414 results on '"Johannes, Ring"'
Search Results
2. ARIA‐EAACI statement on severe allergic reactions to COVID‐19 vaccines – An EAACI‐ARIA Position Paper
- Author
-
Ioana Agache, Eva Untersmayr, Torsten Zuberbier, Jean Bousquet, Karin Hoffmann-Sommergruber, Mübeccel Akdis, María José Torres, Stefano Del Giacco, Cezmi A. Akdis, G. Walter Canonica, Anna Bedbrook, Ludger Klimek, Marek Jutel, Edward F. Knol, Margitta Worm, Tomas Chivato, Mohamed H. Shamji, Johannes Ring, Jürgen Schwarze, Liam O'Mahony, University of Zurich, and Klimek, Ludger
- Subjects
0301 basic medicine ,Allergy ,medicine.medical_specialty ,COVID-19 Vaccines ,Immunology ,Population ,610 Medicine & health ,Herd immunity ,03 medical and health sciences ,0302 clinical medicine ,10183 Swiss Institute of Allergy and Asthma Research ,medicine ,Humans ,Immunology and Allergy ,Medical history ,education ,Intensive care medicine ,Adverse effect ,BNT162 Vaccine ,Asthma ,Vaccines ,2403 Immunology ,education.field_of_study ,SARS-CoV-2 ,business.industry ,COVID-19 ,medicine.disease ,Vaccination ,030104 developmental biology ,030228 respiratory system ,2723 Immunology and Allergy ,business ,Anaphylaxis - Abstract
Coronavirus disease 2019 (COVID-19) vaccine BNT162b2 received approval and within the first few days of public vaccination several severe anaphylaxis cases occurred. An investigation is taking place to understand the cases and their triggers. The vaccine will be administered to a large number of individuals worldwide and concerns raised for severe adverse events might occur. With the current information, the European Academy of Allergy and Clinical Immunology (EAACI) states its position for the following preliminary recommendations that are to be revised as soon as more data emerges. To minimize the risk of severe allergic reactions in vaccinated individuals, it is urgently required to understand the specific nature of the reported severe allergic reactions, including the background medical history of the individuals affected and the mechanisms involved. To achieve this goal all clinical and laboratory information should be collected and reported. Mild and moderate allergic patients should not be excluded from the vaccine as the exclusion of all these patients from vaccination may have a significant impact on reaching the goal of population immunity. Health care practitioners vaccinating against COVID-19 are required to be sufficiently prepared to recognise and treat anaphylaxis properly with the ability to administer adrenaline. A mandatory observation period after vaccine administration of at least 15 minutes for all individuals should be followed. The current data has not shown any higher risk for patients suffering from allergic rhinitis or asthma and this message should be clearly stated by physicians to give our patients trust. The benefit of the vaccination clearly outweighs the risk of severe COVID-19 development including the more than 30% of the population suffering from allergic diseases.
- Published
- 2021
- Full Text
- View/download PDF
3. AWMF-Leitlinie zu Akuttherapie und Management der Anaphylaxie – Update 2021
- Author
-
Claudia Kugler, Isidor Huttegger, Thomas Fuchs, Margitta Worm, Knut Brockow, Roland Seifert, Johannes Ring, Axel R. Heller, Britta Stöcker, Christian Vogelberg, Oliver Pfaar, Ernst Rietschel, Florian Hoffmann, Regina Treudler, T. Jakob, Helmut Sitter, Matthias V. Kopp, F. Ruëff, Tilo Biedermann, Kirsten Beyer, Matthias Fischer, Sabine Schnadt, Ludger Klimek, Lars Lange, Andreas J. Bircher, and Thomas Werfel
- Subjects
medicine.medical_specialty ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,medicine ,Immunology and Allergy ,Guideline ,Intensive care medicine ,medicine.disease ,business ,Anaphylaxis - Published
- 2021
- Full Text
- View/download PDF
4. Anaphylaxis: subjective symptom reports of patients with a special focus on 'near-death' experiences
- Author
-
Knut Brockow, Martine Grosber, Anna Maria Farschtschi, and Johannes Ring
- Subjects
Allergy ,business.industry ,media_common.quotation_subject ,Anaphylactic reaction ,Anaphylactic reactions ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,Feeling ,Immunology and Allergy ,Medicine ,business ,Everyday life ,Anaphylaxis ,Bright light ,030215 immunology ,Clinical psychology ,media_common - Abstract
SummaryAlmost all anaphylactic reactions are associated with subjective symptoms, which are also referred to “prodromi”, and are often not taken seriously. In 100 patients categorized with different severity grades, subjective symptoms were investigated in a personal interview with free/open questions regarding subjective feelings and symptoms (duration 5–90 min). After the interview, the patients were asked to complete a questionnaire about the exact occurrence of the reaction. Special focus was given to near-death experiences in severe reactions. Patients described feelings of “elevation”, “looking at themselves from outside”, “tunnel experiences” and “bright light”. In the kinetics of the anaphylactic reaction, cutaneous symptoms were most often reported as the first or second symptom, while cardiovascular and airway symptoms were also reported as the 3rd, 4th or 5th symptom. In 37% of the patients with severe reactions, everyday life has changed since suffering the anaphylactic episode.
- Published
- 2021
- Full Text
- View/download PDF
5. Guideline (S2k) on acute therapy and management of anaphylaxis: 2021 update
- Author
-
Sabine Schnadt, Knut Brockow, Isidor Huttegger, Johannes Ring, Lars Lange, Thomas Fuchs, Claudia Kugler, Matthias V. Kopp, Christian Vogelberg, Ernst Rietschel, Ludger Klimek, Kirsten Beyer, Florian Hoffmann, Andreas J. Bircher, Thomas Werfel, Roland Seifert, Axel R. Heller, Margitta Worm, Tilo Biedermann, Matthias Fischer, Helmut Sitter, Regina Treudler, F. Ruëff, Britta Stöcker, T. Jakob, and Oliver Pfaar
- Subjects
medicine.medical_specialty ,Allergy ,business.industry ,Emergency management ,Food allergy ,Anaphylaxis ,Group education ,Drug allergy ,Vaccination ,Auto-injector ,COVID-19 ,Adrenalin ,Pharmacotherapy ,Immunology and Allergy ,Medicine ,610 Medicine & health ,Guideline ,610 Medizin und Gesundheit ,business ,Intensive care medicine ,medicine.disease - Published
- 2021
- Full Text
- View/download PDF
6. Anaphylaxie-Risiko bei der COVID-19-Impfung: Empfehlungen für das praktische Management
- Author
-
Roland Seifert, Thilo Jakob, Axel R. Heller, Uwe Gieler, Knut Brockow, Claudia Kugler, Thomas Fuchs, Franziska Ruëff, Johannes Ring, Marek Lommatzsch, Tilo Biedermann, Sabine Schnadt, Matthias Fischer, Ernst Rietschel, Florian Hoffmann, Britta Stöcker, Thomas Werfel, Helmut Sitter, Ludger Klimek, Oliver Pfaar, Andreas J. Bircher, Margitta Worm, Regina Treudler, Christian Vogelberg, Kirsten Beyer, Isidor Huttegger, Lars Lange, and Matthias V. Kopp
- Subjects
medicine.medical_specialty ,2019-20 coronavirus outbreak ,COVID-19 Vaccines ,Covid-19 vaccination ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Vaccination ,MEDLINE ,risk assessment ,COVID-19 ,General Medicine ,allergy ,medicine.disease ,FB_Übersicht ,medicine ,Humans ,ddc:610 ,Intensive care medicine ,business ,Anaphylaxis - Published
- 2021
- Full Text
- View/download PDF
7. A Pilot Study of a Mindfulness-Based Stress Reduction Programme in Patients Suffering from Atopic Dermatitis
- Author
-
Johannes Ring, Peter Schmid-Grendelmeier, Michael Seitlinger, Daniela Münch, Julia Harfensteller, Martin Offenbächer, Ulf Darsow, Christina Schnopp, and Niko Kohls
- Subjects
medicine.medical_specialty ,Mindfulness ,atopic dermatitis ,business.industry ,Stressor ,Atopic dermatitis ,Dermatology Life Quality Index ,Disease ,medicine.disease ,BF1-990 ,ddc ,Mindfulness-based stress reduction ,stress ,Intervention (counseling) ,psychosomatic interactions ,Physical therapy ,Psychology ,Medicine ,Pharmacology (medical) ,eczema ,business ,mindfulness stress reduction ,Disease burden ,Article - Abstract
Introduction: Patients with atopic dermatitis (AD) have several potential stressors including the symptoms of the disease itself, the stigmatization due to their appearance, and emotional and psychological strain. Psychological factors and stress can trigger and exacerbate the symptoms of skin diseases and there is evidence that stress has a relevant clinical effect on the function of skin cells in vivo. Our objective was to evaluate in a pilot study the feasibility, acceptance, and effectiveness of a Mindfulness-Based Stress Reduction (MBSR) programme in AD patients in a clinical setting. Methods: 10 patients took part in an 8-week MBSR programme, which included, e.g., mindful and conscious awareness of the body and bodywork, and seated meditation. We assessed sociodemographics and disease related variables with standardized measures at predefined time points including Score of Atopic Dermatitis, Patient Oriented Eczema Measure, Dermatology Life Quality Index, Perceived Stress Questionnaire, Freiburg Mindfulness Inventory (FMI), and others. Participants also gave qualitative feedback regarding the effects of the intervention. Results: The mean age was 53.10 years (SD = 15.04), seven patients were female, and disease duration was 36.6 years (SD = 25.5). Calculating pre-post effect sizes (Cohen’s d), the FMI indicated significant improvement in the “presence” and “acceptance” subscales. There was also tendency for less stress. This was confirmed by the qualitative statements of the participants. Conclusions: The MBSR programme is feasible and acceptable for AD patients. Considering the long disease history and the severity of disease burden, the effects of this intervention seem promising as an adjunct to conventional treatments for patients with AD.
- Published
- 2021
- Full Text
- View/download PDF
8. Proposal of 0.5 mg of protein/100 g of processed food as threshold for voluntary declaration of food allergen traces in processed food: A first step in an initiative to better inform patients and avoid fatal allergic reactions, A GA²LEN position paper
- Author
-
Giovanni Battista Pajno, Stefan Wöhrl, Sasho Stoleski, Caroline Nilsson, Mary Jane Marchisotto, Ronald van Ree, Carina Venter, Anna Nowak-Wegrzyn, Montserrat Fernandez-Rivas, Akio Tanaka, Barbara Rogala, Benjamin Kendziora, Michihiro Hide, Stefano Del Giacco, Katarina Stevanovic, Dragan Mijakoski, Enrico Heffler, Nikolaos G. Papadopoulos, Werner Aberer, Antoine Deschildre, Lisa A. Beck, Kate Grimshaw, M. Gotua, Torsten Zuberbier, Hugh A. Sampson, Marek Jutel, Mikela Odemyr, Carlo Lombardi, Erkka Valovirta, Antonella Cianferoni, Nicolette W. de Jong, Jovanka Karadzinska Bislimovska, Michael J. Cork, Christer Janson, Karin Hoffmann-Sommergruber, Gianenrico Senna, Jean Bousquet, Michael Makris, Carsten Bindslev-Jensen, Tamara Dörr, Joan Bartra, Ana Todo-Bom, Mika J. Mäkelä, Ulf Darsow, Margitta Worm, Richard Loh, Rosan Meyer, Giampaolo Ricci, Roy Gerth van Wijk, Audrey Dunn Galvin, Joaquim Mullol, M Alvaro, Alessandro Fiocchi, Zuotao Zhao, Stefania Arasi, Marta Ferrer, Norito Katoh, Philippe Bégin, Brigita Sitkauskiene, Sushil Paudel, Knut Brockow, Johannes Ring, Edward F. Knol, Susanne Lau, Gary W.K. Wong, Jordan Minov, Cristoforo Incorvaia, Marcus Maurer, Hasan Arshad, Fatih A Topal, Bright I Nwaru, Hania Szajewska, Andrew Bush, Tamar Kinaciyan, Adnan Custovic, Elizabeth Angier, O M Kurbacheva, Diana Deleanu, Harald Renz, Peter Smith, Motohiro Ebisawa, J. Grünhagen, Swen Malte John, Carla P. Jones, Barbara Ballmer-Weber, Ear, Nose and Throat, Experimental Immunology, AII - Inflammatory diseases, APH - Global Health, and APH - Personalized Medicine
- Subjects
Food industry ,Eggs ,Immunology ,Provocation test ,Declaration ,medicine.disease_cause ,03 medical and health sciences ,0302 clinical medicine ,Allergen ,Food allergy ,Food Labeling ,Environmental health ,anaphylaxis ,Immunology and Allergy ,Medicine ,Ingestion ,Animals ,Humans ,SDG 2 - Zero Hunger ,030304 developmental biology ,2. Zero hunger ,0303 health sciences ,Meal ,food allergy ,business.industry ,digestive, oral, and skin physiology ,Allergens ,medicine.disease ,3. Good health ,nutrition ,030228 respiratory system ,Food processing ,business ,600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit ,Food Hypersensitivity - Abstract
Background\ud \ud Food anaphylaxis is commonly elicited by unintentional ingestion of foods containing the allergen above the tolerance threshold level of the individual. While labeling the 14 main allergens used as ingredients in food products is mandatory in the EU, there is no legal definition of declaring potential contaminants. Precautionary allergen labeling such as “may contain traces of” is often used. However, this is unsatisfactory for consumers as they get no information if the contamination is below their personal threshold. In discussions with the food industry and technologists, it was suggested to use a voluntary declaration indicating that all declared contaminants are below a threshold of 0.5 mg protein per 100 g of food. This concentration is known to be below the threshold of most patients, and it can be technically guaranteed in most food production. However, it was also important to assess that in case of accidental ingestion of contaminants below this threshold by highly allergic patients, no fatal anaphylactic reaction could occur. Therefore, we performed a systematic review to assess whether a fatal reaction to 5mg of protein or less has been reported, assuming that a maximum portion size of 1kg of a processed food exceeds any meal and thus gives a sufficient safety margin.\ud \ud \ud \ud Methods\ud \ud MEDLINE and EMBASE were searched until 24 January 2021 for provocation studies and case reports in which one of the 14 major food allergens was reported to elicit fatal or life-threatening anaphylactic reactions and assessed if these occurred below the ingestion of 5mg of protein. A Delphi process was performed to obtain an expert consensus on the results.\ud \ud \ud \ud Results\ud \ud In the 210 studies included, in our search, no reports of fatal anaphylactic reactions reported below 5 mg protein ingested were identified. However, in provocation studies and case reports, severe reactions below 5 mg were reported for the following allergens: eggs, fish, lupin, milk, nuts, peanuts, soy, and sesame seeds.\ud \ud \ud \ud Conclusion\ud \ud Based on the literature studied for this review, it can be stated that cross-contamination of the 14 major food allergens below 0.5 mg/100 g is likely not to endanger most food allergic patients when a standard portion of food is consumed. We propose to use the statement “this product contains the named allergens in the list of ingredients, it may contain traces of other contaminations (to be named, e.g. nut) at concentrations less than 0.5 mg per 100 g of this product” for a voluntary declaration on processed food packages. This level of avoidance of cross-contaminations can be achieved technically for most processed foods, and the statement would be a clear and helpful message to the consumers. However, it is clearly acknowledged that a voluntary declaration is only a first step to a legally binding solution. For this, further research on threshold levels is encouraged.
- Published
- 2021
9. Allergy and Civilization
- Author
-
Johannes Ring and Heidrun Behrendt
- Subjects
Allergy ,education.field_of_study ,business.industry ,Population ,Disease ,medicine.disease ,medicine.disease_cause ,Eastern european ,Allergen ,Hygiene hypothesis ,Environmental health ,medicine ,business ,education ,Anaphylaxis ,Asthma - Abstract
Allergy is an alteration of immunological reactivity leading to hypersensitivity disease with inflammation of skin and mucous membranes up to life-threatening generalized reactions (anaphylaxis). Allergies have increased in prevalence worldwide to an estimated 20% of the population affected. The reasons for this increase are explained mainly by two hypotheses: (1) decrease of early life immune stimulation (“hygiene hypothesis”) and (2) increase of environmental pollutants in the environment (“pollution hypothesis”). The most marked increase in allergy prevalence occurred in the Northern hemisphere in the decades 1960–1990 together with reduction of rural environments and increased traffic exhaust exposure and urbanization. These changes occurred at a slower rate in Eastern European former communist countries leading to the well-known East–West differences in allergy prevalence. Climate change with increasing pollination periods and intrusion of allergenic neophytes additionally contributes to the increased allergy prevalence. Other sequels of climate change like heavy weather events (thunderstorms) lead to exacerbations of asthma by exposure to small respirable allergenic particles and long distance allergen transport. Allergies therefore represent an indirect health outcome parameter of climate change. Psychosocial factors connected with the acceleration of daily life and increasing psychologic stress may also play a role. Allergies have been called the “epidemic of the twenty-first century”. Allergies have been called the “epidemic of the twenty-first century.” There is no doubt that apart from genetic susceptibility, civilization-associated environmental factors with the so-called modern lifestyle play a critical role in the development of allergies.
- Published
- 2021
- Full Text
- View/download PDF
10. Development of subcutaneous allergen immunotherapy (part 2): preventive aspects and innovations
- Author
-
Regina Treudler, Randolf Brehler, Margitta Worm, Matthias V. Kopp, Ludger Klimek, Eckard Hamelmann, Johannes Ring, Oliver Pfaar, and Thilo Jakob
- Subjects
Allergen immunotherapy ,Allergy ,business.industry ,medicine.medical_treatment ,Hypoallergenic ,Immunotherapy ,medicine.disease_cause ,medicine.disease ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Subcutaneous injection ,0302 clinical medicine ,Allergen ,030228 respiratory system ,CpG site ,Antigen ,Immunology ,medicine ,Immunology and Allergy ,business - Abstract
Allergen immunotherapy with subcutaneous injection (SCIT) of the relevant allergen is the classic causal treatment method for IgE-mediated allergic respiratory disease and has already been successfully used for over 100 years. This publication is based on a selective literature search in PubMed and MEDLINE. Recent publications in German-language journals that are not available in literature databases were also analyzed. This literature search included original and review articles both in German and in English. Primary, secondary and tertiary prevention characteristics have been demonstrated for SCIT; however, these require further evaluation. In combination with biologic agents, the safety, and in some cases the efficacy, of SCIT can be increased. Adjuvants seem to offer enormous development potential for SCIT. Aluminum salts, microcrystalline tyrosine (MCT), and monophosphoryl lipid A (MPL) are already used in commercial SCIT preparations. At the same time, other adjuvants are being researched, e.g., liposomes, microspheres, CpG motifs (C: nucleotide cytosine, p: phosphate, G: nucleotide guanine), or virus-like particles (VLPs). The therapeutic extracts themselves are also undergoing further development, for instance as recombinant allergens, hypoallergenic variants such as site-directed mutants (SDM), conformational variants, allergen fragmentation, allergen oligomers, deletion mutants, and hybrid allergens/mosaic antigens. SCIT preparations are among the most innovative treatment options in the immunotherapy of allergic diseases. Due to the numerous immunological approaches, they will make treatment safer and more effective in the future with reduced effort.
- Published
- 2019
- Full Text
- View/download PDF
11. Prevalence of Hymenoptera venom allergy and sensitization in the population-representative German KORA cohort
- Author
-
Stephanie Haemmerle, Simon Blank, Carsten B. Schmidt-Weber, Dennis Russkamp, Teresa Jaeger, Johannes Ring, and Markus Ollert
- Subjects
Anaphylaxis ,Honeybee Venom ,Insect Venom Allergy ,Specific Ige ,Systemic Reaction ,Venom Sensitization ,Yellow Jacket Venom ,medicine.medical_specialty ,Allergy ,Population ,Venom ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Insect venom allergy ,Internal medicine ,medicine ,Immunology and Allergy ,education ,Honeybee venom ,Sensitization ,education.field_of_study ,business.industry ,Yellow jacket venom ,medicine.disease ,Venom sensitization ,Systemic reaction ,Sting ,Specific IgE ,medicine.anatomical_structure ,030228 respiratory system ,Cohort ,Population study ,business ,Yellow jacket - Abstract
Purpose: Allergic reactions to Hymenoptera venoms represent potentially life-threatening conditions. However, studies on their prevalence in Germany and their relation to specific IgE sensitization are rare. The aim of this study was to evaluate the prevalence of Hymenoptera venom allergy as well as the frequency of venom-specific IgE sensitization in a large population-based adult German cohort. Methods: Questionnaire data were collected from the participants of the German population-based KORA (Cooperative Health Research in the Region of Augsburg) S4 baseline study population (n = 4261) and the follow-up F4 study population (n = 3074), which was conducted seven years later. Moreover, sIgE antibodies to honeybee (HBV) and yellow jacket venom (HJV) as well as to common aeroallergens were measured in the S4 study population. Results: The prevalence of systemic sting reactions ranged between 2.3% and 2.6%. sIgE sensitization (≥0.35kUA/L) to HBV and YJV was demonstrated in 23.1% and 31.7% of the population, respectively (41.6% to HBV and/or YJV). Double-sensitization to both venoms occurred in 13.2% of the individuals. Approximately 53% and 77% of the individuals who reported shock symptoms after honeybee and yellow jacket stings, respectively, exhibited sIgE ≥ 0.35kUA/L to the culprit venom. In contrast, only 2.8% of the venom-sensitized individuals reported symptoms exceeding local reactions. Local reactions were reported by 4.4 to 4.8% of the population. Conclusions: Self-reported Hymenoptera sting reactions and venom sensitization are frequent in the general German population. In many cases, sensitization and clinically relevant allergy are not observed in the same individual, indicating that comprehensive diagnostic approaches are a prerequisite for the identification of patients at risk for severe reactions.
- Published
- 2019
- Full Text
- View/download PDF
12. Changes in Angiotensin Peptides in Plasma and Urine in Patients with Anaphylaxis
- Author
-
Klaus Hermann and Johannes Ring
- Subjects
medicine.medical_specialty ,business.industry ,Immunology ,Provocation test ,Hymenoptera venom allergy ,General Medicine ,Urine ,Plasma levels ,medicine.disease ,Endocrinology ,Internal medicine ,Renin–angiotensin system ,Blood plasma ,cardiovascular system ,medicine ,Immunology and Allergy ,In patient ,business ,hormones, hormone substitutes, and hormone antagonists ,Anaphylaxis - Abstract
Angiotensins (ANG) I and II were measured in the plasma of patients with hymenoptera venom allergy and found to be significantly decreased as compared to controls. An inverse correlation between the plasma levels of ANG I and ANG II and the intensity of clinical symptoms of anaphylaxis was observed. In a separate study, ANG I and ANG II were measured in urine from healthy volunteers and from patients with anaphylactic reactions to drugs, food, and additives. An increase in both peptides was observed in patients with anaphylactic reactions during oral provocation. These findings suggest a possible involvement of ANG peptides in anaphylactic reactions.
- Published
- 2021
13. In vivo Modulation of the High-Affinity Receptor for IgE (FcεRI) on Human Epidermal Langerhans Cells
- Author
-
Thomas Bieber and Johannes Ring
- Subjects
Mycosis fungoides ,Langerhans cell ,Lupus erythematosus ,biology ,Immunology ,General Medicine ,medicine.disease ,Immunoglobulin E ,Atopy ,medicine.anatomical_structure ,Cell surface receptor ,Psoriasis ,medicine ,biology.protein ,Immunology and Allergy ,Receptor - Abstract
The presence of IgE-bearing epidermal Langerhans cells (LC) has been reported not only in patients with atopic eczema (AE) but also in patients with various inflammatory dermatoses unrelated to atopic diathesis. We have shown very recently that normal LC express the high-affinity receptor for IgE (FceRI) which accounts for the binding of monomeric IgE on these cells. In the present study, we investigated the IgE-binding capacity of resident LC on cryosections from skin of normal individuals and from uninvolved and involved skin of patients with atopic eczema, psoriasis, lupus erythematosus and mycosis fungoides. When compared to LC from uninvolved or normal skin, an increased binding of IgE was observed in LC from lesional skin of all four diseases studied here. This binding could be blocked by anti-FceRI mAb. Furthermore, increased IgE binding capacity of LC correlated to an increased expression of FceRI on these cells. These results clearly demonstrate that the expression of FceRI on LC is increased in inflammatory skin areas. Since this phenomenon is observed in several unrelated diseases, it suggests the presence in these conditions of a similar microenvironment which up-regulates the FceRI expression on LC.
- Published
- 2021
14. Physiology and pathology of eosinophils: Recent developments: Summary of the Focus Workshop Organized by DGAKI
- Author
-
Nan Zhang, Johannes Ring, Claudia Berek, Christian Taube, Ulrike Raap, Hans-Uwe Simon, Thomas Werfel, Harald Renz, David Voehringer, Francesca Levi-Schaffer, Claus Bachert, Sabine Gisela Ploetz, Peter Valent, and Eckard Hamelmann
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Clinical immunology ,Immunology ,hypereosinophilic syndrome ,Medizin ,interleukin 5 ,610 Medicine & health ,Disease ,DNAzyme against GATA3 ,Cell Communication ,diseases ,03 medical and health sciences ,Leukocyte Count ,0302 clinical medicine ,Eosinophilic ,Eosinophilia ,medicine ,Medicine and Health Sciences ,Animals ,Homeostasis ,Humans ,eosinophil ,Mast Cells ,Intensive care medicine ,Hypereosinophilic syndrome ,business.industry ,anti‐ ,Disease Management ,General Medicine ,respiratory system ,medicine.disease ,Eosinophils ,030104 developmental biology ,Eosinophilic inflammation ,Organ Specificity ,Host-Pathogen Interactions ,Cytokines ,Disease Susceptibility ,Inflammation Mediators ,business ,Biomarkers ,030215 immunology - Abstract
Over the last century, eosinophils have been regarded ambiguously either as 'friends' or 'foes'. Recent developments have greatly enhanced our understanding of the role and function of eosinophils in health and disease. Pathogenic eosinophilic inflammation can lead to severe diseases in various organs, such as the gastrointestinal tract, airways, heart and skin. In a 2-day focus workshop of the German Society for Allergology and Clinical Immunology (DGAKI), the state of the art was discussed and practical recommendations for diagnosis and treatment of eosinophilic diseases, with a particular focus on new biologics, such as anti-interleukin 5 and anti-interleukin 5R, were derived.
- Published
- 2021
- Full Text
- View/download PDF
15. Autoreactive T cells and their role in atopic dermatitis
- Author
-
Johannes Ring, Fariza Mishaal Saiema Badloe, Jan Gutermuth, Inge Kortekaas Krohn, Tina De Bruyn Carlier, Faculty of Medicine and Pharmacy, Dermatology, Artificial Intelligence supported Modelling in clinical Sciences, Gerontology, and Skin function and permeability
- Subjects
0301 basic medicine ,Cytotoxicity, Immunologic ,T-Lymphocytes ,Immunology ,Autoimmunity ,Cross Reactions ,Immunoglobulin E ,medicine.disease_cause ,Autoantigens ,Allergic inflammation ,Autoimmune Diseases ,Dermatitis, Atopic ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,T-Lymphocyte Subsets ,Autoreactive T cells ,medicine ,Immunology and Allergy ,Animals ,Humans ,Autoantibodies ,030203 arthritis & rheumatology ,atopic dermatitis ,biology ,integumentary system ,business.industry ,Pemphigus vulgaris ,Molecular Mimicry ,Peripheral tolerance ,Disease Management ,Atopic dermatitis ,medicine.disease ,Connective tissue disease ,030104 developmental biology ,biology.protein ,Cytokines ,Bullous pemphigoid ,Disease Susceptibility ,business ,Immunologic Memory - Abstract
Atopic dermatitis (AD) is an itchy, non-contagious relapsing and chronic inflammatory skin disease that usually develops in early childhood. This pathology is associated with food allergy, allergic asthma, allergic rhinitis and anaphylaxis which may persist in adulthood. The underlying mechanisms of AD (endotypes) are just beginning to be discovered and show a complex interaction of various pathways including skin barrier function and immune deviation. Immune reactions to self-proteins (autoantigens) of the skin have been identified in patients with inflammatory skin diseases, such as chronic spontaneous urticaria, connective tissue disease, pemphigus vulgaris and bullous pemphigoid. IgE antibodies and T cells directed against epitopes of the skin were observed in adult patients with severe and chronic AD as well. This was associated with disease severity and suggests a progression from allergic inflammation to severe autoimmune processes against the skin. IgE-mediated autoimmunity and self-reactive T cells might accelerate the ongoing skin inflammation or might contribute to the relapsing course of the disease. However, to date, the exact mechanisms of IgE-mediated autoimmunity and self-reactive T cells in the pathophysiology of AD are still unclear. The aim of this review is to evaluate the development of (autoreactive) T cells and their response to (auto)antigens, as well as the role of the peripheral tolerance in autoimmunity in the pathophysiology of AD, including the unmet needs and gaps.
- Published
- 2021
16. White paper on peanut allergy- part1: Epidemiology, burden of disease, health economic aspects
- Author
-
Hans F. Merk, Christian Vogelberg, Natalija Novak, Sven Becker, Katja Nemat, Thomas Spindler, Eckard Hamelmann, Michael Gerstlauer, Adam Chaker, Randolf Brehler, Torsten Zuberbier, Norbert Mülleneisen, Thomas Fuchs, Kirsten Beyer, Holger Wrede, Wolfgang Czech, Wolfgang Wehrmann, Tobias Ankermann, Ludger Klimek, Sebastian Schmidt, Kirsten Jung, Andrea Bauer, Wolfgang Schlenter, Katharina Blumchen, Uta Rabe, Lars Lange, Johannes Ring, and Thilo Jakob
- Subjects
Burden of disease ,medicine.medical_specialty ,Allergy ,Review ,Food allergy ,Anaphylaxis ,Oral immunotherapy ,COVID-19 ,Children ,business.industry ,Peanut allergy ,food and beverages ,Allergen avoidance ,medicine.disease ,ddc ,White paper ,Environmental health ,Epidemiology ,medicine ,Immunology and Allergy ,ddc:610 ,business - Abstract
Peanuts are Leguminosae, commonly known as the legume or pea family, and peanut allergy is among the most common food allergies and the most common cause of fatal food reactions and anaphylaxis.The prevalence of peanut allergy increased 3.5-fold over the past two decades reaching 1.4–2% in Europe and the United States. The reasons for this increase in prevalence are likely multifaceted. Sensitization via the skin appears to be associated with the development of peanut allergy and atopic eczema in infancy is associated with a high risk of developing peanut allergy.Until recently, the only possible management strategy for peanut allergy was strict allergen avoidance and emergency treatment including adrenaline auto-injector in cases of accidental exposure and reaction.This paper discusses the various factors that impact the risks of peanut allergy and the burden of self-management on peanut-allergic children and their caregivers.
- Published
- 2021
17. History of Allergy: Clinical Descriptions, Pathophysiology, and Treatment
- Author
-
Johannes Ring
- Subjects
Allergy ,biology ,business.industry ,Cellular Immunology ,Basophil ,medicine.disease ,Immunoglobulin E ,humanities ,Atopy ,medicine.anatomical_structure ,Immunology ,medicine ,biology.protein ,Hay fever ,business ,Anaphylaxis ,Asthma - Abstract
Allergy has shown a dramatic increase in prevalence in the last decades. However, allergic diseases are probably not new. Asthma and eczema have been described in ancient societies like Egypt, China and in the Greco-Roman culture. In the middle-ages descriptions of hay fever can be found in Persian-Arabian literature (called "rose fever"). Scientific allergology started in the nineteenth century with descriptions of hay fever and experimental studies showing pollen as elicitors. Milestones in the twentieth century comprise the description of anaphylaxis, the creation of the terms "allergy" and "atopy", the Prausnitz-Kustner test and finally the discovery of IgE and the development of the Radio-Allergo-Sorbent-Test (RAST) for routine detection of specific IgE antibodies. Progress in cellular immunology led to the description of T-cell subsets Th1 and Th2. Mast cell and basophil research progressed since the first description to histamine release studies. Leukotrienes were detected. Pharmacotherapy started in the early twentieth century with adrenaline (epinephrine) followed by antihistamines and cortisone. Allergen-specific immunotherapy was introduced. Epidemiologic studies pointed to a role of environmental pollutants as allergy enhancing factors and protective influences from farm environment. Through the progress in experimental allergology and immunology targeted therapeutics have been developed for various atopic conditions.
- Published
- 2021
- Full Text
- View/download PDF
18. The 'grandfather of allergy'
- Author
-
Johannes Ring and Ludger Klimek
- Subjects
Allergy ,medicine.medical_specialty ,business.industry ,Immunology and Allergy ,Medicine ,business ,medicine.disease ,Dermatology - Published
- 2021
- Full Text
- View/download PDF
19. ARIA-EAACI statement on severe allergic reactions to COVID-19 vaccines -- an EAACI-ARIA Position Paper
- Author
-
Ruby Pawankar, Giorgio Walter Canonica, Eva Untersmayr, Torsten Zuberbier, Margitta Worm, Marek Jutel, Mübeccel Akdis, Stefano Del Giacco, Ioana Agache, Ludger Klimek, María José Torres, Anna Bedbrook, Mohamed H. Shamji, Jean Bousquet, Johannes Ring, Liam O'Mahony, and Cezmi A. Akdis
- Subjects
medicine.medical_specialty ,Allergy ,business.industry ,medicine.disease ,Herd immunity ,Vaccination ,Health care ,medicine ,Position paper ,Medical history ,Intensive care medicine ,business ,Adverse effect ,Anaphylaxis - Abstract
Coronavirus disease 2019 (COVID-19) vaccine BNT162b2 received approval and within the first few days of public vaccination several severe anaphylaxis cases occurred. An investigation is taking place to understand the cases and their triggers. The vaccine will be administered to a large number of individuals worldwide and concerns raised for severe adverse events might occur. With the current information, the European Academy of Allergy and Clinical Immunology (EAACI) states its position for the following preliminary recommendations that are to be revised as soon as more data emerges. To minimize the risk of severe allergic reactions in vaccinated individuals, it is urgently required to understand the specific nature of the reported severe allergic reactions, including the background medical history of the individuals affected and the mechanisms involved. To achieve this goal all clinical and laboratory information should be collected and reported. Mild and moderate allergic patients should not be excluded from the vaccine as the exclusion of all these patients from vaccination may have a significant impact on reaching the goal of population immunity. Health care practitioners vaccinating against COVID-19 are required to be sufficiently prepared to recognise and treat anaphylaxis properly with the ability to administer adrenaline. A mandatory observation period after vaccine administration of at least 15 minutes for all individuals should be followed. The current guidelines, which exclude patients with severe allergies from vaccination with BNT162b2, should be re-evaluated after more information and experience with the new vaccine develops.
- Published
- 2020
- Full Text
- View/download PDF
20. Figurate erythemas – update and diagnostic approach
- Author
-
Alexander Boehner, Ruth Neuhauser, Johannes Ring, and Alexander Zink
- Subjects
Erythema gyratum repens ,medicine.medical_specialty ,Physical examination ,Dermatology ,Malignancy ,Diagnosis, Differential ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Medical diagnosis ,Physical Examination ,integumentary system ,medicine.diagnostic_test ,Erythema marginatum ,Erythema annulare centrifugum ,business.industry ,Skin Diseases, Genetic ,medicine.disease ,ddc ,Erythema ,Erythema Chronicum Migrans ,Erythema migrans ,medicine.symptom ,business ,Clinical reaction - Abstract
Figurate erythemas (FE) represent an etiopathophysiologically heterogeneous group of diseases defined by their characteristic annular erythematous skin lesions. Diagnosis is made primarily by clinical examination together with histological findings; often it is a diagnosis made by exclusion. While some authors discuss FE as clinical reaction pattern rather than distinct clinical entities, others identify four classic FE: erythema annulare centrifugum, erythema gyratum repens, erythema migrans and erythema marginatum. The differential diagnoses of FE are numerous and often challenging. We therefore present a potential diagnostic algorithm for FE that discriminates the differentials according to their temporal evolution and the clinical/histological phenotype of the various subtypes. Since some FE may present with an underlying malignancy, diligent clinicians are needed when dealing with those entities.
- Published
- 2020
21. IgE autoantibodies and autoreactive T cells and their role in children and adults with atopic dermatitis
- Author
-
Fariza Mishaal Saiema Badloe, Carsten B. Schmidt-Weber, Shauni De Vriese, Inge Kortekaas Krohn, Johannes Ring, Jan Gutermuth, Katarina Coolens, Dermatology, Faculty of Medicine and Pharmacy, Basic (bio-) Medical Sciences, Artificial Intelligence supported Modelling in clinical Sciences, Gerontology, Skin function and permeability, and Surgical clinical sciences
- Subjects
Pulmonary and Respiratory Medicine ,Allergy ,Endotype ,Immunology ,Disease ,Dermatology ,Review ,Immunoglobulin E ,Allergic inflammation ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Autoallergens ,Autoreactive T cells ,medicine ,Immunology and Allergy ,Atopic dermatitis ,biology ,business.industry ,IgE autoantibodies ,Autoantibody ,RC581-607 ,medicine.disease ,030228 respiratory system ,Autoreactivity ,biology.protein ,Immunologic diseases. Allergy ,Antibody ,Atopic Dermatitis ,Autoreactive T Cells ,Ige Autoantibodies ,business - Abstract
The pathophysiology of atopic dermatitis (AD) is highly complex and understanding of disease endotypes may improve disease management. Immunoglobulins E (IgE) against human skin epitopes (IgE autoantibodies) are thought to play a role in disease progression and prolongation. These antibodies have been described in patients with severe and chronic AD, suggesting a progression from allergic inflammation to severe autoimmune processes against the skin. This review provides a summary of the current knowledge and gaps on IgE autoreactivity and self-reactive T cells in children and adults with AD based on a systematic search. Currently, the clinical relevance and the pathomechanism of IgE autoantibodies in AD needs to be further investigated. Additionally, it is unknown whether the presence of IgE autoantibodies in patients with AD is an epiphenomenon or a disease endotype. However, increased knowledge on the clinical relevance and the pathophysiologic role of IgE autoantibodies and self-reactive T cells in AD can have consequences for diagnosis and treatment. Responses to the current available treatments can be used for better understanding of the pathways and may shed new lights on the treatment options for patients with AD and autoreactivity against skin epitopes. To conclude, IgE autoantibodies and self-reactive T cells can contribute to the pathophysiology of AD based on the body of evidence in literature. However, many questions remain open. Future studies on autoreactivity in AD should especially focus on the clinical relevance, the contribution to the disease progression and chronicity on cellular level, the onset and therapeutic strategies.
- Published
- 2020
22. ETFAD/EADV Eczema task force 2020 position paper on diagnosis and treatment of atopic dermatitis in adults and children
- Author
-
Michael J. Cork, Mette Deleuran, Jean-François Stalder, Stephan Weidinger, Magdalena Trzeciak, Ulf Darsow, Z. Szalai, Annice Heratizadeh, L.B. von Kobyletzki, Johannes Ring, Jacob P. Thyssen, DirkJan Hijnen, Dagmar Simon, Thomas Werfel, Julien Seneschal, Sébastien Barbarot, R. Fölster-Holst, Christian Vestergaard, Åke Svensson, M S de Bruin-Weller, Andreas Wollenberg, S. Christen-Zäch, Alain Taieb, U. Gieler, B. Kunz, L. De Raeve, Carle Paul, Ludwig-Maximilians-Universität München (LMU), Physiopathologie des Adaptations Nutritionnelles (PhAN), Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Internal Medicine, and Dermatology
- Subjects
Adult ,medicine.medical_specialty ,[SDV]Life Sciences [q-bio] ,Provocation test ,Calcineurin Inhibitors ,Anti-Inflammatory Agents ,Eczema ,Dermatology ,Tacrolimus ,Dermatitis, Atopic ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Pimecrolimus ,0302 clinical medicine ,Food allergy ,medicine ,Adjuvant therapy ,Humans ,030212 general & internal medicine ,SCORAD ,Child ,medicine.diagnostic_test ,business.industry ,Pruritus ,Atopic dermatitis ,medicine.disease ,Dupilumab ,3. Good health ,Infectious Diseases ,business ,medicine.drug - Abstract
International audience; Atopic dermatitis (AD) is a highly pruritic, chronic inflammatory skin disease. The diagnosis is made using evaluated clinical criteria. Disease activity and burden are best measured with a composite score, assessing both objective and subjective symptoms, such as SCORing Atopic Dermatitis (SCORAD). AD management must take into account clinical and pathogenic variabilities, the patient's age and also target flare prevention. Basic therapy includes hydrating and barrier-stabilizing topical treatment universally applied, as well as avoiding specific and unspecific provocation factors. Visible skin lesions are treated with anti-inflammatory topical agents such as corticosteroids and calcineurin inhibitors (tacrolimus and pimecrolimus), which are preferred in sensitive locations. Topical tacrolimus and some mid-potency corticosteroids are proven agents for proactive therapy, which is defined as the long-term intermittent anti-inflammatory therapy of frequently relapsing skin areas. Systemic anti-inflammatory or immunosuppressive treatment is a rapidly changing field requiring monitoring. Oral corticosteroids have a largely unfavourable benefit-risk ratio. The IL-4R-blocker dupilu-mab is a safe, effective and licensed, but expensive, treatment option with potential ocular side-effects. Other biologicals targeting key pathways in the atopic immune response, as well as different Janus kinase inhibitors, are among emerging treatment options. Dysbalanced microbial colonization and infection may induce disease exacerbation and can justify additional antimicrobial treatment. Systemic antihistamines (H1R-blockers) only have limited effects on AD-related itch and eczema lesions. Adjuvant therapy includes UV irradiation, preferably narrowband UVB or UVA1. Coal tar may be useful for atopic hand and foot eczema. Dietary recommendations should be patient-specific, and elimination diets should only be advised in case of proven food allergy. Allergen-specific immunotherapy to aeroallergens may be useful in selected cases. Psychosomatic counselling is recommended to address stress-induced exacerbations. Efficacy-proven 'Eczema school' educational programmes and therapeutic patient education are recommended for both children and adults.
- Published
- 2020
- Full Text
- View/download PDF
23. Therapy of allergic rhinitis in routine care: evidence-based benefit assessment of freely combined use of various active ingredients
- Author
-
Moritz Gröger, Adam Chaker, Tilo Biedermann, Wolfgang Schlenter, Torsten Zuberbier, Peter Hellings, Hans F. Merk, Wolfgang Wehrmann, Karl-Christian Bergmann, Jean Bousquet, Oliver Pfaar, Ralph Mösges, Johannes Ring, Sven Becker, Kirsten Jung, Ingrid Casper, Heidi Olze, Ludger Klimek, German Society for Otorhinolaryngology HNS, Zentrum für Rhinologie und Allergologie [Wiesbaden, Germany], Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], Technische Universität Munchen - Université Technique de Munich [Munich, Allemagne] (TUM), Vieillissement et Maladies chroniques : approches épidémiologique et de santé publique (VIMA), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM), FMC VIA LR, 371, avenue Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Department of Microbiology, Immunology and Transplantation [Leuven], Catholic University of Leuven - Katholieke Universiteit Leuven (KU Leuven), Universitätsklinikum RWTH Aachen - University Hospital Aachen [Aachen, Germany] (UKA), RWTH Aachen University, Clinical Research International Ltd [Hamburg, Germany] (CRI), Deutsches Herzzentrum München, Technische Universität München, Munich, Department of Otolaryngology and Head and Neck Surgery, Johnson and Johnson, J&J Meso Scale Diagnostics, MSD GlaxoSmithKline Australia, GSK, S. Becker received grants, fees and non-financial support from Ambu, ALK-Abelló, Allergopharma, Bencard Allergie GmbH, Bristol-Myers Squibb, HAL Allergie and Sanofi Genzyme, outside of the present work. T. Biedermann received grants and/or fees from Alk-Abelló, Astellas, Bencard, Biogen, Janssen, Leo, Meda, MSD, Novartis, Phadia and Thermo Fisher, outside of this work. Outside of this work, J. Bousquet received fees from and worked as an adviser (advisory board member, lectures) for Chiesi, Cipla, Hikma, Menarini, Mundipharma, Mylan, Novartis, Sanofi-Aventis, Takeda, Teva, Uriach and Kyomed. L Klimek received grants and/or fees from Allergopharma, Meda/Mylan, HAL Allergy, ALK-Abelló, Leti Pharma, Allergy Therapeutics, Stallergenes, Quintiles, Sanofi, AstraZeneca, GSK, ASIT Biotech and Lofarma, outside of this work. L. Klimek is also President of the AeDA and a member of the following companies: DGHNO, DGAKI, GPA and EAACI. R. Mösges received fees and/or grants and/or non-financial support from ALK-Abelló, ASIT Biotech, Allergopharma, Allergy Therapeutics, Bencard, Leti Pharma, Lofarma, Roxall, Stallergenes, Optima, Friulchem, Hexal, Servier, Klosterfrau, Atmos, Bayer, Bionorica, FAES, GSK, MSD, Johnson & Johnson, Meda, Novartis, Otonomy, Stada, UCB, Ferrero, BitopAG, Hulka, Nuvo and Ursapharm, outside of this work. H. Olze is a member of the Advisory Board at Meda Pharma. O. Pfaar received grants and/or fees from ALK-Abelló, Allergopharma, Stallergenes Greer, HAL Allergy Holding/HAL Allergie, Bencard Allergie/Allergy Therapeutics, Lofarma, Biomay, Circassia, ASIT Biotech Tools, Laboratorios Leti/Leti Pharma, Meda Pharma/Mylan, Anergis, Mobile Chamber Experts (a GA2LEN partner), Indoor Biotechnologies, GSK, Astellas Pharma Global, Euforea, Roxall, Novartis and Sanofi Aventis, outside of this work. J. Ring received fees from Mylan, Allergics, Galderma, Sanofi-Genzyme, ThermoFisher and Leo Pharma, outside of the present work. T. Zuberbier received fees (for example for lectures, advice, expert opinions) from Bayer Health Care, FAES, Novartis, Henkel, Novartis, Henkel, AstraZeneca, Abbvie, ALK, Almirall, Astellas, Bayer Health Care, Bencard, Berlin Chemie, FAES, HAL, Leti, Meda, Menarini, Merck MSD, Novartis, Pfizer, Sanofi, Stallergenes, Takeda, Teva, UCB, Henkel, Kryolan and L’Oréal, outside of this work. I. Casper, K.-C. Bergmann, P. Hellings, K. Jung, H. Merk, W. Schlenter, M. Gröger, A. Chaker and W. Wehrmann declare that there are no conflicts of interest., and Ear, Nose and Throat
- Subjects
medicine.medical_specialty ,Allergy ,Evidence-based practice ,medicine.medical_treatment ,[SDV]Life Sciences [q-bio] ,Disease ,medicine.disease_cause ,Decongestants ,03 medical and health sciences ,0302 clinical medicine ,Allergen ,medicine ,Immunology and Allergy ,Combination therapy ,030223 otorhinolaryngology ,Intensive care medicine ,Fluticasone ,business.industry ,Incidence (epidemiology) ,Immunotherapy ,Mast cell stabilizers ,medicine.disease ,Azelastine ,3. Good health ,Nasal glucocorticoids ,030228 respiratory system ,Antihistamines ,business ,medicine.drug - Abstract
Background Allergic rhinitis (AR) continues to increase in incidence and is the most common allergic disease. If abstention of the allergen triggering substances is not possible, allergen-specific immunotherapy (AIT) as causal treatment or a drug therapy with mast cell stabilizers, antihistamines (AHs), glucocorticoids (GCs), leukotriene (LT) receptor antagonists and decongestants is indicated. Despite these diverse therapeutic options, studies on the real-life care situation of patients with AR regularly show that a considerable proportion of patients do not feel adequately treated with monotherapy of the usual drugs and therefore use several preparations with different active ingredients simultaneously and in various combinations. However, such parallel applications of several active ingredients are normally not tested in approval studies and therefore carry a potential risk of side effects or lack of efficacy. Methods For the present publication, a focused literature search in PubMed, Livivo and on the World Wide Web for the previous 20 years (period 01/1999 to 01/2020) was carried out. This literature search included original and review articles in German or English. A further analysis of current publications was also conducted for German-language journals that are not available in international literature databases. Results AHs and nasal GCs represent the therapeutic standard in AR. Their efficacy is well documented for several preparations. The evidence for combination therapies is documented very well for a fixed combination of azelastine and fluticasone (MP29-02). For the simultaneous use of non-fixed combined monopreparations, only a few efficacy and safety studies based on modern evidence criteria exist. Conclusion The free combination therapies of mast cell stabilizers, decongestants, AHs and nasal GCs, frequently used in the routine care of patients with AR, cannot be recommended because they are not evidence-based. Due to the fact that over-the-counter antiallergic drugs are not reimbursable in Germany, there is no medical supervision of the therapy. In addition, there are doubts about appropriate treatment, especially of patients with persistent rhinitis with severe symptoms, as these patients often use several preparations at the same time to alleviate their symptoms.
- Published
- 2020
- Full Text
- View/download PDF
24. Immediate-Type Allergy: Rhinoconjunctivitis, Asthma, Anaphylaxis
- Author
-
Knut Brockow and Johannes Ring
- Subjects
medicine.medical_specialty ,business.industry ,medicine ,Immediate type allergy ,medicine.disease ,business ,Dermatology ,Anaphylaxis ,Asthma - Published
- 2020
- Full Text
- View/download PDF
25. Das muss der Hausarzt über den allergischen Schock wissen
- Author
-
Margitta Worm, Annette Sperl, Ludger Klimek, and Johannes Ring
- Subjects
Gynecology ,medicine.medical_specialty ,Allergic reaction ,business.industry ,General Medicine ,Emergency treatment ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,medicine ,030212 general & internal medicine ,business ,Anaphylaxis - Abstract
Der Begriff Anaphylaxie bezeichnet eine in der Regel IgE-vermittelte uberschiesende Reaktion des Immunsystems. Entscheidend fur den Verlauf einer Anaphylaxie ist eine fruhzeitige Behandlung, insbesondere bei Beteiligung des Herz-Kreislauf-Systems oder der unteren Atemwege. Aus diesem Grund ist die Kenntnis einer adaquaten Therapie fur Nothelfer und Patienten essenziell.
- Published
- 2017
- Full Text
- View/download PDF
26. Anti-inflammatory substances from onions could be an option for treatment of COVID-19—a hypothesis
- Author
-
Johannes Ring and Walter Dorsch
- Subjects
2019-20 coronavirus outbreak ,Allergy ,Coronavirus disease 2019 (COVID-19) ,medicine.drug_class ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,medicine.disease ,Anti-inflammatory ,Anti-COVID-19 effects (hypothesis) ,Call for cooperation ,Immunology ,medicine ,Anti-inflammatory activities ,Immunology and Allergy ,Antiviral activities ,business ,Letter to the Editor ,Antithrombotic activities - Published
- 2020
27. Legends of allergy and immunology: Georg Rajka
- Author
-
Johannes Ring
- Subjects
Allergy ,Clinical immunology ,business.industry ,Immunology ,MEDLINE ,Atopic dermatitis ,medicine.disease ,Dermatitis, Atopic ,Allergy and Immunology ,Hypersensitivity ,Humans ,Immunology and Allergy ,Medicine ,business - Published
- 2020
- Full Text
- View/download PDF
28. Legends of allergy and immunology: Alain L. de Weck (1928‐2013)
- Author
-
Johannes Ring
- Subjects
Allergy ,business.industry ,Immunology ,Drug allergy ,Immunologic Tests ,medicine ,Immunology and Allergy ,medicine.disease ,business - Published
- 2020
- Full Text
- View/download PDF
29. Medical algorithm: Diagnosis of atopic dermatitis in early childhood (part I)
- Author
-
Martine Grosber, Jan Gutermuth, Sherief R. Janmohamed, Johannes Ring, Lawrence F. Eichenfield, Medicine and Pharmacy academic/administration, Dermatology, Skin function and permeability, Artificial Intelligence supported Modelling in clinical Sciences, and Gerontology
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Allergy ,Medical algorithm ,diagnosis ,Immunology ,Eczema ,Dermatology ,Atopic ,Dermatitis, Atopic ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Immunology and Allergy ,Humans ,Early childhood ,Children ,childhood ,algorithm ,atopic dermatitis ,business.industry ,Inflammatory skin disease ,Atopic dermatitis ,medicine.disease ,allergy ,body regions ,030104 developmental biology ,Immune system ,pediatric ,030228 respiratory system ,Child, Preschool ,business ,Algorithms ,Food Hypersensitivity - Abstract
Atopic dermatitis (AD, atopic eczema) is a chronic, relapsing, pruritic, non-communicable inflammatory skin disease that affects children and adults1 . It almost always has its debut in early life2,3 , therefore this medical algorithm focuses on diagnosis (part I) and therapy (part II4 ) of AD in early childhood, which is defined by UNESCO as 'the period from birth to eight years old'.
- Published
- 2019
30. Quality of care in atopic dermatitis - a position statement by the European Task Force on Atopic Dermatitis (ETFAD)
- Author
-
Jacob P. Thyssen, Sébastien Barbarot, Carle Paul, Christian Vestergaard, Johannes Ring, Andreas Wollenberg, Aarhus University Hospital, University of Copenhagen = Københavns Universitet (KU), Centre hospitalier universitaire de Nantes (CHU Nantes), CHU Toulouse [Toulouse], Technische Universität Munchen - Université Technique de Munich [Munich, Allemagne] (TUM), and Ludwig Maximilians University of Munich
- Subjects
Position statement ,Adult ,medicine.medical_specialty ,MEDLINE ,Dermatology ,GUIDELINES ,Dermatitis, Atopic ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Social support ,0302 clinical medicine ,Patient Education as Topic ,medicine ,Humans ,Quality of care ,Child ,ComputingMilieux_MISCELLANEOUS ,Societies, Medical ,Quality of Health Care ,Biological Products ,Task force ,business.industry ,Social Support ,ADULTS ,Atopic dermatitis ,medicine.disease ,3. Good health ,Europe ,Infectious Diseases ,030220 oncology & carcinogenesis ,Family medicine ,PAPER ,Dermatologic Agents ,business ,[SDV.MHEP.DERM]Life Sciences [q-bio]/Human health and pathology/Dermatology - Abstract
International audience
- Published
- 2019
- Full Text
- View/download PDF
31. Reply to a correspondence addressing the European guideline for treatment of atopic eczema, functional textiles and the <scp>CLOTHES</scp> trial
- Author
-
Stephanie Christen-Zäch, Johannes Ring, Andreas Wollenberg, and Peter Schmid-Grendelmeier
- Subjects
medicine.medical_specialty ,business.industry ,030503 health policy & services ,MEDLINE ,Dermatology ,Guideline ,Atopic dermatitis ,Clothing ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Infectious Diseases ,Family medicine ,Medicine ,030212 general & internal medicine ,0305 other medical science ,business - Abstract
We have read with interest the respectfully written correspondence by Wuthrich et al. regarding antimicrobial silk textiles for atopic dermatitis (AD) (1). Though it was submitted as a comment to the European consensus-based S2k guidelines on treatment of atopic eczema (2,3), it is discussing in 70% of its length the CLOTHES trial - published in two non-JEADV-publications which we have neither designed nor authored (4,5). This article is protected by copyright. All rights reserved.
- Published
- 2019
- Full Text
- View/download PDF
32. ARIA guideline 2019 : treatment of allergic rhinitis in the German health system
- Author
-
Adam Chaker, Thomas Fuchs, Torsten Zuberbier, Giorgio Walter Canonica, Joaquim Mullol, Hans F. Merk, Karl Hörmann, Thomas B. Casale, Ludger Klimek, Sanna Toppila-Salmi, Joachim Saloga, Carsten B. Schmidt-Weber, Roland Buhl, Oliver Pfaar, Michael Gerstlauer, Norbert Mülleneisen, Wytske Fokkens, Eckard Hamelmann, Anna Bedbrook, Peter Hellings, Victoria Cardona, D. sirée Larenas-Linnemann, Kirsten Jung, Wolfgang Wehrmann, Marek Jutel, Thomas Werfel, Randolf Brehler, Ingrid Casper, Wolfgang Czech, Wienczylawa Czarlewski, Petra Staubach, Vera Mahler, Thilo Jakob, Holger Wrede, Christian Vogelberg, Claus Bachert, Regina Treudler, Matthias V. Kopp, Holger Seyfarth, J. rg Fischer, Johannes Ring, Katja Nemat, Sven Becker, Andrea Wallrafen, Thomas Spindler, Jean Bousquet, Thomas Bieber, Annette Sperl, Nikolaos G. Papadopoulos, Wolfgang Schlenter, Uta Rabe, Sebastian Strieth, University of Helsinki, Department of Pathology, HUS Inflammation Center, Department of Pathology, Medicum, Ear, Nose and Throat, and AII - Inflammatory diseases
- Subjects
neurodermatitis ,Allergy ,Cost effectiveness ,Health care system ,Allergic asthma ,Guideline ,cross allergy ,German ,0302 clinical medicine ,Health care ,Immunology and Allergy ,Medicine ,030212 general & internal medicine ,randomized controlled trial (topic) ,General Environmental Science ,atopic dermatitis ,Allergic diseases ,General Engineering ,3. Good health ,comorbidity ,language ,adrenergic receptor stimulating agent ,medicine.drug ,Integrated care pathway ,medicine.medical_specialty ,corticosteroid ,education ,drug cost ,desensitization ,drug utilization review ,Allergen-specific Immunotherapy ,Allergic Asthma ,Allergic Diseases ,Health Care System ,Integrated Care Pathway ,3121 Internal medicine ,Article ,respiratory tract disease ,03 medical and health sciences ,contact sensitization ,pollen allergy ,human ,Intensive care medicine ,Asthma ,National health ,allergic rhinitis ,business.industry ,practice guideline ,visual analog scale ,Drug Utilization Review ,asthma ,medicine.disease ,Azelastine ,language.human_language ,Integrated care ,Allergen-specific immunotherapy ,allergic disease ,030228 respiratory system ,azelastine ,antihistaminic agent ,3121 General medicine, internal medicine and other clinical medicine ,General Earth and Planetary Sciences ,anamnesis ,business ,Healthcare providers ,patient preference - Abstract
Background The number of patients affected by allergies is increasing worldwide. The resulting allergic diseases are leading to significant costs for health care and social systems. Integrated care pathways are needed to enable comprehensive care within the national health systems. The ARIA (Allergic Rhinitis and its Impact on Asthma) initiative develops internationally applicable guidelines for allergic respiratory diseases. Methods ARIA serves to improve the care of patients with allergies and chronic respiratory diseases. In collaboration with other international initiatives, national associations and patient organizations in the field of allergies and respiratory diseases, real-life integrated care pathways have been developed for a digitally assisted, integrative, individualized treatment of allergic rhinitis (AR) with comorbid asthma. In the present work, these integrated care pathways have been adapted to the German situation and health system. Results The present ICP (integrated care pathways) guideline covers key areas of the care of AR patients with and without asthma. It includes the views of patients and other healthcare providers. Discussion A comprehensive ICP guideline can reflect real-life care better than traditional guideline models.
- Published
- 2019
33. Supportive care of patients with anaphylaxis — options and shortcomings: an assessment on behalf of the working group on anaphylaxis training and education (AGATE), Germany
- Author
-
Sabine Schnadt, Kirsten Beyer, Margitta Worm, Rüdiger Szczepanski, Lars Lange, Ernst Rietschel, U. Gieler, Ludger Klimek, Thilo Jakob, Tilo Biedermann, Oliver Giessler-Fichtner, N Gebert, Franziska Ruëff, Cäcilia Siemens, Jörg Fischer, Claudia Kugler, Knut Brockow, Johannes Ring, and Imke Reese
- Subjects
medicine.medical_specialty ,Allergy ,Emergency management ,business.industry ,Disease ,medicine.disease ,Hypersensitivity reaction ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,030228 respiratory system ,Physical therapy ,Immunology and Allergy ,Medicine ,Anxiety ,Medical prescription ,medicine.symptom ,business ,Intensive care medicine ,Anaphylaxis - Abstract
Anaphylaxis is an acute-onset, life-threatening, systemic hypersensitivity reaction. The acute reaction occurs due to a permanently immunologically altered response, which can result in mild to severe reactions and, in isolated cases, to fatal reactions upon allergen contact. The avoidance strategies required lifelong in affected individuals significantly impair quality of life. An expert analysis of the supportive care situation of anaphylaxis patients. The trigger of the reaction — mostly food, insect venom, or drugs — can normally be identified by means of allergy diagnostics. However, allergy workups unfortunately are not always performed in anaphylaxis patients. Unequivocal diagnosis and/or causal classification of the trigger is not always easy, particularly in the presence of summation factors, such as physical exertion or the use of analgesics or alcohol. Complex cases present too rarely in allergy centers with appropriate experience. Following anaphylaxis patients are given guidance on allergen avoidance and after obligatory instruction from a medical expert, receive a prescription for an emergency self-medication kit. However, studies show that allergen avoidance often fails and patient self-medication is frequently not performed. Therefore, the German working group on anaphylaxis training and education (Arbeitsgemeinschaft Anaphylaxie Training und Education, AGATE) formulated a structured written interdisciplinary educational training program that is currently used in 24 registered centers in Germany. In a multicenter study using control groups, the anaphylaxis training program showed significant efficacy in terms of practical emergency management and reduced anxiety. The nationwide implementation of the training program and cost-coverage by statutory health insurances appear reasonable given the potentially life-threatening nature of this disease. Since statutory health insurances have not guaranteed cost-coverage to date, it is not possible to offer the training program to all patients in need. Subject to region and center, there are good treatment options for anaphylaxis patients in Germany. However, these options are not always sufficiently implemented.
- Published
- 2016
- Full Text
- View/download PDF
34. Leitlinie Allergologische Diagnostik von Überempfindlichkeitsreaktionen auf Arzneimittel
- Author
-
Knut Brockow, Hans F. Merk, Johannes Ring, T. Jakob, Margitta Worm, Andreas J. Bircher, Randolf Brehler, Torsten Zuberbier, Lars Lange, Maja Mockenhaupt, Gerda Wurpts, Hagen Ott, Werner Aberer, Bernhard Przybilla, Wolfgang Pfützner, Thomas Fuchs, Helmut Sitter, Regina Treudler, Bettina Wedi, Oliver Pfaar, Heinrich Dickel, Bernhardt Sachs, and Axel Trautmann
- Subjects
Drug ,medicine.medical_specialty ,Allergy ,business.industry ,media_common.quotation_subject ,Provocation test ,Guideline ,medicine.disease ,Hypersensitivity reaction ,Time course ,Immunology and Allergy ,Medicine ,Drug intoxication ,business ,Intensive care medicine ,Anaphylaxis ,media_common - Abstract
Drug hypersensitivity reactions are unpredictable adverse drug reactions. They manifest either within 1 - 6 h following drug intake (immediate reactions) with mild-to-life-threatening symptoms of anaphylaxis, or several hours to days later (delayed reactions), primarily as exanthematous eruptions. It is not always possible to detect involvement of the immune system (allergy). Waiving diagnostic tests can result in severe reactions on renewed exposure on the one hand, and to unjustified treatment restrictions on the other. With this guideline, experts from various specialist societies and institutions have formulated recommendations and an algorithm for the diagnosis of allergies. The key principles of diagnosing allergic/hypersensitivity drug reactions are presented. Where possible, the objective is to perform allergy diagnostics within 4 weeks to 6 months following the reaction. A clinical classification of symptoms based on the morphology and time course of the reaction is required in order to plan a diagnostic work-up. In the case of typical symptoms of a drug hypersensitivity reaction and unequivocal findings from validated skin and/or laboratory tests, a reaction can be attributed to a trigger with sufficient confidence. However, skin and laboratory tests are often negative or insufficiently reliable. In such cases, controlled provocation testing is required to clarify drug reactions. This method is reliable and safe when attention is paid to indications and contraindications and perfouned under appropriate medical supervision. The results of the overall assessment are discussed with the patient and documented in an "allergy passport" in order to ensure targeted avoidance in the future and allow the use of alternative drugs where possible.
- Published
- 2016
- Full Text
- View/download PDF
35. Different Psychosocial Factors Are Associated with Seasonal and Perennial Allergies in Adults: Cross-Sectional Results of the KORA FF4 Study
- Author
-
Karl-Heinz Ladwig, Lisa Krabiell, Katharina Harter, Lars Schwettmann, Annette Peters, Gertrud Hammel, Hamimatunnisa Johar, Claudia Traidl-Hoffmann, Birgit Linkohr, and Johannes Ring
- Subjects
Adult ,Male ,Allergy ,Rhinitis, Allergic, Perennial ,media_common.quotation_subject ,Immunology ,Anxiety ,03 medical and health sciences ,0302 clinical medicine ,Germany ,Immunology and Allergy ,Medicine ,Personality ,Humans ,Psychology ,ddc:610 ,030223 otorhinolaryngology ,Depression (differential diagnoses) ,media_common ,Multinomial logistic regression ,Aged ,Aged, 80 and over ,business.industry ,Depression ,Confounding ,Rhinitis, Allergic, Seasonal ,General Medicine ,Middle Aged ,medicine.disease ,Mental Health ,Psychosocial Stress ,Social Status ,Cross-Sectional Studies ,030228 respiratory system ,Socioeconomic Factors ,Female ,Self Report ,medicine.symptom ,business ,Psychosocial ,Stress, Psychological ,Demography ,Social status - Abstract
Background: Psychosocial factors are supposed to play a central role in the development of allergic diseases. Associations with seasonal and perennial forms of allergies have not been investigated, yet. Objectives: The aim of the study was to investigate the associations of psychosocial factors (social status, depression, generalized anxiety, psychosocial stress, Type-D personality) with seasonal, perennial, and other forms of allergies in adults. Method: The analysis of self-reported data of the KORA FF4 study was performed with SAS 9.4. The sample consisted of 1,782 study participants in the study region of Augsburg (39–88 years, 61 years, 51.1% female). Descriptive bivariate statistics and multinomial logistic regression models were performed. Age, sex, family predisposition, and smoking status were considered possible confounders. Moreover, several sensitivity analyses were carried out to check whether missing values distorted the results. Results: A positive association between generalized anxiety and seasonal allergies was found in the multivariate model. Depression was positively, and anxiety negatively, associated with perennial allergies. No association between the analyzed psychosocial factors and other forms of allergies could be found. Conclusion: The results support the relevance of psychosocial factors in association with allergies. Looking at the psychosocial factors, a separate consideration of seasonal and perennial allergies seems reasonable. Further longitudinal studies should investigate the direction of the associations, the underlying mechanisms, and other psychosocial factors, such as coping mechanisms, in confirmed allergies.
- Published
- 2018
36. Adrenaline in the Acute Treatment of Anaphylaxis
- Author
-
Margitta Worm, Ludger Klimek, and Johannes Ring
- Subjects
Adult ,0301 basic medicine ,medicine.medical_specialty ,Allergy ,Epinephrine ,Review Article ,Injections, Intramuscular ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Pharmacotherapy ,Randomized controlled trial ,Autoinjector ,law ,medicine ,Humans ,Dosing ,Intensive care medicine ,Adverse effect ,Anaphylaxis ,business.industry ,General Medicine ,Adrenergic beta-Agonists ,medicine.disease ,Treatment Outcome ,030104 developmental biology ,030228 respiratory system ,business ,medicine.drug - Abstract
Background Anaphylaxis is the most serious manifestation of an immediate allergic reaction and the most common emergency event in allergology. Adrenaline (epi- nephrine) is the mainstay of acute pharmacotherapy for this complication. Although epinephrine has been in use for more than a century, physicians and patients are often unsure and inadequately informed about its proper administration and dosing in everyday situations. Methods This review is based on pertinent publications from the period 1 January 2012 to 30 September 2017 that were retrieved, on the basis of the existing guide- lines of 2007 and 2014, by a PubMed search employing the keywords "anaphylaxis treatment," "allergic shock," "adrenaline," and "epinephrine," as well as on further ar- ticles from the literature. Results Adrenaline/epinephrine administration often eliminates all manifestations of anaphylaxis. The method of choice for administering it (except in intensive-care medicine) is by intramuscular injection with an autoinjector; this is mainly done to treat reactions of intermediate severity. The injection is given in the lateral portion of the thigh and can be repeated every 10-15 minutes until there is a response. The dose to be administered is 300-600 µg for an adult or 10 µg/kg for a child. The risk of a serious cardiac adverse effect is lower than with intravenous administration. There have not been any randomized controlled trials on the clinical efficacy of ephi- nephrine in emergency situations. The use of an autoinjector should be specially practiced in advance. Conclusion The immediate treatment of patients with anaphylaxis is held to be ad- equate, yet major deficiencies remain in their further diagnostic evaluation, in the prescribing of emergency medications, and in patient education. Further research is needed on cardiovascular involvement in anaphylaxis and on potential new thera- peutic approaches.
- Published
- 2018
- Full Text
- View/download PDF
37. Superficial radiation therapy in peyronie’s disease: An effective and well-tolerated therapy
- Author
-
Knut Brockow, Johannes Ring, Bernadette Eberlein, Tilo Biedermann, Jan Gutermuth, M. Zirbs, Harald Bruckbauer, Gunilla Pietsch, Heidelore Hofmann, Tobias Anzeneder, Gerontology, Skin function and permeability, and Dermatology
- Subjects
lcsh:Medical physics. Medical radiology. Nuclear medicine ,medicine.medical_specialty ,Treatment response ,Erythema ,Visual analogue scale ,lcsh:R895-920 ,medicine.medical_treatment ,030232 urology & nephrology ,Disease ,Benign Disease ,lcsh:RC254-282 ,superficial radiation therapy ,03 medical and health sciences ,0302 clinical medicine ,Patient satisfaction ,medicine ,Radiology, Nuclear Medicine and imaging ,Medicine(all) ,peyronie's disease ,business.industry ,questionnaire ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,medicine.disease ,Surgery ,ddc ,Radiation therapy ,Oncology ,030220 oncology & carcinogenesis ,Peyronie's disease ,medicine.symptom ,business ,Superficial radiation - Abstract
Purpose: This study aimed to assess the safety, efficacy, and patient satisfaction of superficial radiation therapy in the treatment of Peyronie's disease (PD) in a retrospective analysis. Methods and materials: We performed a retrospective analysis of 83 patients who underwent radiation therapy between 1999 and 2008 with 8 fractions of 4 Gy over a period of 6 months. With a mean follow-up time of 52 months, patients responded to a comprehensive questionnaire that covered patient characteristics, disease duration before radiation therapy, course of disease, treatment response, side effects, and patient satisfaction. Results: After a mean follow-up time of 52 months, 78% of the treated patients reported that PD progression had stopped. Furthermore 47% of patients had a symptom regression. Only 7% of patients reported PD progression. The penile curvature was improved in 49% of patients, and plaque induration could be reduced in 42% of patients. Moreover, 71% of patients reported substantial pain relief, as measured by a visual analogue scale (1 = not satisfied; 10 = very satisfied). Treatment satisfaction was rated with a median of 8 in a visual analogue scale out of 10. Side effects included transient erythema in 38.6% of patients and 9.6% reported of transient or chronic dryness. No severe side effects were observed. Conclusions: Radiation therapy for PD in the disease's early stages proved to be a safe and well-tolerated method with good results in pain relief, especially in patients aged
- Published
- 2018
38. Frequency of undiagnosed psoriatic arthritis among psoriasis patients in Australian dermatology practice
- Author
-
Christopher Stuart Baker, Alan Cooper, Michael R Lee, Lynda Spelman, K Thirunavukkarasu, George Varigos, Johannes Ring, Pablo Fernandez-Penas, and John C Su
- Subjects
Adult ,Male ,medicine.medical_specialty ,Arthritis ,Efficiency ,Dermatology ,Severity of Illness Index ,Psoriatic arthritis ,Chronic large plaque psoriasis ,Quality of life ,Risk Factors ,Surveys and Questionnaires ,Psoriasis ,Absenteeism ,Severity of illness ,Epidemiology ,Prevalence ,medicine ,Humans ,business.industry ,Arthritis, Psoriatic ,Australia ,Middle Aged ,Presenteeism ,medicine.disease ,Comorbidity ,Infectious Diseases ,Nails ,Scalp Dermatoses ,Quality of Life ,Female ,business - Abstract
Background Psoriatic arthritis commonly develops in psoriasis patients and, if undiagnosed, can lead to potentially avoidable joint damage and an increased risk of comorbidity and mortality. Increased awareness of PsA symptoms among dermatologists provides an opportunity for earlier diagnosis, more timely therapy and prevention of disability. Objective To provide Australian epidemiological data on the frequency of undiagnosed PsA among psoriasis patients in dermatology practice, and to investigate the impact of psoriasis on quality of life and work productivity. Methods Nine tertiary centre dermatology practices enrolled patients presenting with plaque psoriasis and no prior rheumatologist-confirmed PsA diagnosis. Patients were screened using the Psoriatic Arthritis Screening and Evaluation (PASE) questionnaire and were referred to a rheumatologist for assessment of PsA status using CASPAR criteria if they had a PASE score ≥44. Results Based on the composite and sequential application of PASE and CASPAR criteria, undiagnosed PsA among psoriasis patients in this study is 9% [95% CI: 6, 12]. The PPV of PASE in this setting is 26% [95% CI: 19, 34]. Nail involvement and chronic large plaque psoriasis were identified as independent positive predictors of PsA, whereas scalp psoriasis was an independent negative predictor of PsA. Patients with moderate-to-severe psoriasis (PASI ≥15) had lower quality of life scores than patients with less severe psoriasis. Conclusion In this study, the frequency of undiagnosed PsA in Australian dermatology practice was 9% among plaque psoriasis patients with no prior PsA diagnosis. Compared with psoriasis alone, the impact of undiagnosed PsA on health-related quality of life of psoriasis patients is substantial.
- Published
- 2015
- Full Text
- View/download PDF
39. Eczema – in the focus between dermatology and allergology
- Author
-
Johannes Ring
- Subjects
medicine.medical_specialty ,Allergy ,business.industry ,Acanthosis ,Atopic dermatitis ,medicine.disease ,Dermatology ,immune system diseases ,Psoriasis ,Seborrheic dermatitis ,otorhinolaryngologic diseases ,medicine ,Immunology and Allergy ,medicine.symptom ,skin and connective tissue diseases ,business ,Parakeratosis ,Contact dermatitis ,Spongiosis - Abstract
Eczemas represent the most common non-communicable inflammatory skin diseases. Eczema is a non-contagious epidermo-dermitis with typical clinical (redness, scaling, oozing, crusting, lichenification and itch) and dermatohistological (acanthosis, parakeratosis, spongiosis, lymphocytic infiltrates) signs. Eczema mostly occurs on the basis of hypersensitivity. In a simple classification, eczema can be differentiated into contact eczema (irritative toxic, allergic), atopic eczema (atopic dermatitis), seborrheic eczema, nummular eczema and others. Eczema can also be classified according to elicitors (e. g. nickel eczema, chromate eczema) or localization (e. g. eyelid eczema, leg eczema etc.). There is a gap between the progress in pathophysiological understanding of the deviated immune response and the practical management in everyday clinics. At the moment there is not yet a targeted treatment with biologics as is available for psoriasis. However, with anti-IL4 receptor antagonists there is hope on the horizon.
- Published
- 2015
- Full Text
- View/download PDF
40. Guideline for the diagnosis of drug hypersensitivity reactions
- Author
-
Axel Trautmann, Torsten Zuberbier, Andreas J. Bircher, Wolfgang Pfützner, Thomas Fuchs, Randolf Brehler, Thilo Jakob, Heinrich Dickel, H. Sitter, Bettina Wedi, Hans F. Merk, Bernhardt Sachs, Margitta Worm, Gerda Wurpts, Hagen Ott, Oliver Pfaar, Lars Lange, Maja Mockenhaupt, Bernhard Przybilla, Regina Treudler, Knut Brockow, Werner Aberer, and Johannes Ring
- Subjects
Drug ,medicine.medical_specialty ,Allergy ,business.industry ,media_common.quotation_subject ,Provocation test ,Guideline ,medicine.disease ,Surgery ,Hypersensitivity reaction ,Time course ,medicine ,Immunology and Allergy ,Drug intoxication ,Intensive care medicine ,business ,Anaphylaxis ,media_common - Abstract
Drug hypersensitivity reactions are unpredictable adverse drug reactions. They manifest either within 1–6 h following drug intake (immediate reactions) with mild to life-threatening symptoms of anaphylaxis, or several hours to days later (delayed reactions), primarily as exanthematous eruptions. It is not always possible to detect involvement of the immune system (allergy). Waiving diagnostic tests can result in severe reactions on renewed exposure on the one hand, and to unjustified treatment restrictions on the other. With this guideline, experts from various specialist societies and institutions have formulated recommendations and an algorithm for the diagnosis of allergies. The key principles of diagnosing allergic/hypersensitivity drug reactions are presented. Where possible, the objective is to perform allergy diagnostics within 4 weeks–6 months following the reaction. A clinical classification of symptoms based on the morphology and time course of the reaction is required in order to plan a diagnostic work-up. In the case of typical symptoms of a drug hypersensitivity reaction and unequivocal findings from validated skin and/or laboratory tests, a reaction can be attributed to a trigger with sufficient confidence. However, skin and laboratory tests are often negative or insufficiently reliable. In such cases, controlled provocation testing is required to clarify drug reactions. This method is reliable and safe when attention is paid to indications and contraindications and performed under appropriate medical supervision. The results of the overall assessment are discussed with the patient and documented in an „allergy passport“ in order to ensure targeted avoidance in the future and allow the use of alternative drugs where possible.
- Published
- 2015
- Full Text
- View/download PDF
41. When Can Immunotherapy for Insect Sting Allergy Be Stopped?
- Author
-
Johannes Ring and Ulrich R. Müller
- Subjects
medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Insect bites and stings ,Insect sting allergy ,Honey Bees ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,Hypersensitivity ,medicine ,Animals ,Humans ,Immunology and Allergy ,Epinephrine autoinjector ,skin and connective tissue diseases ,Anaphylaxis ,Arthropod Venoms ,Skin Tests ,business.industry ,fungi ,Insect Bites and Stings ,Immunotherapy ,medicine.disease ,Hymenoptera ,eye diseases ,Residual risk ,Sting ,Treatment Outcome ,Desensitization, Immunologic ,Immunology ,business - Abstract
Stings by Hymenoptera (honey bees, vespids, ants) can cause systemic allergic reactions (SARs). Venom immunotherapy (VIT) is highly effective and reduces an allergic patient's risk of a recurrent SAR to less than 5-20%. The risk of a recurrent SAR to a re-sting decreases the longer VIT is continued. The recommended duration of VIT is at least 3 to 5 years.Risk factors for recurrent SARs to a sting after stopping VIT have been identified and discussed: Recommendations concerning stopping VIT: For patients without any of the identified risk factors, VIT should be continued for 5 rather than 3 years. In patients with definite risk factors, a longer duration of VIT has to be discussed before stopping it. In mast cell disorders, VIT for life is recommended. Because of the residual risk of SARs after VIT, all patients are advised to carry an epinephrine autoinjector indefinitely and to continue to take measures to avoid Hymenoptera stings.
- Published
- 2015
- Full Text
- View/download PDF
42. Safety and Efficacy of Pimecrolimus in Atopic Dermatitis
- Author
-
Bardur Sigurgeirsson, Thomas A. Luger, Rada Dakovic, Sigurdur Kristjansson, Yves Poulin, Antonio Nieto, Uwe Schauer, Gail Todd, Marielouise Schuttelaar, Mark Boguniewicz, André Vertruyen, Johannes Ring, Xuejun Zhu, Andrzej Boznański, Andrea von Berg, Amy S. Paller, Paul Y. Qaqundah, and Public Health Research (PHR)
- Subjects
Cellular immunity ,Pediatrics ,medicine.medical_specialty ,CHILDHOOD ,INFANTS ,CHILDREN ,ECZEMA ,Disease ,Tacrolimus ,law.invention ,Dermatitis, Atopic ,Pimecrolimus ,Quality of life ,Randomized controlled trial ,law ,Adrenal Cortex Hormones ,QUALITY-OF-LIFE ,hemic and lymphatic diseases ,Medicine ,Humans ,Adverse effect ,Dose-Response Relationship, Drug ,business.industry ,Infant ,Atopic dermatitis ,TOPICAL CALCINEURIN INHIBITORS ,medicine.disease ,Intervention studies ,Long-Term Care ,CREAM 1-PERCENT ,ANTIINFLAMMATORY DRUG ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Drug Therapy, Combination ,Dermatologic Agents ,SDZ ASM 981 ,business ,SKIN ,medicine.drug - Abstract
BACKGROUND AND OBJECTIVES:Atopic dermatitis (AD) primarily affects infants and young children. Although topical corticosteroids (TCSs) are often prescribed, noncorticosteroid treatments are needed because compliance with TCSs is poor due to concerns about their side effects. In this longest and largest intervention study ever conducted in infants with mild-to-moderate AD, pimecrolimus 1% cream (PIM) was compared with TCSs.Methods:A total of 2418 infants were enrolled in this 5-year open-label study. Infants were randomized to PIM (n = 1205; with short-term TCSs for disease flares) or TCSs (n = 1213). The primary objective was to compare safety; the secondary objective was to document PIM’s long-term efficacy. Treatment success was defined as an Investigator’s Global Assessment score of 0 (clear) or 1 (almost clear).Results:Both PIM and TCSs had a rapid onset of action with >50% of patients achieving treatment success by week 3. After 5 years, >85% and 95% of patients in each group achieved overall and facial treatment success, respectively. The PIM group required substantially fewer steroid days than the TCS group (7 vs 178). The profile and frequency of adverse events was similar in the 2 groups; in both groups, there was no evidence for impairment of humoral or cellular immunity.Conclusions:Long-term management of mild-to-moderate AD in infants with PIM or TCSs was safe without any effect on the immune system. PIM was steroid-sparing. The data suggest PIM had similar efficacy to TCS and support the use of PIM as a first-line treatment of mild-to-moderate AD in infants and children.
- Published
- 2015
- Full Text
- View/download PDF
43. White-fruited strawberry genotypes are not per se hypoallergenic
- Author
-
Ulf Darsow, Wilfried Schwab, Kathrin Edelmann, Elisabeth Kurze, Dominic Helm, Philip Bleicher, Klaus Olbricht, Bernadette Eberlein, Katrin Franz-Oberdorf, and Johannes Ring
- Subjects
0106 biological sciences ,0301 basic medicine ,Allergy ,Genotype ,Biology ,medicine.disease_cause ,01 natural sciences ,Fragaria ,03 medical and health sciences ,chemistry.chemical_compound ,Allergen ,Botany ,medicine ,Humans ,Cultivar ,Cells, Cultured ,food and beverages ,Ripening ,Hypoallergenic ,Allergens ,Antigens, Plant ,medicine.disease ,Basophils ,Horticulture ,030104 developmental biology ,chemistry ,Anthocyanin ,Fruit ,Food Hypersensitivity ,010606 plant biology & botany ,Food Science - Abstract
The strawberry fruit Fra a 1-proteins are homologues of the major birch pollen allergen Bet v 1 and have essential biological functions in pigment formation during fruit ripening. Patients affected by allergy against birch pollen tolerated fruits of a naturally occurring white-fruited F.×ananassa genotype, which showed reduced levels of Fra a 1 proteins along with enzymes of the anthocyanin pigment pathway. We evaluated the cross-reactive allergenic potential of a number of naturally occurring white- and red-fruited strawberry varieties to detect genotypes with low allergenic reactivity, whose fruit might be tolerated by patients with mild allergy. Protein extracts of 51 different strawberry varieties (Fragaria×ananassa, F. vesca, and F. nilgerensis) were screened by Western blot analysis with a polyclonal Fra a 1.02 antibody. Besides, activation of basophils of eight atopic patients allergic to birch pollen were studied using Bet v 1a and different concentrations of 15 selected strawberry protein extracts out of the 51 strawberry genotypes. Median percentages of activated basophils stimulated by extracts from white- and red-fruited genotypes ranged from 36 to 84% and 44 to 76%, respectively indicating that white-fruited strawberry are not per se hypoallergenic. Protein extracts from white-fruited F. vesca cv. Yellow Wonder showed the lowest cross-reactivity but high biological variability. The knowledge about the allergenic potential of different strawberry genotypes may help to improve food safety and can serve as starting point for the development of red-fruited hypoallergenic strawberry cultivars.
- Published
- 2017
44. Microbial Triggers in Autoimmunity, Severe Allergy and Autoallergy
- Author
-
Sherief R. Janmohamed, Johannes Ring, Jan Gutermuth, Fariza Mishaal Saiema Badloe, Schmidt-Weber, Carsten B., Surgical clinical sciences, Faculty of Medicine and Pharmacy, Skin function and permeability, Dermatology, and Gerontology
- Subjects
Allergy ,Severe allergy ,business.industry ,Immunology ,medicine ,Atopic dermatitis ,medicine.disease ,medicine.disease_cause ,business ,Asthma ,Autoimmunity - Abstract
The prevalence of immune-mediated diseases (allergies, autoimmune diseases, and autoinflammatory diseases) is rising world-wide and their management is difficult, since treatments usually are mainly symptomatic. Insight in the exact pathomechanisms is crucial for focused prevention or improvement of therapies.
- Published
- 2017
45. Skin symptoms as diagnostic clue for autoinflammatory diseases
- Author
-
Johannes Ring, Alvaro Moreira, Kilian Eyerich, Juliano Peruzzo, Alberto Mota, and Barbara Torres
- Subjects
Cryopyrin-associated periodic syndromes ,Tumor necrosis factor receptor-associated peptides and proteins ,Familial Mediterranean fever ,Still's disease, adult-onset ,Review ,Dermatology ,Behçet syndrome ,Systemic inflammation ,Skin Diseases ,Autoimmune Diseases ,Proinflammatory cytokine ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Schnitzler syndrome ,Mevalonate kinase deficiency ,Hereditary autoinflammatory diseases ,medicine ,Humans ,Inflammation ,030203 arthritis & rheumatology ,Acquired hyperostosis syndrome ,business.industry ,Sweet Syndrome ,Autoantibody ,Sweet syndrome ,Cryopyrin-associated periodic syndrome ,medicine.disease ,RL1-803 ,Immunology ,Familial mediterranean fever ,medicine.symptom ,business - Abstract
Autoinflammatory disorders are immune-mediated diseases with increased production of inflammatory cytokines and absence of detectable autoantibodies. They course with recurrent episodes of systemic inflammation and fever is the most common symptom. Cutaneous manifestations are prevalent and important to diagnosis and early treatment of the syndromes. The purpose of this review is to emphasize to dermatologists the skin symptoms present in these syndromes in order to provide their early diagnosis.
- Published
- 2017
46. Visual analogue scales (VAS): Measuring instruments for the documentation of symptoms and therapy monitoring in cases of allergic rhinitis in everyday health care: Position Paper of the German Society of Allergology (AeDA) and the German Society of Allergy and Clinical Immunology (DGAKI), ENT Section, in collaboration with the working group on Clinical Immunology, Allergology and Environmental Medicine of the German Society of Otorhinolaryngology, Head and Neck Surgery (DGHNOKHC)
- Author
-
Karl-Christian Bergmann, Oliver Pfaar, Philippe Stock, Hans F. Merk, Ralph Mösges, Wolfgang Wehrmann, Heidi Olze, Ludger Klimek, Kirsten Jung, Wolfgang Schlenter, Jean Bousquet, Peter Hellings, Martin Wagenmann, Tilo Biedermann, Johannes Ring, and Ear, Nose and Throat
- Subjects
medicine.medical_specialty ,Allergy ,business.industry ,medicine.disease ,language.human_language ,3. Good health ,German ,03 medical and health sciences ,0302 clinical medicine ,Documentation ,030228 respiratory system ,Otorhinolaryngology ,Health care ,medicine ,Physical therapy ,language ,Immunology and Allergy ,Position paper ,Medical history ,030223 otorhinolaryngology ,Environmental medicine ,business - Abstract
Visual analogue scales (VAS) are psychometric measuring instruments designed to document the characteristics of disease-related symptom severity in individual patients and use this to achieve a rapid (statistically measurable and reproducible) classification of symptom severity and disease control. VAS can also be used in routine patient history taking and to monitor the course of a chronic disease such as allergic rhinitis (AR). More specifically, the VAS has been used to assess effectiveness of AR therapy in real life, both in intermittent and persistent disease. This position paper takes a detailed look at the historical development of VAS and its method-specific principles. Particular focus is put on aspects of practical application in daily routine and on a critical discussion of the advantages and disadvantages of the individual methods. VAS are well validated for the measurement of AR symptoms and correlate well with the ARIA (allergic rhinitis and its impact on asthma) severity classification and also correlated well with rTNSS and RQLQ. Moreover, several treatment studies on AR have used VAS as an evaluation parameter. Thanks to the use of new (real-life and real-time) communication technologies, such as smartphone apps, Discussion: VAS can be used relatively simply and highly effectively to assess disease control. The VAS lends itself very well to digitization and has now been incorporated into a smartphone app (called Allergy Diary) to assess AR control and direct treatment decisions as part of an AR clinical decision support system (CDSS). MASK Rhinitis has developed this app, which is currently available in 15 different languages
- Published
- 2017
47. What is new in atopic dermatitis/eczema?
- Author
-
Antonia Todorova, Sabine Gisela Plötz, Markus Wiesender, and Johannes Ring
- Subjects
medicine.medical_specialty ,Exacerbation ,Provocation test ,Anti-Inflammatory Agents ,Eczema ,Administration, Cutaneous ,medicine.disease_cause ,Systemic therapy ,Dermatitis, Atopic ,Pathogenesis ,medicine ,Animals ,Humans ,Pharmacology (medical) ,Molecular Targeted Therapy ,Glucocorticoids ,Pharmacology ,business.industry ,medicine.disease ,Dermatology ,Calcineurin ,Atopic dermatitis (eczema) ,Drug Design ,Superinfection ,Immunology ,Etiology ,Dermatologic Agents ,business ,Immunosuppressive Agents - Abstract
Atopic eczema (AE) is a chronic relapsing inflammatory skin condition and one of the most common, potentially debilitating diseases with increasing incidence.The complex etiology of AE with multiple systemic and local immunologic and inflammatory responses and interactions between susceptibility genes and environmental factors leading to defects in skin barrier function and eczematous skin lesions is presented. Knowledge of pathogenesis is important for understanding the more innovative treatment approaches discussed.Basic therapy consists of hydrating topical treatment and avoidance of specific and unspecific provocation factors. For acute eczematous skin lesions, anti-inflammatory treatment consists mainly of topical glucocorticoids and topical calcineurin inhibitors. Microbial colonization and superinfection may induce skin exacerbation, which can be treated by either topical or systemic antimicrobial treatment. Systemic anti-inflammatory therapy is limited to severe cases and consists of systemic steroids, cyclosporine A or mycophenolate mofetil. Novel anti-inflammatory concepts that go beyond corticosteroids are in the early phases of development. There are targeted therapeutic approaches, such as cytokine and chemokine modulators, and it remains to be investigated how effective they will be and what side effects they may carry. Existing treatment modalities such as barrier repair therapy, topical immunosuppressive agents, antiseptic treatment as well as systemic treatment options are discussed.
- Published
- 2014
- Full Text
- View/download PDF
48. Acupuncture for allergic disease therapy – the current state of evidence
- Author
-
G. I. Athanasiadis, Johannes Huss-Marp, Vitaly Napadow, Peter C. Schalock, Florian Pfab, and Johannes Ring
- Subjects
Allergy ,medicine.medical_specialty ,business.industry ,Immunology ,Acupuncture Therapy ,Alternative medicine ,Atopic dermatitis ,Acupuncture treatment ,medicine.disease ,Rhinitis, Allergic ,Dermatology ,law.invention ,Disease therapy ,Randomized controlled trial ,law ,Hypersensitivity ,medicine ,Acupuncture ,Humans ,Immunology and Allergy ,business ,Asthma - Abstract
This review summarizes current evidence for acupuncture treatment of allergies. Several randomized controlled trials have demonstrated a specific effect of acupuncture for allergic rhinitis; while a few studies have shown positive effects for atopic dermatitis, asthma and itch. Specifically for allergic rhinitis and asthma, acupuncture may be cost-effective in terms of money spent per quality-of-life gained. Acupuncture plays an increasingly important role as an evidence-based therapy for allergy relief and can be recommended as adjunct therapy for allergic rhinitis. Future randomized controlled trials need to further explore acupuncture efficacy for the treatment of itch, atopic dermatitis and asthma. More experimental research is also needed to investigate mechanisms of action underlying acupuncture for allergy relief.
- Published
- 2014
- Full Text
- View/download PDF
49. Guideline for acute therapy and management of anaphylaxis
- Author
-
Lars Lange, Knut Brockow, Johannes Ring, Franziska Ruëff, Eva-Maria Varga, Tilo Biedermann, Frank Friedrichs, Helmut Sitter, Margitta Worm, Thilo Jakob, Andreas J. Bircher, Jörg Fischer, Roland Seifert, Kirsten Beyer, Ludger Klimek, Sabine Schnadt, Ernst Rietschel, Hans F. Merk, D. Duda, Oliver Pfaar, Uwe Gieler, Bodo Niggemann, Thomas Fuchs, and Bernhard Przybilla
- Subjects
medicine.medical_specialty ,Allergy ,business.industry ,medicine ,Immunology and Allergy ,Guideline ,Medical emergency ,medicine.disease ,Intensive care medicine ,business ,Anaphylaxis - Published
- 2014
- Full Text
- View/download PDF
50. Anaphylaxis: classification and clinical symptoms
- Author
-
Knut Brockow, Johannes Ring, and Jarmila Liptak
- Subjects
medicine.medical_specialty ,business.industry ,Medicine ,business ,medicine.disease ,Dermatology ,Anaphylaxis - Published
- 2014
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.