Gerold Kick’s research while affiliated with Ludwig-Maximilians-Universität in Munich and other places

Despite its worldwide and abundant consumption, beer has rarely been found to cause anaphylaxis. Barley malt contained in lager beers seems to be an important elicitor. To report the unusual case of severe anaphylaxis following the ingestion of wheat beer. A 59-year-old man experienced angioedema, generalized urticaria, and unconsciousness after ingestion of wheat beer. He tolerated lager beer well. For diagnostic evaluation, skin prick tests, oral challenge tests, and identification of specific IgE antibodies were performed. Skin prick test results with standard series of common aeroallergens and food allergens were negative with the exception of a 1 + reaction to wheat flour. The results of skin prick tests with native materials were positive for 2 brands of wheat beer and wheat malt shred but negative for baker's yeast, hops, and a brand of lager beer. Oral challenges with wheat beer or wheat flour elicited urticaria. By CAP-FEIA, specific IgE antibodies to wheat and barley flour but not to hops or baker's yeast were found in serum. Immunoblot analysis revealed that patient's IgE was bound to a protein of approximately 35 kDa in wheat extract. This is the first report, to our knowledge, on anaphylaxis to beer attributable to wheat allergy.

Background Delayed type allergy to heparin, which can cause skin reactions to subcutaneously administered heparin, is not rare. If further heparin therapy is necessary, management is problematic. Case reports We report the cases of two female patients who had developed erythematous infiltrations at the injection sites of subcutaneously applied heparin. Few days before an urgent bypass operation, the patients presented for allergologic diagnostics to assess what intraoperative antithrombotic treatment could be used. Allergological investigations revealed erythematous infiltrations typical of delayed-type reactions to the intradermal test with heparin sodium and to the subcutaneous challenge with danaparoid sodium, which had been considered to be used as a substitute for heparin. Considering all circumstances, intravenous administration of heparin sodium was chosen as the most reliable anticoagulant regimen despite the allergic reaction to subcutaneous heparin. After intravenous premedication with corticosteroids and H1- and H2-blocking antihistamines, intravenous heparin sodium was tolerated without reaction intraoperatively. Conclusions In both patients intravenous heparin was tolerated despite a delayed type reaction to subcutaneously administered heparin. As such tolerance is not predictable, careful consideration of risk and benefit as well as careful observation of the patient are necessary in case this approach is used.

Although chronic widespread dermatophyte infection is reported widely in the literature, neither a uniform nomenclature, nor even a clear definition of this syndrome have been established so far. Thus, we suggest Trichophyton rubrum syndrome (TRS) for denomination and define the following obligatory clinical and mycological criteria for TRS. (A) Skin lesions at the following four sites: (1) feet, often involving soles; (2) hands, often involving palms; (3) nails; and (4) at least one lesion in another location than (1) (2) or (3), except for groins. (B) Positive microscopic analyses of potassium hydroxide preparations of skin scrapings in all four locations. (C) Identification of Trichophyton rubrum by cell culture at three of the four locations at least. For diagnosis of TRS the criteria (A) and (B) and (C) have to be fulfilled. This standardization is a prerequisite for further investigations of underlying mechanisms of this disease. The typical clinical pattern of TRS is illustrated by the presentation of two paradigmatic cases.

Background: Delayed type allergy to heparin, which can cause skin reactions to subcutaneously administered heparin, is not rare. If further heparin therapy is necessary, management is problematic. Case reports: We report the cases of two female patients who had developed erythematous infiltrations at the injection sites of subcutaneously applied heparin. Few days before an urgent bypass operation, the patients presented for allergologic diagnostics to assess what intraoperative anti-thrombotic treatment could be used. Allergological investigations revealed erythematous infiltrations typical of delayed-type reactions to the intradermal test with heparin sodium and to the subcutaneous challenge with danaparoid sodium, which had been considered to be used as a substitute for heparin. Considering all circumstances, intravenous administration of heparin sodium was chosen as the most reliable anticoagulant regimen despite the allergic reaction to subcutaneous heparin. After intravenous premedication with corticosteroids and H1- and H2-blocking antihistamines, intravenous heparin sodium was tolerated without reaction intraoperatively. Conclusions: In both patients intravenous heparin was tolerated despite a delayed type reaction to subcutaneously administered heparin. As such tolerance is not predictable, careful consideration of risk and benefit as well as careful observation of the patient are necessary in case this approach is used.

Ectopic late cutaneous schistosomiasis is usually preceded or accompanied by visceral schistosomiasis infection. Our patient presented the very rare case of late cutaneous schistosomiasis as an isolated skin manifestation. Perigenital lesions occurred 1 year after contact with infested water. Identification of the few eggs remaining in the late lesion among the dense cellular infiltrate was difficult. Electron-microscopic studies clearly demonstrated the characteristic eggshell ultrastructure. Copyright (C) 2000 S. Karger AG, Basel.

For various skin diseases long-term administration of glucocorticosteroids is established as therapy of first choice (1). Some of the frequent adverse drug reactions like hyperglycemia and hypertension can be antagonized, thus reducing complications and rate of discontinuation. Regarding osteoporosis, the situation is different. So far estrogens, anabolic steroids, thiazide diuretics, cholecalciferol and calcitonin have been used for prevention and management of glucocorticosteroid-induced osteoporosis. However, studies upon the efficacy of these regimens published so far show conflicting evidence (2-4). Encouraging results of recently published studies prove bisphhosphonates to represent first-line treatment of glucocorticosteroid-induced osteoporosis (5-8). This summary outlines the pathophysiology of glucocorticosteroid-induced osteoporosis, the required diagnostic steps preceding a long-term treatment by glucocorticosteroids and the common measures of osteoporosis prevention. Furthermore mechanisms of the action of bisphosphonates are demonstrated and the results of studies upon different bisphosphonates are discussed.