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ABSTRACT: Background: Erysipelas of the thigh and the gluteal region are rarely described and not well characterized. Therefore we aim to describe the prevalence, clinical characteristics, and risk factors of these erysipelas types. Methods: The files of 1,423 patients with erysipelas were analyzed. Data from patients with erysipelas of the thigh or the gluteal region were compared between the two groups and with a control group with erysipelas of the lower leg. Results: The thigh was exclusively affected in 2.1%, and the gluteal region in 0.6% of erysipelas patients. Gluteal erysipelas had conspicuous irregular borders and sometimes appeared bilaterally. Major risk factors for erysipelas of both sites were previous surgical interventions. Gluteal erysipelas was common in patients with the metabolic syndrome and required a more intense antibiotic therapy. Conclusion: Erysipelas of the thigh and the gluteal region are rare and significantly associated with prior surgical disruption of lymphatic vessels.
Dermatology 12/2012; · 2.05 Impact Factor
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Immunotherapy 11/2011; 3(11):1277-9. · 1.85 Impact Factor
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ABSTRACT: Nowadays, clinical and evidence based guidelines are considered one of the major efforts to improve patient care in medical practices as well as hospital settings. In the literature, clinical guidelines have been defined as "systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances", which promote both clinically effective standards and cost-effective care. Despite controversial discussion about the clinical impact of guidelines, they may provide workable recommendations that may thus be important for improving the individual patient's care. Adverse drug reactions (drug allergies, drug hypersensitivities) often represent a major hazard for the affected patient, and a definite diagnosis is important for further drug therapies in most cases. In this context, any diagnostic procedure must be preceded by an individual risk-benefit assessment. Drug provocation testing is regarded as the gold standard, but this kind of testing should be performed in accordance with established criteria and, in the vast majority of cases, in a hospital setting. In this paper we present a clinical guideline for drug provocation testing in Austria.
Wiener klinische Wochenschrift 09/2011; 123(19-20):585-91. · 0.81 Impact Factor
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Archives of dermatology 03/2011; 147(3):362-4. · 4.76 Impact Factor
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The Journal of allergy and clinical immunology 03/2011; 128(1):247-8; author reply 248. · 9.17 Impact Factor
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Torsten Zuberbier, Werner Aberer,
Knut Brockow,
Jürgen Grabbe,
Eckard Hamelmann,
Karin Hartmann,
Thilo Jakob,
Hans F Merk,
Markus Ollert,
Franziska Ruëff,
Peter Schmid-Grendelmeier,
Petra Staubach,
Ingrid Voigtmann,
Bettina Wedi,
Marcus Maurer
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ABSTRACT: Abschnitte jedoch unverändert übernommen. Bei-de Abschnitte sind von derselben Autorengruppe gleichzeitig bearbeitet worden, aber die Autoren-reihenfolge der Abschnitte differiert, um die un-terschiedlichen Involvierungen der Arbeitsschritte zu dokumentieren. Die Leitlinie besteht aus zwei Abschnitten, die ursprünglich als separate Leitlinien angemeldet wurden, da sie auf einer Übersetzung und Bearbei-tung der englischen Originale beruhen, die separat publiziert wurden. Für die deutsche Version wur-den diese unter einem Titel zusammengefasst, die
Allergo Journal: interdisziplinäre Zeitschrift für Allergologie und Umweltmedizin: Organ der Deutschen Gesellschaft für Allergie- und Immunitätsforschung 01/2011; 20:249-58.
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ABSTRACT: Nowadays, clinical and evidence based guidelines are considered one of the major efforts to improve patient care in medical practices as well as hospital settings. In the literature, clinical guidelines have been defined as "systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances", which promote both clinically effective standards and cost-effective care [1–4]. Despite controversial discussion about the clinical impact of guidelines [5, 6], they may provide workable recommendations that may thus be important for improving the individual patient's care [1, 4]. Adverse drug reactions (drug allergies, drug hypersensitivities) often represent a major hazard for the affected patient, and a definite diagnosis is important for further drug therapies in most cases. In this context, any diagnostic procedure must be preceded by an individual risk-benefit assessment. Drug provocation testing is regarded as the gold standard, but this kind of testing should be performed in accordance with established criteria and, in the vast majority of cases, in a hospital setting. In this paper we present a clinical guideline for drug provocation testing in Austria.
Wiener Klinische Wochenschrift. 01/2011; 123:585-591.
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ABSTRACT: The term histamine intolerance stands for a range of symptoms involving various effector organs after the consumption of histamine-rich food. Our intention was to objectify and quantify histamine-associated symptoms and to analyse whether oral administration of the histamine-degrading enzyme diamine oxidase (DAO) caused a reduction of symptoms.
Four Austrian centres participated. Patients suspected to be histamine intolerant were recruited. The first step consisted in the open oral provocation of these patients with 75 mg of liquid histamine. Patients who developed symptoms were tested in a randomised double blind crossover provocation protocol using histamine-containing and histamine-free tea in combination with DAO capsules or placebo. Main and secondary symptoms (strongest and weaker symptoms based on a ten-point scale) were defined, the grand total of all symptoms of the individual provocation steps was determined and changes in symptoms after administration of DAO were measured.
Thirty nine patients reacted to the open histamine provocation and were enrolled in the blinded part. Here, both the main and secondary symptoms were not reproducible. Subjects reacted sometimes unexpectedly and randomly. Regarding the total symptom scores, the differences between the three treatment groups were statistically significant. The intake of DAO demonstrated a statistically significant reduction of histamine-associated symptoms compared to placebo (P = 0.014).
Oral provocation with 75 mg of liquid histamine failed to reproduce histamine-associated single symptoms in many patients. One may suggest that histamine-intolerant subjects reacted with different organs on different occasions. As a consequence, reproducibility of single symptoms alone may not be appropriate to diagnose histamine-intolerance whereas a global symptom score could be more appropriate. The fact, that the intake of DAO capsules compared to placebo led to a statistically significant reduction of total symptom scores, may indirectly point in the same direction.
Wiener klinische Wochenschrift 01/2011; 123(1-2):15-20. · 0.81 Impact Factor
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Marija Geroldinger-Simic,
Thomas Zelniker, Werner Aberer,
Christof Ebner,
Cornelia Egger,
Antonia Greiderer,
Nicole Prem,
Jonas Lidholm,
Barbara K Ballmer-Weber,
Stefan Vieths,
Barbara Bohle
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ABSTRACT: Patients with birch pollen allergy often develop allergic reactions to plant foods.
To evaluate the prevalence, main symptoms, and triggers of birch pollen-related food allergy and the role of food-specific IgG(4) antibodies in food tolerance.
Food-induced symptoms were evaluated in 225 individuals with birch pollen allergy by using a standardized questionnaire. IgE and IgG(4) levels specific for the major birch pollen allergen Bet v 1 and birch profilin Bet v 2 and the Bet v 1 homologs in apple (Mal d 1) and hazelnut (Cor a 1) were quantified by ImmunoCAP. Mock-treated and IgG-depleted sera from patients tolerating hazelnuts in food challenges were compared for their inhibitory activity for binding of Cor a 1-IgE complexes to B cells.
In total, 73% of the study population experienced food allergy, which was perennial in 86% of the affected individuals. The oral allergy syndrome was the main clinical manifestation. However, more than 58% of the patients also experienced food-induced rhinoconjunctivitis. Apples and hazelnuts were identified as the most frequent triggers. Food allergy correlated with IgE reactivity to Bet v 1 but not to Bet v 2. Mal d 1-specific and Cor a 1-specific IgG(4)/IgE ratios were significantly higher in food-tolerant individuals than individuals with food allergy. Sera from IgG(4)-positive food-tolerant patients possessed IgG-dependent IgE-inhibitory activity.
Birch pollen-related food allergy is highly prevalent and often perennial. High food allergen-specific IgG(4)/IgE ratios seem associated with food tolerance, potentially because specific IgG(4) blocks IgE binding to food allergens. Thus, the presence of food allergen-specific IgG(4) antibodies is no diagnostic marker for birch pollen-related food allergy.
The Journal of allergy and clinical immunology 01/2011; 127(3):616-22.e1. · 9.17 Impact Factor
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Gunter J Sturm,
Chunsheng Jin,
Bettina Kranzelbinder,
Wolfgang Hemmer,
Eva M Sturm,
Antonia Griesbacher,
Akos Heinemann,
Jutta Vollmann,
Friedrich Altmann,
Karl Crailsheim,
Margarete Focke, Werner Aberer
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ABSTRACT: Double sensitization (DS) to bee and vespid venom is frequently observed in the diagnosis of hymenoptera venom allergy, but clinically relevant DS is rare. Therefore it is sophisticated to choose the relevant venom for specific immunotherapy and overtreatment with both venoms may occur. We aimed to compare currently available routine diagnostic tests as well as experimental tests to identify the most accurate diagnostic tool.
117 patients with a history of a bee or vespid allergy were included in the study. Initially, IgE determination by the ImmunoCAP, by the Immulite, and by the ADVIA Centaur, as well as the intradermal test (IDT) and the basophil activation test (BAT) were performed. In 72 CAP double positive patients, individual IgE patterns were determined by western blot inhibition and component resolved diagnosis (CRD) with rApi m 1, nVes v 1, and nVes v 5.
Among 117 patients, DS was observed in 63.7% by the Immulite, in 61.5% by the CAP, in 47.9% by the IDT, in 20.5% by the ADVIA, and in 17.1% by the BAT. In CAP double positive patients, western blot inhibition revealed CCD-based DS in 50.8%, and the CRD showed 41.7% of patients with true DS. Generally, agreement between the tests was only fair and inconsistent results were common.
BAT, CRD, and ADVIA showed a low rate of DS. However, the rate of DS is higher than expected by personal history, indicating that the matter of clinical relevance is still not solved even by novel tests. Furthermore, the lack of agreement between these tests makes it difficult to distinguish between bee and vespid venom allergy. At present, no routinely employed test can be regarded as gold standard to find the clinically relevant sensitization.
PLoS ONE 01/2011; 6(6):e20842. · 4.09 Impact Factor
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ABSTRACT: Vorstände der Arbeitsgruppe Allergologie der ÖGDV Leitlinien-Stufe: S-1, informelle Konsensbildung von mit der Thematik vertrauten Experten (Fachärzten für Dermatologie und Venerologie) Verfahren zur Konsensbildung: Komissionssitzungen der Fachgruppe Allergologie der Österreichischen Gesellschaft für Dermatologie und Venerologie (ÖGDV) Expertengruppe/Mitarbeit (alphabetisch): Beirat der Arbeitsgruppe Allergologie der ÖGDV: Prim. Prof. Dr. Werner Aberer (Univ.-Klinik für Dermatologie und Venerologie, 8036 Graz werner.aberer@medunigraz.at), Dr. Johann Derhaschnig (FA für Dermatologie, 9400 Wolfsberg, ordination@derhaschnig.com), OA Dr. Daevi Ferch-Haselbach (LKH Klagenfurt, Dermatologi-sche Abteilung, 9026 Klagenfurt, daevi.ferch@kabeg.at), OA Dr. Thomas Hawranek, Paracelsus Medizinische Privatuniversität Salzburg, Univ.-Klinik für Dermatologie, 5020 Salzburg, t.hawranek@salk.at), Doz. Dr. Wolfgang Hemmer (Floridsdorfer Allergie-zentrum, 1210 Wien, hemmer@faz.at), Prof. Dr. Reinhart Jarisch (Floridsdorfer Allergiezentrum, 1210 Wien, jarisch@faz.at), OÄ Dr. Nicole Kemmler (LKH Feldkirch, Abt. Für Dermatologie, 6897 Feldkirch, Nicole.Kemmler@lkhf.at), Dr. Adelheid Kienzl (FÄ für Dermatologie, 3100 St. Pölten, a.kienzl@aon.at), OÄ Prof. Dr. Tamar Kinaciyan (Univ.-Klinik für Dermatologie, Abt. für Immunder-matologie und infektiöse Hautkrankheiten, 1090 Wien, Tamar.Kinaciyan@meduniwien.ac.at), Prim. Doz. Dr. Georg Klein (Dermatologische Abt. KH der Elisabethinen, 4020 Linz, georg.klein@elisabethinen.or.at), Doz. Dr. Heinz Kofl er (Allergieambula-torium, 6060 Hall in Tirol, heinz.kofl er@kofl er-haut.at), OA Prof. Dr. Birger Kränke (Univ.-Klinik für Dermatologie und Venerologie, 8036 Graz, birger.kraenke@medunigraz.at), Dr. Udo Längle (FA für Dermatologie, 6850 Dornbirn, r.laengle@hautarzt.at), Prim. Dr. Wolf Pachinger (LKH Klagenfurt, Dermatologische Abteilung, 9026 Klagenfurt, wolf.pachinger@lkh-klu.at), OA Dr. Detlev Pirkhammer (Dermatologische Abteilung der Krankenanstalt Rudolfstiftung, 1030 Wien, ordination@gesunde-haut.at), Prof. Dr. Norbert Reider (Univ.-Klinik für Dermatologie und Venerologie, 6020 Innsbruck, norbert.reider@i-med.ac.at), OA Doz. Dr. Paul Sator (Dermatologie KH Hietzing, 1130 Wien, paul.sator@wienkav.at), Prim. Prof. Dr. Georg Stingl (Univ.-Klinik für Dermatologie, Abt. für Immundermatologie und infektiöse Hautkrankheiten, 1090 Wien, georg.stingl@meduniwien.ac.at), OA Dr. Alexander Trost (Abteilung für Dermatologie, Wilhelminenspital, 1160 Wien, alexander.trost@wienkav.at), em. OA Dr. Manfred Wohofsky (FA für Dermatologie, 9020 Klagenfurt, wohofsky.manfred@aon.
Wiener klinische Wochenschrift 01/2011; · 0.81 Impact Factor
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ABSTRACT: Anogenital warts are a common sexually transmitted disease caused by human papillomaviruses. Despite the fact, that imiquimod and podophyllotoxin represent common topical agents, direct comparative studies lack. This work compares the effectiveness and safety of self-applied imiquimod 5% cream and podophyllotoxin 0.5% solution.
Within 2 years, consecutive patients presenting with untreated anogenital warts were included in a randomized, open label trial. The primary endpoint was complete clearance at the end of treatment (4 weeks after the start with podophyllotoxin, 16 weeks after the start of imiquimod therapy). Side effects were evaluated as a secondary endpoint.
A total of 45 patients, 7 women and 35 men, of whom 5 were circumcised, concluded the treatment and were eligible for evaluation. The rates of clearance of baseline warts among treatment groups were 72% (95% confidence interval [CI], 52%-86%) in the podophyllotoxin group and 75% (95% CI, 53%-98%) in the imiquimod group. Statistically, clearance rates were identical (P=1). The differences in side effects between treatment groups were statistically not significant (P=0.24).
The current study, a direct comparison of both, confirms the previously obtained mathematical data, that imiquimod 5% cream and podophyllotoxin 0.5% solution have an identical beneficial effect on anogenital warts and are associated with identical and acceptable side effects. Both substances constitute effective and safe treatments of untreated anogenital warts in immunocompetent individuals.
Sexually transmitted diseases 10/2010; 38(3):216-8. · 2.58 Impact Factor
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ABSTRACT: The basophil activation test (BAT) based on CD203c upregulation has been validated as a reliable tool for the diagnosis of IgE-mediated allergies. Nevertheless, CD203c-based BAT is hardly comparable with that of CD63-based tests, as the mechanisms of CD203c versus CD63 induction differ considerably. The aim of the present study was to identify potent influencing factors of the CD203c-based BAT and to emphasize differences between CD63 and CD203c detection.
CD203c-based BAT was determined in 82 healthy controls and in 79 allergic patients. The effects of interleukin (IL)-3 and degranulation enhancing substances were investigated and compared with CD63 upregulation. Furthermore, the influence of different storage conditions and incubation times was evaluated and the impact of antiallergic drugs on the test results was assessed.
CD203c and CD63 expression was rapidly upregulated reaching a maximum after 20-30 min. Basophil CD203c upregulation assayed after storage times up to 48 h declined already after 4 h. IL-3 treatment increased CD203c and CD63 baseline levels and decreased basophil CD203c responses in a dose-dependent manner. In contrast, cytochalasin B and latrunculin B did not affect CD203c responses but decreased CD63-based BAT. Finally, therapeutic concentrations of dimetindene and desloratadine did not affect CD203c upregulation.
CD203c-based basophil activation test should be performed preferentially within 4 h after taking the blood samples. Priming and degranulation-enhancing factors are not required for CD203c-based BAT. In contrast to skin testing, CD203c-based BAT can be performed in patients undergoing antiallergic treatment. © 2010 International Clinical Cytometry Society.
Cytometry Part B Clinical Cytometry 09/2010; 78(5):308-18. · 2.53 Impact Factor
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Franziska Ruëff,
Bernhard Przybilla,
Maria Beatrice Biló,
Ulrich Müller,
Fabian Scheipl, Werner Aberer,
Joëlle Birnbaum,
Anna Bodzenta-Lukaszyk,
Floriano Bonifazi,
Christoph Bucher, [......],
Thomas Hawranek,
Iwona Kucharewicz,
Helmut Küchenhoff,
Roland Lang,
Oliviero Quercia,
Norbert Reider,
Maurizio Severino,
Michael Sticherling,
Gunter Johannes Sturm,
Brunello Wüthrich
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ABSTRACT: Severe side effects during venom immunotherapy (VIT) are associated with a variety of risk factors.
Our aim was to evaluate the association of baseline serum tryptase concentration (BTC) and of other parameters, which are routinely recorded during patient evaluation, with the frequency of severe reactions requiring an emergency intervention during the buildup phase of VIT.
In this observational prospective multicenter study, we enrolled 680 patients with established honeybee or vespid venom allergy who underwent VIT. Data were collected on tryptase concentration, age, sex, culprit insect, cardiovascular medication, degree of preceding sting reaction, preventive antiallergic medication before therapy, time between last preceding sting reaction and VIT, venom specific IgE concentration, and type of buildup procedure. Relative rates were calculated with generalized additive models.
Fifty-seven patients (8.4%) required an emergency intervention during buildup because of a severe systemic reaction. The frequency of interventions increased significantly with higher BTC (log-linear association; adjusted odds ratio, 1.56; 95% CI, 1.15-2.11; P < .005). The predictive power of BTC was markedly greater when VIT was performed for vespid venom allergy than for bee venom (for bee VIT, no significant association; for vespid VIT, log-linear association; adjusted odds ratio, 2.33; 95% CI, 1.28-4.26; P = .005). The most important other factor significantly associated with severe reactions during the buildup phase of VIT was bee venom allergy.
Before vespid VIT, measurement of baseline serum tryptase concentration should be used to identify patients with a high risk for side effects. Patients with bee venom allergy require a particularly high degree of surveillance during VIT.
The Journal of allergy and clinical immunology 07/2010; 126(1):105-11.e5. · 9.17 Impact Factor
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ABSTRACT: The identification of the disease-causing insect in venom allergy is often difficult.
To establish recombinant allergen-based IgE tests to diagnose bee and yellow jacket wasp allergy.
Sera from patients with bee and/or wasp allergy (n = 43) and patients with pollen allergy with false-positive IgE serology to venom extracts were tested for IgE reactivity in allergen extract-based tests or with purified allergens, including nonglycosylated Escherichia coli-expressed recombinant (r) Api m 1, rApi m 2, rVes v 5, and insect cell-expressed, glycosylated rApi m 2 as well as 2 natural plant glycoproteins (Phl p 4, bromelain).
The patients with venom allergy could be diagnosed with a combination of E coli-expressed rApi m 1, rApi m 2, and rVes v 5 whereas patients with pollen allergy remained negative. For a group of 29 patients for whom the sensitizing venom could not be identified with natural allergen extracts, testing with nonglycosylated allergens allowed identification of the sensitizing venom. Recombinant nonglycosylated allergens also allowed definition of the sensitizing venom for those 14 patients who had reacted either with bee or wasp venom extracts. By IgE inhibition studies, it is shown that glycosylated Api m 2 contains carbohydrate epitopes that cross-react with natural Api m 1, Ves v 2, natural Phl p 4, and bromelain, thus identifying cross-reactive structures responsible for serologic false-positive test results or double-positivity to bee and wasp extracts.
Nonglycosylated recombinant bee and wasp venom allergens allow the identification of patients with bee and wasp allergy and should facilitate accurate prescription of venom immunotherapy.
The Journal of allergy and clinical immunology 06/2010; 125(6):1300-1307.e3. · 9.17 Impact Factor
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The Lancet Infectious Diseases 04/2010; 10(4):288. · 17.39 Impact Factor
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International Archives of Allergy and Immunology 01/2010; 153(2):107-8. · 2.40 Impact Factor
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ABSTRACT: An 8-year-old boy developed vesicular lesions on the skin in different parts of the body, occurring four to six times a year. He had a history of eczema herpeticum as a young child. We confirmed a diagnosis of multifocal herpes simplex infection, and hypothesize that this was a result of his previous eczema herpeticum, an unusual complication, in an otherwise healthy and immunocompetent child.
Pediatric Dermatology 01/2010; 27(1):113-4. · 1.07 Impact Factor
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ABSTRACT: Hypersensitivity reactions against nonsteroidal antiinflammatory drugs (NSAIDs) like diclofenac (DF) can manifest as Type I-like allergic reactions including systemic anaphylaxis. However, except for isolated case studies experimental evidence for an IgE-mediated pathomechanism of DF hypersensitivity is lacking. In this study we aimed to investigate the possible involvement of drug- and/or metabolite-specific antibodies in selective DF hypersensitivity.
DF, an organochemically synthesized linkage variant, and five major Phase I metabolites were covalently coupled to carrier proteins. Drug conjugates were analyzed for coupling degree and capacity to crosslink receptor-bound IgE antibodies from drug-sensitized mice. With these conjugates, the presence of hapten-specific IgE antibodies was investigated in patients' samples by ELISA, mediator release assay, and basophil activation test. Production of sulfidoleukotrienes by drug conjugates was determined in PBMCs from DF-hypersensitive patients. All conjugates were shown to carry more than two haptens per carrier molecule. Immunization of mice with drug conjugates induced drug-specific IgE antibodies capable of triggering mediator release. Therefore, the conjugates are suitable tools for detection of drug-specific antibodies and for determination of their anaphylactic activity. Fifty-nine patients were enrolled and categorized as hypersensitive either selectively to DF or to multiple NSAIDs. In none of the patients' samples evidence for drug/metabolite-specific IgE in serum or bound to allergic effector cells was found. In contrast, a small group of patients (8/59, 14%) displayed drug/metabolite-specific IgG.
We found no evidence for an IgE-mediated effector mechanism based on haptenation of protein carriers in DF-hypersensitive patients. Furthermore, a potential involvement of the most relevant metabolites in DF hypersensitivity reactions could be excluded.
PLoS ONE 01/2010; 5(10):e13707. · 4.09 Impact Factor
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ABSTRACT: Schnitzler syndrome is a rare disease characterized by a chronic urticarial eruption and monoclonal gammopathy, as well as clinical and laboratory signs of inflammation. The pathophysiology is still unknown, although various autoantibody-mediated mechanisms have been described. Complete remission of symptoms has been reported recently in patients with Schnitzler syndrome treated with anakinra, an interleukin-1 receptor antagonist.
Two patients with Schnitzler syndrome treated with anakinra therapy are presented.
We report two cases of nearly complete remission of symptoms in Schnitzler syndrome after the initiation of anakinra therapy, and the first observation of a relapse under continuous daily anakinra therapy. A review of the published literature on the treatment of Schnitzler syndrome with anakinra is presented.
Based on published data, monotherapy with anakinra is currently the most promising treatment for Schnitzler syndrome, because it is able to induce complete remission of symptoms.
International journal of dermatology 11/2009; 48(11):1190-4. · 1.18 Impact Factor
