Background
Currently available tests are unable to distinguish between asymptomatic sensitization and clinically relevant Hymenoptera venom allergy. A reliable serological marker to monitor venom ...immunotherapy (VIT) does also not exist. Our aim was to find reliable serological markers to predict tolerance to bee and vespid stings.
Methods
We included 77 asymptomatically sensitized subjects, 85 allergic patients with acute systemic sting reactions, and 61 allergic patients currently treated with VIT. Levels of sIgE and sIgG4 to bee and vespid venom, rApi m 1, and rVes v 5 were measured immediately after allergic sting reactions or before sting challenges and 4 weeks later. All sting challenges were tolerated. The inhibitory activity was determined using BAT inhibition and ELIFAB assay.
Results
Median sIgG4 levels were 96‐fold higher in VIT patients (P < .001) while sIgE/sIgG4 ratios were consistently lower (P < .001). The ELIFAB assay was paralleled by low sIgE/sIgG4 ratios in VIT patients, showing markedly higher allergen‐blocking capacity (P < .001). An almost complete inhibition of the basophil response was seen in all patients treated with vespid venom, but not in those treated with bee venom. Four weeks after the sting, sIgE and sIgG4 levels were increased in allergic and asymptomatically sensitized patients, but not in VIT patients.
Conclusion
Immunological responses after stings varied in bee and vespid venom‐allergic patients. In patients under VIT, sIgE and sIgG4 remained completely stable after sting challenges. Monitoring VIT efficacy was only possible in vespid venom allergy, and the sIgG4 threshold for rVes v 5 had the highest sensitivity to confirm tolerance. The BAT inhibition test was the most reliable tool to confirm tolerance on an individual basis.
An anaphylactic reaction due to a Hymenoptera sting is a clinical emergency, and patients, their caregivers as well as all healthcare professionals should be familiar with its recognition and acute ...management. This consensus report has been prepared by a European expert panel of the EAACI Interest Group of Insect Venom Hypersensitivity. It is targeted at allergists, clinical immunologists, internal medicine specialists, pediatricians, general practitioners, emergency department doctors, and any other healthcare professional involved. The aim was to report the scientific evidence on self‐medication of anaphylactic reactions due to Hymenoptera stings, to inform healthcare staff about appropriate patient self‐management of sting reactions, to propose indications for the prescription of an adrenaline auto‐injector (AAI), and to discuss other forms of medication. First‐line treatment for Hymenoptera sting anaphylaxis is intramuscular adrenaline. Prescription of AAIs is mandatory in the case of venom‐allergic patients who suffer from mast cell diseases or with an elevated baseline serum tryptase level and in untreated patients with a history of a systemic reaction involving at least two different organ systems. AAI prescription should also be considered in other specific situations before, during, and after stopping venom immunotherapy.
For many years, only the major allergen rApi m 1 has been available on the ImmunoCAP system for routine diagnosis of bee venom (BV) allergy. Now, there are five components available, and we aimed to ...detect the sensitivity and specificity of rApi m 1, 2, 3, 5, and 10 in BV‐allergic patients. We further evaluated the sensitivity of rApi m 1 and 2 of an alternative platform and investigated possible differences in the sensitization profile between monosensitization and clinically relevant double sensitization. Analysis of the whole panel of BV allergens of the CAP system still resulted in a lower sensitivity than analysis of the combination of rApi m 1 and 2 of the Immulite (71.6% vs 85.8%). Sensitization rate of rApi m 5 was more than doubled in double‐sensitized patients, while there was no difference for rApi m 2. The benefit of the commercially available panel of BV components is questionable, due to the insufficient sensitivity and still unavailable important cross‐reacting allergens.
Stings in the head region are considered to be a risk factor for severe systemic reactions to hymenoptera stings. We supposed that stings in skin areas, which are well supplied with blood, lead to ...more severe reactions and tested our hypothesis in 847 patients with confirmed hymenoptera venom allergy. However, symptom severity was independent from sting site: only 16.3% of patients with severe reactions were stung on the head (P = 0.017). But we confirmed age > 40 years (P < 0.001) as well as elevated basal tryptase levels (P = 0.001) as risk factors. Taking antihypertensive drugs seemed to have an influence: 41.7% of patients taking antihypertensive drugs experienced a severe reaction compared to 29.5% of patients, not taking such drugs (P = 0.019). However, considering patients' age in regression analysis, taking antihypertensive drugs had no effect on symptom severity (P = 0.342). Importantly, in most patients with severe reactions, cutaneous signs were absent (P < 0.001).
Aims In the presence of impaired renal function, patients require less insulin mainly because insulin clearance is prolonged. The aim of this study was to evaluate the insulin requirement related to ...glomerular filtration rate (GFR) in nephropathic Type 1 and Type 2 diabetic patients.
Methods In a retrospective study we compared insulin requirement in 20 nephropathic Type 1 diabetic patients and 20 insulin‐treated Type 2 diabetic patients from the onset of overt nephropathy until the final stage of renal disease. All patients had proteinuria > 0.5 g/24 h and creatinine clearance ≥ 80 ml/min per 1.73 m2 at baseline. Creatinine clearance, urinary protein excretion, glycated haemoglobin and the required insulin doses were determined 3‐ to 6‐monthly, basal C‐peptide was measured at the beginning and the end of the observation period. The required insulin doses were evaluated at creatinine clearance rates of 80, 60, 40, 20 and 10 ml/min per 1.73 m2 (or at the initiation of dialysis treatment).
Results The insulin requirement of patients with Type 1 diabetes was reduced from 0.72 ± 0.16 IU/kg per day at a creatinine clearance rate of 80 ml/min, to 0.45 ± 0.13 IU/kg per day at a creatinine clearance rate of 10 ml/min (decrement of 38%, P < 0.001). The insulin dose required by Type 2 diabetic patients was reduced from 0.68 ± 0.28 IU/kg per day at a creatinine clearance rate of 80 ml/min to 0.33 ± 0.19 IU/kg per day at a clearance rate of 10 ml/min (decrement 51%, P < 0.001). The fall in GFR, urinary protein excretion and glycated haemoglobin levels was similar in the two groups. In patients with Type 2 diabetes, C‐peptide levels at the beginning and the end of renal function impairment were 2.2 (0.4–7.3) vs. 2.7 (0.1–4.9) ng/ml (NS). The reduction in insulin requirement was approximately the same in patients with an initial C‐peptide level < 1.0 and in those ≥ 1.0 ng/ml (decrement 57% vs. 46%).
Conclusions The reduction in insulin requirement in renal insufficiency is similar in Type 1 and insulin‐treated Type 2 diabetic patients. In subjects with Type 2 diabetes, the residual insulin secretion has no impact on the reduction in insulin requirement dependent on the GFR.
In this work, we bridge fundamental electromagnetics and chemical process engineering with the aim to develop tailor-made (microwave or high frequency radiowave) applicators for heating of micro- and ...small-structured process equipment. In this context, two simple configurations with well-defined single mode field patterns, namely a cylindrical and a rectangular cavity both containing a homogeneous cylindrical load were analyzed either analytically or numerically. We present design charts that illustrate how important operating, geometric and materials parameters relate with each other. It was found that load size, heating uniformity and desired frequency mutually constrain one another. The required cavity volume increases with increasing heating uniformity or with increasing load permittivity for a given heating uniformity requirement. At the popular frequency of 2.45
GHz the load is restricted to a small size, compared to the cavity size, in order to achieve high heating uniformity. Opting for lower resonance frequencies allows for bigger load volumes to be heated uniformly. Furthermore, we show that the relations found for the operating, structural and material properties on the basis of these simple configurations can provide design guidelines and first approximations for more realistic process equipment geometries.
The benefit and risk of oral anticoagulation in dialysis patients are debated controversially.
We prospectively followed 235 dialysis patients of the INVOR Study (Study of Incident Dialysis Patients ...in Vorarlberg) for up to 7 years and analysed the prevalence and incidence of atrial fibrillation (AF) and the impact of coumarin therapy on survival. Oral anticoagulation was monitored frequently.
A total of 748 person-years were recorded with a median follow-up of 2.84 years. Twelve patients (5.1%) had AF at the start of dialysis. During follow-up, 40 patients (17.0%) developed AF, representing an incidence of 5.85 per 100 person-years. AF was positively associated with mortality (P = 0.004). Forty-six (19.6%) of the 235 patients were treated with coumarins. The majority (93.7%) had a clear indication for oral anticoagulation. In 65% of our patients, AF was the indication for coumarins. Patients without coumarins and without AF represented our reference group. The mortality risk of the coumarin-treated patients with AF or an alternative indication for coumarins was slightly lower compared to the reference group hazard ratio (HR) 95% confidence interval (CI): 0.80 (0.28-2.29), P = 0.679 and 0.42 (0.16-1.10), P = 0.078, respectively. No patient under sufficient oral anticoagulation experienced a stroke or a fatal bleeding event. Patients with AF and a contraindication for coumarins had a significantly higher mortality risk compared to the reference group HR (95% CI): 3.90 (2.16-7.04), P < 0.001.
Our data suggest that coumarins might be less harmful than previously anticipated when clearly indicated and closely monitored.
PDF
