Clinical relevance is associated with allergen-specific wheal size in skin prick testing.

BACKGROUND: Within a large prospective study, the Global Asthma and Allergy European Network (GA(2) LEN) has collected skin prick test (SPT) data throughout Europe to make recommendations for SPT in clinical settings. OBJECTIVE: To improve clinical interpretation of SPT results for inhalant allergens by providing quantitative decision points. METHODS: The GA(2) LEN SPT study with 3068 valid data sets was used to investigate the relationship between SPT results and patient-reported clinical relevance for each of the 18 inhalant allergens as well as SPT wheal size and physician-diagnosed allergy (rhinitis, asthma, atopic dermatitis, food allergy). The effects of age, gender, and geographical area on SPT results were assessed. For each allergen, the wheal size in mm with an 80% positive predictive value (PPV) for being clinically relevant was calculated. RESULTS: Depending on the allergen, from 40% (blatella) to 87-89% (grass, mites) of the positive SPT reactions (wheal size ≥ 3 mm) were associated with patient-reported clinical symptoms when exposed to the respective allergen. The risk of allergic symptoms increased significantly with larger wheal sizes for 17 of the 18 allergens tested. Children with positive SPT reactions had a smaller risk of sensitizations being clinically relevant compared with adults. The 80% PPV varied from 3 to 10 mm depending on the allergen. CONCLUSION: These 'reading keys' for 18 inhalant allergens can help interpret SPT results with respect to their clinical significance. A SPT form with the standard allergens including mm decision points for each allergen is offered for clinical use.

GA2LEN skin test study III: minimum battery of test inhalent allergens needed in epidemiological studies in patients.

BACKGROUND: The number of allergens to be tested in order to identify sensitized patients is important in order to have the most cost-effective approach in epidemiological studies. OBJECTIVE: To define the minimal number and the type of skin prick test (SPT) allergens required to identify a patient as sensitized using results of the new Pan-European GA(2)LEN skin prick test study. METHOD: In a large Pan-European multicenter (17 centers in 14 countries) patient based study, a standardized panel of 18 allergens has been prick tested using a standardized procedure. Conditional approach allowed to determine the allergens selection. RESULT: Among the 3034 patients involved, 1996 (68.2%) were sensitized to at least one allergen. Overall, eight allergens (grass pollen, Dermatophagoides pteronyssinus, birch pollen, cat dander, Artemisia, olive pollen, Blatella and Alternaria) allowed to identified more than 95% of sensitized subjects. However, differences were observed between countries, two allergens being sufficient for Switzerland (grass pollen and cat dander) as opposed to nine for France (grass pollen, Dermatophagoides pteronyssinus, olive pollen, cat dander, Blatella, cypress, dog dander, alder and [Artemisia or Alternaria]). According to country, up to 13 allergens were needed to identify all sensitized subjects. CONCLUSION: Eight to ten allergens allowed the identification of the majority of sensitized subjects. For clinical care of individual patients, the whole battery of 18 allergens is needed to appropriately assess sensitization across Europe.

GA(2)LEN skin test study I: GA(2)LEN harmonization of skin prick testing: novel sensitization patterns for inhalant allergens in Europe.

BACKGROUND: Skin prick testing is the standard for diagnosing IgE-mediated allergies. However, different allergen extracts and different testing procedures have been applied by European allergy centres. Thus, it has been difficult to compare results from different centres or studies across Europe. It was, therefore, crucial to standardize and harmonize procedures in allergy diagnosis and treatment within Europe. AIMS: The Global Asthma and Allergy European Network (GA(2)LEN), with partners and collaborating centres across Europe, was in a unique position to take on this task. The current study is the first approach to implement a standardized procedure for skin prick testing in allergies against inhalant allergens with a standardized pan-European allergen panel. METHODS: The study population consisted of patients who were referred to one of the 17 participating centres in 14 European countries (n = 3034, median age = 33 years). Skin prick testing and evaluation was performed with the same 18 allergens in a standardized procedure across all centres. RESULTS: The study clearly shows that many allergens previously regarded as untypical for some regions in Europe have been underestimated. This could partly be related to changes in mobility of patients, vegetation or climate in Europe. CONCLUSION: The results of this large pan-European study demonstrate for the first time sensitization patterns for different inhalant allergens in patients across Europe. The standardized skin prick test with the standardized allergen battery should be recommended for clinical use and research. Further EU-wide monitoring of sensitization patterns is urgently needed.

GA(2)LEN skin test study II: clinical relevance of inhalant allergen sensitizations in Europe.

BACKGROUND: Skin prick testing is the standard for diagnosing IgE-mediated allergies. A positive skin prick reaction, however, does not always correlate with clinical symptoms. A large database from a Global Asthma and Allergy European Network (GA(2)LEN) study with data on clinical relevance was used to determine the clinical relevance of sensitizations against the 18 most frequent inhalant allergens in Europe. The study population consisted of patients referred to one of the 17 allergy centres in 14 European countries (n = 3034, median age = 33 years). The aim of the study was to assess the clinical relevance of positive skin prick test reactions against inhalant allergens considering the predominating type of symptoms in a pan-European population of patients presenting with suspected allergic disease. METHODS: Clinical relevance of skin prick tests was recorded with regard to patient history and optional additional tests. A putative correlation between sensitization and allergic disease was assessed using logistic regression analysis. RESULTS: While an overall rate of >or=60% clinically relevant sensitizations was observed in all countries, a differential distribution of clinically relevant sensitizations was demonstrated depending on type of allergen and country where the prick test was performed. Furthermore, a significant correlation between the presence of allergic disease and the number of sensitizations was demonstrated. CONCLUSION: This study strongly emphasizes the importance of evaluating the clinical relevance of positive skin prick tests and calls for further studies, which may, ultimately, help increase the positive predictive value of allergy testing.

Lipopolysaccharide exposure makes allergic airway inflammation and hyper-responsiveness less responsive to dexamethasone and inhibition of iNOS.

Allergic airway disease can be refractory to anti-inflammatory treatment, whose cause is unclarified. Therefore, in the present experiment, we have tested the hypothesis that co-exposure to lipopolysacharide (Lps) and allergen results in glucocorticoid-resistant eosinophil airway inflammation and hyper-responsiveness (AHR). Ovalbumin (Ova)-sensitized BALB/c mice were primed with 10 microg intranasal Lps 24 h before the start of Ova challenges (20 min on 3 consecutive days). Dexamethasone (5 mg/kg/day) was given on the last 2 days of Ova challenges. AHR, cellular build-up, cytokine and nitrite concentrations of bronchoalveolar lavage fluid (BALF) and lung histology were examined. To assess the role of iNOS-derived NO in airway responsiveness, mice were treated with a selective inhibitor of this enzyme (1400W) 2 h before AHR measurements. More severe eosinophil inflammation and higher nitrite formation were found in Lps-primed than in non-primed allergized mice. After Lps priming, AHR and concentrations of T-helper type 2 cytokines in BALF were decreased, but still remained significantly higher than in controls. Eosinophil inflammation was partially, while nitrite production and AHR were observed to be largely dexamethasone resistant in Lps-primed allergized animals. 1400W effectively and rapidly diminished the AHR in Ova-sensitized and challenged mice, but failed to affect it after Lps priming plus allergization. In conclusion, Lps inhalation may exaggerate eosinophil inflammation and reduce responsiveness to anti-inflammatory treatment in allergic airway disease.

Evaluation of asthma knowledge and quality of life in Hungarian asthmatics.

BACKGROUND: The objective was to develop an educational instrument, to assess its impact as an intervention instrument and to examine quality of life (QoL). METHODS: 119 asthmatics were randomized (64 in the intervention and 55 in the reference group). The education instrument was developed based on the EuroPharm-Forum Guidelines and its impact assessed by a self-developed questionnaire. Patients' QoL, asthma knowledge was assessed twice, once before and after the education seminar, education was only provided for the intervention group. QoL was measured with the St George's Respiratory Questionnaire (SGRQ) and a visual analogue scale (VAS). RESULTS: We found significant differences in answers to the asthma questions, by 40% improvement, but no changes in the control group. In inhaler-use technique, we could not find significant changes neither in the intervention nor in the control group. There were no significant differences between the results of the two visits neither with the VAS nor with the SGRQ on the QoL data. CONCLUSION: The results indicate that asthmatics experience lower QoL. As the subjects were regularly controlled asthmatics they had better general knowledge and inhaler-use technique was expected. The results suggest that it is necessary to regularly refresh asthma knowledge, to assess patients' self-management plans to achieve long-term effectiveness of asthma management.

The effects on teeth of radiotherapy for nasal endodermal sinus tumor (yolk sac tumor) in childhood.

A rare case of a 10-year-old girl with an endodermal sinus tumor that occurred in the nasal cavity is presented. She received chemotherapy and radiotherapy at the age of 4. The subsequent abnormal development of the maxillary teeth is described and discussed in the light of the known effects of radiotherapy.

[Frequency of supernumerary teeth and possibilities of treatment]. / A maradó számfeletti fogak elófordulási gyakorisága és kezelésük lehetóségei.

According to dental literature, the frequency of supernumerary teeth is 1-3%. The authors analyzed the orthopantomograms of 1875 children and adolescents aged between 6 and 18 years to determine the frequency of supernumerary teeth at the Department of Dentistry for Children and Orthodontics. The frequency was found to be 1.92%. The sequence of frequency of supernumerary teeth was: mesiodens, lateral incisor, central incisor. 77.8% of the supernumerary teeth occurred in the maxilla, 97.2% in the frontal region. Besides the data found, two successful cases of surgical and orthodontic treatment are also presented.

[The state of dentistry education in Europe]. / A fogászati szakképzés helyzete Európában.

In order to find out what branches of Dentistry are recognized in Europe as Dental specialties a questionnaire was designed and sent to various Associations and groups across Europe. It contained eight main questions covering the various specialties that were recognised or were to be recognised. Responses were obtained from 28 countries, 15 EU member states and 13 non member states. The results from the questionnaire indicated that there was a broad agreement on many of the questions but a considerable variety of opinions. There seems to be a desire to harmonize standards across Europe for the benefit of the profession and the public.

Validity of viscoelastic models of blood vessel wall.

Quantitative description of biomechanical behaviour of the blood vessel wall is needed for understanding normal and pathologic functions of the vascular system. In this study we investigated the stress relaxation of blood vessels. Strips were cut from the vessel wall and they were stretched in a stepwise manner until they tore. The mechanical stress (approximately 10(5)-10(6) Pa) induced in the strips was determined. This showed an initial steep rise and then a slow, near exponential decay (stress relaxation) after each step of stretch. For the mathematical description we used two technical models (the Maxwell and the Kelvin model--they are built of two elastic elements and of one viscous element), as well as a one-dimensional continuum mechanical model. The moduli of the models were identified with a curve fitting method. Our aim was to compare these models in order to elucidate, which one describes the rheological behaviour of the blood vessel more correctly. The results of our analysis show that the corresponding moduli diverge from each other in the Maxwell and Kelvin models: that is, they depend on the mode of the assumed connection between the mechanical units. In contrast, moduli of the continuous model are unambiguous. We conclude that the continuous model properly describes the stress relaxation of the vascular wall. Its advantage over the technical models is that moduli describing the viscoelastic behaviour of the tissue do not depend on the not wholly well-known structure of the wall components.

Specialisation in dentistry in Europe--a review.

In order to find out what branches of Dentistry are recognized across Europe as Dental specialties, a questionnaire was designed and sent to various Associations and groups across Europe. It contained 8 main questions covering the various specialties that were recognised or were to be recognised. Responses were obtained from 27 countries, 15 EU member states and 12 non member states. The results from the questionnaire indicated that there was a broad agreement on many of the questions, but a considerable variety of opinions. There seems to be a desire to harmonize standards across Europe for the benefit of the profession and the public.

Sterically inhomogenous viscoelastic behavior of human saccular cerebral aneurysms.

To clarify the mechanism leading to the development and rupture of intracranial aneurysms, tensile strength and viscoelastic parameters of 22 human saccular aneurysms were investigated. Meridional and circumferential strips from the thin and the thick part of the aneurysm sack and 18 control strips from the basilar artery of 8 patients with pathologies not affecting the cerebral arterial system were studied. The length of the strips was increased in 200- microm steps, while distending force was recorded. Tensile strength and viscoelastic parameters were computed. In both directions, tensile strength of thick strips was significantly lower than that of controls. In the meridional direction, tensile strength of thin strips was significantly larger than that of thick ones (14.5 +/- 4.1 x 10(6) vs. 7.5 +/- 2.0 x 10(6) dyn/cm2, p < 0.05). In the circumferential direction, thin strips tore at lower strain values than thick ones (29 +/- 4 vs. 55 +/- 16%, p < 0.05). Viscoelastic parameters changed in parallel. In circumferential direction, values of thick and thin strips were significantly lower than those of controls. In the meridional direction, values of thin strips were significantly higher than those of the thick ones. These observations show that characteristic mechanical deterioration and steric inhomogeneities accompany the loss of smooth muscle cells and the derangement of connective tissue elements in the wall of intracranial aneurysms, which may explain certain steps in their initiation, enlargement and rupture.

Segmental differences in geometric, elastic and contractile characteristics of small intramural coronary arteries of the rat.

The depedence of elastic and contractile properties on the caliber of small intramural coronary arteries was investigated in the rat in vitro. Different segments of the left anterior descending coronary artery branching system were prepared for microarteriography. The segments were cannulated at both ends, immersed in oxygenated normal Krebs Ringer (nKR) solution. Intraluminal pressure was changed at a rate of about 0.5 mm Hg/s between 0 and 150 mm Hg in repeated cycles. The outer diameter was continuously measured with microangiometry. Pressure-diameter curves were recorded after preconditioning pressure cycles in nKR, with PGF2alpha in the bath (7.5 x 10(-6) M), and in maximal relaxation with papaverine (2.8 x 10(-4) M). Biomechanical parameters were computed for vessels grouped according to their calibers (inner diameters: 50-150, 150-250, 250-350, >350 microm). Distensibility and contractility decreased with increasing caliber of the vessels, while the elastic modulus increased. Spontaneous tone was (at 100 mm Hg in mechanically preconditioned vessels) 18.8 +/- 4.5, 8.4 +/- 4.4, 9.7 +/- 3.7 and 8.3 +/- 3.8% in the four groups, respectively. PGF2alpha contraction was maximal around the 300- microm caliber. Our study is the first direct demonstration that intramural small coronary arteries exhibit characteristic variability in their elastic and contractile properties as a function of their caliber. Such differences may be important in segmentally specific control processes of the coronary microcirculation.

[Incidence of structural disorders of teeth in hereditary epidermolysis bullosa]. / A fogak szerkezeti rendellenességének elöfordulása epidermolysis bullosa hereditariában.

Authors present a 12-year old boy, whose diagnosis was epidermolysis bullosa. Beside the general characteristics of the illness they discuss the dental status of the patient and sum up the literary references together with other anomalies occurring in epidermolysis bullosa hereditaria.

[Eosinophil activation markers in status asthmaticus]. / Eosinophil aktivációs markerek status asthmaticusban.

Eosinophil activation markers-eosinophil cationic protein, eosinophil protein-X-were investigated in acute severe asthma. The elevation of the eosinophil activity markers were found in every cases at the time of admission. The measurements were repeated eight days later. The eosinophil cationic protein and eosinophil protein-X levels were increased at the time of the admission, and a decreasing tendency was detected eight days later. The peak expiratory flow rates were monitored during the period of the hospital staying. It is important to note that, the size of the bronchial obstruction did not show any similarity in all cases comparing to the elevation or decrease of eosinophil activity markers. The authors proved the eosinophil activation in vivo in acute severe asthma. The continuous monitor of the eosinophil activity markers might have a practical value in searching of the optimal therapeutic modalities in the asthmatic patients.

[Brief history of the Fédération Dentaire Internationale (FDI)]. / A Fédération Dentaire Internationale (FDI) rövid története.

FDI was founded in 1900, Paris, 95 years ago. At this International Dental Congress professors József Arkövy and Lajos Ottófy both held lectures. The Hungarian Dental Association (HDA) could join FDI, however, only in 1966. Today close contacts and collaboration are developing between HDA and FDI.

Kinematic analysis of wing and leg movements for type I motility in E9 chick embryos.

Based on studies using direct observation methods, type I motility, the first motility pattern to emerge in chick embryos, is characterized as random, uncoordinated movement. Yet, electromyographic (EMG) studies indicate that leg muscles are recruited in orderly patterns of alternating flexor and extensor activity during type I motility. It has been suggested that this apparent paradox may be attributable to perturbations arising during movement in ovo under buoyant conditions. It is also possible that direct observation methods are insufficient to detect the extent of coordination between body parts during type I motility. To address the apparent discrepancy between random features reported in observational studies and reliable features reported in EMG studies, embryos were video recorded continuously for 60 min at embryonic day 9 and criteria were established to obtain homogeneous samples of motility for kinematic analysis of synchronous wing and leg movements. Limited to a single camera attached to a stereomicroscope, methods were developed to correct for out-of-plane movements of the ipsilateral wing and leg. Also, amniotic fluid was extracted from the egg in some recordings to test the possibility that movement under buoyant conditions may mask coordinated movement. Extended sequences of activity were digitized and analyzed. Results indicated that within a limb (wing or leg), direction and timing of excursions at adjacent joints co-varied and limb excursions were characterized by reliable patterns of alternating flexion and extension consistent with EMG studies.(ABSTRACT TRUNCATED AT 250 WORDS)

Correcting two-dimensional kinematic errors for chick embryonic movements in ovo.

In motor behavior studies of chick embryos in ovo, kinematic recording is limited to a single camera system and produces kinematic data that are distorted if out-of-plane movements are not considered. CONVERT is a rule based algorithm designed to calculate 3D limb movements given 2D kinematic data. CONVERT's calculations are based on a stationary reference point, limited translation of the chick embryo's trunk point, a multi-linked model of the body, and approximate limb segment lengths. Simulations indicate CONVERT calculates joint movements from 2D data with a maximum error of 6 degrees compared to a maximum error of 79 degrees if out-of-plane considerations are ignored. The approach used to correct two-dimensional kinematic measurement errors can be readily applied to other experimental conditions that restrict video recording to single camera systems.

[Langerhans cell histiocytosis]. / Langerhans-sejtes histiocytosis.

The authors describe a case of a 4 years old boy. In connection with this case they discuss the latest classification of histiocytosis accepted by the Histiocytosis Society, and the stomatological aspects of the disease (severe gingivitis, necrosis of the gingivae, ulceration, and high degree of tooth mobility). The new classes of the disease: Langerhans cell's histiocytosis, Non-Langerhans cell's histiocytosis, malignant histiocytosis.