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Biomedical subjects

J Ring

Publications and source records attributed to J Ring.

At least 271 records · Page 15Linked to original sources
PubMed1997

Efficacy of antihistamine pretreatment in the prevention of adverse reactions to Hymenoptera immunotherapy: a prospective, randomized, placebo-controlled trial.

BACKGROUND: Some clinical studies suggest that a combination of an H1- and H2-antagonist may be effective in the prophylaxis of allergic reactions. OBJECTIVE: The efficacy of pretreatment with an H1/H2-antagonist combination, H1-antagonist alone, or placebo in the prophylaxis of local and systemic adverse reactions to specific immunotherapy with Hymenoptera venom was compared. METHODS: In a prospective, randomized, double-blind, placebo-controlled study, 121 patients with Hymenoptera venom allergy were treated with rush immunotherapy and pretreatment with one of the following: 120 mg of terfenadine plus 300 mg of ranitidine, 120 mg of terfenadine alone, or placebo. The incidence of unwanted systemic adverse and local reactions was recorded for up to 50 weeks. RESULTS: In seven patients (6%), six in the placebo group and one in the terfenadine group, systemic side effects required cessation of therapy (p = 0.005). Subjective symptoms occurred in four patients (10%) in the terfenadine plus ranitidine group and in three patients (7%) in the terfenadine group. Regarding local reactions, significantly fewer patients treated with a combination of terfenadine and ranitidine and with terfenadine alone as compared with placebo had severe local symptoms of erythema (29%, 29%, and 49%), edema (24%, 18%, and 41%), and pruritus (13%, 11%, and 31%) at week 1 (p < 0.05). This therapeutic benefit was limited to the first 4 weeks of treatment. Treatment with a combination of terfenadine and ranitidine was not superior to treatment with terfenadine alone. CONCLUSIONS: Pretreatment with H1-antihistamines with or without H2-antihistamines significantly reduced local and systemic adverse reactions to immunotherapy with Hymenoptera venom and may therefore be helpful in the management of immunotherapy.

Administration, Oral↗
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

Maternal smoking during pregnancy and lactation increases the risk for atopic eczema in the offspring.

BACKGROUND: Maternal smoking during pregnancy has been shown to lead to immunologic changes in the offspring. However, little is known about the influence of this exposure on atopic manifestations. OBJECTIVE: Our purpose was to investigate the influence of air pollutants on manifestations of atopy in preschool children. METHODS: Unselected cohorts of a total of 678 5- to 6-year-old preschool children (350 boys, 328 girls) were investigated in areas with different degrees of air pollution in Bavaria. Data on the history of atopic diseases and other relevant factors were obtained by questionnaire. A skin-prick test was performed with common aeroallergens. Manifestation of atopy was defined as personal history of atopic disease or positive prick test to either grass pollen, house dust mite, or cat and analyzed multivariately. RESULTS: Of all children, 38.9% exhibited at least one manifestation of atopy. Atopic eczema was reported in 7.9% to 15.5%, hayfever in 4.1% to 25.6%, and asthma in 3.0% to 8.1%. Of the mothers, 12.6% smoked during pregnancy or lactation or both. Analysis of the manifestation of atopy including sex, location, nitrogen oxide and sulfur dioxide exposure and maternal smoking as covariates revealed an influence of the maternal smoking during pregnancy/lactation. Of children whose mothers had smoked during pregnancy/lactation, 52.2% exhibited manifestations of atopy in contrast to 35.7% of children of nonsmoking mothers (p < 0.044). A history of atopic eczema was the only component of the variable "manifestation of atopy" that was significantly associated with maternal smoking during pregnancy and lactation. A causal interpretation of this finding, however, was not supported by a follow-up study. CONCLUSION: Maternal smoking during pregnancy or lactation or both might play a role in the development of atopic eczema and should be avoided.

Allergens↗
PubMed1997

Gramineae pollen as trigger factors of atopic eczema: evaluation of diagnostic measures using the atopy patch test.

After contact with grass pollen, seasonal exacerbations of eczematous skin lesions have been described in a subgroup of patients with atopic eczema (AE). Epicutaneous patch testing with aeroallergens (atopy patch test. APT) has been used to investigate these patients. We performed comparative APT in 79 patients with AE and 20 control subjects (14 non-atopic volunteers and six patients with grass pollen allergic rhinoconjunctivitis). Subjects were tested with grass pollen allergen extract in petrolatum and with unprocessed native dry pollen of Dactylis glomerata. Results after 48 h were compared with the patient's history, corresponding skin prick test and specific IgE. Fifteen of the 79 AE patients showed clear-cut eczematous reactions to unprocessed D. glomerata pollen; 14 of these had an elevated serum IgE to D. glomerata and 13 had a positive skin prick test. Twenty patients had a positive APT reaction to grass pollen allergen extract, including 12 of the D. glomerata reactive subjects (P < 0.001). Positive patch test reactions to D. glomerata were seen in 66.7% of cases with and 10.5% of patients without a predictive history of exacerbations during the pollen season. For the standardized extract, these percentages were 75% vs. 16.4% (P < 0.001). No side-effects were observed. Control subjects showed no positive reactions. We conclude that grass pollen preparations may be used to investigate trigger factors for eczematous skin lesions in a subgroup of patients with AE.

Adolescent↗
PubMed1997

Experiences with the severity scoring of atopic dermatitis in a population of German pre-school children.

Severity scoring of atopic dermatitis (SCORAD) was introduced as a standard tool but has not been used in a population-based epidemiological study; the objective of the present study was to determine the practicability of this instrument in this setting. We assessed the distribution of the severity of atopic eczema in the community and investigated differences between east and west Germany. A factor analysis was then carried out to characterize the variables of this scoring system and to analyse possible relationships within them. A multicentre cross-sectional study was carried out in five east German and two west German locations in 1994; pre-school children (5-6 years old) were investigated and cases of atopic eczema identified by a dermatological examination. The SCORAD was used to determine the severity of atopic eczema and the results assessed using analysis of variance and principal component analysis (varimax rotation). In all, 1511 (76.2%) of the children originally contacted participated and 11.3% were diagnosed with atopic eczema at the time of examination. The median severity scores was 21.4 (interquartile range 13.5) and there was a tendency to higher scores in west Germany for the mean overall score, the intensity score and the extent. 'Erythema' (1.30 vs. 1.06; P = 0.006) and 'excoriation' (0.77 vs. 0.36; P = 0.002) were significantly more prominent in children with eczema from west Germany (adjusted for observer). Interobserver variabilities of the SCORAD parameters were calculated, adjusted for location and were in accordance with earlier findings. Principal component analysis identified three independent factors accounting for 54.1% of the total variance. A severity factor, characterized by 'extent', 'lichenification', 'excoriation' and 'pruritus', was separated from a factor with an acute eczema-type profile ('erythema', 'oedema', 'oozing') and a factor whose major characteristics were 'extent', 'dryness', and 'sleep loss'. We conclude that atopic eczema is frequent in pre-school children. The SCORAD proved to be readily applicable and useful in epidemiological studies, but further validation is needed.

Analysis of Variance↗
PubMed1997

Immunohistochemical analysis of late local skin reactions during rush venom immunotherapy.

During rush venom immunotherapy (VIT), about 65% of patients develop large local reactions (LLR) at the application site that last for at least 24 h. However, LLR subside during long-term treatment. To learn more about the provenance of infiltrating cells in late, local skin reactions during VIT, we analyzed the skin infiltrates of 23 Hymenoptera venom (HV)-allergic patients. Punch biopsies were obtained 24 h after s.c. injection of HV allergens from 23 HV-allergic patients and five nonallergic controls. Seven patients did not show LLR at the beginning of VIT. Ten patients had LLR when the dose of HV allergens was increased. Six patients showed reduced LLR after long-term treatment. Immunoenzymatic labeling of the cryostal sections with a panel of monoclonal antibodies was performed by the APAAP method. S.c. application of HV allergens induced a perivascular and periadnexial cutaneous mononuclear cell infiltrate consisting mainly of CD4+, CD45RO+; and HLA-DR+ cells in patients without clinically apparent LLR. In contrast, LLR were associated with a significant increase in total cells, CD4+ cells, CD8+ cells, CD11c+ cells, EG2+ cells, NP57+ cells, HLA-DR+ cells, CD45RO+ cells, CD45RA+ cells, CD23+ cells and CD25+ cells (P < 0.001). Decreased LLR after long-term VIT was correlated with a significantly reduced recruitment of CD4+ cells, EG2+ cells, and CD23+ cells as compared to LLR in the course of dose increases (P < 0.05), whereas the number of CD8+ cells, CD11c+ cells, NP57+ cells, and CD25+ cells remained high. Our data suggest that s.c. injections of HV allergens attract CD4+ helper T cells, of both the naive (CD45RA+) and memory (CD45RO+) phenotypes, to the allergen application site. LLR represent delayed allergic rather than toxic reactions to HV components and might be relevant to the development of clinical protection during VIT.

Adolescent↗
PubMed1997

Epidemiology of allergic diseases.

The escalation of allergic diseases (hay fever, asthma, atopic eczema) over recent decades has been linked to an increase in environmental pollutants. The prevalence of hay fever is associated with genetic predisposition, and some reports show an association with urban areas, socioeconomic status, and combined high allergen and automobile exhaust exposure. In asthma, there is also some evidence for geographical variations in prevalence; exercise challenge tests prove positive more often in urban areas than in rural areas. Although genetic predisposition is the strongest single risk factor for atopic eczema, air pollutants may aggravate the condition by acting as unspecific irritants and immunomodulators, leading to increased immunoglobulin E expression. In a study of 678 pre-school children, the influence of maternal smoking habits on individual measures of atopy revealed a positive association between smoking during pregnancy/lactation, and a positive history of atopic eczema. An East-West German comparative study examining different types and levels of air pollution, i.e. sulphurous (industrial; East) and oxidising (urban; West), showed that the prevalence of atopic eczema was greatest in East Germany. When various direct and indirect parameters of air pollution exposure were measured, the greatest association with atopic eczema was found with NOx exposure (indoor use of gas without a cooker hood), and close proximity to roads with heavy traffic. The increased prevalence of atopic eczema cannot be explained by changes in study methodology over time, or conventional risk factors alone; environmental risk factors may be an important contributing factor.

Animals↗
PubMed1997

Wood's light in Microsporum canis positive patients.

In 64 patients with culturally proven Microsporum canis infections, Wood's light examination was performed. In 30 patients (47%) the characteristic fluorescence correlated with the cultural findings, whereas in the remaining 34 patients (53%), Microsporum canis was isolated, although Wood's light examination was negative. Of the 30 positive and 34 negative cases eight patients of each group had been pre-treated. From the results presented, Wood's light examination has a poor sensitivity in cases of Microsporum canis-infections.

Evaluation Studies as Topic↗
PubMed1997

The renin-angiotensin system in patients with repeated anaphylactic reactions during hymenoptera venom hyposensitization and sting challenge.

Patients with a history of anaphylactic reactions to hymenoptera venom who tolerated the hyposensitization and the sting provocation without problems (n = 10) had angiotensin I (ANG I), angiotensin II (ANG II), angiotensinogen and renin similar to the values found in healthy nonallergic controls (n = 11). In contrast, patients who repeatedly experienced anaphylactic reactions during hyposensitization and who displayed anaphylactic reactions to sting provocation with a living insect (n = 6) showed significantly lower renin (p < 0.05), angiotensinogen (p < 0.05), ANG I (p < 0.05) and ANG II (p < 0.05) plasma levels as compared to healthy nonallergic controls (n = 11). Sting provocation with a living insect induced clinical symptoms of anaphylaxis in all of the 6 patients. A decrease in ANG I was found in 4 of the patients (67%) after provocation as compared to the concentration before the sting challenge. Angiotensinogen decreased in 3 of the patients (50%) whereas renin activity decreased in 2 of the patients (29%). In all cases a decrease in ANG II was noticed (100%). It is concluded that patients at high risk of developing anaphylactic reactions possess a dysfunctional renin-angiotensin system (RAS) which is not stimulated and does not respond appropriately. These findings point to an important role of the RAS as a defense mechanism in response to anaphylactic reactions.

Adolescent↗
PubMed1997

Clinical validation and guidelines for the SCORAD index: consensus report of the European Task Force on Atopic Dermatitis.

BACKGROUND: We have previously reported how the SCORAD index was designed. This cumulative index combines objective (extent and intensity of lesions) and subjective (daytime pruritus and sleep loss) criteria. AIMS: To study interobserver variability in scoring for objective SCORAD criteria and to optimize the scoring guidelines. MATERIAL AND METHODS: Three scoring sessions were organized in 1993-1994 in Hamburg, Bordeaux and Rotterdam totalizing 19 patients (14 children and 5 adults) and 23 physicians, among whom 12 participated in at least 2 scoring sessions; 169 evaluation sheets have been processed using the SCORAD File Marker Pro software. At each session, total body photographs and close-up views were taken of each patient, and this material was reviewed at the final evaluation. RESULTS: The extent of lesions according to the rule of nines showed interobserver variability mostly for patients with lesions of moderate intensity involving 20-60% of body surface. Intensity items were scored with more consistency overall, but variations subsided especially for oozing/crusts and lichenifications. Low and high scorer profiles and the benefit of training were noted. CONCLUSIONS: This study has allowed to optimize clinical scoring using the SCORAD system. A proposal has been made to grade the severity of atopic dermatitis according to objective criteria in three groups for inclusion in clinical trials. The SCORAD index remains the major criterion for follow-up in trials.

Adolescent↗
PubMed1997

Perioral dermatitis in children--clinical presentation, pathogenesis-related factors and response to topical metronidazole.

BACKGROUND: Perioral dermatitis, a common skin disorder in young women, is rarely described in children. OBJECTIVE: This study elaborates the clinical features of perioral dermatitis in children as well as possible pathogenetic mechanisms and the response to topical metronidazole. METHODS: Seven children (4 females, 3 males between 4 and 12 years of age) were evaluated and dermatological examination was carried out. Pretreatment with topical corticosteroids was documented. Skin prick test with a panel of six common aeroallergens was performed in all children. All children were screened for gastrointestinal colonization with Candida albicans. Patients were treated with topical metronidazole 1% during the first 2 weeks. From the 3rd week on 2% metronidazole was used. RESULTS: In all but one child topical corticosteroids had been used in the face prior to the first presentation at our outpatient department suggesting a possible pathogenetic role. An association with atopy or intestinal candida colonization was not found. In all children skin lesions resolved after 3-6 months. The children remained free of symptoms over an observation period of 2 years. CONCLUSION: Perioral dermatitis has to be considered as differential diagnosis in children presenting with erythematous papules and papulovesicles in typical locations. Metronidazole proved to be effective and safe in the treatment of perioral dermatitis in children. Atopy and gastrointestinal colonization with C. albicans do not seem to play a role in the pathogenesis of perioral dermatitis.

Administration, Topical↗
PubMed1997

The early phase of epidermal barrier regeneration is faster in patients with atopic eczema.

BACKGROUND: Altered epidermal barrier function as determined by transepidermal water loss (TEWL) is a typical feature in patients with atopic eczema (AE). OBJECTIVE: The purpose of this study was to assess the kinetics of epidermal regeneration after barrier perturbation induced by two different stimuli, namely acetone treatment (removal of stratum corneum lipids) and tape stripping (removal of the nonviable stratum corneum). METHODS: Fifteen patients with AE and 12 nonatopic healthy controls were investigated. An area of 9.0 cm2 of clinically normal skin of the forearm flexural side was treated by acetone or tape stripping in a way that an increase in TEWL of 3.5-4.0 times the pretreatment value was achieved. TEWL was recorded directly after perturbation (tO), after 15 min (tl), 3 h (t2), 6 h (t3), 24 h (t4), 48 h (t5), 72 h (t6) and 96 h (t7). RESULTS: The speed of epidermal regeneration was faster after acetone treatment, both in the patient and the control groups, with no significant difference between the two. However, after tape stripping at points t2, t5 and t6, TEWL values relative to tO were significantly lower in atopic skin as compared to normal skin (p < 0.05). CONCLUSION: The faster regeneration of barrier function after tape stripping in patients with AE may be the result of a persisting mild disturbance of barrier function. It may be speculated that repair mechanisms are permanently activated, and therefore barrier recovery is faster. However, a complete restoration of the epidermal barrier function is not achieved, perhaps because of the decreased content of ceramides in atopic skin.

Acetone↗
PubMed1997

Topical application of a platelet-activating factor (PAF) antagonist in atopic dermatitis.

Platelet-activating factor (PAF acether) is a lipid mediator with a potent proinflammatory activity. Results derived both from in vitro and in vivo studies suggest a possible role of this substance in the pathophysiology of atopic dermatitis. A double-blind, randomized, multi-center, within-patient study was performed to evaluate the efficacy of a topically applied PAF antagonist (RO-24-0238) in 36 patients with atopic dermatitis. Over a period of 28 days, 0.25 ml of the PAF antagonist and the vehicle (placebo) were applied twice daily on opposite sites of symmetrical lesions (measuring 10 to 20 cm2 each). The overall assessment of the therapeutic efficacy did not demonstrate a superior effect of the PAF antagonist in comparison to placebo, and this was the same with the individual study parameters erythema, scaling, induration and exudation. For reducing pruritus, as assessed by the patient using a visual analogue scale, a statistically significant action was documented during the first 2 weeks of the study (p < 0.04; Wilcoxon rank sum test), with a continued, yet not statistically significant efficacy after weeks 3 and 4. The exact role of the pathological events of atopic dermatitis that might be influenced by a PAF antagonist remains to be determined, but the anti-pruritic component of this substance especially deserves further scientific interest.

Administration, Topical↗