Biomedical subjects
Publications and source records attributed to D Vieluf.
The case of a young suckling is reported in whom widespread candidosis of the napkin area was followed by the clinical signs of both erythema multiforme and dermatitis seborrhoides infantum. Both these diseased states are considered as candidids.
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The fall of the Berlin wall in 1989 offered the unique opportunity to compare populations of a similar genetic and geographic background which had been living under quite different environmental exposure conditions for over 40 years. Since 1990 comparative epidemiological studies were performed between various regions in former East and West Germany with yearly questionnaires and 3 years' physical, dermatological, allergological and exposure examination in a total of about 30,000 preschool children. There were striking differences between the various German regions with higher prevalence rates of respiratory atopy (hay fever, asthma) and atopic sensitization (prick test, RAST) in West Germany, while atopic eczema was significantly higher in East Germany (17.5 vs. 11.4% in West Germany). Total serum IgE levels were markedly higher in children in the east of Germany, similarly to the prevalence of parasitic infestation (questionnaire data as well as positive ascaris RAST). In multivariate logistic regression analysis the following factors were significantly associated with atopic eczema: animal contact (odds ratio, OR 2.9), animal furs in the bedroom (OR 2.2), use of gas without ventilation (OR 1.7) and living near road with heavy traffic (OR 1.7). Furthermore, socioeconomic factors measured as parental educational status (university vs. elementary school) were significantly associated (OR 2.3) with atopy. Respiratory tract infections and irritant responses decreased together with decreasing SO2 and suspended particulate air pollution in East Germany from 1991 to 1997. It is concluded that environmental factors from the physical, chemical, biological, and psychological environment (characteristic of a 'modern' or 'western' society) do influence the development of atopic sensitization and disease.
'Mild' analgesic preparations (MAPs) are well known elicitors of anaphylactoid reactions (ARs). The identification of the causative agent is often difficult since reliable skin tests or in vitro methods are not available. In 128 patients (32 males, 96 females) with a history of ARs to MAPs containing only one single analgesic compound, placebo-controlled oral provocation tests (OPTs) were performed. Among 100 of them undergoing the OPT with the suspected drug, there was a concordance between the patient's history and the OPT in 44 patients. Concomitant ARs to other mild analgesics (without a history of previous incompatibility) were observed in 113 of 413 OPTs, but in almost all cases one or more alternative analgesics were tolerated in the OPT. Our results confirm that the OPT remains at present the most reliable diagnostic procedure alongside a comprehensive history in patients with ARs to MAPs. Because many of the patients showed concomitant ARs to unsuspicious analgesics OPTs should include a standard battery of different analgesics. The simple recommendation of one single preparation, such as acetaminophen, as a 'safe' substitute without an OPT is not recommended.
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The atopy patch test (APT) is a procedure involving epicutaneous patch tests with allergens known to elicit IgE-mediated reactions and the evaluation of eczematous skin lesions. APT can be performed on normal uninvolved skin without artificial manipulations such as tape stripping or use of irritants. APT has been standardized regarding the use of vehicle and dose response relationships. In several studies, approximately two thirds of patients with atopic eczema (AE) showed positive APT reactions to aeroallergens, most frequently to house dust mite. Positive APT reactions were significantly more frequent in patients with a typical air-exposed eczematous distribution pattern. Using evaporimetry to study transepidermal water loss, allergen-induced disturbance of epidermal barrier functions was found to be significantly more pronounced on APT reactions compared to classical contact allergy patch test sites in the same individual. It has been shown that with APT eczematous skin lesions can be elicited by skin contact with aeroallergens, at least in a subgroup of patients with AE, and thereby, that IgE-mediated allergy does play a role in the etiopathophysiology of this disease. Future studies should help to bring this test into clinical routine in order to establish an equivalent for 'skin provocation' comparable to nasal and bronchial provocation tests in respiratory allergy.
Earlier epidemiologic studies within Germany found a higher frequency of allergic sensitization in West Germany. The reasons for that and the role of environmental factors in the process of allergic sensitization are not fully understood. This study aimed to determine the prevalence of positive skin-prick test results 5 years after unification and to investigate risk factors for allergic sensitization in preschool children. A total of 1235 children (5-6 years) from two West and five East German locations were skin-prick tested after the compulsory school entrance examination. Six common aero- (birch, grass, mugwort pollen, cat, HDM, alternaria) and two food allergens (egg, milk) were used and additional information was obtained by questionnaire. Of the tested children 23.3% exhibited at least one positive reaction. The prevalence of sensitization to the single allergens was as follows: grass (14.4%), birch (6.6%), mugwort pollen (4.5%), cat (8.5%), HDM (5.5%), alternaria (4.9%), egg (2.8%), and milk (3.9%). In the crude analysis significantly more children were sensitized in the East German city Magdeburg (40.2%) compared to the West German control region Borken (23.5%) (OR 2.20, CI 1.47-3.29). Dampness and visible molds were reported in 8.8% of all households, but significantly more often for East German apartments (10.3% versus West Germany 1.9%, OR 5.85, CI 2.55-16.53). Dampness and molds were associated with a higher frequency of sensitizations (40.6% versus 27.6% in unaffected homes). After controlling for sex, parental atopy, SES, family size, and smoking during pregnancy, this association remained statistically significant (OR 1.93, CI 1.19-3.12). With regard to single allergens, dampness and visible molds were significantly associated with sensitization to HDM (OR 3.37, CI 1.63-6.96), cat (OR 3.19, CI 1.11-5.74), and mugwort pollen (OR 2.86, CI 1.29-6.35). In addition, family size was inversely and linearly associated with the frequency of sensitization (OR for four, three, and two-person households: 1.10 (0.74-1.63), 1.57 (1.06-2.42), 2.70 (1.39-5.24), respectively, when compared to family size of five or more). Neither parental predisposition for atopic diseases nor parental education level influenced the prick test reactivity. We conclude that in addition to genetic predisposition, environmental factors like indoor climate and probably infectious stimuli (family size) play an important role in the process of allergic sensitization in children.