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Biomedical subjects

A Helbling

Publications and source records attributed to A Helbling.

At least 19 recordsLinked to original sources
PubMed1999

T cell involvement in persulfate triggered occupational contact dermatitis and asthma.

BACKGROUND: Ammonium and potassium persulfates may induce a variety of cutaneous and respiratory diseases. The precise underlying mechanisms, however, are unclear. OBJECTIVE: To describe a hairdresser, who developed contact dermatitis, rhinoconjuntivitis, and bronchial asthma of delayed onset after occupational exposure to hair bleaches containing persulfate salts and to provide evidence for a common T-cell mediated mechanism responsible for the clinical manifestations. METHODS: We performed skin testing, routine histologic and immunohistochemical examination of the skin reaction after prick testing, lymphocyte proliferation analysis, nasal challenge test, and pulmonary function testing. RESULTS: The causative role of bleaching powder and ammonium persulfate was demonstrated by case history, skin tests, and a nasal challenge test. Patch tests produced a delayed cutaneous reaction to ammonium persulfate confirming contact sensitization. Prick tests with bleaching powder and ammonium persulfate were negative at 15 minutes but revealed a late skin reaction with a papule at the prick sites after 24 hours. Histologic examination of this late reaction demonstrated a perivascular infiltration comprising predominantly T lymphocytes. Further, a significant proliferation of T cells to bleaching powder was reproducibly found by a lymphocyte proliferation analysis. Nasal challenge test with bleaching powder showed a significant reduction of air flow after 24 hours. CONCLUSION: Our findings suggest that immunologic mechanism with direct involvement of T cells may not only play an important role in the pathogenesis of the cutaneous but also in the respiratory and rhinoconjunctival reactions.

Adult↗
PubMed1999

Respiratory allergy to mushroom spores: not well recognized, but relevant.

BACKGROUND: Although basidiospores are a major component of the air spora in many parts of the world, their clinical significance as triggers of respiratory allergy has rarely been demonstrated. Therefore, the class of basidiomycetes as an aeroallergen is not well known. OBJECTIVE: To demonstrate a cause and effect relationship between respiratory allergy and basidiospores, we illustrate this case report of a 38-year-old housewife. METHODS: Skin prick test, immunoblot, and active anterior rhinomanometry were used as diagnostic tools to verify specific reactivity of a Pleurotus pulmonalis spore extract. Two atopic subjects served as controls. RESULTS: The skin prick test positive study subject reacted with subjective and objective signs including a significant drop of the FEV1 by nasal challenge at a concentration of 0.1 mg/mL of the Pleurotus spore extract while both controls were negative even at a higher test concentration. IgE-immunoblot revealed several distinct bands in the serum of the Pleurotus-sensitized subject. CONCLUSION: Spores of Pleurotus pulmonalis, a common mushroom of the fungal class of basidiomycetes, can cause specific, IgE-mediated acute rhinoconjuncivitis and asthma in sensitized individuals.

Adult↗
PubMed1999

Chronic idiopathic urticaria: natural course and association with Helicobacter pylori infection.

BACKGROUND: Chronic urticaria is a common disease, though only few data on its natural course are available. In most cases the cause cannot be determined. Recently a relationship of chronic urticaria to infection with Helicobacter pylori (HP) has been postulated, but no controlled study has been performed to prove this association. METHODS: In this prospective study the clinical course and rate of HP infection in 46 patients with chronic 'idiopathic' urticaria were investigated. Infected patients were treated in a double-blind placebo-controlled crossover study with amoxycillin and lansoprazol. Eradication and clinical course were followed up 2 months after each treatment, respectively, 3 and 6 months after the first consultation. RESULTS: In 19/46 (41%) the chronic 'idiopathic' urticaria resolved within 6 months. 12 patients (24%) were infected with HP, which corresponds to the infection rate of the population at comparable ages without urticaria in Switzerland. Eradication of HP was achieved in 3, but only in 1 was the eradication associated with the resolution of urticaria. CONCLUSIONS: Our data show that in young patients with a rather short history of chronic urticaria frequently a rather favourable natural course of chronic idiopathic urticaria can be seen. No association between HP infection and chronic urticaria could be demonstrated.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1998

[Food allergy. Most often conceals an inhalational allergy].

Food allergy (hypersensitivity) is a form of adverse food reaction in which the reaction is caused by an immunological response to a food. Most immediate allergic reactions to food are IgE-mediated. The prevalence of food allergy in the general population without the oral allergy syndrome is about 1-2%. Although many foods have been described to cause an allergic reaction, only a few are responsible for the majority of hypersensitivity symptoms. Based on continuous studies by B. Wüthrich, Allergy Unit of the Dermatology Department, University Hospital, Zurich, celery (42%) followed by dairy products (16%), carrot (13%), hen's egg (12%) and fish (7%) is by far the major source of food allergy in Switzerland. In adults food hypersensitivity is mainly due to cross-reactivity between inhalative and food allergens. Pathophysiologically, IgE antibodies induced by aeroallergens recognize structurally similar components in certain foods even from taxonomically unrelated plants. Following an accurate allergological examination, oral provocation tests are considered the most conclusive procedures to establish diagnosis. The only proven form of management in food allergy is strict elimination of the offending food. Food-allergic patients must be provided with emergency medications. Identification of allergens and their characterization finally will improve our understanding for pathophysiologic mechanisms of food allergy.

Adult↗
PubMed1998

[Anaphylaxis: clinical aspects, etiology and course in 118 patients].

Systemic anaphylaxis is a potentially life-threatening clinical syndrome resulting from the release of biologically active substances such as histamine or prostaglandins upon a target organ. The aims of our study were to analyze clinical data, causative agents and follow-up in subjects with severe anaphylaxis. Of 5689 subjects who were referred from May 1994 through October 1996 to the allergy-immunology out-patient clinic of the University of Berne, 118 (2.1%; 68 females and 50 males; mean age 41 years) had experienced severe systemic anaphylaxis with hypotension, loss of consciousness or shock. 104 individuals (88.1%) showed accompanying dermal symptoms, 85 (72.0%) respiratory and 52 (44.1%) gastrointestinal signs. Causative agents were identified in 93.2% of these attacks; they included drugs (33.9%), insect stings (23.7%), foods (18.6%), exercise (8.5%), latex (7.6%), and immunotherapy (0.9%) with pollen extracts. A suspected cause could not be determined in 8 subjects. Atopy was present in 64 individuals (54%). Prior to the index anaphylaxis, 21 of 110 subjects (19.1%) with an identified cause had experienced more than one episode of anaphylaxis. Follow-up survey showed that 29 of these 110 individuals (26.4%) were accidentally reexposed to the causative agents. 19 of 24 patients (79.2%) used their emergency kits, while 5 were not equipped with. Only one severe systemic reaction occurred in a subject who intentionally reexposed himself to the identified cause of anaphylaxis. Besides cardiovascular symptoms, systemic anaphylaxis most often involves the skin and respiratory tract. Since prevention of anaphylaxis focuses upon avoidance of precipitating factors, all individuals with anaphylaxis should be referred to an allergologist for identification of the causative agents. The cause of anaphylaxis could be determined in the majority of patients with anaphylaxis. However, unexpected exposures are frequent. Thus, all patients who have had one or more episodes of anaphylaxis should carry an emergency kit for self-administration, and should be instructed in its use.

Adolescent↗
PubMed1998

Mushroom (Basidiomycete) allergy: diagnosis established by skin test and nasal challenge.

BACKGROUND: Fungal spores are universal components in the air and established as important causes of respiratory allergies. Whereas fungi imperfecti are accepted sources of allergic asthma and rhinitis, the significance of basidiomycetes as respiratory allergens is not established. OBJECTIVES: The aims of the present study were to investigate the rate of sensitization in subjects referred to an allergy clinic to 3 basidiomycetes commonly found in Europe. We demonstrate the clinical relevance of basidiomycete sensitization by active anterior rhinomanometry and identified basidiomycete allergens by immunoblotting. METHODS AND RESULTS: Consecutive outpatient clinic attendees (n = 1207, >12 years of age) were given the skin prick test with a panel of common inhalant allergens and extracts of Boletus, Coprinus, and Pleurotus. To evaluate a cause-and-effect relation between basidiomycete allergens and respiratory allergies, 12 Pleurotus pulmonalis spore-sensitized subjects with respiratory symptoms and 6 control subjects were challenged by anterior rhinomanometry. SDS-PAGE immunoblots were used to identify basidiomycete-specific IgE antibodies in sera from subjects with positive skin prick test results. Of 1207 subjects tested, 48 (4%) reacted to at least 1 of the basidiomycete extracts. Whereas all of the 12 subjects with Pleurotus pulmonalis-positive skin test results showed a significant decrease in nasal air flow (mean 73%), none of the control subjects reacted. Immunoblots revealed several different IgE-binding proteins in Pleurotus and Coprinus extracts. CONCLUSIONS: Our results demonstrate that sensitization to basidiomycetes in subjects with respiratory allergies is frequent. Furthermore, Pleurotus pulmonalis spore extracts can definitely induce respiratory allergy in sensitized subjects. Immunoblot assays disclosed different IgE-reactive bands indicating the existence of basidiomycete allergens.

Adolescent↗
PubMed1997

[Important cross-reactive allergens].

Food allergy in adults is mainly due to cross-reactivity between inhalative and food allergens. IgE antibodies are induced against aero-allergens, which recognize a structurally similar component in certain foods. Not all patients with such food allergies have clinical symptoms of pollinosis, although a sensitization to the inducing aero-allergens is always found. Dependent on the main allergen, namely Bet v 1 or Bet v 2, different symptoms can be observed. Bet v 1 mainly causes mild symptoms localized around the area of the oropharynx (oral allergy syndrome). It is mainly caused by apples, cherries, peaches and plums, but can also be observed with other allergens which cause generalized symptoms. Sensitization to Bet v 2 is commonly associated with more generalized symptoms, in particular urticaria and angioedema (mugwort/celery syndrome). Recently, new cross-reactivities have been detected based on latex sensitivity or housedust mite sensitivity. Latex allergy can cause food allergy to avocado, banana and chestnut, housedust mite allergens to crustacea and snails. Knowledge of these cross-reactivities is important for the clinician, since the majority of food allergies are caused by such cross-reactive IgE-antibodies. Further characterization of these allergens may open up ways of inducing tolerance to these substances.

Allergens↗
PubMed1997

Hymenoptera sting anaphylaxis and urticaria pigmentosa: clinical findings and results of venom immunotherapy in ten patients.

BACKGROUND: Occasional patients with urticaria pigmentosa and anaphylaxis after Hymenoptera stings have been described. In this situation the question arises: Is anaphylaxis IgE-mediated or induced by pharmacologic mediator release from mast cells? METHODS: We investigated 10 patients with histologically confirmed urticaria pigmentosa and a history of anaphylaxis after honeybee or Vespula stings before and during immunotherapy with the respective venom. RESULTS: In eight of 10 patients, an elevated serum tryptase level was found. In two of 10 patients, no venom-specific IgE could be detected by either skin tests or RAST. Five patients had no detectable venom-specific serum IgE, and in the remaining patients the level was low (<1 Phadebas RAST unit). Venom immunotherapy was well tolerated and caused only one mild systemic reaction in a patient during the dose increase phase. Six patients were re-stung while receiving venom immunotherapy: only one had a mild systemic reaction (angioedema) after a Vespula sting. CONCLUSION: Anaphylactic symptoms after Hymenoptera stings in patients with urticaria pigmentosa are most often IgE-mediated but can occasionally be observed in the absence of IgE sensitization to venom allergens. Venom immunotherapy can be safely and successfully used in patients with urticaria pigmentosa and sting anaphylaxis.

Adult↗
PubMed1996

[Antiphospholipid antibodies syndrome: follow-up of patients with a high antiphospholipid antibodies titer].

41 subjects with highly elevated IgG anticardiolipin antibody (aCL) titers (> 30 GPL-U/ml) were retrospectively evaluated regarding underlying disease, clinical symptoms, and in particular the influence of drugs on aCL titer and clinical symptoms. Whereas 31/41 (76%) fulfilled the criteria for an antiphospholipid antibody syndrome (APS), 10 (24%) did not. About half (47%) of the patients had an autoimmune disease (mainly systemic lupus erythematosus). 26 (63%) had had recurrent thrombophilic events, 3 (7%) recurrent spontaneous abortions and 10 (24%) associated thrombocytopenia. 8/34 (23%) subjects followed up over 6-42 months had a thrombophilic complication again. 6/16 (37%) developed deep venous thrombosis in spite of oral anticoagulation (INR 1.5-3.0), one of three under acetylsalicylic acid treatment and only one subject without therapy. ACL titer decreased (> 12 U/ml) in 20/34 subjects (59%) during the follow-up period, mainly in patients under immunosuppressive treatment due to the underlying autoimmune disease. In comparison with 5/14 subjects (36%) with consistently high aCL, only 3/20 (15%) with decreasing aCL developed thrombosis. Patients treated by immunosuppressive agents had a higher incidence of decreasing aCL than those without. This investigation indicates that a high titer of aCL in asymptomatic subjects does not justify prophylactic anticoagulation therapy. However, if a history of recurrent deep venous thromboses or pulmonary embolisms is established, long-term anticoagulation therapy should be maintained at or above the international normalized ratio (INR) of 3. ACL titers in subjects with an autoimmune disease may decline, as a result of immunosuppressive treatment or otherwise, and this decline is associated with a lower incidence of thrombophilic disorders.

Abortion, Habitual↗
PubMed1996

[Latex allergy: from contact urticaria to asthma].

Latex, a natural plant material, has gained increasing interest over the last years because of its allergenic potency inducing problems in medical professions as well as in daily life. Since 1979 reports on allergic spontaneous reactions induced by latex products (such as gloves, condoms, balloons, cofferdam) have increased steadily. Symptoms manifest clinically as contact urticaria, rhinoconjunctivitis, asthma or anaphylactic shock. Some of these patients may additionally have an alimentary allergy (avocado, banana, maron i.e.), possibly containing agents cross-reacting with latex. Pathophysiologically the allergy is IgE-mediated, because antigen-specific IgE antibodies have been found in vitro as well as in vivo. Health professionals, workers in gum manufacturing and individuals with spina bifida have been found to be at special risk for a latex allergy therefore, it is important that these persons at risk are recognized and occasionally tested prior to interventions or operations. Strict avoidance of the use of latex products is the primary preventive measure, which may occasionally be difficult, particularly in patients with respiratory diseases.

Allergens↗
PubMed1996

[Episodic headache, diminished performance and depressive mood].

By the example of two case reports, typical signs of caffeine withdrawal like headache, increased irritability, decreased performance and disturbed concentration are described. These symptoms occurred two times within one week in two healthy nonsmoking individuals volunteering in a scientific study including periods of 24 hours with standardized caffeine-free-diet. The two volunteers were used to a regular coffee consumption of eight cups per day (about 600 mg/day). Since caffeine obviously represents the most common psycho-stimulant worldwide and since even moderate coffee consumption may lead to dependence, withdrawal symptoms induced by sudden reduction of consumption or withdrawal of caffeine may occur more often than usually assumed.

Adult↗
PubMed1996

[A 17-year-old female patient with recurring fever, chills, exanthema, myalgia and polyserositis].

The 17-year-old was admitted for investigation of a fever persisting for three weeks in spite of antibiotic treatment. Based on the clinical picture presenting with fugitive exanthema during febrile episodes, myalgia, polyserositis, leucocytosis with toxic granulations and-- after an antibiotic window--negative cultures of all investigated fluids (blood, pleural and peritoneal fluid), adult-type Still's disease was diagnosed. Treatment with steroids and indomethacine was only temporarily successful. Therapeutic stabilization first occurred under administration of phenylbutazone. The course was complicated by three surgical abdominal interventions because of an unclear acute abdomen, a strangulation ileus and a small-bowel perforation.

Adolescent↗
PubMed1996

Immunopathogenesis of fish allergy: identification of fish-allergic adults by skin test and radioallergosorbent test.

BACKGROUND: As the consumption of fish increases in the United States, the importance of allergic reactions to fish has become clear. Since most previous studies on fish allergy have focused on children reacting mainly to codfish, there is a need to investigate allergic reactions to other fish in adults. OBJECTIVE: To identify fish-allergic adults, and to assess cross-reactivity among different species of fish by RAST inhibition. METHODS: Thirty-nine individuals who reported fish allergy were selected for study; 32 (82%) were atopic as defined by two or more positive skin tests to common inhalant allergens and a history of allergic reactions and 33 (85%) experienced allergic symptoms within 30 minutes after ingesting fish. The most frequently reported symptoms were hives (69%), itching (69%), and wheezing/chest tightness (54%). Study subjects were skin tested with fish extracts and their sera assayed for IgE antibodies to different fish species. RESULTS: Thirty-six (92%) of the subjects tested had a positive skin test to at least one of 17 fish extracts tested; 9/35 (26%) reacted to all 17 extracts. Of the atopic (two or more positive skin tests to common inhalant allergens plus a personal and/or family history of allergy) and nonatopic fish-tolerant controls, 20/26 (77%) reacted by skin test to one or more fish extracts tested; the most prevalent positive reaction was to anchovy (73%). A significant correlation (P < .01) was observed between skin test reactivity of fish-allergic subjects to most fish extracts and fish RAST reactions. Radioallergosorbent inhibition testing demonstrated significant cross-reactivity among pollack, salmon, trout, and tuna; and between mackerel and anchovy. CONCLUSION: These results suggest that fish-allergic subjects may be clinically sensitive to more than one species of fish. Skin test reactivity to fish by itself is not an adequate criterion for the confirmation of clinically relevant fish allergy; consequently, fish-allergic subjects with positive skin tests to several fish species should exercise caution when eating fish until tolerance can be demonstrated by double-blind, placebo-controlled food challenge, at the patient's earliest convenience.

Adult↗