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Biomedical subjects

B Przybilla

Publications and source records attributed to B Przybilla.

At least 55 records · Page 3Linked to original sources
PubMed1999

[Desensitization of allergy to hymenoptera venoms].

Hyposensitization (immunotherapy) of hymenoptera venom allergy has been practised for 70 years. About 20 years ago the use of ineffective whole-body extracts was abandoned, as effective therapy with preparations of bee venom and wasp venom became available. The diagnosis of hymenoptera venom allergy is based on history, skin tests and determination of venom specific IgE-antibodies in the serum. Only rarely other tests are needed (histamine or leukotriene release tests, immunoblot, specific IgG antibodies). To achieve a definite diagnosis, all findings have to be considered carefully, as "false positive" and "false negative" results can occur in all test systems. Hyposensitization is indicated in all patients with systemic IgE-mediated immediate type reactions, only in children with exclusive skin symptoms it may not be needed. Contraindications of hyposensitization are to be considered. Allergen preparations for subcutaneous injection are available as aqueous preparations or as aluminium hydroxide-adsorbed depot extracts. Various rush or conventional treatment protocols are used to reach the maintenance dose of usually 100 micrograms venom/four weeks. The most frequent side effects are large local reactions, which are observed in almost all patients. Systemic anaphylactic side effects also occur in up to 40%, in most cases the symptoms are mild. To identify patients who are not protected by the usual maintenance dose, a sting challenge test with a living insect should be performed. By this, about 80 to 100% of the patients are found to be protected from systemic symptoms, and in those still reacting an increased dose of 200 micrograms (or even higher) eventually induces protection. Hyposensitization may be stopped if it lasted at least for 3 to 5 years, if systemic side-effects did not occur and if the patient has tolerated a sting challenge or a field-sting without systemic symptoms. In patients intensely exposed to hymenoptera or in those with an increased risk of severe reactions, longer treatment has to be considered.

Anaphylaxis↗
PubMed1998

Protective effect against sunburn of combined systemic ascorbic acid (vitamin C) and d-alpha-tocopherol (vitamin E).

BACKGROUND: UV radiation causes acute adverse effects like sunburn, photosensitivity reactions, or immunologic suppression, as well as long-term sequelae like photoaging or malignant skin tumors. UV radiation induces tissues to produce reactive oxygen species, eicosanoids and cytokines. Inhibition of these mediators might reduce skin damage. Antioxidants such as ascorbic acid and d-alpha-tocopherol have been found to be photoprotective in some in vitro studies and animal experiments. OBJECTIVE: Our purpose was to assess the protective effect of systemic vitamins C and E against sunburn in human beings. METHODS: In a double-blind placebo-controlled study, each of 10 subjects took daily either 2 gm of ascorbic acid (vitamin C) combined with 1000 IU of d-alpha-tocopherol (vitamin E) or placebo. The sunburn reaction before and after 8 days of treatment was assessed by determination of the threshold UV dose for eliciting sunburn (minimal erythema dose [MED]) and by measuring the cutaneous blood flow of skin irradiated with incremental UV doses against that of nonirradiated skin. RESULTS: The median MED of those taking vitamins increased from 80 to 96.5 mJ/cm2 (p < 0.01), whereas it declined from 80 to 68.5 mJ/cm2 in the placebo group. Cutaneous blood flow changed significantly (p < 0.05) for most irradiation doses with decreases in those given vitamins and increases in the placebo group. CONCLUSION: Combined vitamins C and E reduce the sunburn reaction, which might indicate a consequent reduced risk for later sequelae of UV-induced skin damage. The increase of sunburn reactivity in the placebo group could be related to "priming" by the previous UV exposure.

Administration, Oral↗
PubMed1998

Ultraviolet B radiation-induced production of interleukin 1alpha and interleukin 6 in a human squamous carcinoma cell line is wavelength-dependent and can be inhibited by pharmacological agents.

Ultraviolet (UV) B irradiation induces keratinocytes to produce among others the proinflammatory cytokines interleukin (IL) 1 and IL-6. The wavelength dependence of this UVB effect has not yet been assessed. We evaluated the potential of different UVB wavelength regions to release cytokines from the squamous carcinoma cell line SCL II and also assessed the effect of various putative inhibitors. Confluent monolayers of the cells were irradiated with 0.5-2.0 mJ/cm2 UVB at 280, 290, 300, 310 or 320 (each +/- 5) nm. In additional experiments dexamethasone (10-9-10-5 mol/L), ascorbic acid, d-alpha-tocopherol or indomethacin (each 10-7-10-4 mol/L) were added to the culture medium 24 h before, immediately after or combined before and after irradiation with 1 mJ/cm2 UVB at 280 +/- 5 nm. Supernatants of the cell cultures were recovered at 24 h after irradiation, and IL-1alpha or IL-6 were determined by an enzyme-linked immunosorbent assay (ELISA). IL-1alpha and IL-6 production were induced by UVB at 280, 290 and 300 nm, the production depended on the UV dose and decreased with increasing wavelengths. Irradiation at 310 or 320 nm did not induce cytokine production up to the maximum dose used. The production of IL-1 alpha/IL-6 was inhibited up to 80/89% (10-7-10-6 mol/L before and after irradiation) by dexamethasone in a concentration-dependent manner and with all conditions of incubation. Release of cytokines was also suppressed by indomethacin, d-alpha-tocopherol or ascorbic acid, but concentration dependence was not always evident. These results show that particularly shorter UVB radiation, which is expected to increase due to stratospheric ozone depletion, induces prominent production of proinflammatory cytokines, indicating major biological effects. Different pharmacological compounds can interfere with this effect and seem worth further evaluation with regard to their clinical effects.

Aged↗
PubMed1998

Natural rubber-latex allergy in patients not intensely exposed.

Immediate-type allergy to natural rubber latex (NRL) is common in highly exposed groups, particularly in health-care workers and patients with spina bifida. The occurrence of NRL allergy was investigated in subjects not belonging to such risk groups. A total of 493 patients presenting with various diseases for allergologic evaluation was studied. A questionnaire-based history was taken, skin prick tests with NRL milk and common aeroallergens were done, and NRL-specific serum IgE antibodies were measured. A total of 317 subjects (64.3%) was atopic. There were skin prick test reactions to NRL in 80 (16.2%) and NRL-specific IgE in the serum in 79 (16.0%) subjects; both were found in 25 patients (5.1%). Altogether, NRL sensitization was found in 134 patients (27.2%). By history and/or challenge tests, 13 subjects (2.6%) were diagnosed as having clinically relevant NRL allergy. In five of these, anaphylactic reactions had occurred during dental procedures, and in four during general anesthesia; 10 subjects reported immediate-type reactions to NRL products in daily life. All patients with clinically relevant NRL allergy had a skin prick test reaction to NRL milk (sensitivity 100%). Nine had specific IgE antibodies in the serum (sensitivity 69.2%); respective specificity was 86.0% or 85.4%. Nine of the 13 patients (69.2%) with NRL allergy were atopic. Despite exclusion of those at risk, many patients had clinically relevant allergy to NRL, and many of these had had severe reactions. NRL allergy is an important health issue also beyond the known risk groups.

Adolescent↗
PubMed1998

Tree-pollen allergy is efficiently treated by short-term immunotherapy (STI) with seven preseasonal injections of molecular standardized allergens.

The efficacy and tolerance of short-term immunotherapy (STI) by seven preseasonal injections of tree-pollen allergens (ALK7 Frühblühermischung) was investigated in a double-blind, placebo-controlled, multicenter study with 111 rhinoconjunctivitis patients. Nasal and bronchial symptoms simultaneously analyzed, and nasal symptoms as a single end point, but not the overall score of nasal, bronchial, and conjunctival symptoms, showed a significantly lower increase with STI during birch-pollen exposure (both P=0.033, n=105, Mann-Whitney U-test). However, a selective analysis with patients from centers with high recruitment figures (n> or =10 patients, n=29 STI, n=32 placebo) showed a significantly lower increase of nasal, bronchial, and overall symptom score (STI 11.0 vs placebo 18.0, P=0.001, U-test). STI had equidirected effects on conjunctival, nasal, and bronchial symptoms analyzed as multiple end points, although conjunctival symptoms were not significantly different as a single end point. The seasonal increase in drug use was reduced by 62% in the STI group compared with placebo (P=0.032, t-test). Specific IgG4 increased only after STI (P<0.001); IgE was not significantly different. Eosinophil cationic protein remained unchanged with STI, but significantly increased with placebo in the pollen season (P=0.003). STI was well tolerated. In conclusion, STI was shown to be efficacious and safe for the treatment of patients with tree-pollen rhinoconjunctivitis.

Adolescent↗
PubMed1997

[Latex allergy].

Explore the source record for details and available documents.

Condoms↗
PubMed1997

[Epidural lipomatosis as a complication of glucocorticoid treatment].

Epidural lipomatosis can be induced by systemic glucocorticoid treatment and may cause severe neurologic deficits. So far, 41 patients have been reported in the literature. Early recognition of this rare, relatively unknown, but extremely important side effect of exogenously administered glucocorticoids can help avoid persistent neurological sequelae.

Epidural Space↗
PubMed1997

Short-term immunotherapy: a prospective, randomized, double-blind, placebo-controlled multicenter study of molecular standardized grass and rye allergens in patients with grass pollen-induced allergic rhinitis.

BACKGROUND: Short-term immunotherapy (STI) can be beneficial for patients who are noncompliant with long-term specific immunotherapy. OBJECTIVE: The efficacy and tolerance of STI with seven preseasonal injections of molecular standardized allergens from grass and rye pollen has been investigated in a double-blind, placebo-controlled multicenter study with 87 patients at 12 German University hospitals. METHODS: Symptoms of the eyes, nose, and bronchi and use of symptomatic drugs were documented daily in diaries by patients with allergic rhinitis to grass and/or rye pollen and without bronchial asthma. Patients were monitored by skin prick test titration and measurement of levels of specific IgE and IgG4. RESULTS: The median nasal score for the 10 weeks with the strongest symptoms during the grass pollen season was significantly lower (p = 0.014) with 35.0 for STI (n = 41) versus 69.0 for placebo (n = 40); the overall symptom score was 54.0 for STI versus 97.5 for placebo (p = 0.020). Only STI-treated patients exposed to less than 40 pollen grains per cubic meter per week showed a significantly lower nasal symptom score of 39.0 versus 75.0 for placebo (p = 0.006); these patients also had fewer nasal symptoms and less use of topical nasal drugs (p < 0.001). The threshold dose in skin prick tests was significantly higher, being 9.06 histamine equivalent for skin prick test (HEP) for STI-treated patients who received the maximum dose (n = 22) versus 4.33 HEP for placebo (p = 0.005). Specific IgE levels were significantly higher, being 55.9 SU/ml for STI versus 39.2 SU/ml for placebo after seven injections (p = 0.006) and level of specific IgG4 was 5.36% for STI versus 1.28% for placebo (p < 0.001). No severe systemic reactions were observed. CONCLUSION: STI with seven preseasonal injections with molecular standardized allergens is effective and well tolerated.

Adolescent↗
PubMed1997

Phototoxic properties of neuroleptic drugs.

BACKGROUND: Photo-induced eruptions are well-known adverse effects of some neuroleptic drugs, particularly chlorpromazine. OBJECTIVE: By a photohemolysis test we assessed in vitro the phototoxic properties of 12 phenothiazines (chlorpromazine, dixyrazine, fluphenazine, levomepromazine, perazine, perphenazine, promazine, promethazine, prothipendyl, thioridazine, trifluoperazine, triflupromazine) and 5 thioxanthenes (chlorprothixene, clopenthixol, flupenthixol, thiothixene, zuclopenthixol). METHODS: Human erythrocytes from 3 donors were incubated with the compounds and irradiated with light sources rich in UVA or UVB, respectively. Doses were up to 100 J/cm2 UVA or up to 1,600 mJ/cm2 UVB. Photo-induced hemolysis was calculated as percentage of complete hemolysis. RESULTS: Photo-induced hemolysis >10% due to radiation rich in UVA was found with chlorpromazine (maximal median: 98%), dixyrazine (100%), fluphenazine (84%), perazine (100%), perphenazine (100%), promazine (16%), promethazine (25%), prothipendyl (96%), trifluoperazine (100%), triflupromazine (76%), chlorprothixene (100%) and thiothixene (31%). UVB-rich radiation induced hemolysis only with chlorpromazine (73%), dixyrazine (45%) and perazine (60%). CONCLUSION: Most neuroleptics are strongly phototoxic in vitro indicating a potential risk for photo-induced reactions also to occur in patients treated with these drugs.

Antipsychotic Agents↗