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Biomedical subjects

R Brehler

Publications and source records attributed to R Brehler.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1998

Glove powder affects skin roughness, one parameter of skin irritation.

Most patients with immediate-type-hypersensitivity to natural rubber latex (NRL) give a history of hand eczema. Susceptibility to allergens is increased by irritant hand eczema due to damage to the skin barrier. Therefore, especially for employees in medical or paramedical professions, reduction in skin irritation is of importance. The present study reports the effect of glove powder on skin roughness, one feature of skin irritancy. Skin replicas, performed before and after wearing different types of gloves, were evaluated by laser profilometry. Significant alteration of skin roughness was evident and determined by different factors. Use of unpowdered Biogel gloves on prepowdered hands results in an increase in skin roughness, in contrast to the use of Biogel gloves on hands without any pre-application. On the other hand, powdered Manex neoderm gloves show no influence on the skin structure, whereas powdered Peha taft gloves also increase the roughness of the skin. Other potential candidates causing skin morphology alteration could be the glove pH, rubber chemicals with irritant potential and other characteristics of gloves, which are already under investigation.

Adult↗
PubMed1997

Recent developments in the treatment of atopic eczema.

Atopic eczema remains a therapeutic challenge. However, new developments in the understanding of the pathogenesis of this complex disease have prompted new therapeutic strategies. This review focuses on recently described treatment modalities for atopic eczema that are currently available or under investigation. The effectiveness of phototherapy, cytokines, and immunosuppressive drugs is evaluated. In addition, some new and promising but still experimental approaches are discussed.

Cytokines↗
PubMed1997

Neutrophilic hidradenitis induced by chemotherapy involves eccrine and apocrine glands.

Neutrophilic eccrine hidradenitis is a self-limited inflammatory dermatosis primarily induced by chemotherapeutic agents. We report the case of a 43-year-old patient treated with cytarabine, daunorubicin, and thioguanine for acute myelogenous leukemia who developed painful, red nodules in both axillae on the third day of chemotherapy. The lesions healed spontaneously without sequelae and reappeared once when chemotherapy was readministered. Histologic examination and immunohistochemical staining for carcinoembryonic antigen (CEA), epithelial membrane antigen (EMA), and S100 revealed necrosis of eccrine and apocrine glands. As a secondary event, neutrophils, histiocytes, and lymphocytes of T and B cell types were infiltrating the glandular coils. Electron microscopic examination confirmed the presence of severe cellular degeneration of the secretory epithelia and coiled sweat ducts. Ultrastructural features and absence of labeling with a nick-end labeling technique were consistent with a non-apoptotic mode of cell death. Our findings strongly suggest a cytotoxic effect of chemotherapeutic agents as accumulated in the secretory epithelia of sweat glands. Distal ducts and myoepithelial cells remained intact and may account for rapid regeneration of the glandular structures after discontinuation of chemotherapy. In view of the involvement of both eccrine and apocrine glands, we suggest the term neutrophilic hidradenitis, which is part of the spectrum of drug-associated sweat gland reactions.

Adult↗
PubMed1997

"Latex-fruit syndrome": frequency of cross-reacting IgE antibodies.

An association between allergies to latex proteins and to various foods has been reported and confirmed by RAST and immunoblotting inhibition. However, no significant data had been collected on the frequency of specific IgE antibodies to fruits in these patients and the frequency of a history of fruit intolerance. Serum samples of 136 patients with well-documented, clinically relevant, immediate-type hypersensitivity against latex proteins were analyzed for IgE antibodies against a panel of different fruits. Patient history of food intolerance was documented by a standardized questionnaire. Fruit-specific IgE antibodies were detected in 69.1% of serum samples. Cross-reacting IgE antibodies recognizing latex and fruit allergens (papaya, avocado, banana, chestnut, passion fruit, fig, melon, mango, kiwi, pineapple, peach, and tomato) were demonstrated by RAST-inhibition tests. Of our patients, 42.5% reported allergic symptoms after ingestion of these fruits and a total of 112 intolerance reactions were recorded. However, fruit-specific IgE antibodies were detected only in serum samples from 32.1% of the patients who perceived symptoms due to these fruits. Thus, serologic tests seem to be of low significance for prediction o food allergy in latex-allergic patients.

Adolescent↗
PubMed1997

IgE-mediated hypersensitivity to latex in childhood.

A total of 267 children scheduled to receive anesthesia during a surgical, neurosurgical, or orthopedic intervention were investigated. IgE antibodies against latex were detected in serum samples of 6.4% (17/267 children) of the patients. The most important difference between sensitized and nonsensitized children was the number of surgical interventions in the past. The median of surgical interventions was 1.0 in the nonsensitized group of children and 3.0 in the sensitized group. Only 0.9% of the children with up to two surgical interventions and 34.1% with three or more procedures were sensitized to latex. Only one of the sensitized children developed intraoperative anaphylaxis during intervention after our investigation. We conclude that children with a history of three or more surgical interventions have a high risk of sensitization to latex proteins. Nevertheless, the predictive value of IgE antibodies against latex for development of anaphylaxis during anesthesia seems to be low.

Adolescent↗
PubMed1997

Contact urticaria due to rubber chemicals?

Contact urticaria due to gloves is mostly related to immediate-type allergy to natural rubber latex (NRL), and rarely due to rubber chemicals. We report the results of prick tests with rubber chemicals carried out on 75 latex-allergic patients. Clinically relevant hypersensitivity was not observed in our patient collection. Thus, we conclude that contact urticaria due to rubber chemicals is a very rare finding in latex-allergic patients, but has to be considered in patients with contact urticaria due to synthetic rubber gloves, as well as in patients with contact urticaria due to NRL gloves but no latex allergy. Therefore prick tests with rubber chemicals are unnecessary in the routine diagnostic assessment of latex-allergic patients.

Adolescent↗
PubMed1997

Glove powder--a risk factor for the development of latex allergy?

Studies are described which compare the prevalence of sensitisation against latex proteins in medical personnel in different hospitals. The objective of these studies was to find out whether the use of powdered or unpowdered gloves could be related to the prevalence of latex allergy. Employees of one of the investigated hospitals (Germany) were using only powdered latex gloves, and in the other two hospitals (Great Britain) low protein powder-free latex gloves were used. Methods by which latex allergy can be avoided are suggested.

Allergens↗
PubMed1996

[Ficus benjamina allergy].

We report the case of a 48-year-old patient suffered from asthma and conjunctivitis caused by an immediate type allergy to weeping fig (Ficus benjamina). By RAST inhibition test we could demonstrate that IgE antibodies react with allergens of fig; however our patient tolerated figs in oral provocation test. Sensitization to latex proteins reported to be cross reactive to Ficus species was not found. Ficus benjamina allergens represent relevant indoor allergens. A standardized allergen extract for skin testing is not yet available. Allergen specific IgE is mostly found in patients with strongly positive prick test results using the native sap of the tree. In 12 of 64 latex allergic patients we found simultaneous sensitization to weeping fig, so that cros-sensitization has to been considered in patients with IgE-mediated sensitization to latex.

Asthma↗
PubMed1995

[Allergic and pseudo-allergic reactions in anesthesia. I: Pathogenesis, risk factors, substances].

In this article we present a survey on the pathogenesis of allergic or pseudoallergic reactions in anaesthesia, the risk factors and the responsible substances. The incidence of anaphylactoid reactions is between 1:3500 and 1:20,000 anaesthetic cases. The estimated mortality rate amounts to 3-6%. Neuromuscular blocking drugs account for most of the cases of significant anaphylactoid reactions (59-70%). However, the incidence of latex-related reactions in increasing. Risk factors for anaphylaxis are a history of IgE-mediated drug allergy, repeated anaesthesias, atopy, hyperventilation tetany, and the use of neuromuscular blocking drugs in females. Risk factors for pseudoallergic reactions are emotional stress, atopic predisposition, increased sensitivity for histamin, hyperventilation tetany and female gender.

Analgesics↗
PubMed1995

[Allergic and pseudo-allergic reactions in anesthesia. II: Symptoms, diagnosis, therapy, prevention].

In this article we present the symptomatic features and discuss relevant diagnostic and therapeutic aspects of anaphylactoid reactions. In addition we give practical advice as to how to avoid and manage allergic or pseudoallergic reactions during anaesthesia. Measurements of serum tryptase-levels and of methylhistamine in urine have been introduced in clinical diagnostic routine. Skin tests and determination of specific antibodies are essential to identify responsible substances. Preventive measures like careful premedication, calm atmosphere, slow injection of drugs, the use of diluted solutions, and the use of drugs with a low potential for anaphylactoid reactions are important. Substances like inhalation anaesthetics, propofol, etomidate, ketamine, midazolam, fentanyl, alfentanil and bupivacain without epinephrine should be used.

Anesthesia, General↗
PubMed1994

[Clinically relevant solitary palladium allergy].

A 54-year-old woman patient had symptoms of stomatitis and asthma following the provision of a dental prosthesis in July 1991. We found a positive patch test reaction to palladium only, without any concomitant metallic contact dermatitis; in particular there was no sensitization to nickel. This is a very rare sensitization. After replacement of the dental alloy the clinical symptoms improved.

Dental Prosthesis↗
PubMed1993

[Mercury sensitization in amalgam fillings. Assessment from a dermatologic viewpoint].

Epicutaneous tests were performed on 88 patients (27 men, 61 women; mean age 36.8 [18-68] years) thought to have an allergy against amalgam or mercury. In addition their oral mucosa was assessed clinically. The epicutaneous test was positive for mercury sensitization in seven patients, five of them reporting oral mucosa symptoms. Such symptoms also occurred, although less frequently, in non-sensitized patients (30 of 81). In three sensitized patients there was evidence of perioral dermatitis which in two of them cleared up after removal of the amalgam fillings. Two further patients had no further complaints, such as burning sensation on the oral mucosa, recurrent aphthous ulcers or gingivitis, after removal of amalgam fillings. In one patient each peroral eczema and diarrhoea aggravated after amalgam fillings had been taken out. These observations indicate that responses to mercury allergy are not uniform and show considerable individual variations. There is no reason to advise against or prohibit the use of amalgam fillings. Their substitutions by other materials may well bring about other types of allergy.

Adolescent↗
PubMed1993

[Lymphoplasmocytoid immunocytoma of the skin].

A 68-year-old male patient presented with numerous red-brown papules on the trunk and neck. Cutaneous lymphoplasmocytoid immunocytoma was diagnosed following histological and electron microscopical detection of atypical lymphoid cells in the dermis. Immunohistochemistry revealed a monoclonal proliferation of IgG-kappa-positive B-lymphocytes. There was no extracutaneous manifestation of the lymphoma. Complete remission was affected by total-body irradiation with an electron beam.

Biomarkers, Tumor↗
PubMed1986

[Immunohistochemical studies of the determination of the hormone receptor status of breast cancer].

Immunohistochemical examinations of 89 breast cancer specimens were performed using two different monoclonal antibodies. One marked the nuclear estrogen-receptor (ER) protein (anti-ER, Abbott), whereas the other marked an ER-related cytoplasmic protein (ER-D5 Amersham). Comparison of the results of the biochemical assay with those of the immunohistochemical markers revealed the following correlations: 75% anti ER and 71% ER-D5. Clinical follow-up studies are necessary to specify the relevance of these new immunohistochemical techniques in the anti-hormonal therapeutic management of breast cancer patients.

Antibodies, Monoclonal↗
PubMed1986

[Morphologic criteria in breast-saving surgery].

Efficiency of radiation therapy is dependent on the tumor mass on the one hand and on "radiosensitivity" on the other hand. Thus the locoregional acribic surgery is an urgently required presupposition regarding therapeutic success. In cases of early breast cancer (pT 1 N0 M0) unfavorable prognostic factors may initiate a discussion on adjuvant therapy. From the curative point of view at present breast preserving surgery referring tumors bigger that 2 cm (pT2) should be performed in cases with more advantageous prognostic parameters (low grade malignancy up to grade II a, low degree of tumor cell dissociation, favorable subtype, no relevant lymphangiosis carcinomatosa detectable, etc.). Additional immunohistochemical analysis of the receptor status and the proliferative compartment can be helpful for later therapeutic decisions. The possibility of breast preservation in only palliatively treated cases must be discussed separately.

Breast↗