Hypersensitivity to unfractionated and low-molecular-weight heparins and semisynthetic heparinoids is increasingly common. 7 female patients between 30 and 74 years with delayed-type allergy to heparins and semisynthe...Hypersensitivity to unfractionated and low-molecular-weight heparins and semisynthetic heparinoids is increasingly common. 7 female patients between 30 and 74 years with delayed-type allergy to heparins and semisynthetic heparinoids were investigated for (cross)-reactivity to fondaparinux, a new pentasaccharide with selective factor Xa inhibition. All patients showed delayed-type reactions to heparins and some additional cross-reaction to a heparinoid on intracutaneous testing. 6/7 tolerated fondaparinux on intradermal testing as well as on subcutaneous challenge testing. However, the 7th patient developed a characteristic delayed-type reaction to both skin tests with fondaparinux. Fondaparinux is a new synthetic pentasaccharide with a molecular weight of 1.728 Da. In some patients with cross-reactivity between various heparins and semisynthetic heparinoids, lepirudin, a recombinant hirudin, may be a safe and effective alternative. However, combined allergy to hirudin and heparins has been reported. Sometimes, intravenous administration of heparins or heparinoids may be tolerated. However, these patients are at risk of developing a systemic reaction. The pathogenesis of heparin hypersensitivity is not fully understood, Heparins may act as haptens by binding to dermal and/or subcutaneous structural proteins. The chemical structures of heparins and fondaparinux are different concerning their α-and β-configuration and the molecular weight. However, some of their functional groups are nearly identical and therefore similar chemical and pharmacological reactivity, is to be expected. Fondaparinux seems to be a valuable alternative in most cases of heparin and hirudin hypersensitivity. The clearly rare cross-reaction between fondaparinux and heparins, now confirmed by us, may be due to differences in the response to haptens.展开更多
The role of contact allergy in rosacea has rarely been investigated. In this retrospective study, 361 out of 76 697 patients tested and documented by the Information Network of Departments of Dermatology between 1995 ...The role of contact allergy in rosacea has rarely been investigated. In this retrospective study, 361 out of 76 697 patients tested and documented by the Information Network of Departments of Dermatology between 1995 and 2002 had rosacea. Patch tests included standard series and constituents of cosmetics and topical medicaments. 118/361 had additionally been patch tested with their own cosmetics/medicaments. Positive reactions occurred to nickel (II) sulfate in 9.3% , fragrance mix in 8.8% , thimerosal in 6.9% , Myroxylon pereirae resin in 5.9% , potassium dichromate in 4.6% and propolis in 2.8% . Whereas rosacea patients had a significantly high er risk of contactallergy to propolis compared to the remaining patients, in an age- and sex- adjustedanalysis,contactallergy to nickel was significantly less frequent in this group. For Lyral., the risk was elevated, albeit not significantly. Only 2/329 patients were positive to neomycin sulfate and 1/100 to gentamicin sulfate, among the panel of (topical) antibiotics tested. Among 118 patients tested with their own products, 3 were tested to metronidazole, 1 reacting positively. Irritant or doubtful patch test reactions were provoked by various substances (vehicles, oxidants and preservatives of various creams), which might also be clinically important, considering the heightened sensitivity of rosaceous skin.展开更多
Background.Propionibacterium acnes is primarily associated with the pathogenesis of acne vulgaris but reports are increasing in number implicating P.acnes in other diseases such as abscess formation, meningitis and en...Background.Propionibacterium acnes is primarily associated with the pathogenesis of acne vulgaris but reports are increasing in number implicating P.acnes in other diseases such as abscess formation, meningitis and endocarditis.The pathogenicity of P.acnes is thought to be partly due to the interaction of the bacterium with the immune system.Historically, investigations have focused on hummoral and cell-mediated immune responses to P.acnes antigens without attention to the possibility that different antigens may be expressed by different isolates.Objective.Investigations were performed to determine whether there were differences between a laboratory strain of P.acnes (P-37) and fresh clinical isolates in their ability to stimulate naive and adult lymphocytes.Material and methods.The fresh isolates were collected from a patient with inflammatory acne and a patient with P.acnes-induced prosthetic valve endocarditis.The lymphocyte transformation assay was used to detect responses to whole-cell suspensions of stationary phase P.acnes isolates during 7 days of incubation.Results.The acne isolate was significantly more stimulatory for cord blood mononuclear cells (CBMNCs) than the laboratory isolate (P.acnes P-37) at day 4 of incubation.There were no significant differences between the three strains at any other time points.However, the isolate cultivated from inflammatory acne was significantly more stimulatory for peripheral blood mononuclear cells (PBMNCs) from acne donors than the endocarditis isolate or the laboratory strain at most time points.There were no significant differences between the endocarditis strain and the laboratory strain.Conclusion.It can be hypothesized that in case of P.acnes-induced endocarditis lymphocyte stimulation is a disadvantage for the microorganism and therefore a lack of lymphocyte stimulation may be relevant to the pathogenesis of endocarditis.展开更多
文摘Hypersensitivity to unfractionated and low-molecular-weight heparins and semisynthetic heparinoids is increasingly common. 7 female patients between 30 and 74 years with delayed-type allergy to heparins and semisynthetic heparinoids were investigated for (cross)-reactivity to fondaparinux, a new pentasaccharide with selective factor Xa inhibition. All patients showed delayed-type reactions to heparins and some additional cross-reaction to a heparinoid on intracutaneous testing. 6/7 tolerated fondaparinux on intradermal testing as well as on subcutaneous challenge testing. However, the 7th patient developed a characteristic delayed-type reaction to both skin tests with fondaparinux. Fondaparinux is a new synthetic pentasaccharide with a molecular weight of 1.728 Da. In some patients with cross-reactivity between various heparins and semisynthetic heparinoids, lepirudin, a recombinant hirudin, may be a safe and effective alternative. However, combined allergy to hirudin and heparins has been reported. Sometimes, intravenous administration of heparins or heparinoids may be tolerated. However, these patients are at risk of developing a systemic reaction. The pathogenesis of heparin hypersensitivity is not fully understood, Heparins may act as haptens by binding to dermal and/or subcutaneous structural proteins. The chemical structures of heparins and fondaparinux are different concerning their α-and β-configuration and the molecular weight. However, some of their functional groups are nearly identical and therefore similar chemical and pharmacological reactivity, is to be expected. Fondaparinux seems to be a valuable alternative in most cases of heparin and hirudin hypersensitivity. The clearly rare cross-reaction between fondaparinux and heparins, now confirmed by us, may be due to differences in the response to haptens.
文摘The role of contact allergy in rosacea has rarely been investigated. In this retrospective study, 361 out of 76 697 patients tested and documented by the Information Network of Departments of Dermatology between 1995 and 2002 had rosacea. Patch tests included standard series and constituents of cosmetics and topical medicaments. 118/361 had additionally been patch tested with their own cosmetics/medicaments. Positive reactions occurred to nickel (II) sulfate in 9.3% , fragrance mix in 8.8% , thimerosal in 6.9% , Myroxylon pereirae resin in 5.9% , potassium dichromate in 4.6% and propolis in 2.8% . Whereas rosacea patients had a significantly high er risk of contactallergy to propolis compared to the remaining patients, in an age- and sex- adjustedanalysis,contactallergy to nickel was significantly less frequent in this group. For Lyral., the risk was elevated, albeit not significantly. Only 2/329 patients were positive to neomycin sulfate and 1/100 to gentamicin sulfate, among the panel of (topical) antibiotics tested. Among 118 patients tested with their own products, 3 were tested to metronidazole, 1 reacting positively. Irritant or doubtful patch test reactions were provoked by various substances (vehicles, oxidants and preservatives of various creams), which might also be clinically important, considering the heightened sensitivity of rosaceous skin.
文摘Background.Propionibacterium acnes is primarily associated with the pathogenesis of acne vulgaris but reports are increasing in number implicating P.acnes in other diseases such as abscess formation, meningitis and endocarditis.The pathogenicity of P.acnes is thought to be partly due to the interaction of the bacterium with the immune system.Historically, investigations have focused on hummoral and cell-mediated immune responses to P.acnes antigens without attention to the possibility that different antigens may be expressed by different isolates.Objective.Investigations were performed to determine whether there were differences between a laboratory strain of P.acnes (P-37) and fresh clinical isolates in their ability to stimulate naive and adult lymphocytes.Material and methods.The fresh isolates were collected from a patient with inflammatory acne and a patient with P.acnes-induced prosthetic valve endocarditis.The lymphocyte transformation assay was used to detect responses to whole-cell suspensions of stationary phase P.acnes isolates during 7 days of incubation.Results.The acne isolate was significantly more stimulatory for cord blood mononuclear cells (CBMNCs) than the laboratory isolate (P.acnes P-37) at day 4 of incubation.There were no significant differences between the three strains at any other time points.However, the isolate cultivated from inflammatory acne was significantly more stimulatory for peripheral blood mononuclear cells (PBMNCs) from acne donors than the endocarditis isolate or the laboratory strain at most time points.There were no significant differences between the endocarditis strain and the laboratory strain.Conclusion.It can be hypothesized that in case of P.acnes-induced endocarditis lymphocyte stimulation is a disadvantage for the microorganism and therefore a lack of lymphocyte stimulation may be relevant to the pathogenesis of endocarditis.
