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Biomedical subjects

L Klimek

Publications and source records attributed to L Klimek.

At least 19 recordsLinked to original sources
PubMed2006

[Olfactory testing: diagnostic methods for investigating the sense of smell].

For the testing of a person's sense of smell, both subjective and objective methods are available. Subjective tests include odor identification, threshold and discrimination tests. A prerequisite for successful testing is the ability and willingness of the patient to cooperate. For testing smell in the demented, comatose or simulating patient, the measurement of chemosensory evoked potentials (CSEP) is an established method.

Chemoreceptor Cells↗
PubMed2006

[The value and possibilities of immunotherapy in the treatment of allergic rhinitis].

Aside from allergen avoidance and medication, specific immunotherapy, represents the third important mainstay in a balanced therapeutic concept for the treatment of allergic rhinitis. In the case of subcutaneous immunotherapy (SCIT), clinical effectiveness, duration of the therapeutic result, prevention of bronchial asthma, reduced generation of additional co-sensitizations, and tolerability are all well-established. For such modern therapeutic concepts as "cluster", "rush" and ultra-rush" regimens, this is not yet the case. For sublingual therapy, too, questions about the impact on asthma development, new sensitizations and long-term outcomes have not yet been fully clarified.

Administration, Sublingual↗
PubMed2006

[Cluster immunotherapy in allergic rhinoconjunctivitis: review of a new therapeutic approach].

Apart from allergen avoidance, specific immunotherapy (SIT) represents the only potentially curative treatment available to patients with allergic rhinoconjunctivitis. Evidence for its clinical efficacy has been clearly demonstrated in several controlled clinical trials and depends on the allergen to which the patient is sensitive, the quality and total amount of allergen administered, and the SIT schedule. In classic SIT, gradually ascending dosages of the allergen extract are injected subcutaneously (dose-increase period) until the individual maximum dose is reached (dose-maintenance period). Several dosage schedules have been worked out. In cluster immunotherapy, 2-3 injections per day of treatment are given once a week to rapidly reach the maintenance dose. Several cluster schedules have been described. Recent data demonstrate that the frequency and severity of adverse effects in cluster immunotherapy correspond to those in other dosage schedules. As far as safety goes, cluster immunotherapy is an interesting alternative for the dose-increase period. In addition, recent studies reveal that clinical benefits appear sooner with cluster immunotherapy.

Allergens↗
PubMed2006

[Bronchial asthma--what is of importance for the ENT-specialist?].

In Germany the prevalence of bronchial asthma in adults is 5 % and up to 10 % in children. This explains its enormous medical and economic importance. Bronchial asthma is not only the most-frequent allergic lung disease; it is the most prevalent chronic illness of the childhood. Alongside with other atopic diseases--allergic rhinitis and atopic dermatitis--in the last decades the incidence increased significantly. Allergic and non allergic rhinitis and sinusitis are strongly correlated with asthma. This explains why ENT-specialists are often consulted first by patients with chronic inflammations of both the upper and lower airways. Hence, the ENT-specialist should clearly understand the pathophysiologic mechanisms of the disease, become familiar with the typical clinical findings and get a broader knowledge of the standard diagnostic methods and therapeutic issues. This article gives a detailed overview on these topics and the current guidelines.

Administration, Inhalation↗
PubMed2005

Intranasal trigeminal sensitivity in subjects with allergic rhinitis.

Trigeminal nerve endings of the human nasal mucosa are activated by chemical, physical or thermal stimuli. Activation of these A(delta) and C fibers can be quantified through the recording of chemo-somatosensory event-related potentials (ERP). The aim of this study was to investigate whether allergy-related activation of trigeminal nerve endings leads to changes in their responsiveness to intranasal trigeminal stimulation. Gaseous carbon dioxide (CO(2)) stimuli were applied in three sessions (baseline, after NaCl solution and after allergen application) to the nasal mucosa of 13 subjects with allergic rhinitis. Chemo-somatosensory ERP were recorded, and subjects rated the intensity of rhinitis symptoms. Administration of allergen produced a significant shortening of chemo-somatosensory ERP peak latencies P1 and N1. Observed changes of latencies were in line with rhinitis symptoms subjects indicated during the session. In addition, there was a negative relation between the general symptom score and ERP peak latencies, obtained both at baseline and after allergen exposure. In conclusion, it is hypothesized that in patients suffering from allergic rhinitis, nasal itching and sneezing after allergen exposure are, at least in part, clinical correlates of the activation of trigeminal nerve endings due to local inflammatory mechanisms. The correlations between ERP latencies and the patients' symptoms indicate that ERP latencies may possess a predictive value of the subjects' responsiveness to allergens.

Acoustic Stimulation↗
PubMed2005

[Relapsing facial erysipelas caused by nickel allergy. Significance of allergy diagnostics in ENT practice].

This case report shows a typical complication of allergic contact dermatitis as it is often seen in hand and foot eczema: relapsing erysipelas. To our knowledge the occurrence of such a complication in the face has never been reported. In the case presented, relapsing facial erysipelas were treated four times in a period of 2 years symptomatically without having identified or eliminated the causing allergen. This clearly indicates how important it is to have a sound knowledge of allergology and its diagnostic procedures, especially in ENT-practice.

Adult↗
PubMed2005

[Diagnosis and treatment of insect venom allergy. An important allergic issue for the ear, nose and throat specialist].

The increasing incidence and the potentially life-threatening reactions to venom stings indicate the necessity for otolaryngologists to have a basic knowledge of the diagnosis and treatment of venom allergy. The diagnosis of insect venom allergy is based on the history, skin prick testing (ideally performed as a titration series), and in vitro analysis of specific IgE antibodies to venoms. An emergency medication kit should be prescribed for the patient in case of future venom stings, comprising an H1-blocking antihistamine, a steroid and an adrenaline pen for self-injection. Subcutaneous allergen-specific immunotherapy (sSIT) is the standard treatment to avoid allergic reactions following venom stings in the future. SIT is indicated following all immediate-type reactions to venom stings; contraindications relate to the general recommendations of allergen-specific immunotherapy. Aqueous as well as alum-adsorbed depot allergen preparations can be used for subcutaneous injections. The important dose-increase phase can be performed using conventional, cluster, rush or ultra-rush schedules. Specific immunotherapy is successful in nearly 90% to 100% of patients after 3-5 years of treatment.

Arthropod Venoms↗
PubMed2005

The effects of short-term immunotherapy using molecular standardized grass and rye allergens compared with symptomatic drug treatment on rhinoconjunctivitis symptoms, skin sensitivity, and specific nasal reactivity.

BACKGROUND: The efficacy and safety of short-term immunotherapy with molecular standardized allergens (STI) has been demonstrated by double-blind placebo-controlled clinical trials. The aim of this study was to compare STI with symptomatic drug treatment. METHODS: Forty-eight patients with rhinoconjunctivitis to grass and/or rye pollen were treated either with STI (ALK(7), n = 24) plus anti-allergic drugs or anti-allergic drugs, alone (n = 24) in a prospective, randomized study. Symptoms and use of drugs were reported in patient diaries and titrated nasal provocation and skin prick tests were performed at baseline, before, and after season. RESULTS: Median overall symptom (P = 0.022, U test) and medication scores (P = 0.003) were significantly lower in the STI group, as was the result for a simultaneous analysis of conjunctival, nasal, and bronchial symptom scores and medication (P = 0.005). Sensitivity in the nasal provocation test decreased in the STI group but not in the drug-treated group. These differences became significant directly after STI (P = 0.027) as well as after the grass pollen season (P < 0.001). Skin sensitivity did not change in the STI group but increased in the drug-treated group after season, with a significant difference between the two groups for the erythema (P < 0.001). CONCLUSIONS: STI reduces grass pollen-induced rhinoconjunctivitis symptoms and drug use, and specific nasal reactivity and skin sensitivity, more efficiently than a standard symptomatic treatment.

Adolescent↗
PubMed2005

Potential of levocetirizine in the relief of nasal congestion.

Nasal congestion is a common and troublesome symptom of allergic rhinitis. Because it impairs the natural human drive for nasal breathing, it -- in addition -- leads to lower self-esteem and to impaired quality of life. It is a symptom that is difficult to treat. Traditionally, intranasal steroids, because of their potent anti-inflammatory properties, and vasoconstrictors have been utilized for relieving the nasal passages from the inflamed and congested mucosal tissues. Recent studies with the last-generation antihistamines have demonstrated the decongestant properties of these antihistamines in both the more acute seasonal allergic rhinitis and the more chronic and lasting perennial allergic rhinitis. This study aims to review the efficacy of the potent antihistamine, levocetirizine, in relieving nasal congestion as reported in various studies and settings. Comparisons with placebo and with other antihistamines have been presented in order to help general medical practitioners differentiate between the properties of the various available antihistamines.

Administration, Inhalation↗
PubMed2004

[Type I hypersensitivity to a silicone tube after laryngectomy].

While irritation of the tracheal mucosa is a common finding after laryngectomy, specific hypersensitivity to tracheal tubes or their components is extremely rare and has only been documented as a contact allergy. In this case report, we present type I hypersensitivity to tracheal tube components for the first time. The patient regularly used a special silicone tube for swimming after laryngectomy and complained about increasing tracheal irritation during and after the use of this tube. A standard skin prick test with common aeroallergens and a skin patch test with standard, rubber and adhesive allergens as well as with parts of the silicone tube was performed. Different parts of the tracheal tube were also tested with a scratch test. Total IgE as well as specific IgE for latex allergens was measured. Both skin prick and patch tests were negative. No specific IgE for latex allergens was detected. The scratch test generated strongly positive reactions against native tube material. The positive findings in the skin tests demonstrate specific hypersensitivity to the tracheal tube or its components in terms of a type I hypersensitivity. The causative component remains unclear.

Carcinoma, Squamous Cell↗
PubMed2004

[Cystic myoepithelioma. A rare differential diagnosis of a cystic lesion of the parotid gland].

By sonography, we found a sharply demarcated tumor with cystic areas in the parotid gland of a 41 year old male, indicating Warthin's tumor. Subtotal parotidectomy was performed. Microscopy showed an encapsulated tumor with myoepithelial cells and, in particular, central pseudocysts. Immunohistochemically, the tumor cells expressed cytokeratin 5/6 and S-100 protein as well as smooth muscle-actin. These features led to the diagnosis of a cystic myoepithelioma. Histopathologically, several different lesions of the salivary glands should be considered in the differential diagnosis of myoepithelioma, especially of this hitherto unique case in the parotid gland. The differential diagnoses are reviewed and discussed. Treatment is by surgical resection. Because of the tendency of myoepitheliomas to recur and to malignant transformation, tumor-free margins are recommended.

Adult↗
PubMed2004

[Specific immunotherapy in inhalative allergy to rat epithelium].

BACKGROUND: The only causal treatment that can be offered to allergic patients apart from allergen avoidance is specific immunotherapy. Its efficacy depends on the specific allergen the patient is allergic to, the quality of the extract, the total amount of allergen administered to the patient and the administration schedule. METHODS AND PATIENT: Our patient suffered from inhalative allergy to rat epithelium with severe rhinoconjunctivitis and bronchial asthma. She regularly worked with laboratory rats as a biologist. A job-shift was impossible for the patient, and so was allergen avoidance. We therefore decided to treat the patient with specific immunotherapy. Treatment was performed as in-patient procedure with Rush-Immunotherapy in dosage increase phase. Maintenance injections were administered as out-patient. RESULTS: As early as some months after induction of the therapy, the patient felt subjective symptom relief, blood samples taken revealed decrease of total IgE and specific IgE towards rat epithelium. Therapy was continued for 18 months, specific IgE against rat epithelium could not be detected any more. The patient does not claim any allergy symptoms when working in the rat laboratory any more. CONCLUSIONS: Even in unusual allergies, specific immunotherapy can be indicated. In our patient, specific immunotherapy to rat epithelium lead to complete symptom relief and enabled the patient to practise her profession without restraints.

Adult↗
PubMed2003

[Cluster-immunotherapy in seasonal allergic rhinitis: safety aspects of induction therapy with depot allergoids (Purethal)].

BACKGROUND: Specific immunotherapy (SIT) represents the only specific treatment that can be offered to allergic patients apart from allergen avoidance. SIT has been widely used in pollen allergic rhinitis. Clinical efficacy has been demonstrated in several controlled clinical trials and depends on the specific allergen the individual patient is sensitive to, the quality and total amount of allergen applied, and the SIT schedule. In classic SIT, gradually increasing dosages of the allergen extract are injected subcutaneously. Several dosage schedules for subcutaneous SIT can be applied. In Cluster-SIT, 2 - 3 injections per day of treatment are given once a week during induction treatment. PATIENTS: In this study, we investigated 64 patients (33 female, 31 male) from 18 to 54 years (26.9 +/- 5.1 years) in terms of side-effects of Cluster-SIT during induction treatment. RESULTS: The total amount of enlarged local reactions (> grade 1) was n = 77 or 15.2 % of all injections. Of these, 68 (88 %) were classified as immediate reactions, 8 (11 %) were late phase reactions and 1 (1 %) was immediate as well as late phase reaction. Of all enlarged local reactions, 48 (62 %) were grade 1 reactions, 13 (17 %) were grade 2 reactions, 13 (17 %) were grade 3 reactions and 1 (1 %) was a grade 4 reaction. The total amount of systemic reactions was n = 22 or 4.3 % of all injections. Of these, 19 (86 %) were classified as immediate reactions, 3 (14 %) were delayed reactions. Of all systemic reactions, 18 (82 %) were grade 1 reactions and 4 (18 %) grade 2 reactions. Grade 3 or grade 4 reactions did not occur. There were no differences in gender or age regarding the occurrence of side effects (all p > 0.05). CONCLUSIONS: Frequency and severity of adverse side effects in Cluster-SIT correspond to those in other dosage schedules. On behalf of security aspects, Cluster-SIT could become an interesting alternative dosage schedule for dose increase during SIT. Furthermore, in Cluster-SIT with allergoids, induction treatment can be carried out in two treatment days of approximately 2.5 hours each.

Adolescent↗
PubMed2002

Assessment of rhinological parameters for evaluating the effects of airborne irritants to the nasal epithelium.

OBJECTIVES: The initial contact area of inhaled toxins with the human body is the nasal mucosa. Upon irritation, nasal symptoms may occur that are well known as common viral infections of the airway and thus neglected by patients and physicians. Therefore, objective methods should be used to determine even minor irritative or inflammatory changes. METHODS: Objective methods to assess changes in the nasal epithelium include endoscopy, rhinomanometry, acoustic rhinometry, anemometry, thermometry, laser Doppler flowmetry, measurements of mucociliary transport time and ciliary beat frequency, analysis of nasal secretions, nasal cytology, and subjective (UPSIT, CCCRC, Sniffin Sticks) and objective (electro-olfactogram, olfactory event related potentials) and olfaction tests. RESULTS: Several different inhaled irritative and toxic substances, including metal dusts and steam, volatile organic substances, and inorganic gases, may harm the nasal epithelium. CONCLUSIONS: The objective evaluation of nasal functions should be used to assess effects of airborne irritants. For patients complaining of toxic effects, early diagnosis is important in the prevention of severe damage to the upper and lower airways.

Air Pollutants, Occupational↗