Prevalence and treatment profile of patients with grass pollen and house dust mite allergy.

BACKGROUND: In Europe, grass pollen and house dust mites are the most common allergens responsible for IgE-mediated allergies. The aim of our study was to examine the data provided by various medical practices specialized in allergic diseases in Germany regarding patients with rhinoconjunctivitis in terms of demographic data and the prescribed treatment by different medical specialists. PATIENTS AND METHODS: Data from patients who were diagnosed with allergic rhinoconjunctivitis were taken from the "disease-analyzer" database (IMS Health GmbH) and analyzed. The data assessment was anonymous in accordance with the guidelines for data protection. The information collected included specific data about diagnosis and treatment in private practices in Germany. RESULTS: The majority of patients with grass pollen allergy were treated by their general practitioners, while those with house dust mite allergy were treated by a specialist with a background in allergic diseases (pulmonologists, otorhinolaryngologists, and dermatologists). Treatment was primarily symptomatic, usually consisting of antihistamines. Allergen-specific immunotherapy, the only causal treatment for IgE-mediated allergies at present, was performed rarely. CONCLUSIONS: The data suggest the need for an interaction and knowledge transfer between various specialists in order to improve patient-centered care in regard to allergic diseases.

Development and preliminary clinical evaluation of a peptide immunotherapy vaccine for cat allergy.

BACKGROUND: Allergic sensitization to cat allergens is common and represents a major risk factor for asthma. Specific immunotherapy (SIT) is effective but cumbersome and associated with IgE-dependent adverse events. Immunotherapy targeting allergen-specific T cells, with synthetic peptides representing T-cell epitopes, might improve safety and reduce the duration of treatment. OBJECTIVE: We sought to define major T-cell epitopes of Fel d 1 for peptide immunotherapy, generate a peptide vaccine, and evaluate its safety and tolerability in subjects with cat allergy. METHODS: We determined the binding affinities of Fel d 1 peptides for 10 commonly expressed HLA-DR molecules. Functionally immunodominant peptides were identified by means of proliferation and cytokine secretion. Histamine-releasing activity was assessed, and a peptide vaccine was formulated. Safety and tolerability were evaluated in a dose-ranging phase IIa clinical trial. RESULTS: MHC-binding sequences were identified throughout Fel d 1. Some regions contained multiple overlapping T-cell epitopes that bound multiple MHC molecules. Immunodominant sequences were identified on the basis of proliferative and cytokine (IFN-γ, IL-10, and IL-13) responses. Cat allergen extract, but not peptides, induced histamine release in blood basophils. A single administration of peptide vaccine was safe and well tolerated. The dose of vaccine resulting in the greatest inhibition of the late-phase skin response to intradermal whole allergen challenge was 3 nmol. CONCLUSIONS: Fel d 1 contains multiple overlapping MHC-binding motifs. A peptide vaccine comprising the immunodominant regions of the allergen was safe and well tolerated when given to subjects with cat allergy as a single dose. The dose of vaccine resulting in the greatest reduction in late-phase skin response was defined for future clinical development.

Treatment of atopic dermatitis with pimecrolimus - impact on quality of life.

Atopic dermatitis (AD) is a multifactorial chronic remittent skin disease which requires long-term treatment. Pimecrolimus cream 1% is a nonsteroid selective inhibitor of inflammatory cytokines and effective in the treatment of AD. Various clinical trials have shown its long-term safety and efficacy in pediatric and adult patients suffering from mild to moderate AD. In this article we discuss data which has assessed the impact of AD on the patient's quality of life, and the consequent role of topical anti-inflammatory therapy for long-term AD treatment.

Frequency of atopic dermatitis and relevance of food allergy in adults in Germany.

Many factors may aggravate atopic dermatitis. The aim of this study was to determine the frequency of atopic dermatitis in an unselected population sample and to evaluate the role of food allergy. Patients with atopic dermatitis were recruited from the population in Berlin, Germany, using a postal questionnaire. Skin prick tests for allergens were performed, followed by food challenges. A total of 1739 questionnaires was returned. In all, 23.5% of patients stated that they had atopic dermatitis, and 146 persons (8.4%) fulfilled our atopic dermatitis criteria after a detailed telephone interview. Of these, 111 were examined, and 28 (1.6%) were identified as currently suffering from atopic dermatitis. Twenty-seven patients were further evaluated: 9/27 were found to be skin prick test negative, 19/27 were skin prick test positive either to pollen and/or food allergens. Nine of 27 were challenged with the suspected food allergen: 1/9 showed a worsening of the eczema, 3/9 had oral symptoms, and 5/9 were negative. In conclusion, only 20% of adults with a positive history of atopic dermatitis show active eczema lesions at a given time point. The data indicate that most individuals with atopic dermatitis were sensitized against pollen allergens and according to that, pollen-associated food allergens. A non-selected AD patient cohort does not frequently suffer from clinically relevant pollen-associated food allergy.

[Efficacy of tracrolimus 0.1% ointment in prurigo]. / Wirksamkeit von Tacrolimus-0,1-%-Salbe bei Prurigoerkrankungen.

BACKGROUND: Potent topical corticosteroids are used the intense pruritus in prurigo diseases. Their long-term application leads to local side effects such as atrophy and telangiectasia. PATIENTS AND METHODS: We treated 6 women (average age 64 years) with chronic prurigo with tacrolimus 0.1 % ointment (Protopic) to evaluate its efficacy in this clinical setting. Tacrolimus 0.1% ointment was applied twice a day for 4 weeks. RESULTS: After one week, both clinical improvement and reduced pruritus were observed in all patients. CONCLUSION: Tacrolimus 0.1% ointment represents a therapeutic option for the treatment of prurigo.

Evidence for a restricted rather than generalized stimulatory response of skin-derived human mast cells to substance P.

To resolve the controversy regarding substance P (SP) mediated stimulation of mast cells (MC), we demonstrate that SP triggers histamine release from purified human skin MC (sMC), but contrast to stimulation via FcepsilonRI, does not effect the production of TNF-alpha or IL-8. Conversely, both anti-IgE and SP are suppressive in terms of IL-6. By quantitative RT-PCR, the amount of templates at baseline (per 25 ng total RNA) is 2178 (IL-6), 2,665 (IL-8) and 94 (TNF-alpha), and remains unaltered by SP. Contrast to sMC, LAD2 MC respond to SP with stronger histamine release and robust TNF-alpha production in an only partially neurokinin-1R mediated manner, while histamine release of sMC is chiefly mediated by this receptor. We conclude that human sMC are responsive to SP in a selective manner by eliciting degranulation without the induction of cytokines and that SP-triggered cytokine production varies among MC subtypes, likely through differences in signaling mechanisms.