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Hypersensitivity reactions to alcoholic beverages (particularly red wine) are relatively frequent, affecting 10% of the general population. Hypersensitivity reactions due to alcoholic drinks, mainly in the form of airway reactions (rhinitis and asthma), occur significantly more frequently in persons with pre-existing rhinitis and asthma. In terms of pathogenesis, it has to be differentiated between immunologic, mainly IgE-mediated, hypersensitivity reactions (wine allergies), and intolerance reactions in which no causative allergen-specific immune mechanisms can be detected. Allergens responsible for wine allergy could be: grape (Vitis vinifera) proteins (particularly the major allergen lipid transfer protein Vit v1), proteins and ingredients used for the fining of wines such as fish gelatin or isinglass (swim bladder of the fish huso, family of sturgeons), ovalbumin, dairy (casein) products, gum arabic, enzymes (lysozyme, pectinase, glucanase, cellulase, glucosidase, urease, aromatic enzymes), molds (particularly Botrytis cinerea) responsible for the noble rot in wines, yeasts and proteins from insects that contaminated the mash. Type 1 allergic reactions (positive prick tests) have been described for inorganic components like ethanol, acetaldehyde, acetic acid and sulfites, but no specific IgE could be detected in the serum. Ethanol, acetaldehyde and acetic acid, flavonoids (anthocyanins and chatechines), sulfites, histamine and other biogenic amines are the main causative agents of intolerance reactions (pseudoallergic reactions) to wine. After a short historic review of viticulture and the importance of wine in classical antiquity, we go into the chemical processes of alcoholic fermentation and the genetically inherited “flush syndrome” caused by an acetaldehyde dehydrogenase 2 polymorphism, subsequently we focus on the different etiologic factors of allergies and intolerance reactions to wine. The most frequent intolerance reactions to sulfites occur particularly after the ingestion of white wine and in asthma patients. Intolerance reactions to histamine and other biogenic amines occur mainly after ingestion of red wine and in persons with diamine oxidase (DAO) deficiency.

Aus der Geschichte der Allergologie: les „quadrillages cutanes“ nach Blamoutier – eine ko-saisonale Behandlung der Pollenallergie Die epikutane Applikation von Pollen­ extrakten nach schachbrettartiger Skarifika­ tion an der Volarseite der Vorderarme (so­ genannte „quadrillages cutanes“) nach den franzosischen Allergologen Pierre und Jean Blamoutier war eine beliebte ko­saisonale Behandlung der Pollinose, als die nichtsedie­ renden Antihistaminika noch nicht auf dem Markt waren. In modifizierter Form (epi­ kutane Applikation von Pollenextrakten) un­ ter Okklusivverband uber 48 Stunden nach vorheriger Abradierung der Hornschicht er­ fahrt diese Methode heute eine Renaissance.

In the course of 18 months, allergic bronchial asthma due to wild silk was diagnosed in 26 patients (19 women, 7 men) of the relatively high mean age at onset of 34 years. In 25 patients the allergy started 1-36 months after acquiring a so-called wild-silk rug, which contains wild-silk waste; one patient fell ill after occupational contact with the waste of wild silk. In all patients the scratch test with wild-silk waste was strongly positive. Elimination of the rug or the occupational exposure made all the symptoms disappear. Wild-silk waste, product of wild-growing oak silkworms, is thus a relatively strong inhalation allergen. Exposure to wild-silk rugs should routinely be considered in the diagnostic work-up of allergies.

Celery allergies are commonly observed in mugwort pollen-allergic patients. This situation is frequently associated with an allergy to spices of the umbelliferous family. Thus a "celery-mugwort-spice syndrome" has been established. In 31 patients (27 females, 4 males) allergy to celery was diagnosed between 1978 and 1982. They were followed up in 1983 and complementary tests (skin and RAST) with various raw vegetables, spices and mugwort pollen were done. For specific diagnosis of allergy to celery skin testing (scratch or prick) with fresh celery bulb was reliable. In contrast, RAST was not sufficiently sensitive, 87% of patients allergic to celery had pollinosis in the form of mugwort pollen sensitisation established by skin testing and RAST. Allergy to carrots was clinically and by testing currently associated in 52%. In contrast, a clinically relevant hypersensitivity to caraway (26%), parsley (16%), fennel (13%), green pepper (10%) and aniseed (3%) was found less frequently although these allergens showed a much larger positivity in skin testing. This signifies group sensitisation within the umbelliferous plants. The association of celery-mugwort allergy with allergy to mango fruit described here for the first time cannot be explained as group sensitisation within a botanic relation, as mango, and pistachio-nut, belong to the family of anacardiaceae.

History Three patients developed recurrent anaphylactic reactions after ingestion of different kinds of food (Asian food, chocolate products, bakery products). Investigations In all three patients a severe peanut allergy was confirmed either by skin prick testing or serologically (specific IgE for peanut of CAP class 3,4 and 6 respectively). Peanut allergy in all patients explained the anaphylactic reactions due to ingestion of hidden peanut in the food. Treatment Patients were told to avoid the allergen. Because accidental ingestion is frequent in peanut allergy, they were equipped with a document stating the severity of the allergy and emergency medication (antihistamines, oral steroids, adrenaline injector). Conclusions Peanuts can be concealed in different kinds of food because they are cheap, rich in protein and are often used to change the viscosity of other foods. Especially the American and Asian cuisines use peanuts in a wide variety of recipes. Furthermore accidental ingestion can occur due to false or lacking declaration of peanuts in processed food. Patients with peanut allergy should be informed about these possibilities.

Among sera from 379 patients with atopy tested with the radio-allergo-sorbent test (RAST) for domestic dust and house-dust mite (Dermatophagoides pteronyssinus), 104 were positive only for house dust. Positive results for both house dust and house-dust mites were obtained in 130, while in 145 the RAST result was positive only for house-dust mites. 104 sera, negative for house-dust mites, were tested by RAST for specific IgE against epithelia from cats, dogs, guinea-pigs, horses and cattle, as well as cockroaches (Blatella germanica). A positive RAST result for at least one of these animal epithelia was obtained in 89.5% of sera, for cockroaches in 7.7%. Cat epithelia were of special importance with respect to both rate and degree of sensitization. Except for dog epithelia, sensitization (as demonstrated with RAST) against the other domestic animal epithelia was more frequent than the history had indicated. After immune-adsorption of its homologous specific IgE with cat epithelia, but not after adsorption with epithelia of dog, guinea-pig, horse and cattle, inhibition of the house-dust RAST level in 60-80% was demonstrated in pool-sera. This finding proves that sensitization to cat epithelia, in addition to house-dust mites, can be the cause of a positive house-dust RAST reaction; cat epithelia are an important allergen of inhalation allergies caused by house dust.

History and clinical findings A 58-year-old woman was admitted because of intermittent fever for 4 weeks accompanied by slowly developing anaemia and increase in inflammatory parameters. She was being treated for hypertension with atenolol and chlorthalidone, but until 6 weeks before the onset of the described symptoms she had only taken the beta blocker, at which time the diuretic was added because the hypertension was inadequately controlled. Other than slightly impaired general condition and nocturnal fever up to 39.5 degrees C physical examination was unremarkable. Investigations She had a normochromic normocytic anaemia and the erythrocyte sedimentation rate and C-reactive protein were clearly elevated. Other biochemical tests and blood cultures as well as serological and immunological tests were negative. Bone marrow biopsy showed nonspecific reactive changes. The chest radiograph, lung scintigraphy and abdominal ultrasound were unremarkable. Treatment and course There was no further fever after the antihypertensive medication had been discontinued. The patient's general condition rapidly improved and all biochemical tests became normal. The lymphocyte transformation test demonstrated stimulation by chlorthalidone. Conclusion Drug fever, in this case due to a sulphonamide derivative, should always be considered in the differential diagnosis of fever of unknown aetiology. No previous case of hypersensitivity reaction to chlorthalidone has been found on a search of the literature.

Background: Clinical efficacy has been documented for sublingual immunotherapy (SLIT) in monosensitized patients with seasonal allergic rhinoconjunctivitis (SARC) using extracts containing only 1 allergen; but to our knowledge, no SLIT study has ever been published in polysensitized patients using mixed extracts. Objective: To investigate the clinical efficacy of SLIT with mixed extracts in polysensitized patients of an out-patient clinic and to evaluate the relative clinical efficacy in relation to systemic side effects. Methods: A 3 -year prospective open study including 79 polysensitized patients, mean age 33, range 7 - 62,49% male, 51% female, with SARC receiving sublingual-swallow immunotherapy with mixed pollen extracts. During the pollen season patients recorded symptoms (0 = absent, 1 = mild, 2 = moderate, 3 = severe) for rhinitis, conjunctivitis and asthma and their need for medication (oral antihistaminic, antihistaminic eye drops and nasal spray or corticosteroid nasal spray or inhaled antiasthmatic drugs (β-agonists and/or inhaled corticosteroids)). If rhinoconjunctivitis was uncontrolled, prednisone tablets were allowed. Clinical efficacy was evaluated separately for clinical symptoms (symptom scores) and for use of rescue drugs (medication scores). Improvement of rhinitis, conjunctivitis and asthma is described by the changes in the individual frequency of symptoms (in 4 stages ranging from less than once per week to several times daily) and in the severity of symptoms (in 5 stages ranging from none to very severe). The frequency of symptoms was classified both at the start of the titration period and the end of the observation phase of the maintenance period into "less than once per week", "several per week", "once per day", or "several per day". To avoid problems with data not being normally distributed, nonparametric statistics were used on an explorative basis. Demographic data were analyzed by Χ 2 test or Fishers exact test. Within group comparison Wilcoxon tests were applied for the primary outcome parameter, i.e. clinical efficacy and Mann-Whitney for side effects, p values - 0.05 were considered significant. Results: Clinical efficacy was estimated in 79 patients completing 3 years of treatment by subtracting baseline data and by calculating the ratio third treatment year vs. baseline. The monthly dose of 1,200 IR for 1 allergen extract mixture was 150 times higher than the subcutaneous dose administered typically in the same time period. The total cumulative dose varied between 43,200 IR (1 allergen) and 10,800 IR (4 allergen mixtures) for the 3-year treatment period. SLIT diminished the median disease severity of rhinitis, conjunctivitis and asthma at the start to 1/2 of baseline after 3 years and and marked improve the intraindividual frequency of the three main symptoms. Symptom and medication scores showed statistically significant and clinically relevant effectiveness. SLIT treatment only resulted in local mild side-effects. Conclusion: SLIT with mixed extracts is clinically effective in polysensitized patients with SARC.

Objective. To assess whether prevalence of active commuting and regular car trips to school varies across communities and language regions in Switzerland and to determine personal and environmental correlates. Methods. During the school year 2004/2005, 1345 parental questionnaires (response rate 65%) of children attending 1st, 4th and 8th grades were completed, 1031 could be linked to a GIS environmental database. A German-speaking, a French-speaking and a bilingual study area were included. Usual mode of transportation and frequency of regular car trips to school were assessed. Associations with personal and environmental factors were evaluated with multivariate regression models. Results. Seventy-eight percent of the children actively traveled to school. Twelve percent were regularly driven at least once a week by car. Major road crossings and distance were significantly related to usual mode of transportation, but not to regular car trips. Age, daycare attendance, parental safety concerns, number of cars in the household and belonging to French-speaking population were significantly associated with increased regular car trips. Conclusion. Objective predictors are main deciding factors for active commuting to school as main mode of transport whereas personal and lifestyle factors are important factors associated with frequency of car use. Not only objective but also differing cultural attitudes should be considered when promoting non-motorized travel.

Atopic dermatitis (AD) patients mount IgE antibody responses to a variety of environmental allergens and also to autoantigens. We analyzed serum samples from four AD patients who had received oral cyclosporine A (CyA) treatment for up to 17 months regarding IgE autoreactivity to nitrocellulose‐blotted human epithelial cell extracts and IgE levels to environmental allergens by quantitative ImmunoCap measurements. Skin inflammation was assessed by SCORAD. During full‐dose treatment, a strong reduction in T‐cell‐mediated skin symptoms was observed which reappeared when CyA treatment was reduced or stopped. The intensity of IgE autoreactivity seemed to follow skin inflammation as it was reduced during full‐dose treatment and increased upon inflammation. Interestingly, IgE levels to exogenous allergens were boosted by allergen exposure, declined thereafter, and seemed to be unaffected by CyA. Our data thus indicate that allergen‐specific IgE production is boosted by allergen contact and cannot be reduced by CyA‐mediated T‐cell suppression.

The frequency of allergies to particular foods in adults has never been documented over time. Therefore, it is not possible to give evidence about a possible shift in the spectrum of food allergens over the years. There are periodic analyses of the patients of the Allergy Unit of the Department for Dermatology at the University Hospital of Zurich that were diagnosed with food allergies between 1978 - 1998. Detailed data about food allergens are taken from previous published data. In order to detect trends in food allergens, the yearly frequency of food, responsible for systemic allergic reactions among food allergic patients diagnosed in these publications, is calculated for the observation period. Between 1978 - 1982: 173, between 1983 -1987: 229, between 1990 - 1994: 383 and in the year 1998: 87 patients have been evaluated to have a food allergy. Over the entire observation period of 20 years, celery root was the most frequent allergen. The frequency of carot allergy was stable, but - in respect to celery - over all relatively low. Since the 90s, a marked increase of the following food allergies can be observed: allergies to peanuts and soy, which are both "legumes", as well as to nuts (hazelnuts and almonds), exotic fruits (kiwis and bananas), and, in the year 1998, to crustaceans. The possible explanations for these findings, for example an increase of pollen allergies and, consequently, of pollen-associated food allergies (birch fruits vegetables nuts syndrome, mugwort celery spices syndrom), the "latex fruit syndrome", the fast advancing and globalization of the American fast food culture (peanuts), among others are discussed.

87 (1.6% of all patients) predominantly adult patients with IgE-mediated food allergy (FA), were seen at the Allergy Unit of the University Hospital of Zurich during the year 1998. The age of manifestation was between 1 and 60 years, with a mean of 27.7 years. These patients were classified according to the way of sensitization (via gastrointestinal tract or via aerogeneous allergens with crossreactivities with foods) and the age of manifestation into the types A, B, C of food allergies, according to the concept of Pichler [1998]. FA type A is seen in infants and small children, which get sensitized to food proteins via the gastrointestinal tract. FA type B is due to crossreactivities of IgE, which are originally directed to aerogeneous allergens in pollen, latex, house dust mites, etc. FA type C does not appear predominantly in atopic persons. The affected persons get sensitized via gastrointestinal tract to selected, stable food proteins. In the present series, only 7 children (8%), 1 - 4 years old, belonged to type A and the FA was higly associated with a familial, or personal atopy. The main food, eliciting symptoms of the skin and gastrointestinal tract were nuts and eggs. This small group is not representative as such cases are seen by pediatricians. FA type B was diagnosed in 64 patients (73.6%), aged between 6 - 60 years. The peak of age manifestation was between 21 - 30 years. 64.1% were females; 78.1% of the patients had a pollen allergy and, therefore, the main crossreactivities were birch or mugwort pollen associated (80.7%). The "latex-fruit syndrome" was seen in 18.8%, the "house dust mite-crustaceans syndrome" in 12.5%, the "grass-cereals syndrome" and the "ragweed-melon syndrome" in 4.7% each. Only 1 patient (1,6%) presented itself with a "pork-cat syndrome". Fruits, vegetables, hazelnut and spices elicited mainly an oral allergy syndrome (OAS) (in 67.2% of the cases), but also symptoms of the skin (urtikaria in 48.8%) and the airways (65.6%, particularly as dyspnea (48.8%)). The main food allergens in this group were apple (40.6%), celery (34.4%) and hazelnut (23.4%). FA type C represents 16 patients (18.4%, age between 12 and 58 years; 62.5% were females. This group is heterogeneous; only 31.3% had a family history and 18.8% had a personal history of atopic diseases, and the symptoms due to FA were predominantly acute or recurrent. Fish and crustaceans, meat and kiwi were predominant as food allergens and often elicited symptomes of the skin and airways. An OAS was rare. In 1 previoulsy nonatopic patient, the way of sensitization was the skin due to occupational contact with fish and crustaceans (contact urticaria syndrome). This may represent a fourth type (D) of FA.

Philodendron species are popular indoor plants and are not known to elicit immediate-type allergic reactions so far. We report on a 46-year-old female with persistant rhinoconjunctivitis at home, where a Philodendron (Ph.) bipennifolium was present. The skin prick tests with routine inhalant allergens were positive for grass-, rye-, hazel- and ash pollen. A scratch test was positive for Ph. bipennifolium leaves and Ficus benjamina. Specific IgE (CAP-FEIA) was elevated for Ph. bipennifolium, Ph. scandens, Ficus benjamina and natural rubber latex. A nasal provocation (NPT) with fresh extract from Ph. bipennifolium leaves resulted in rhinorrhea, itching of the throat and increased resistance of the nasal airways. This is the first report on immediate-type allergic reaction to Ph. bipennifolium and detection of specific IgE. The clinical relevance was shown by NPT. Philodendron spp. therefore have allergen(s) potent enough to cause allergic disease in an indoor environment.

Undeclared peanut allergens as contaminants in foodstuffs represent a major health problem for sensitized persons. Various immunochemical techniques are employed to detect and quantify peanut allergens. There is an urgent need to compare and standardize those test systems to enable comparable allergen analyses of foodstuffs, comparable studies, and consequent and consistent measures against the presence of hidden peanut allergens. The present study compared commercially available peanut ELISA kits with human sera-based immunoassay techniques (dot blotting and Western blotting), enabling semiquantitative and quantitative detection, and identification of peanut contaminants in foodstuffs. Additionally, the effect of conventional roasting conditions on the detection and quantification of peanut with the selected methods was investigated.

Kontaktallergische Reaktionen auf Mar-kierungsstifte, welche z.B. fur Hautmarkie-rungen bei Epikutantestungen verwendetwerden, sind auserordentlich selten. Es sindvor allem die verschiedenen Farbbestandtei-le, welche fur die kontaktallergischen Reak-tionen verantwortlich gemacht werden kon-nen; aber auch andere Bestandteile von Mar-kierungsstiften, die vor allem fur die mecha-nisch-physikalischen Eigenschaften verant-wortlichsind,konnenSpattypsensibilisierun-gen hervorrufen. Im vorliegenden Fall wirdeine Sensibilisierung vom Spattyp auf Astra-flex Chrysoidin RR, einem Azo-Farbstoff,beschrieben, welcher ein Farbbestandteil ei-nes Hautmarkierungsstiftes darstellt und einUberblick uber die in der Literatur erwahntenFalle gegeben.

A 54-YEAR-OLD woman was referred to the allergy unit of the department of dermatology at University Hospital Zurich for a diagnostic work-up after she had emergency treatment for an episode of angioedema of the tongue and throat. Angioedematous symptoms occurred 30 min after she ate a spaghetti dinner with clam and tomato sauce. Otherwise, the personal history was noncontributory, except for the mild pancytopenia reported in the referral letter. In particular, no previous food allergies/intolerance reactions were reported. Angioedema and the patient's complaint of persistent gastrointestinal pain prompted the assessment of complement C4 and the regulatory protein C1 inhibitor (C1INH). Both proteins were undetectable (C4 ,0.01 g/l, normal range 0.1±0.4; C1-INH concentration ,0.03 g/l, normal range 0.2±0.36; C1-INH function ,18%, normal range 70±135%). A preliminary diagnosis of hereditary (HAE) or acquired angioedema (AAE) was made, and treatment with the attenuated androgen danazol (400 mg daily for 2 weeks; then 200 mg per day for a total duration of 3 weeks) was initiated. Ten days after initiation of danazol therapy, a rise in the international normalized ratio (INR) for coagulation was noted. A subsequent coagulation work-up revealed the presence of antiphospholipid antibodies (anticardiolipin-IgM 520 IU/l, normal ,15 IU/l). Serology for antinuclear and antinative DNA antibodies was unremarkable, excluding the diagnosis of systemic lupus erythematosus (SLE). The initial diagnosis was revised in favor of acquired C1-INH de®ciency in association with antiphospholipid antibody syndrome. AAE was con®rmed in two individual samples collected 1 day apart by low C1q and C1r values (C1q: 0.014 g/l, normal range 0.046±0.116 g/l; C1r 37%, normal range 75±125%, respectively). Finally, a bone-marrow biopsy specimen allowed us to diagnose AAE in conjunction with B-cell non-Hodgkin's lymphoma (NHL, IgG k). This particular case seems to be very instructive for various reasons

Im Folgenden wird der Fall eines ausge-bildetenArbeitersinderAromen-undRiech-stoffindustrie vorgestellt. Bei ihm waren zu-vor noch nie atopische Manifestationen wieAsthma, Heuschnupfen oder atopisches Ek-zem aufgetreten. Nach der ersten Expositiongegenuber einempulverformigen Enzympra-parat mit hoher Peptidase- und Proteina-se-Aktivitat (Umamizyme) entwickelte erakutes Asthma,Rhinokonjunktivitis und eineZungenschwellung. Der Prick-Test und IgE-CAP waren eindeutig positiv fur das Enzym-praparat. Eine wahrscheinliche fruhere, la-tenteSensibilisierunggegen andere proteoly-tische Enzyme, mit denen der Patient auf-grund seines Berufs Umgang hatte, konntedieTatsacheerklaren,dassernachdemerstenKontakt mit dem Enzym reagierte. Untersu-chungen auf spezifisches IgE gegen Enzyme,die in der Waschmittelindustrie angewandtwerden (Maxatase, Alkalase, Savinase), odergegen Proteasen pflanzlichen Ursprungs(Bromelain, Papain) waren negativ. UnseresWissens ist dies der erste Fall, bei dem Se-rum-IgE-Antikorper gegen dieses proteolyti-sche Enzym mit hoher Peptidase-Aktivitatund ohne Kreuzreaktivitat gegen andere Pro-teasenauftreten.DieserFallzeigterneut,dassder Umgang mit pulverformigen EnzymenauchbeiNicht-Atopikern zuSensibilisierungund Allergie fuhren kann.

Background Farm children suffer less frequently from pollinosis and bronchial asthma, although they are exposed to higher concentrations of airborne allergens. How do farm children differ from children in the general population with respect to immunological sensitization to airborne allergens? Methods Since 1983, a continuing seroepidemiological study of allergic reactions of schoolchildren in a rural area was conducted. Each year, all 15 year-old schoolchildren were given a standardized allergy questionnaire and are tested serologically (RAST/CAP-test) for their IgE sensitization towards the four major groups of airborne allergens: timothy grass pollen, birch pollen, house-dust mites, and cat dander. Farm children were compared with children who only occasionally help out on farms and also with those who had no direct contact with agriculture. Results From a total of 1307 children, 1287 questionnaires (98.5%) and 1100 (84.2%) of the serological tests could be analysed. Over the 16 years of the study, a statistically significant increase in the incidence and severity of hay fever and asthma was found in the children with no direct contact to agriculture. This was coupled with a significant increase in the sero-prevalence of sensitisation to the major airborne allergens. Among the 133 farm children, the prevalence of hay fever was: any history of hay fever in 2.4%, hay fever within the last year in none. A history of asthma was found in 1.6% of the children. Among children who occasionally worked on or had contact with farms, the prevalences were: any history of hay fever 9.3%, hay fever within the last year 9.3%, asthma 4.4%. Corresponding prevalences in children with no direct contact to farms were 18.3%, 18.6% and 9.1%, respectively. The seroepidemiological tests showed that the farm children not only had an overall lower rate of seroprevalence of antibodies towards the 4 marker allergens, but they also became sensitized to a lesser extent. At increasing cut-off values of the specific IgE titers, the odds ratio of the farm children in comparison to the control children became increasingly significant. This trend was found with all four marker allergens. The paradoxical immune reaction of farm children towards airborne allergens shows two characteristic quantitative features: in spite of high exposure rates, the children became sensitized less often and more weakly than control classmates from the same village. Children who had intermittent contact with farms showed intermediate results with respect to both symptoms and sensitization. Conclusions These farm children have thus become adapted towards the allergens to which they are exposed. This immunological form ist similar to results from East Germany and the former USSR, in spite of the fact that lifestyle and exposure to microbes differ greatly. The immunological adaptation can best be interpreted as the result of a greater and continual stimulation of the Th1-immune response towards anthropozoonotic antigens.

Im Rahmen einer kontinuierlichen seroepidemiologischen Studie wurden 1985, 1990, 1995, 1996 und 1997 die adoleszenten Schuler einer Landgemeinde in der Ostschweiz auch hinsichtlich Sensibilisierungen gegenuber Latex (Naturgummi, Naturlatex, Latex des Gummibaumes Hevea brasiliensis) serologisch mittels dem CAP-Test untersucht. Unter 424 nicht selektiv erfasten Schulern akzeptierten 342 (80,7%) eine Blutentnahme. 9,6% zeigten einen positiven IgE-Antikorper-Titer auf Latex (CAP-Test ≥ Klasse 2).

A 58 year old patient with hepatitis virus C (HCV) infection had a secondary polyclonal IgG-IgM cryoglobulinemia with a benign 20 year course. Clinically the patient suffered from progressive pigmented purpura (PPP). Histologic evaluation revealed a lymphocytic vasculitis. Food containing tartrazine triggered flares of the PPP, as demonstrated with controlled oral provocation testing. In most of the previously described cases of HCV and type III cryoglobulinemia, the typical cutaneous finding was palpable purpura with leukocytoclastic vasculitis.

Background: Cyclosporin A (CsA) has been shown to be highly effective in the therapy of atopic dermatitis (AD). However, little information exists on the treatment of AD patients with Sandimmun Neoral® (Neoral), a microemulsion of CsA with improved pharmacokinetic properties in comparison to Sandimmun®. Objective: We have compared the efficacy and tolerability of Sandimmun and Neoral. Methods: In a randomised, monocentric, double-blind, cross-over pilot study (n = 14), each formulation was administered for 8 weeks, followed by switching to the other treatment group for another 8 weeks. Results: After 2 weeks of therapy, the improvement under Neoral therapy was significantly higher than with Sandimmun (disease activity p = 0.047; extent of disease p = 0.016). In contrast, after 8 weeks of therapy, both formulations yielded similar improvement in the patients’ condition. Conclusion: While both formulations are effective and well tolerated in the treatment of severe AD, Neoral may have a faster onset of action and higher initial efficacy, which makes it an adequate replacement for Sandimmun.

Background Symptoms elicited by IgE-mediated food allergy range from mild local to severe systemic reactions. Allergens in spices are particularly dangerous due to their hidden presence in many dishes. Objectives and Methods According to clinical observations, mugwort and birch pollen allergy, and hypersensitivity to spices are frequently associated, but the crossreacting compounds were not defined so far. We tested sera of 15 patients who experienced adverse reactions to spiced food and characterized their IgE-binding patterns on anise, fennel, coriander and cumin extracts through immunoblot and inhibition experiments. Results The use of anti-Bet v 1 (MoAb) and anti-profilin (rabbit) antibodies revealed the presence of crossreacting allergens in the tested spice extracts. Inhibition experiments showed that IgE-binding to allergens in Apiaceae spices could be blocked by preincubation of sera with rBet v I or rBet v 2 (birch profilin). Moreover, we detected crossreacting allergenic molecules in the molecular weight range of 60 kDa. IgE-binding to spice allergens occurred only with sera of 10/15 (66%) patients with allergy to pollen (birch, mugwort) and/ or celeriac. In five out of 15 (33%) patients with a history of adverse reaction to spices, but without pollen and celeriac allergy, no IgE-binding to any spice protein could be demonstrated. It is possible that these clinical reactions could be elicited by other types of hypersensitivity (Type II, III, IV), however, as spices contain highly reactive substances, the symptoms may most likely be classified as food-intolerant. Conclusions Bet v 1- and profilin-related allergens may, besides higher molecular weight allergenic molecules, be responsible for Type I allergy to anise, fennel, coriander or cumin, members of the Apiaceae.

Adverse reactions to seafood are common and may cause many types of symptoms that are difficult to define. The nature of these reactions are variable including allergic and toxic reactions as well as infectious diseases. The differentiation between these entities is essential in choosing therapy. We describe 9 patients with IgE mediated allergic reactions due to crustaceans and fish diagnosed from case history, clinical findings, skin tests and specific IgE antibodies. Most symptoms of a IgE mediated allergic reaction appear within 30 minutes after ingestion. Characteristics clinical features may include an urticarial rash, gastrointestinal symptoms and even anaphylaxis. In this case immediate therapy with intravenous glucocorticoids, antihistamine and perhaps subcutaneous epinephrine is required.

Hydrolysis, heat treatment and ultrafiltration are methods to reduce the allergenicity of cow milk proteins. Animal studies and clinical experience suggest that such hypoallergenic formulas are safe for infants and children allergic to cow milk.