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J Rakoski

Publications and source records attributed to J Rakoski.

At least 37 records · Page 2Linked to original sources
PubMed1996

Design of an optimally-diagnostic skin test solution for diagnosis of sensitivity to timothy grass (Phleum pratense) pollen.

BACKGROUND: Although most of the common allergen extracts that are used for diagnosis of type 1 hypersensitivity are now well standardized, this gives no assurance that they are within the concentration range that gives the best chance of a true diagnosis. OBJECTIVE: The objective of this study was to identify the most appropriate concentration range of timothy grass pollen Phleum pratense extract to diagnose sensitivity to this pollen correctly through skin-testing. METHODS: Dilutions of a well-standardized extract were made and used to skin test "true' positive and "true' negative populations of subjects as identified by case history, challenge tests and radioallergosorbent test (RAST). Weal diameters were measured and the data were submitted to receiver operating characteristics (ROC) analysis. For any particular weal size cut-off, the optimal diagnostic concentration (ODC) range was thus calculated. RESULTS: A 3 mm weal diameter cut-off was chosen as an appropriate size for routine diagnosis. Therefore the ODC range at this diameter was used to establish a product target concentration and specification for formulation of the diagnostic reagent. This method of allergen extract standardization can lead to a true-biological unitage that can be used for labelling purposes. CONCLUSION: The optimum concentration range at which to formulate an allergen extract, in terms of an in vitro immunologically based assay, can be determined by carrying out ROC analysis of the results of clinical studies as described in this communication. Diagnostic units (DU), are now used by us for labelling of such final formulations which conveys the information that the product is at the most appropriate concentration for diagnosis.

Allergens↗
PubMed1996

The disturbance of epidermal barrier function in atopy patch test reactions in atopic eczema.

Atopic eczema (AE) is a common skin disorder. Eczematous lesions showing macroscopic, microscopic and immunopathological resemblance to lesional AE can be induced by aeroallergens by epicutaneous testing (atopy patch test, APT). Altered epidermal barrier function, as determined by transepidermal water loss (TEWL), is a typical feature of patients with AE. The present investigation was performed to define the differences in the epidermal barrier function between positive APT reactions to aeroallergens and positive patch test reactions to contact allergens in AE patients. Allergen extracts from grass pollen, birch pollen, cat dander and house dust mite (Dermatophagoides pteronyssinus) were applied in large Finn chambers on Scanpor for 48 h on the clinically unaffected and untreated skin of the back, in 11 patients with AE. The same procedure was done with 27 contact allergens of a standard test battery. Test reactions were read and TEWL was measured after 48 and 72 h. Eight of the 11 patients developed positive APT reactions to D. pteronyssinus, two to cat dander and one to birch pollen. Seven of the 11 patients showed positive patch test reactions to nickel sulphate, two to potassium dichromate, one to thiuram-mix and one to paraphenylenediamine. Vehicle controls were negative. The TEWL of the positive APT reactions was significantly higher, both after 48 h (mean +/- standard deviation 10.0 +/- 6.5 g/m2h) and after 72 h (9.7 +/- 5.4 g/m2h) as compared with the control site (48/72h: 4.4 +/- 1.5/4.1 +/- 1.4 g/m2h) (P < 0.01). In contrast, TEWL of the positive patch test reactions to contact allergens (48/72 h: 5.4 +/- 2.2/5.4 +/- 1.9 g/m2h) was similar to that of the control site (48/72 h: 5.2 +/- 2.1/5.0 +/- 1.8 g/m2h) (not significant). The relative TEWL at 48 h and 72 h, expressed as the ratio between the positive patch test and the control site, was significantly higher in the positive APT reactions (48/72 h: 218.8 +/- 80.4%/232.0 +/- 85.9%) compared with positive patch test reactions to contact allergens (48/72 h: 102.1 +/- 12.0%/107.1 +/- 9.5%) (P < 0.01). It is concluded that the epidermal barrier function in AE patients is altered only in positive APT reactions, in contrast to positive patch test reactions to contact allergens. As a consequence of this aeroallergen-induced altered epidermal barrier function, further allergens can more easily penetrate the skin, inducing a vicious circle and perpetuating the eczematous lesions.

Adult↗
PubMed1994

Cutaneous melanoma in a patient with neurofibromatosis: a case report and review of the literature.

We report the occurrence of a malignant melanoma in a patient with neurofibromatosis (von Recklinghausen's disease; NF 1). Neurofibromatosis, like malignant melanoma, is believed to be a disorder of neural crest origin, and is associated with a number of different malignancies, but a definite association between cutaneous malignant melanoma and neurofibromatosis has not been established. We describe a patient with a malignant melanoma and with neurofibromatosis, and review the literature pertinent to this topic. The malignant melanoma was not related to a café-au-lait patch or congenital naevus. The paucity of reports of patients with neurofibromatosis associated with cutaneous malignant melanoma suggests that these diseases probably do not occur together with any greater frequency than that determined by chance alone.

Adult↗
PubMed1993

[Munchausen syndrome. Artefacts in dermatology].

Cutaneous artefacts in the presence of Munchausen's syndrome can be clearly distinguished from simulation and hypochondria. In this paper we illustrate by means of two case reports the syndrome first described by Richard Asher in 1951. Patients with artefactual disease do not want to be cured, because the artefact may be the only possible way of reacting to and making contact with their surroundings. Because of their often dramatic history the relationship between physician and patient is emotionally charged from the very beginning, which is often very difficult for the attendant physician.

Adult↗
PubMed1991

Clinical characteristics of patients with repeated systemic reactions during specific immunotherapy with hymenoptera venoms. A retrospective study.

In general, specific immunotherapy with hymenoptera venoms can be considered as safe, but occasionally there are patients who cannot reach the maintenance dose due to repeated systemic reactions (RSR) or who suffer from RSR during maintenance therapy. In a multicenter retrospective study comprising seven departments in Germany, Austria and Switzerland 23 patients with RSR were reported from approximately 3000 patients treated with hymenoptera venoms (bee and wasp venom to approximately equivalent frequency). From these, 22 were allergic to bee venom and only one to vespid venom. In general the clinical symptoms of RSR were milder than the initial reaction. But 4/23 (18%) exhibited cardiovascular reactions up to full shock. Neither anamnestic details, reactivity in skin tests or in vitro tests revealed a special pattern of patients with RSR. In some patients, however, an extremely high reactivity in the skin test was found and may indicate the possibility of further RSR.

Adolescent↗
PubMed1991

Patch testing with amalgam at various concentrations.

27 patients with positive D3 reactions on patch testing to 3 mercury screening allergens were patch tested with 13 mercury patch test preparations, 6 inorganic and 7 organic, and amalgam 20% pet. The 13 patients (all women) showing positive reactions to 20% amalgam were then patch tested to reducing concentrations. 2 patients reacted down to 1%, 4 down to 2%, 4 down to 5%, 2 down to 10% and 1 only to 20%, a total of 10 of the 13 patients therefore reacting to the 5% concentration of amalgam. The appropriate patch test concentration of amalgam is discussed and the clinical significance and female preponderance of amalgam reactivity suggested as being worthy of further investigation.

Adolescent↗
PubMed1989

[Type I allergy to rubber gloves containing latex].

We report on a 23-year-old female patient showing anaphylactoid mucosal reactions when handling Latex rubber gloves. Usually, type I intolerance against rubber gloves is due to allergy against Latex mediated by IgE. In addition, we discuss some general allergologic problems regarding the handling of rubber gloves.

Adult↗
PubMed1989

[The significance of dermatologic management in computer-assisted occupational dermatology consultation].

At our occupational outpatient clinic, 230 patients were treated for about 15 months. With the help of a standardized questionary, we registered all the data regarding the relevant substances the patients contacted during their work as well as their various jobs since they left school. The patients were repeatedly seen and trained in procedures of skin care and skin protection. If required, we took steps to find new jobs for them within their employing company; this was done in cooperation with the trade cooperative association according to the dermatological insurance consultanship. If these proceedings did not work out, the patient had to change his profession altogether. All data were computerized. As an example for this computer-based documentation we present the data of barbers.

Adult↗
PubMed1988

[Reproducibility of epicutaneous test results].

857 non-dermatologic patients were patch-tested with the Finn-Chamber-technique. The sequent testings under identical conditions were made after 3-12 months. Readings were done after 24, 72, 96 hours and later. During the first test-series we found 44 reactions to be positive, 20 remained identical during repetition-testings, 7 became negative and 36 positive reactions appeared. So reproducibility was 46% for the positive results of the first testing serie.

Allergens↗
PubMed1988

[Risks of specific hyposensitization treatment].

In appropriate cases of diseases mediated by IgE, specific hyposensitization may be a successful way of treatment. According to prospective studies, the risk of side effects ranges between 0.1 and 1% per injection. We report on cases with fatal outcome and suggest suitable strategies in order to avoid serious complications.

Anaphylaxis↗
PubMed1988

[Hyposensitization with cross-reacting pollen allergens].

Grass-pollen are one of the most common allergens in pollinosis. Rye-pollen are the most important allergens among cereals-pollen in Germany. Between pollen-allergens, the phenomenon of cross-sensitivity is well-known. In the RAST und RAST-Inhibitionstest the cross-sensitivity between grass-pollen and rye-pollen is well documentated. In the clinic the test and challenge with some grass-pollen ist suitable for the diagnosis and planing of therapy. Therefore, it seems, that therapy with grass-pollen should produce the same results as a treatment with grass- and rye-pollen. We treated 35 patients allergic with poaceae-pollen for 3 years in two different ways: One group we treated only with grass-pollen, the other group we treated with grass- and rye-pollen. Under the therapy we controlled the specific IgE and IgG, the nasal challenge-test and the subjective symptoms by diaries and questionnaires. The specific IgE for phleum pratense and rye-pollen decreased, the specific IgG increased in both groups. There were no differences between the two therapy-groups. In the clinical data-subjective and nasal challenge-the therapeutic effect seemed to be better in the group treated with grass- and rye-pollen.

Adult↗
PubMed1985

[Frequent occurrence of dyshidrosis-type eczemas of the hand caused by oil-in-water emulsion in metalworkers].

In a metal working enterprise, about 1/3 of the workers who had come into contact with a certain cutting solution, fell ill with an eczema of the hand in short time, the clinical aspect of which reminded a dyshidrosiform eczema of the hand. An epicutaneous test made with the emulsion oil-in-water had a negative result. After the cutting solution had been replaced by another product, the hand lesions disappeared rapidly. In the literature, we could not find any informations concerning dyshidrosiform eczemas of the hand, while manipulating emulsions oil-in-water. However, a tendency to sudation of the hands is known.

Adult↗
PubMed1985

[Allergic bronchial asthma caused by lizard scales].

A 23-year-old patient with chronic rhinitis suffered from attacks of asthma. We found positive reactions in the prick test and rubbing test to the scales of the lizard Egernia cunninghami and others, which the patient kept as house-pets at this time or earlier. The bronchial function test showed bronchial obstruction after the patient had been at home with the lizards.

Adult↗