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Johannes Ring

Publications and source records attributed to Johannes Ring.

At least 73 records · Page 4Linked to original sources
PubMed2003

Hay fever and predictive value of prick test and specific IgE antibodies: a prospective study in children.

Little is known from population-based studies in children about the diagnostic values of allergen-specific IgE antibodies (RAST) and skin prick test (SPT) with respect to hay fever. We aimed to determine and compare the diagnostic values of SPT and RAST to aeroallergens with respect to the incidence of hay fever cases in schoolchildren at different cut-off points. A prospective cohort study was performed on 1100 school children (5-7 and 8-10 years). Information on a doctor's diagnosis of hay fever was obtained by questionnaire and allergic sensitization to grass and birch pollen, cat, and Dermatophagoides pteronyssinus were measured using SPT and RAST between September 1992 and July 1993. Thirty-eight children give a history of hay fever (3.5%) in 1992/93 and additionally 37 cases occurred until 1996. Allergic sensitization was present in 17.9% (SPT), 30.2% (RAST) and more frequent in children with a history of hay fever (SPT: OR 11.7, 5.5-24.7; RAST: OR 10.6, 4.3-26.4). This difference was most pronounced for sensitization to pollen allergens. The sensitivity, specificity, positive and negative predictive values (PPV, NPV) for SPT and RAST were 65.6, 83.7, 11.9, 98.6 and 79.3, 71.6, 9.3, 99.0, respectively, with differences for specificity being significant (p < 0.001). Whereas NPV were equally high for SPT (99.2) and RAST (99.3), the incidence of hay fever cases were predicted rather poorly though somewhat better by SPT than by RAST (PPV 16.7 vs. 9.8; p < 0.001) initially. With increasing cut-off point for RAST reactivity, the PPV increased and reached 25.0 at 17.5 kU/l, whereas the NPV decreased to 97.9, which was lower than that of SPT reactivity (p < 0.01). At the cut-off point of 1.5 kU/l almost identical predictive values for SPT and RAST were obtained. SPT and RAST perform better in the negative than positive prediction of hay fever cases in epidemiological studies. Differences in the predictive capabilities depend on the chosen cut-off point for RAST reactivity.

Allergens↗
PubMed2003

Laboratory acquired infection with recombinant vaccinia virus containing an immunomodulating construct.

Handling of Vaccinia virus represents a risk for laboratory-acquired infections, especially in individuals without completed vaccination. We report the case of a Vaccinia infection in a previously vaccinated researcher working with various genetically modified strains. We could confirm the infection by electron microscopy, positive cell culture, virus-specific PCR, sequence analysis, and viral neutralization test. The isolated virus carried a functionally inactivated cytohesin-1 gene of human origin, which had been shown to impair leukocyte adhesion by interacting with the LFA/ICAM-1 axis. The immunomodulating nature of the inserted construct might thus have added to the infectivity of the virus. We emphasize on the necessity of Vaccinia vaccination in laboratory staff working in the field.

Adjuvants, Immunologic↗
PubMed2003

Orange-induced skin lesions in patients with atopic eczema: evidence for a non-IgE-mediated mechanism.

Oranges are suspected of inducing adverse skin reactions in patients with atopic eczema. We studied 21 adult patients with atopic eczema and a history of adverse reactions to oranges and 10 patients without. A dietary history, skin tests, serum IgE and oral provocation tests with oranges were obtained. Severity of eczema was monitored by SCORAD, and serum tryptase, eosinophil cationic protein and urinary methylhistamine were measured. No allergic reactions were found to orange in skin prick or patch tests. However, 23 patients (74%) had specific serum IgE to orange. Oral provocation testing resulted in pruritic eczematous or maculopapular skin lesions predominantly at the predilection sites in 16 patients (52%). The SCORAD increased significantly in patients positive to the oral provocation test (p <0.05). Specific IgE to orange did not correlate with the clinical outcome of the oral provocation test. No significant changes were found in serum mast cell tryptase, eosinophil cationic protein or in urinary methylhistamine excretion. The negative results in the skin tests and a lack of correlation between specific IgE and oral provocation tests indicate that non-IgE-mediated mechanisms are involved in cutaneous adverse reactions to oranges in patients with atopic eczema.

Adolescent↗
PubMed2003

Toll-like receptor expression in human keratinocytes: nuclear factor kappaB controlled gene activation by Staphylococcus aureus is toll-like receptor 2 but not toll-like receptor 4 or platelet activating factor receptor dependent.

Cultured primary human keratinocytes were screened for their expression of various members of the toll-like receptor (TLR) family. Keratinocytes were found to constitutively express TLR1, TLR2, TLR3, TLR5, and TLR9 but not TLR4, TLR6, TLR7, TLR8, or TLR10 as shown by polymerase chain reaction analysis. The expression of the crucial receptor for signaling of staphylococcal compounds TLR2 was also confirmed by immunohistochemistry, in contrast to TLR4, which showed a negative staining pattern. Next, we analyzed the activation of the proinflammatory nuclear transcription factor kappaB by Staphylococcus aureus strain 8325-4. Using nuclear extract gel shifts, RelA staining, and luciferase reporter transfection plasmids we found a clear induction of nuclear factor kappaB translocation by the bacteria. This translocation induced the transcription of nuclear factor kappaB controlled genes such as inducible nitric oxide synthetase, COX2, and interleukin-8. Transcription of these genes was followed by production of increased amounts of interleukin-8 protein and NO. Inhibition experiments using monoclonal antibodies and the specific platelet activating factor receptor inhibitor CV3988 showed that nuclear factor kappaB activation by S. aureus was TLR2 but not TLR4 or platelet activating factor receptor dependent. In line, the purified staphylococcal cell wall components lipoteichoic acid and peptidoglycan, known to signal through TLR2, also showed nuclear factor kappaB translocation in human keratinocytes, indicating a crucial role of the staphylococcal cell wall in the innate immune stimulation of human keratinocytes. These results help to explain the complex activation of human keratinocytes by S. aureus and its cell wall components in various inflammatory disorders of the skin.

Cells, Cultured↗
PubMed2003

Association of urticaria pigmentosa with café-au-lait spots, neurofibromas and neurofibroma-like neoplasms: a mere coincidence?

BACKGROUND: Urticaria pigmentosa (UP) is characterized by dense aggregates of mast cells in the dermis. There is consistent evidence from the literature that mast cells may play a pathogenetic role in the development of neurofibromas and other tumors. OBJECTIVE: To study the concomitant appearance of UP with neurofibromas and neurofibroma-like neoplasms. METHODS: We analyzed 31,752 records of patients examined at the Department of Dermatology in the year 2000, looking for UP and associated neurofibromas and neurofibroma-like neoplasms in persons younger than 18 years. RESULTS: We identified a total of 27 patients suffering from UP, with 16 persons younger than 18 years. One 12-year-old Caucasian boy demonstrated multiple cutaneous mastocytomas consistent with the diagnosis of UP. On his trunk, four café-au-lait spots were found. A cutaneous neurofibroma was confirmed by skin biopsy. Magnetic resonance imaging detected multiple neoplasms located at the nerve roots of the spine, resembling plexiform neurofibromas. CONCLUSIONS: There may be a concomitant appearance of UP and neoplasms, with mast cells possibly playing a causative role. The existence of neoplasms, including neurofibromas and neurofibroma-like lesions should be considered when examining UP cases.

Adolescent↗
PubMed2003

Impact of pollen on human health: more than allergen carriers?

The transfer of pollen from floral anther to recipient stigma is the critical reproductive event among higher plants--this is the botanical view of pollen. Proteins and glycoproteins from pollen can function as allergens, environmental molecules interacting with the human immune system to elicit an allergic response in susceptible individuals--this is how allergists and immunologists see pollen grains. Between 10 and 25% of the population now have symptoms of hay fever or allergic asthma and the incidence has more than doubled in the past three decades while the reason(s) for this increment are only hypothetical, but there is a multitude of them. Despite our natural focus on this impact of pollen on human health, pollen have to be considered in a larger context. First of all, to evaluate the bioavailability of allergens from pollen, we have to understand their function and their influence factors. Furthermore, pollen grains are not only releasing proteins eliciting specific immune responses, but they also liberate bioactive lipid mediators and this much more rapidly. And last but not least, recent observations indicate, that pollen do not only induce allergy and thus have a much broader impact on human health. This review is an attempt to favour this holistic view of pollen and their impact on human health.

Allergens↗
PubMed2003

Silver-coated textiles reduce Staphylococcus aureus colonization in patients with atopic eczema.

BACKGROUND: In atopic eczema (AE), skin colonization with Staphylococcus aureus is known to play a major triggering and possibly pathophysiological role. METHODS: In this open-labeled controlled side-to-side comparative trial, affected sites (flexures of both elbows) in 15 patients diagnosed as having generalized or localized AE were evaluated regarding S. aureus colonization and clinical severity of AE over a 2-week period. Flexures of the elbows were covered with silver-coated textiles on one arm and cotton on the other for 7 days followed by a 7-day control period. RESULTS: A highly significant decrease in S. aureus colonization could be seen on the site covered by the silver-coated textile already 2 days after initiation lasting until the end of the treatment. Seven days after cessation, S. aureus density remained significantly lower compared to baseline. In addition, significantly lower numbers of S. aureus were observed on the silver-coated textile site in comparison to cotton at the end of treatment as well as at the time point of control. Clinical improvement correlated with the reduction of S. aureus colonization. CONCLUSION: A superior improvement achieved by silver-coated compared to cotton textiles paralleled a potent anti-S.-aureus effect.

Coated Materials, Biocompatible↗
PubMed2003

Efficacy of sublingual immunotherapy in grass pollen allergy.

Sublingual immunotherapy (SLIT) was developed to improve the safety of specific immunotherapy; however, its effectiveness is still subject to discussion although the balance sheet for SLIT is improving. In SLIT laboratory parameters and objective measures of allergen reactivity are nonuniform even in studies showing clinical effectiveness, thus subjective symptom scores remain the principal end points. For allergic rhinitis an expert panel collaborating with the WHO recently proposed that SLIT was a viable alternative for injectable immunotherapy (SIT) since a multitude of double-blind placebo-controlled studies had proved the effectiveness of SLIT. Unfortunately, there are only a small number of studies comparing effectiveness of SLIT directly with subcutaneous SIT. These studies demonstrated comparable effectiveness of both therapies. According to the data so far SLIT can be recommended for the therapy of allergic rhinitis in adults and children refusing injectable therapy. For the treatment of allergic asthma both positive and disappointing results have been published. Effectiveness in preventing the onset of allergic asthma in patients with allergic rhinitis has been demonstrated for SIT, while for SLIT this question cannot yet be answered.

Administration, Sublingual↗
PubMed2003

Influence of UVB, UVA and UVA1 irradiation on histamine release from human basophils and mast cells in vitro in the presence and absence of antioxidants.

UV irradiation is widely used for the treatment of atopic eczema. In recent years, UVA1 phototherapy has gained increasing attention. This study analyzed the influence of different UV wavelengths--especially UVA1--on histamine release from human basophils and mast cells. The modulation of this parameter might be responsible for some of the therapeutic effects of UV irradiation. Enriched human basophils and human mast cells (HMC1 cell line) were irradiated with increasing doses of UVB, UVA and UVA1 in vitro. After irradiation, different stimulants were added to induce histamine release. In additional experiments, basophils were preincubated with superoxide dismutase, ascorbate or trolox to study the role of antioxidants in the modulation of histamine release after UV irradiation. UVA and UVA1 significantly inhibited histamine release from basophils and mast cells. UVB only had an inhibitory effect on mast cells. Preincubation with superoxide dismutase and ascorbate did not influence the inhibitory effect of UVA1 on basophil histamine release, whereas trolox decreased significantly the histamine release from nonirradiated basophils.

Adult↗
PubMed2003

Fabry disease: recognition and management of cutaneous manifestations.

Fabry disease (angiokeratoma corporis diffusum universale) is a rare, X chromosome-linked lysosomal storage disease. The deficient enzyme, alpha-galactosidase A (alpha-gal A), is responsible for the accumulation of neutral glycosphingolipids within vascular endothelial lysosomes of various organs, including skin, kidneys, heart, and brain. The disease manifests primarily in affected hemizygous men and to some extent in heterozygous women ('carriers'). The diagnosis of Fabry disease is made in hemizygous males after the detection of the presence of angiokeratomas, irregularities in sweating, edema, scant body hair, painful sensations, and of cardiovascular, gastrointestinal, renal, ophthalmologic, phlebologic, and respiratory involvement. A deficiency of alpha-gal A in serum, leukocytes, tears, tissue specimens, or cultured skin fibroblasts further supports the diagnosis in male patients. Since heterozygous women show angiokeratomas in only about 30% of cases and may have alpha-gal A levels within normal range, genetic analysis is recommended. Current treatment of angiokeratomas of Fabry disease is based mainly on the use of laser systems, including variable pulse width 532nm Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) laser, 578nm copper vapor laser, and flashlamp-pumped dye laser. When cutaneous and mucous glands are affected, restrictions may be required with regard to the time spent in a warm climate and the amount time spent working or on sporting activities, and may necessitate the use of topical and systemic antiperspirant agents, and topical application of artificial lacrimal fluid and saliva, respectively. For the future, new treatment modalities, including enzyme replacement therapy, substrate deprivation strategies, and gene therapy offer extraordinary options for the cutaneous and visceral lesions in patients with Fabry disease.

Administration, Topical↗
PubMed2003

Management of polymorphous light eruption : clinical course, pathogenesis, diagnosis and intervention.

Optimal management of patients with polymorphous light eruption (PLE), the most frequent photodermatosis, requires knowledge of the individual clinical course of the disease and pathogenic factors. As PLE often causes problems during leisure-time activities and holidays, resulting in a substantial loss of quality of life, prophylaxis is the most important therapeutic approach. Management of PLE must, therefore, focus on basic preventative measures and additional therapeutic approaches, depending on the clinical condition. PLE can be classified into four severity groups (mild, moderate-to-severe, severe and therapy-resistant), which are useful for determining appropriate prophylactic measurements. No specific laboratory tests are available for the diagnosis of PLE, therefore, a clinician must rely on the clinical appearance of the disorder (e.g. clinical symptoms, the location of the lesions, the relationship of the occurrence of the lesions with sun exposure and the time course of the lesions) as well as a patient's medical history in order to make a diagnosis. Basic preventative management of PLE consists of adequate sun protection comprising avoidance of sun exposure, the use of textile sun protection and the application of broadband sunscreens with high UVA protection potential. Other supportive measurements have to be managed individually and are dependent on the patient's medical history and the severity of the disease. Topical antioxidants, systemic immunomodulation, photo(chemo)therapy and systemic immunosuppression may be required in some cases of PLE. Topical antioxidants represent a new treatment approach for moderate-to-severe PLE and are an effective and well tolerated option for this patient population. Severe PLE also requires photo(chemo)therapy. Phototherapy can be in the form of 311 nm UVB or UVA1 irradiation. In cases where 311 nm UVB or UVA1 are ineffective, psoralen plus UVA (PUVA) bath therapy may be used. However, PUVA bath therapy must be used with caution because it is associated with acute and long-term adverse effects. In rare exceptions we would consider using oral PUVA therapy. However, in our outpatient department, quality of life of most patients is improved with the treatment regimens that are recommended for patients with moderate-to-severe PLE, without the need for photo(chemo)therapy.

Administration, Topical↗
PubMed2003

[Quality control in medical education and continuing medical education in allergology in Germany].

Quality control in education and training in allergology comprises activities at the different levels of the curriculum of medical schools, residency programs and postgraduate education. Unfortunately, until now allergology in Germany has not yet been regularly embedded in the medical curriculum of all medical schools. Therefore, the German Society for Allergology and Clinical Immunology (DGAI) has demanded for years that chairs and departments of allergology be introduced at every Medical Faculty in Germany. The new Medical Licensure Rules (Approbationsordnung) offer the possibility to select allergology, amongst others, as an obligatory subject in the medical state examination. Furthermore, allergological topics can now be introduced into the newly established interdisciplinary fields (Querschnittsbereiche). At the level of residency training, doctors who want to become allergists have to undergo a special curriculum in the field of allergology, formerly called additional specialisation in allergology (Zusatzbezeichnung) after having finished their board examination in an organ-related specialty subject. Following a decision of the German "Arztetag" in May 2003, this 24-months curriculum has unfortunately been reduced to 18 months. 12 months of this 18 months requirement may be fulfilled during a residency programme in either dermatovenerology, otolaryngology, internal medicine, pulmology and/or paediatrics. Compared to previous years, this results in a drastic deterioration of allergy training in Germany. The DGAI has decided to take up the fight for its improvement in both a quantitative and qualitative respect. The crucial issue is to develop quality criteria for persons as well as institutions eligible as training centres in allergology. As regards post-graduate education, the German Academy of Allergology and Environmental Medicine (Deutsche Akademie für Allergie und Umweltmedizin, DAAU) has introduced a system of certified continuing medical education (CME), which has been widely accepted in Germany. CME credit points are awarded in co-operation with the regional physicians' chambers ("Landesärztekammer"). Quality control in allergology has to be re-enforced and improved at all levels of medical curricula, training programmes and post-graduate education in order to achieve sustainable improvements in patient care for the large number of people in Germany suffering from allergies.

Allergy and Immunology↗
PubMed2003

[Allergies].

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Allergy and Immunology↗
PubMed2002

Idiopathic anaphylaxis.

Anaphylaxis represents the maximal variant of an immediate-type allergic reaction involving the whole organism with manifestations in different organ systems. IgE-mediated mast cell and basophil activation is the major pathomechanism; however, immune complex and pseudo-allergic reactions also may lead to the same symptomatology. The most common elicitors are drugs, additives, occupational substances, animal venoms, aeroallergens, and contact urticariogens but also physical factors (cold, heat, ultraviolet light, exercise). When no eliciting factors can be detected, the term "idiopathic anaphylaxis" is used. The diagnosis of idiopathic anaphylaxis is, therefore, a diagnosis of exclusion and may be made only after careful allergy history taking and diagnosis involving in vitro tests. Possible mechanisms underlying the pathophysiology of idiopathic anaphylaxis include undetected diseases (eg, mastocytosis occulta), concomitant anaphylaxis-enhancing medication (b-blockers), secretion of histamine-releasing factor from T lymphocytes, autoantibodies against IgE or IgE receptors, and angiotensin II deficiency. One of the many differential diagnoses of anaphylaxis may have been overlooked. The treatment of idiopathic anaphylaxis follows the rules of antianaphylactic therapy.

Anaphylaxis↗
PubMed2002

T-cell receptor repertoire and cytokine pattern in granuloma annulare: defining a particular type of cutaneous granulomatous inflammation.

Granuloma annulare is a common granulomatous infiltration of the skin of unknown etiopathogenesis. We analyzed granuloma annulare biopsies in 11 patients and could find in all patients significant numbers of CD4-T cells. These cells showed a broad usage of the different T cell receptor Vbeta families and a rather unbiased repertoire when the complementary determining region 3 spectra were analyzed by the Immunoscope technique. Comparison with the peripheral blood mononuclear cell repertoire, however, identified in all patients few skin-specific expansions, which were for one patient also present in two distinct skin sites. Extensive sequence analysis of the complementary determining region 3 region confirmed the presence of a limited number of skin-specific expansions together with various nonspecific T cell infiltrations. Analysis of the intralesional cytokine expression revealed abundant production of interleukin-2, which was not dominant in granulomas from leprosy patients and was not reflected by the cytokine profile in peripheral blood mononuclear cells. These results demonstrate the capacity of the granulomatous response to recruit T cells in high numbers with only few clones expanding specifically. The high local production of interleukin-2 might thereby play an important role in the nonspecific attraction of T cells to the granulomatous site.

Adult↗