Reinhold, C. Lindig, S.N. Willich and B. Brüggenjürgen
Page No. 39
Abstract
Allergologie select, Volume 2, Nr. 1/2018 (39-48)
Patient characteristics in German allergological practices – a nationwide survey
T. Reinhold, C. Lindig, S.N. Willich and B. Brüggenjürgen
Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité – Universitätsmedizin Berlin
Introduction: In Western societies a significant incidence and prevalence of allergic asthma and other allergic diseases is observable. The present study investigated epidemiological patterns of allergic diseases and the utilization of health care resources by subjects who are already under specialized allergological treatment. Furthermore the study was performed to identify factors which had a significant impact on accessibility to specific immunotherapy (SIT).
Methods: The study was based on a cross-sectional survey on patient characteristics, which was performed by participating physicians, who were specialized in the field of allergological disorders and SIT, in collaboration with their patients. The analysis of data was divided into descriptive analyses and an analytical part, in which influencing factors for accessibility to specific immunotherapy were investigated. Logistic regression models to identify several predictor variables were used.
Results: 495 physicians documented the data of 19,990 patients. 18,177 patients were included in the analyses. Patients had a mean age of 31.5 ± 15.5 years and 53.2% were female. The most frequent and most severe allergic disorders observable in German allergological practices were conjunctivitis and rhinitis. The seasonal symptoms occurred mainly during March to August, while seasonal disease manifestation was 2.5 times more frequent than perennial forms. The most received anti-symptomatic medications are antihistamines and corticosteroids. Patients who receive SIT were mainly treated using subcutaneous immunotherapy (SCIT) – only in lower age groups, the likelihood of receiving sublingual immunotherapy (SLIT) was increased.
Conclusion: In Germany, conjunctivitis and rhinitis are the most severe allergic disorders in allergological practices. Compared to the German general patient population, people who were already in allergological treatment had better access to SIT.
German version published in Allergologie, Vol. 34, No. 5/2011, pp. 237-247Correspondence to:
Dr. rer. medic. T. Reinhold
Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie
Charité – Universitätsmedizin Berlin
Luisenstraße 57
D–10117 Berlin
Email: [email protected]
Original paper
In search of clinically relevant parameters to monitor successful Omalizumab therapy in allergic asthma
M. Probst, A. Gogolka, M. Krüll and O. Noga
Page No. 49
Abstract
Allergologie select, Volume 2, Nr. 1/2018 (49-55)
In search of clinically relevant parameters to monitor successful Omalizumab therapy in allergic asthma
M. Probst2, A. Gogolka2, M. Krüll1#2 and O. Noga1#2
1Institute of Allergy and Asthma Research Berlin, 2Medical Clinical for Infectiology/Pulmonology, Charité – Universitätsmedizin Berlin
Background: Omalizumab is approved as add-on therapy for the treatment of severe uncontrolled allergic asthma. Increase in quality of life and decrease of exacerbations and hospital admissions, as well as immunmodulatory effects have been described with Omalizumab therapy. However, to date there are little parameters to monitor success and to evaluate the individual advantage of this therapy for the patient. Furthermore no reliable parameter to predict response to treatment exists so far. Aim of this study was to define an easily applicable parameter for response to treatment with Omalizumab.
Method: 43 patients with allergic asthma were treated with Omalizumab at a dose of at least 0,016 mg/ kg/IgE every 4 weeks. Before and 12 weeks after initiation of therapy, bodyplethysmography including airway resistance was performed. Efficacy of treatment was judged by the attending physician on the basis of a five point chart. Furthermore a differential blood count was performed before and 12 weeks after initiation of treatment. Total and specific IgE against all relevant antigens were determined before start of therapy.
Results: Airway resistance in patients with response to treatment with Omalizumab (responder), was significantly decreased in comparison to patients without clinical benefit (non-responder). The number of eosinophil granulocytes in the peripheral blood was decreased in both groups without significant difference. Response to therapy was associated with younger age and lower levels of specific IgE against the allergen with the highest sIgE-level (seasonal and perennial), but not with the sIgE level of the perennial allergens in general.
Conclusion: Measurement of airway resistance might be an additional parameter to monitor response to therapy with Omalizumab. High specific IgE levels, for both perennial and concornitant seasonal allergens and increasing age seem to predict less favorable treatment outcomes.
German version published in Allergologie, Vol. 34, No. 6/2011, pp. 299-306Correspondence to:
Dr. med. O. Noga
Institut für Allergie- und Asthmaforschung Berlin IAAB
Tempelhofer Damm 176
D–12099 Berlin
Email: [email protected]
Review
Nutrition therapy for adverse reactions to histamine in food and beverages
I. Reese
Page No. 56
Abstract
Allergologie select, Volume 2, Nr. 1/2018 (56-61)
Nutrition therapy for adverse reactions to histamine in food and beverages
I. Reese
Ernährungsberatung und -therapie, Munich
Adverse reactions to food are suspected in one third of the German population, but only 10% of these assumed hypersensitivity reactions can be clinically confirmed. While diagnosis of food allergies is fairly easy due to objective laboratory parameters, non-allergic hypersensitivity reactions are difficult to diagnose because these objective markers are lacking so far. Adverse reactions to histamine are often suspected to be the cause of a wide range of symptoms, especially when no allergic pathomechanism can be identified. In order to confirm such a suspicion, it is inevitable to validate a reproducible association between consumption of food and beverages rich in histamine and symptoms, to identify causative agents and to exclude other disorders. Thereafter, avoidance should be performed on the basis of individual requirements. General advices with a lot of restraints are often unnecessarily strict. Nutrition therapy aims at a reduction of symptoms to a minimum while maintaining a high quality of life.
German version published in Allergologie, Vol. 34, No. 3/2011, p. 152-158Correspondence to:
Dr. Imke Reese
Ernährungsberatung und -therapie
Schwerpunkt Allergologie
Ansprengerstraße 19
D–80803 München
Email: [email protected]
Review
Immunomodulation by vitamin D
M. Worm, G. Heine and A. Radbruch
Page No. 62
Abstract
Allergologie select, Volume 2, Nr. 1/2018 (62-66)
Immunomodulation by vitamin D
M. Worm, G. Heine and A. Radbruch
Allergie-Centrum Charité, Klinik für Dermatologie und Allergologie, Charité Campus Mitte – Universitätsmedizin Berlin
Vitamin D exerts besides its homeostatic functions on calcium and bone metabolism several immunological functions. Current data show that relative vitamin D deficiency (< 75 nmol/l 25-dydroxyvitamin D) as well as acquired seasonal vitamin D deficiency (< 50 nmol/l) are frequent in Germany. As confirmed by own data, UV-exposition plays a major role for maintenance of the vitamin D status, e.g. in patients with UV-triggered diseases is vitamin D deficiency more frequent, even throughout the year. The beneficial impact of vitamin D on immune functions is highlighted by epidemiologic, genetic and experimental evidence. In the past years, numerous publications presented associations between vitamin D deficiency on one hand and severity and prevalence of allergic asthma in children and adults on the other hand.
German version published in Allergologie, Vol. 34, No. 11/2011, pp. 538-542Correspondence to:
Prof. Dr. med. Margitta Worm
Allergie-Centrum Charité
Klinik für Dermatologie und Allergologie
Charité Campus Mitte – Universitätsmedizin Berlin
Charitéplatz 1
D–10117 Berlin
Email: [email protected]
Review
Peanut allergens: new consolidated findings on structure, characteristics and allergom
W.M. Becker, A. Petersen and U. Jappe
Page No. 67
Abstract
Allergologie select, Volume 2, Nr. 1/2018 (67-79)
Peanut allergens: new consolidated findings on structure, characteristics and allergom
W.M. Becker1, A. Petersen1 and U. Jappe1#2
1Klinische und Molekulare Allergologie, Klinische Pneumologie des Forschungszentrums Borstel, 2Universitäts-Hautklinik Lübeck
Immunoglobulin E-mediated food allergy is the result of a complex pathomechanism. Factors contributing to the dysfunction of the immune system are the allergenic sources and the variable matrix effects arising from the processes involved in interaction with the gastrointestinal tract, the allergens by themselves through their structural features and the specific behaviour of the individual immune system. The very starting point for elucidating the pathomechanism of food allergy is the identification of allergens and the description of their structure. They are the basis for in vitro diagnostics as well as the development of immunotherapeutic drugs. With regard to class I food allergy, peanut allergy affects by far the largest group of patients. 11 allergens have been identified in peanuts. Ara h 1, Ara h 3 and Ara h 4 belong to the cupin superfamily, Ara h 2, Ara h 6 and Ara h 7 to the prolamin superfamily; Ara h 5 (profilins) and Ara h 8 (superfamily of Bet v 1-homologous proteins) are associated with aeroallergens. Peanut lipid transfer proteins (LTP) and two peanut oleosins are listed as Ara h 9, Ara h 10 and Ara h 11 by the IUIS allergen nomenclature subcommittee. Peanut agglutinin (PNA) and a third oleosin have been shown to possess allergenic properties. The effect of the above specified allergens has to be considered in the context of their matrix, which is influenced by processing factors.
German version published in Allergologie, Vol. 34, No. 8/2011, pp. 398-411Correspondence to:
Prof. Dr. med. Uta Jappe
Klinische und Molekulare Allergologie
Klinische Pneumologie
Forschungszentrum Borstel
Parkallee 35
D–23845 Borstel
Email: [email protected]
Review
Allergic and intolerance reactions to wine
B. Wüthrich
Page No. 80
Abstract
Allergologie select, Volume 2, Nr. 1/2018 (80-88)
Allergic and intolerance reactions to wine
B. Wüthrich
Specialist for Allergology and Clinical Immunology, Specialist for Dermatology, Zollikerberg, Switzerland
Hypersensitivity reactions to alcoholic beverages (particularly red wine) are relatively frequent, affecting 10% of the general population. Hypersensitivity reactions due to alcoholic drinks, mainly in the form of airway reactions (rhinitis and asthma), occur significantly more frequently in persons with pre-existing rhinitis and asthma. Concerning pathogenesis it has to be differentiated between immunologic, mainly IgE-mediated, hypersensitivity reactions (wine allergies), and intolerance reactions, in which no causative allergen-specific immune mechanisms can be detected. Allergens responsible for wine allergy could be: grape (Vitis vinifera) proteins (particularly the major allergen lipid transfer protein Vit v1), proteins and ingredients used for the fining of wines as fish gelatine or bladder of huso (family of sturgeons), oval bumin, dairy (casein) products, gum arabic, enzymes (lysozyme, pectinase, glucanase, cellulase, glucosidase, urease, aromatic enzymes), molds (particularly Botrytis cinerea) responsible for the noble rot of wines, yeasts and proteins from insects that contaminated the mash. Possibly Type 1 allergic reactions (positive prick tests) have been described for inorganic ingredients like ethanol, acetaldehyde, acetic acid and sulfites, but no specific IgE could be detected in the serum. Ethanol, acetaldehyde and acetic acid, flavonoids (anthocyanins and chatechines), sulfites, histamine and other biogenic amines are the main causative agents of intolerance reactions (pseudoallergic reactions) to wine. After a short historic review on viticulture and the importance of wine in the classical antiquity we go into the chemical processes of alcoholic fermentation and on the genetically inherited “flush syndrome” due to an acetaldehyde dehydrogenase 2 polymorphism, subsequently we focus on the different etiologic factors of allergies and intolerance reactions to wine. The most frequent intolerance reactions are caused by sulfites, particularly after the ingestion of white wine and in asthma patients, and by histamine and other biogenic amines, mainly after ingestion of red wine and in persons with diamine oxidase (DAO) deficiency.
German version published in Allergologie, Vol. 34, No. 8/2011, pp. 427-436Correspondence to:
Prof. em. Dr. med. B. Wüthrich
Im Ahorn 18
CH–8125 Zollikerberg
Email: [email protected]
Original paper
Success factors for adherence in hyposensitization
N. Sondermann, K. Shah-Hosseini, K. Henkel, A. Schwalfenberg and R. Mösges
Page No. 89
Abstract
Allergologie select, Volume 2, Nr. 1/2018 (89-93)
Success factors for adherence in hyposensitization
N. Sondermann1, K. Shah-Hosseini1, K. Henkel1, A. Schwalfenberg2 and R. Mösges1
1Institut für medizinische Statistik, Informatik und Epidemiologie, Universitätsklinikum Köln, 2Deutscher Allergie- und Asthmabund e.V., Mönchengladbach
For the success of an immunotherapy regimen, adherence is a major success factor. The goal of our study was to identify the factors that positively and negatively influence patient compliance, and to create strategies to improve it. Four questionnaires were designed for different patient groups: A – after immunotherapy; B – during immunotherapy; C – before immunotherapy; D – no experience with immunotherapy. From March to October 2008, 790 questionnaires were collected. For the first group, questionnaire A was answered by 272 patients. Of these, 15.8% had dropped out of immunotherapy. Women had higher dropout rates than men (16.8% vs. 12.3%). The following aspects of immunotherapy were viewed by the patients as negative: time consuming (69.5%), adverse reactions (62.5%), insufficient patient information (53.7%), no change in use of symptomatic medication (33.8%) and no change in symptoms (60.7%). Despite the mentioned drawbacks, 74% of all patients would still recommend allergen immunotherapy. Questionnaire B was completed by 281 patients. In this group, 8.7% had already considered dropping out. The following unfavourable aspects were identified: time consuming (66.2%), adverse reactions (61.9%), insufficient patient information (54.8%), no change in symptoms (51.2%) and use of symptomatic medication (47.0%). Despite this, up to 95.4% of all patients would recommend immunotherapy. Questionnaire C was filled-out by 55 patients. The following reasons were rated by the patients “important” or “very important” for the decision to start hyposensitization: long-lasting symptom alleviation (100%), few adverse reactions (98.2%), comprehensive patient information (96.3%), easy integration into the daily routine (89.1%), re-assessment of therapy by doctor (83.3%) and reduced need for symptomatic medication (81.8%). Questionnaire D was filled in by 182 participants. 89% had already heard the term hyposensitization before. Their general knowledge regarding this therapy was average (3.23 on a scale of 1 – 6; where 1 = optimum). Long-lasting symptom alleviation (99.5%), comprehensive patient information (97.8%), easy integration into the daily routine (96.1%), reduced symptomatic medication use (92.6%) and re-assessment by doctor (88.8%) were considered “very important” or “important” characters in the desired immunotherapy regime. Adherence to the hyposensitization schedule is essential for its success. The treating doctor should aim at choosing the right therapy and working out a patient-individualized treatment plan. Equally important is offering information to the patient throughout the treatment duration. The doctor should assist the patient to create an optimized time schedule, to help make the therapy less time-consuming.
German version published in Allergologie, Vol. 34, No. 9/2011, pp. 441-446Correspondence to:
Prof. Dr. med. R. Mösges
Institut für Medizinische Statistik, Informatik und Epidemiologie
Universitätsklinikum Köln
Kerpener Straße 62
D–50937 Köln
Email: [email protected]
Review
Cytokines in sensitization to aeroallergens
M. Albrecht and A.-M. Dittrich
Page No. 94
Abstract
Allergologie select, Volume 2, Nr. 1/2018 (94-100)
Cytokines in sensitization to aeroallergens
M. Albrecht and A.-M. Dittrich
Nachwuchsgruppe SFB 587; Pädiatrische Pneumologie, Allergologie und Neonatologie, Medizinische Hochschule Hannover
Knowledge about the immunological mechanisms underlying asthma bronchiale is a prerequisite for development of new (causal) interventions. A large number of studies has proven asthma to be a complex disease with subtypes with different immunological features. Cytokines and chemokines, which are secreted by immune cells as well as structural cells play an important role not only in maintenance and amplification but have significant impact in the initiation of pulmonary inflammations – the asymptomatic sensitization phase. This article describes important immunological mediators in the context of the pulmonary sensitization phase. Moreover chances and constraints of intervention strategies aiming at these mediators are discussed. Several new aspects like classification of immunological phenotypes in bronchial asthma for individualized strategies and taking the sensitization phase into account, reveal possible targets among both “old acquaintances” like IL-4 and newly identified mediators (e.g. IL-17, IL-33).
German version published in Allergologie, Vol. 35, No. 9/2012, pp. 446-453Correspondence to:
Dr. phil. nat. Melanie Albrecht
AG Dittrich – SFB 587
I10-02-7380
Medizinische Hochschule Hannover
Carl-Neuberg-Straße 1
D-30625 Hannover
Email: [email protected]
Review
Workplace exposure to wood dust and the prevalence of wood-specific sensitization
V. Schlünssen, T. Sigsgaard, M. Raulf-Heimsoth and S. Kespohl
Page No. 101
Abstract
Allergologie select, Volume 2, Nr. 1/2018 (101-110)
Workplace exposure to wood dust and the prevalence of wood-specific sensitization
V. Schlünssen1, T. Sigsgaard1, M. Raulf-Heimsoth2 and S. Kespohl2
1Department of Public Health, Unit of Environmental and Occupational Medicine, Aarhus, Denmark, 2Institut für Prävention und Arbeitsmedizin der Deutschen Gesetzlichen Unfallversicherung, Institut der Ruhr-Universität Bochum (IPA), Bochum
Wood is processed worldwide, and occupational exposure to wood dust is affecting millions of workers. Studies have identified wood dust as a risk factor for non-malignant respiratory diseases consistent with both an allergic and a non-allergic origin. This paper summarizes our current knowledge on the importance of specific sensitization among subjects occupationally exposed to wood dust. Specific sensitization to wood dust exists, but is probably of minor importance for most wood species. In order to move the research field forward increased focus on more standardized tools for specific IgE (sIgE) diagnostics is needed and more specific tools are necessary to identify clinical relevant cases of wood dust sensitization. Moreover epidemiological studies on the occurrence of sIgE-mediated sensitization in different populations of woodworkers are needed.
German version published in Allergologie, Vol. 35, No. 8/2012, pp. 402-412Correspondence to:
Vivi Schlünssen, MD, PhD
Department of Public Health
Unit of Environmental and Occupational Medicine
Aarhus University
Bartholins Allé 2, bg 1260
8000 Aarhus C, Dänemark
Email: [email protected]
Original paper
Subcutaneous specific immunotherapy: Economic implications from the perspective of statutory health insurance – a population-based cost-effectiveness estimation
T. Reinhold, S. Willich and B. Brüggenjürgen
Page No. 111
Abstract
Allergologie select, Volume 2, Nr. 1/2018 (111-120)
Subcutaneous specific immunotherapy: Economic implications from the perspective of statutory health insurance – a population-based cost-effectiveness estimation
T. Reinhold, S. Willich and B. Brüggenjürgen
Institute for Social Medicine, Epidemiology and Health Economics, Charité - University Medicine, Berlin, Germany
Background: Specific immunotherapy is the only potentially curative therapy in patients with allergic rhinitis (AR) and allergic asthma (AA). The present study examined the effects of subcutaneous immunotherapy (SCIT) on the financial situation of the German statutory health insurance systems and measures the impact on AR/AA prevalence during the next decades. A further objective was to identify possible SCIT-treatment strategies in order to reach an efficient SCITuse.
Methods: Taking population projections of the German Statistical Federal Office, the number of expected new cases (AR, AA) was calculated until 2050. Based on assumptions about the proportion of patients who received SCIT in the future, age cohorts run through a model-calculation based on Markov chains. Data on effectiveness were extracted from published literature. For determining the cost situation of SCIT pharmacies we used selling prices for Allergovit®. All future costs are discounted at a mean rate of 2%. The model calculation was supplemented by a Delphi panel.
Results: Based on the current situation, a total annual economic burden of 540 million Euros is expected for care of about yearly 6 million patients with AR and AA in Germany between 2011 and 2050. Several scenarios have shown that the use of SCIT seems to be associated with cost savings from the perspective of statutory health insurances, when SCIT is offered to a larger amount of patients with moderate to severe symptoms. That would mainly driven by a reduced number of expensive patients who suffer from AA. The best effects on the future number of diseased patients could be achieved, however, if SCIT additionally would be applied to patients in earlier stages of disease. Due to the large number of patients receiving SCIT in such a scenario, the initial costs would not completely compensated by cost savings. Nevertheless, the additional costs of 300 to 350 Euros per additionally healed patient seem to be justifiable.
Conclusion: From the perspective of the SHI, SCIT is a useful strategic option for preventing the progression of allergic diseases. Particularly with increased use in early disease stages, the number of healed patients is high. Potential cost savings may result from increased treatment rates in patients with advanced disease stages.
German version published in Allergologie, Vol. 35, No. 11/2012, pp. 539-550Correspondence to:
Dr. rer. medic. T. Reinhold
Dipl. Gesundheitsökonom
Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie
Charité – Universitätsmedizin Berlin
Luisenstraße 57
D-10117 Berlin
Email: [email protected]
Review
Acquired and hereditary forms of recurrent angioedema: Update of treatment
K. Bork
Page No. 121
Abstract
Allergologie select, Volume 2, Nr. 1/2018 (121-131)
Acquired and hereditary forms of recurrent angioedema: Update of treatment
K. Bork
Universitäts-Hautklinik, Johannes-Gutenberg-Universität, Mainz
The aim of treatment of hereditary angioedema (HAE) due to C1 esterase inhibitor deficiency (HAE-C1-INH) is either treating acute attacks or preventing attacks by using prophylactic treatment. For treating acute attacks, plasma-derived C1 inhibitor (C1-INH) concentrates, a bradykinin B2 receptor antagonist, and a recombinant human C1-INH are available in Europe. In the United States, a plasma-derived C1-INH concentrate, a bradykinin B2 receptor antagonist, and a plasma kallikrein inhibitor were approved for the treatment of acute attacks. Fresh frozen plasma is also available for treating acute attacks. Short-term prophylactic treatment focuses on C1-INH and attenuated androgens. Long-term prophylactic treatments include attenuated androgens such as danazol, stanozolol, and oxandrolone, antifibrinolytics, and a plasma-derived C1-INH concentrate. Plasma-derived C1-INH and a bradykinin B2 receptor antagonist are admitted for selfadministration and home therapy. So the number of management options increased considerably within the last few years thus helping to diminish the burden of HAE.
German version published in Allergologie, Vol. 36, No. 3/2013, pp. 108-119Correspondence to:
Univ.-Prof. Dr. med. K. Bork
Universitäts-Hautklinik
Johannes-Gutenberg-Universität
Langenbeckstraße 1
D-55131 Mainz
Email: [email protected]
Review
Development of allergic airway inflammation in early life – interaction of early viral infections and allergic sensitization
E. Hamelmann for the Scientific Working Group “Forschung” (Research) of the GPA (German Society of Pediatric Allergology) and the Section “Pediatrics” of the DGAKI (German Society for Allergology and Clinical Immunology)
Page No. 132
Abstract
Allergologie select, Volume 2, Nr. 1/2018 (132-137)
Development of allergic airway inflammation in early life – interaction of early viral infections and allergic sensitization
E. Hamelmann for the Scientific Working Group “Forschung” (Research) of the GPA (German Society of Pediatric Allergology) and the Section “Pediatrics” of the DGAKI (German Society for Allergology and Clinical Immunology)
Klinik für Kinder- und Jugendmedizin, Ruhr-Universität Bochum
Airway inflammation is a key feature of upper and lower respiratory allergic diseases, such as allergic rhinitis and asthma. Characteristically, histological alterations such as goblet cell hyperplasia, mucus hypersecretion, loss of epithelial barrier function, airway infiltration and structural changes such as basal membrane thickening and airway smooth muscle hyperplasia. These inflammatory signs are often obvious already early in life and may be accompanied by structural changes (remodeling) occurring in early lifetime. This review focusses on the main mechanisms underlying the development of airway inflammation and remodeling and discusses the question which factors contribute to the persistence of airway inflammation in chronic allergic airway disease.
German version published in Allergologie, Vol. 36, No. 11/2013, p. 486-491Correspondence to:
Prof. Dr. med. E. Hamelmann
Klinik für Kinder- und Jugendmedizin
Ruhr-Universität Bochum
Alexandrinenstraße 5
D-44791 Bochum
Email: [email protected]
Original paper
Effects of intranasal mometasone furoate on blood pressure in patients with allergic rhinitis
O. Kartal, O. Baysan, M. Gulec, A.Z. Caliskaner, O. Sener and M. Karaayvaz
Page No. 138
Abstract
Allergologie select, Volume 2, Nr. 1/2018 (138-143)
Effects of intranasal mometasone furoate on blood pressure in patients with allergic rhinitis
O. Kartal1, O. Baysan2, M. Gulec1, A.Z. Caliskaner3, O. Sener1 and M. Karaayvaz4
1Gulhane Military Medical Academy and Medical School, Division of Immunology and Allergic Diseases, Ankara, Turkey, 2Guven Hospital, Clinic of Cardiology, Ankara, Turkey, 3Necmettin Erbakan University Meram Medical Faculty, Division of Immunology and Allergy, Konya, Turkey, 4Medicana Hospital, Clinic of Pediatric Allergy Ankara, Turkey
Background: Nasal congestion as the main symptom in patients with allergic rhinitis can impair nasal breathing. It causes hypoxia and concomitant sympathetic system activation which may also lead to increased blood pressure levels in these patients.
Objective: We postulated that appropriate therapy including intranasal steroids decreases blood pressure levels in patients with allergic rhinitis.
Methods: In our study, we investigated the effect of intranasal steroid (4 weeks of mometasone furoate) on blood pressure changes in 45 patients with allergic rhinitis whose main complaint was nasal congestion. We used ambulatory monitoring for determining blood pressure levels before and after intranasal steroid therapy. None of the patients had any other systemic diseases.
Results: We found a significant decrease of daytime systolic and diastolic blood pressures and mean blood pressure values (daytime systolic blood pressure: 120 vs. 117 mmHg, p = 0.024; daytime diastolic blood pressure: 73 vs. 71 mmHg, p = 0.027; daytime mean blood pressure: 86 vs. 83 mmHg, p = 0.007.). Although insignificant, we also found lower nighttime systolic and mean blood pressure values (nighttime systolic blood pressure: 109 vs. 107 mmHg, p = 0.182; nighttime mean blood pressure 77 vs. 73 mmHg, p = 0.116).
Conclusions: We found that posttreatment daytime average systolic, diastolic, and mean arterial blood pressure levels were significantly lower compared to values obtained during exacerbation of allergic rhinitis. Decrease in blood pressure with treatment of allergic rhinitis and nasal congestion suggests that nasal congestion and impaired nasal respiration may affect blood pressure and potentially cause serious problems in hypertensive patients with allergic rhinitis.
German version published in Allergologie, Vol. 38, No. 9/2015, pp. 471-476Correspondence to:
Ozgur Kartal, MD
Assistant Professor in Internal Medicine,
Immunology and Allergic Diseases
Gulhane Military Medical Academy and Medical School
Division of Immunology and Allergic Diseases
06018, Ankara, Turkey
Email: [email protected]
Original paper
The levels of CD4+CD25+ regulatory T cells in patients with allergic rhinitis
Y. Shaoqing, C. Yinjian, Y. Zhiqiang, Z. Ruxin, C. Na and G. Rongming
Page No. 144
Abstract
Allergologie select, Volume 2, No. 1/2018 (144-150)
The levels of CD4+CD25+ regulatory T cells in patients with allergic rhinitis
Y. Shaoqing1, C. Yinjian2, Y. Zhiqiang3, Z. Ruxin4, C. Na1 and G. Rongming1
1Department of Otolaryngology, Tongji Hospital, Tongji University, Shanghai, 2Department of Laboratory Medicine, Jinan General Hospital of PLA, Shandong, 3Department of Otolaryngology, Xuzhou 97th Hospital of PLA, Jiangsu, 4Department of Otolaryngology, Huadong Hospital, Fudan University, Shanghai, China
Background: The involvement of CD4+CD25+ regulatory T cells (CD4+CD25+ TRegs) in allergic diseases was reported previously. However, it remains unclear whether CD4+CD25+ TRegs are involved in allergic rhinitis (AR).
Methods: Fresh whole blood from 20 patients with AR and 16 healthy donors was used to investigate the frequency of CD4+CD25+ and CD4+CD25hi TReg cells using flow cytometry. In addition, serum total IgE (IU/mL) levels were determined using enzyme-linked immunosorbent assays.
Results: Patients with AR had fewer CD4+CD25+ TReg cells (2.80 ± 1.36% vs. 3.94 ± 0.97%, P < 0.01) and CD4+CD25hi TRegs (1.53 ± 0·62% vs. 2.00 ± 0.52%, P < 0.05) than control subjects. The number of CD4+CD25+ and CD4+CD25hi TRegs was correlated negatively with total immunoglobulin E levels (r = -0.79, P < 0.01 and r = -0.61, P < 0.01, respectively).
Conclusion: Deficient regulatory T cells might play a role in the development of AR.
German version published in Allergologie, Vol. 39, No. 3/2016, p. 109-115Correspondence to:
Yu Shaoqing
Department of Otolaryngology
Tongji Hospital
389 Xincun road, Putuo District
Shanghai city 200065, China
Email: [email protected]
Original paper
Associations between sensitization to perennial/seasonal allergens and childhood asthma
M. Kuzdak, J. Jerzynska, I. Stelmach, D. Podlecka, P. Majak, A. Janas, R. Stelmach and W. Stelmach
Page No. 151
Abstract
Allergologie select, Volume 2, Nr. 1/2018 (151-155)
Associations between sensitization to perennial/seasonal allergens and childhood asthma
M. Kuzdak1, J. Jerzynska2, I. Stelmach2, D. Podlecka2, P. Majak2, A. Janas3, R. Stelmach3 and W. Stelmach1
1Department of Social and Preventive Medicine, Social Medicine Institute, Medical University of Lodz, 2Department of Pediatrics and Allergy, Medical University of Lodz, Copernicus Memorial Hospital, 3Institute of Dental Surgery, Faculty of Medicine and Dentistry, Medical University of Lodz, Poland
Background: Childhood asthma is an important public health problem worldwide. Risk factors for asthma development include allergic sensitization and exposure to animals.
Objective: To identify which (perennial or seasonal) inhalant allergens are associated with asthma and allergic rhinitis in children
Methods: This was a cross-sectional, retrospective study. We evaluated data from medical documentation of 6,000 children (aged 6 – 18 years) with diagnosed asthma and/ or allergic rhinitis who had attended our allergy outpatient clinic. Into the analyses we included those subjects who during diagnostic procedures had specific IgE test done to confirm allergen sensitization.
Results: We included 5,076 children in the analysis. We showed that among seasonal allergens only sensitization to timothy or birch significantly changed the prevalence of allergic rhinitis and asthma diagnosis. Of the perennial allergens, house dust mite or cat were most closely related with both allergic rhinitis and asthma. Results of ROC curve analysis showed that in atopic children the specific IgE level of seasonal allergens did not significantly change the prevalence of asthma diagnosis. Sensitization to more than one perennial allergen significantly increased the prevalence of allergic rhinitis and asthma.
Conclusion: We showed that sensitization to the seasonal allergens timothy and birch as well as to the perennial allergens house dust mite and cat, is associated with asthma and allergic rhinitis in children. Our study determined the role of multiple perennial indoor allergens in the developement of allergic diseases in children. The identification of the specific allergens makes them potential targets for intervention and prevention strategies.
German version published in Allergologie, Vol. 40, No. 1/2017, pp. 23-28Correspondence to:
Wlodzimierz Stelmach, MD, PhD
Social Medicine Institute
Department of Social and Preventive Medicine
Medical University of Lodz
Żeligowskiego 7/9
90-752 Lodz, Polen
Email: [email protected]
