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Bernhard Przybilla

Publications and source records attributed to Bernhard Przybilla.

18 recordsLinked to original sources
PubMed2006

Mastocytosis and Hymenoptera venom allergy.

PURPOSE OF REVIEW: Mastocytosis is a rare disease characterized by increased mast cells in skin and/or internal organs. We evaluate the impact of mastocytosis on diagnosis and treatment of Hymenoptera venom allergy. RECENT FINDINGS: Patients with Hymenoptera venom allergy who suffer from mastocytosis develop life-threatening sting reactions more often than those who do not. When patients with Hymenoptera venom allergy were systematically examined for mastocytosis, it was found to be represented to an abnormally high extent. Most patients with mastocytosis tolerate venom immunotherapy with no or only minor systemic symptoms. Venom immunotherapy was found to be marginally less effective in patients with mastocytosis than in those without evidence of mast cell disease (defined as absent cutaneous mastocytosis combined with a serum tryptase concentration of <11.4 microg/l). Several deaths from sting reactions were reported in patients with mastocytosis after venom immunotherapy was stopped. These patients should have venom immunotherapy for the rest of their lives. SUMMARY: Patients suffering from mastocytosis and Hymenoptera venom allergy are at risk from a particularly severe sting anaphylaxis. They need optimal diagnosis and treatment. In patients presenting with Hymenoptera venom allergy, screening tests by measurement of serum tryptase concentration, and a careful skin examination, are highly recommended.

Animals↗
PubMed2006

Hypersensitivity to titanium osteosynthesis with impaired fracture healing, eczema, and T-cell hyperresponsiveness in vitro: case report and review of the literature.

There are very few reports on hypersensitivity reactions in association with titanium-based materials so that the existence of allergy to titanium is still put in question. We report on a patient in whom impaired fracture healing and eczema localized to the perioperative area developed upon titanium-based osteosynthesis. Patch testing gave no reactions to titanium nor to nickel, chromium, or cobalt. However, in the lymphocyte transformation test, the patient's lymphocytes showed markedly enhanced proliferation in vitro to titanium. After removal of the titanium material, fracture healing was achieved and the eczema cleared. Parallel to this, in vitro hyperreactivity to titanium disappeared. Although contact allergic reactions to titanium have been very rarely reported, these findings support a diagnosis of titanium allergy in our patient.

Adult↗
PubMed2005

Contact urticaria to giraffe hair.

BACKGROUND: Immediate-type hypersensitivity to animal proteins is a common problem in people occupationally exposed to animals. METHODS: A 19-year-old female working as a voluntary zookeeper in her off-time suffered from hives on her forearms following contact to the fur of a giraffe. For diagnostic evaluation, skin prick tests, assessment of specific serum IgE antibodies, and basophil activation tests were performed. RESULTS: Skin prick tests with a standard series of common aeroallergens were positive for various pollens. Prick testing with native materials was positive for extracts of hair from two different giraffe subspecies in the patient, but not in control subjects. By CAP-FEIA, no specific serum IgE antibodies to dander of a large variety of animals were found in the patient. In the basophil activation test, expression of the activation marker CD63 was induced by extract of giraffe hair on the cells from the patient, but not on those from unaffected controls. CONCLUSIONS: This patient suffers from an 'exotic' immediate-type contact allergy to giraffe hair.

Adult↗
PubMed2005

Anaphylaxis to viscotoxins of mistletoe (Viscum album) extracts.

BACKGROUND: Extracts of mistletoe (Viscum album) are used in many countries for adjuvant cancer therapy. These extracts contain mistletoe lectins and viscotoxins that are supposed to have immunostimulating and cytotoxic effects, respectively. The treatment is usually well tolerated. OBJECTIVE: To report a case of severe anaphylaxis secondary to mistletoe extract administration with demonstrable anti-IgE antibodies to mistletoe. METHODS: Skin prick tests, basophil histamine release, basophil activation test, and immunoblotting were performed to characterize the pathophysiology of this reaction. RESULTS: The patient had immediate-type skin prick test reactions to the whole commercial preparation and to its mistletoe extract component. A histamine release test and a flow cytometric basophil activation test performed with the patient's peripheral blood leukocytes by incubation with the mistletoe extract yielded a concentration-dependent histamine release and expression of the activation marker gp53 in up to 98% of anti-IgE-positive cells. Immunoblotting revealed IgE binding to 5-kDa proteins of mistletoe in the patient's serum, which corresponds to the molecular weight of viscotoxins. The results of all these tests were negative in controls. CONCLUSIONS: Until now, anaphylaxis to mistletoe extracts has been only rarely reported. In our patient, viscotoxin specific IgE evidently had induced an anaphylactic reaction.

Anaphylaxis↗
PubMed2005

Evaluation of phototoxic properties of antimicrobials used in topical preparations by a photohaemolysis test.

Antimicrobials are widely used in topical formulations as preservatives or as therapeutically active agents. Photosensitization by such compounds has not yet been studied systematically. To identify possible phototoxic properties, antimicrobials (benzyl alcohol, bronopol, chloracetamide, clioquinol, diazolidinyl urea, ethylenediamine dihydrochloride, formaldehyde, glutaraldehyde, imidazolidinyl urea, sodium benzoate, propylene glycol) were evaluated in vitro by means of a photohaemolysis test using suspensions of human erythrocytes. Irradiations were performed with UVA- and UVB-rich light sources. In the presence of bronopol or clioquinol, there was photohaemolysis up to 78.1% or 48.5% with UVA and up to 100% or 34.3% with UVB, respectively. The phototoxic effect depended on the concentration of the compounds and the UV doses administered. None of the other substances tested caused significant photohaemolysis. It is concluded that bronopol and clioquinol exert phototoxic effects in vitro and thus might also cause photosensitization when used on the skin. The clinical significance of this has to be established by further work.

Anti-Infective Agents↗
PubMed2005

Ultraviolet B-induced DNA damage in human epidermis is modified by the antioxidants ascorbic acid and D-alpha-tocopherol.

DNA damage caused by ultraviolet (UV) irradiation is considered the main etiologic factor contributing to the development of skin cancer. Systemic or topical application of antioxidants has been suggested as a protective measure against UV-induced skin damage. We investigated the effect of long-term oral administration of a combination of the antioxidants ascorbic acid (vitamin C) and D-alpha-tocopherol (vitamin E) in human volunteers on UVB-induced epidermal damage. The intake of vitamins C and E for a period of 3 mo significantly reduced the sunburn reaction to UVB irradiation. Detection of thymine dimers in the skin using a specific antibody revealed a significant increase of this type of DNA damage following UVB exposure. After 3 mo of antioxidant administration, significantly less thymine dimers were induced by the UVB challenge, suggesting that antioxidant treatment protected against DNA damage.

Administration, Oral↗
PubMed2005

Baseline serum levels of mast cell tryptase are raised in hemodialysis patients and associated with severity of pruritus.

BACKGROUND: The pathogenesis of pruritus in renal disease is not yet understood. Evidence suggests that mast cells play a role; for example, the number of dermal mast cells is increased in patients on hemodialysis. PATIENTS AND METHODS: To investigate a possible role of mast cell tryptase in pruritus of patients undergoing chronic hemodialysis, serum mast cell tryptase concentrations were measured in blood samples taken from 93 such patients, 53 of whom also recorded the severity of their pruritus on a visual analogue scale. RESULTS: Serum mast cell tryptase levels were above 11.4 microg/l (95th percentile) in 84 of 93 hemodialysis patients (90.3 %). The intensity of pruritus correlated significantly (p = 0.014) with the tryptase levels, an associated not yet shown for other mast cell-related parameters. CONCLUSIONS: Mast cells or even tryptase itself may be involved in the pathogenesis of pruritus of hemodialysis patients.

Adolescent↗
PubMed2004

Anaphylaxis to wheat beer.

BACKGROUND: Despite its worldwide and abundant consumption, beer has rarely been found to cause anaphylaxis. Barley malt contained in lager beers seems to be an important elicitor. OBJECTIVE: To report the unusual case of severe anaphylaxis following the ingestion of wheat beer. METHODS: A 59-year-old man experienced angioedema, generalized urticaria, and unconsciousness after ingestion of wheat beer. He tolerated lager beer well. For diagnostic evaluation, skin prick tests, oral challenge tests, and identification of specific IgE antibodies were performed. RESULTS: Skin prick test results with standard series of common aeroallergens and food allergens were negative with the exception of a 1 + reaction to wheat flour. The results of skin prick tests with native materials were positive for 2 brands of wheat beer and wheat malt shred but negative for baker's yeast, hops, and a brand of lager beer. Oral challenges with wheat beer or wheat flour elicited urticaria. By CAP-FEIA, specific IgE antibodies to wheat and barley flour but not to hops or baker's yeast were found in serum. Immunoblot analysis revealed that patient's IgE was bound to a protein of approximately 35 kDa in wheat extract. CONCLUSIONS: This is the first report, to our knowledge, on anaphylaxis to beer attributable to wheat allergy.

Anaphylaxis↗
PubMed2004

Effect of reduced exposure on natural rubber latex sensitization in health care workers.

BACKGROUND: Knowledge about the long-term course of allergy or sensitization to natural rubber latex (NRL) is insufficient. OBJECTIVE: To investigate the long-term effect of preventive measures on sensitization variables in health care workers who had been diagnosed as having NRL allergy (NRLA) or NRL sensitization (NRLS) without clinical symptoms. METHODS: Repeated follow-up investigations, skin prick tests, and NRL specific IgE serum antibodies were performed in 88 health care workers-33 with NRLA and 55 with NRLS. All workers had been instructed to avoid NRL exposure. At the workplace, powder-free NRL gloves for all other employees were gradually introduced. Re-evaluations were done at 14 +/- 3.7 (N = 86) and 38 +/- 4.0 (N = 78) months after the first examination. RESULTS: At the last follow-up, a loss of skin prick test reactivity to NRL was observed in 1 of 29 subjects with NRLA (3.4%) and 16 of 35 with NRLS (45.7%) with previous skin test reactions (P < .001). Among those subjects who demonstrated a kU/L level (CAP class) equal to or greater than class I to NRL at the initial examination, NRL-specific IgE was absent at the last follow-up in 8 (32.0%) of 25 subjects with NRLA and 14 (38.9%) of 36 with NRLS. At the final examination, we could no longer demonstrate sensitization to NRL by any method in 24 (27.3%) of 88 health care workers. Complete loss of NRL sensitization was less frequent in subjects with NRLA than in those with NRLS (1 of 33 or 3.0% vs 23 of 55 or 41.8%; P < .001). CONCLUSIONS: Implementation of simple preventive measures lowers markers of sensitization to NRL quickly in many health care workers with NRLA or NRLS.

Adult↗
PubMed2004

Venom immunotherapy: adverse reactions and treatment failure.

PURPOSE OF REVIEW: Side effects of venom immunotherapy and lack of efficacy represent significant problems in the treatment of patients allergic to Hymenoptera venom. Among these side effects systemic anaphylactic reactions and large local reactions are the most important. This review aims to discuss new insights in frequency, pathogenesis and handling of these common side effects and of treatment failure during venom immunotherapy. RECENT FINDINGS: Several studies showed that severe side effects due to venom immunotherapy are rare. Recently published studies focus on ultrarush protocols and report good tolerance of an ultrarush venom immunotherapy in which the maintenance dose was reached within several hours or 2 days, respectively. Compared to the use of aqueous extracts (administered according to a rush protocol), frequency of local and also systemic side effects was lower when depot extracts and schedules with a slow conventional dose increase were applied. Concomitant treatment with H1-antihistamines was found to reduce local and mild systemic adverse reactions during venom immunotherapy. Up to 25% of patients are not protected when re-stung while on venom immunotherapy with the usual maintenance dose of 100 microg of venom every 4-8 weeks. These patients can achieve full protection by increasing the maintenance dose. SUMMARY: Conventional dose increase using depot extracts is better tolerated than if aqueous extracts are being administered. Concomitant treatment with H1-antihistamines may be helpful. Increasing the venom dose to 200 microg or even more may be therapeutically effective in patients not protected by a lower maintenance dose. To compare tolerance of different treatment protocols prospective comparative studies are required.

Histamine H1 Antagonists↗
PubMed2003

[Systemic contact eczema against Balsam of Peru].

Balsam of Peru (PB; Myroxylon pereirae) is a natural product derived from resin of a tropical tree (MyroxyIon balsamum (L.) Harms var. pereirae (Royle) Baillon). Because of its antiseptic and aromatic properties PB or PB-components can be found worldwide not only in many health care and cosmetic products, but also in food items and semiluxury food. PB contains a wide variety of potent contact allergens leading to hypersensitivity reactions not only after topical application but also oral uptake. We report a 51-year-old brewer with chronic eczema of the hands who showed delayed-type patch test reactions against PB and fragrance-mix. Oral PB-challenge led to exacerbation of the eczema 5 and in a repeated test 2 days later. We here review this probably quite often overlooked disease and the therapeutic consequences which require profound knowledge about the wide distribution of PB when advising the patient about a PB-restricted diet. In addition, this unusual case report demonstrates that one has to consider marked delayed hypersensitivity reaction when investigating a systemic contact allergy.

Administration, Topical↗
PubMed2003

Atopy patch test reactions show a rapid influx of inflammatory dendritic epidermal cells in patients with extrinsic atopic dermatitis and patients with intrinsic atopic dermatitis.

BACKGROUND: Normal human skin harbors a single epidermal dendritic cell (DC) population, the CD1a(+++)CD11b(-) Langerhans cells. In many chronic inflammatory skin diseases, the epidermal DC pool bears a second population, the CD1a(+)CD11b(+++) inflammatory dendritic epidermal cells (IDECs). Immunophenotypic, ultrastructural, and functional aspects of IDECs have been investigated in chronic untreated skin lesions of intrinsic and extrinsic atopic dermatitis (AD), contact dermatitis (CD), and psoriasis, but little is known about freshly induced early skin lesions. OBJECTIVE: We sought to characterize enumerative and immunophenotypic changes in the epidermal DC pool during the development of eczematous skin lesions. METHODS: The atopy patch test with aeroallergens and food-protein allergens and a conventional patch test with standard-series haptens were performed as models for early skin lesions of extrinsic and intrinsic AD and CD, respectively. After 72 hours, epidermal cell suspensions were prepared, analyzed in a standardized flow cytometric technique, and compared with the results obtained from chronic lesions. RESULTS: The migration of IDECs into the epidermis occurs within 72 hours and is thus an early event. It continues in chronic AD, but not in chronic CD, lesions. The specific upregulation of FcepsilonRI, especially on IDECs, occurs later during formation of extrinsic but not intrinsic AD lesions. LCs were negative for Cd36 in patch test lesions, whereas in chronic skin lesions, LCs expressed Cd36. CONCLUSION: The DC alteration during skin lesion formation can be subdivided into early and late events, with the influx of IDECs as an early event and the alteration of the DC phenotype as a late event.

Adolescent↗
PubMed2003

Predisposing factors and clinical features of eczema herpeticum: a retrospective analysis of 100 cases.

BACKGROUND: Eczema herpeticum (EH) is a widespread herpes simplex virus infection of inflamed skin, most often occurring in patients with atopic dermatitis (AD). A monomorphic eruption of dome-shaped blisters and pustules in the eczematous lesions along with severe systemic illness lead to the clinical diagnosis, but atypical variants with disseminated slits may also occur. Topical use of corticosteroids is alleged to be a pathogenetic factor for EH, but predisposing factors for EH are largely unknown. Objective and methods We sought to characterize the clinical features and predisposing factors for EH. A retrospective analysis of 100 patients with EH seen from 1980 through 1996 and of 105 control patients with AD was performed. RESULTS: Fever and lymphopenia were associated with EH, whereas an increased erythrocyte sedimentation rate was frequently seen in patients with EH and control patients who were impetiginized. In 100 patients with EH, primary herpes simplex virus infection was likely in 20 patients, and a secondary herpes simplex virus infection was suggestive in 26 patients. In all, 13 patients had a second EH, whereas 3 patients had a third EH. Patients with EH had a significantly earlier onset of AD and a significantly higher total serum IgE level than the control patients. More than 75% of the patients with EH had not received corticosteroid treatment in the 4 weeks before onset of EH. CONCLUSIONS: The characteristics of patients with EH are those associated with severe manifestations of AD. The majority of EH occurs in patients with untreated AD, arguing against a role for topical corticosteroids in the development of EH.

Adult↗
PubMed2003

[Insect venom allergies].

Systemic IgE-mediated immediate type reactions (anaphylaxis) due to honeybee or vespid stings are potentially life-threatening; they are reported in up to 5% of the general population. Insect venom allergy is diagnosed by history, skin testing and measurement of insect venom-specific serum IgE; sometimes additional tests are needed. The diagnosis is based on the history of a systemic allergic immediate type sting reaction, without such a medical history any other "positive" test results are irrelevant. Nearly always, patients with systemic allergic sting reactions can be protected from further episodes of anaphylaxis by a carefully performed hyposensitization (specific immunotherapy). If therapeutic efficacy has been proven by tolerance of a re-sting, hyposensitization can be frequently stopped after 3 to 5 years. Patients with a particular risk of frequent re-stings or of very severe sting reactions may have to be treated for a longer time, some of them even life-long.

Animals↗
PubMed2002

Multiple chemical sensitivity (MCS) and others: allergological, environmental and psychological investigations in individuals with indoor air related complaints.

Clinical observations point to an expanding group of individuals attributing hypersensitivity phenomena to indoor air pollution. It was the aim of this study to characterize such subjects by an interdisciplinary approach. Sixty-five individuals, recruited by a public campaign, were studied by a thorough allergological examination and a structured psychological interview. Measurements of common indoor pollutants in the air and in the dust were performed in rooms of several selected patients. Forty-two patients (65%) revealed a sensitization to common allergens, out of these 32 (49%) to house dust mites. Thirty-eight (58%) patients showed a psychosomatic or psychotic disorder. Increased concentrations of at least one of the measured indoor air pollutants were found in 11 out of 13 investigated houses. According to these results, four groups of patients could be identified: Seventeen patients (26%) had "classic" allergic diseases treated inadequately. In 19 patients (29%) allergic diseases were superimposed by strong psychosomatic interactions. An exclusive psychosomatic or psychotic cause of the complaints was found in 19 (29%). Ten subjects (16%) had "classic" allergic diseases (e.g. allergic rhinoconjunctivitis, urticaria), however, there were additional indications of hypersensitivity reactions to components other than classical allergens. Patients presenting with hypersensitivity phenomena attributed by themselves to indoor air pollution are a heterogeneous group and need a diligent work-up including intense allergological examination. The role of increased concentrations of indoor air pollutants has to be elucidated further.

Adult↗