Klinika Alergologii

Klinika Alergologii


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Niedoszytko M.,Klinika Alergologii | Gruchala-Niedoszytko M.,Katedra Zywienia Klinicznego | Chelminska M.,Klinika Alergologii | Jassem E.,Klinika Alergologii
Alergia Astma Immunologia | Year: 2013

Extensive studies on problematic and severe asthma performed in recent years have contributed to a substantial progress in explaining its patophysiology and the development of new treatment procedures. In spite of that progress, diagnosing and treatment of that disease continues to be a major clinical issue in allergologists' practice. The aim of this paper is to summarize the clinical experience in the diagnosis and treatment from the point of view of an allergologist-practitioner, including the critical issues of the necessity to diversify treatment procedures according to individual cases and the requirement to manage co-existing diseases. The impact of patients' willingness to comply with doctor's recommendations and the major results of the studies on problematic and severe asthma have been also reported. © Alergia Astma Immunologia 2013.


Drozd-Werel M.,Klinika Pneumonologii | Porzezinska M.,Klinika Pneumonologii | Cynowska B.,Klinika Pneumonologii | Garbicz S.,NZOZ | And 3 more authors.
Pneumonologia i Alergologia Polska | Year: 2012

Pulmonary actinomycosis is a rare disease caused by Actinomyces sp. Its symptoms and radiological findings are not characteristic, so the diagnosis might be difficult to establish. We report a case of a 59 year old male, who developed bronchopulmonary Actinomycosis due to poor dental hygiene. The infectious process affected lung parenchyma and infiltrated chest wall causing multifocal sternal osteolisis and multiple cutaneous fistulas. The radiological findings sugested neoplasmatical process. The diagnosis was based on histopatological findings of fistular scrapes. The material contained Actinomyces colonies. Afler 6 months of antibiotic therapy the patient's state improved and the cutaneous fistulas healed. Radiological finding revealed partial resolution of the lung infiltration. © 2012 Via Medica.


The updated Rome III Classification of paediatric functional gastrointestinal disorders (FGIDs) associated with abdominal pain comprises: functional dyspepsia (FD), irritable bowel syndrome (IBS), abdominal migraine, functional abdominal pain (FAP), functional abdominal pain syndrome (FAPS). To assess the value of the Rome criteria in identifying FGIDs in children with chronic abdominal pain. The study group consisted of 439 consecutive paediatric patients (192 boys and 247 girls) aged 4-18 years (mean age was 11.95 +/- 3.89 years) referred to the Paediatric Gastroenterology Department at Medical University of Lodz from January 2008 to June 2009 for evaluation of abdominal pain of at least 2 months' duration. After exclusion of organic disease children suspected of functional chronic abdominal pain were categorized with the use of Rome III criteria of FGIDs associated with abdominal pain (H2a-H2d1) and the Questionnaire on Paediatric Gastrointestinal Symptoms (with the permission of doctor L. S. Walker). The patients with known nonabdominal organic disease, chronic illness or handicap were excluded. In 161 patients (36.58%) organic etiology was confirmed. Of the 278 children (63.42%) with functional chronic abdominal pain, 228 (82.02%) met the Rome III criteria for FGIDs associated with abdominal pain (FD, 15.5%; IBS, 21.6%; abdominal migraine, 5%; FAP 24.5%; FAPS, 15.9%). Fifty cases (17.98%) did not fulfill the criteria for subtypes of abdominal pain-related FGIDs--mainly due to different as defined by Rome III criteria (at least once per week) frequency of symptom presentation. (1) In the authors'investigations FGIDs was the most frequent cause of chronic abdominal pain in children. (2) The significant number of children with nonclassified FGIDs implies the need to modify the diagnostic criteria of Rome III classification concerning the prevalence of symptoms.


Ucinska R.,Oddzial Gruzlicy i Chorob Pluc | Damps-Konstanska I.,Klinika Alergologii | Sieminska A.,Klinika Alergologii | Jassem E.,Klinika Alergologii
Pneumonologia i Alergologia Polska | Year: 2012

For the past several years the number of women suffering from chronic obstructive pulmonary disease (COPD) has been steadily increasing. This fact prompts the debate which factors, in addition to considerably increasing prevalence of cigarette smoking among young women, are responsible for these epidemiologic changes. Differences in the natural history and prognosis of COPD in females and males are presented in the paper, as well as the number of potential ethiopathogenetic and pathophysiologic factors influencing these variations. Among them, differences in the COPD risk factors spectrum in both genders and in airways anatomy are pointed out, and the mechanisms responsible for greater women's susceptibility to components of cigarette smoke, which reflect genetic (enzyme polymorphisms), epigenetic (diminished DNA methylation) and hormonal (estrogens) influences on xenobiotics metabolism. Further, sex-related differences regarding COPD phenotypes (chronic bronchitis vs. emphysema), immunological markers and clinical manifestation of disease are underlined in the paper. More frequent coexistence of anxiety and depression, COPD exacerbations and worse quality of life in women are also emphasized. Other differences, pointed out by authors include autoimmunological conception of pathogenesis of COPD (greater female susceptibility to produce autoantibodies), risk factors of disease exacerbation and, at last, response to certain forms of COPD treatment (nicotine replacement therapy, long-term oxygen therapy). © 2012 Via Medica.


Plocek A.,Klinika Alergologii | Toporowska-Kowalska E.,Klinika Alergologii | Wasowska-Krolikowska K.,Klinika Alergologii
Pediatria Wspolczesna | Year: 2011

Introduction: Children with functional gastrointestinal disorders (FGIDs) are characterized by a broad range of gastrointestinal symptoms. Rome III criteria classify functional diagnostic entities on the basis of distinct constellation of gastrointestinal symptoms. It is common for different FGIDs to overlap. Aim of the study: The aim of this study was to assess the prevalence of FGIDs in children with functional abdominal pain using the current Rome criteria and analyze the proportion of diagnoses that overlap. Material and methods: The participants were 272 consecutive new pediatric patients (116 boys and 156 girls) aged 4-18 years (mean age was 11.95±3.89 years) referred to the Pediatric Gastroenterology Department at Medical University of Łódź from January 2009 to March 2010 whose medical evaluation of chronic abdominal pain yielded no evidence of organic disease. FGIDs diagnoses were based on a parent-report version of the Questionnaire on Pediatric Gastrointestinal Symptoms (QPGS-RIII). Results: Of the 272 children with functional etiology of abdominal pain, 238 (88%) met the criteria for at least one diagnosis of FGIDs. 34 cases (12%) did not fulfill any diagnostic criteria. Of the 238 patients with specific diagnoses of FGIDs, 176 (74%) were given one diagnosis, 59 (25%) two and 3 (1%) three. The most prevalent diagnoses were irritable bowel syndrome (n=104; 38%), abdominal migraine (n=51; 20%), functional abdominal pain (n=45; 17%) and functional dyspepsia (n=36; 13%). In children with two diagnoses of FGIDs the most common combinations were irritable bowel syndrome (IBS) and aerophagia (n=15), IBS and abdominal migraine (n=13) and abdominal migraine and cyclic vomiting syndrome (n=6). Conclusions: 1. FGIDs associated with abdominal pain are the most common reason of chronic nonorganic abdominal pain in children. 2. IBS and abdominal migraine were the most common functional entities. 3. One fourth of children with FGIDs met the criteria for two or more diagnoses, abdominal migraine and aerophagia tended to overlap with IBS. © 2011 Cornetis.


Sieminska A.,Klinika Alergologii
Pneumonologia i Alergologia Polska | Year: 2010

Numerous studies indicate genetical background of susceptibility to tobacco smoking. The current review presents new achievements and perspectives in searching for genes involved in tobacco smoking and dependence, which have been described in recent years as a result of the development of molecular techniques. It has been emphasized that tobacco smoking is a complex, polygenic behavior. Presence of multiple gene-gene and gene-environment interactions makes it difficult to find a strong genetic association. The causes of inconsistency in the results of candidate gene association studies, as well as the new perspectives in searching for genetic determinants of tobacco smoking, are also widely discussed. In particular, the focus is on the genome-wide association studies which allow the complex analysis of links between thousands of single nucleotide polymorphisms with smoking phenotypes. Copyright © 2010 Via Medica.


Eosinophilic esophagitis (EG) is a disease characterised by eosinophilic infiltration within multilayer epithelium of the oesophagus (in oesophageal mucosa more than 15 eosinophils in field of view 400x). Activation of eosinophils causes the release of number of mediators which are responsible for clinical signs (nausea, vomiting, pain), endoscopic changes (narrowing, ulceration, polyps, annular and linear grooves of mucosa) and histological view. Among patients treated in the clinic between 2010 and 2011, EG was diagnosed in 2 cases. The first was a 1-year-old girl with vomiting as the main clinical problem. Initially acid gastroesophageal reflux was diagnosed (reflux index - 24,1%). In the endos-copy the erosions of mucosa and a chronic eosophagitis were found. The PPI therapy was applied with improvement of clinical status and pH-finding. However, the massive endoscopic changes were still present despite the therapy. She was hospitalized again at the age of 2,5y due to abdominal and chest pains and vomiting. Anamnesis revealed chronic and recurrent bronchitis, pneumonia, rhinitis and snoring at night. GER (gastro-esophageal reflux) and IgE-depend-ed allergy were excluded. The histological signs of EG were found. Another patient was a 1,5y boy with many congenital defects, encephalopathy and epilepsy, fed by PEG (percutaneus endoscopic gastrostomy). Vomiting, swallowing disorders and positive bacteriological test from the upper respiratory tract were observed periodically. EG was confirmed by histological examination. In both cases PPI and hypoal-lergic diet without cow's milk were applied. This type of inflammation may often effect in difficulties in obtaining a positive therapeutic effect. © 2012 Cornetis.


Regulatory T (Treg) cells play a key role in controlling adaptive immune response and maintaining tolerance to innocuous self- and environmental proteins. There is a growing speculation that impairment in these pathways could be central in pathogenesis of many immune diseases, including allergic diseases. Although several studies suggest deficiencies in allergen-specific Treg cell numbers or function in allergic diseases, others have shown the opposite. Based on a review of recent literature, this article presents current views on naming, distribution, molecular characterization, mechanism of the action of regulatory T lymphocytes, and shows their importance in allergic diseases in both adults and children, with particular reference to food allergy. Understanding the mechanisms of immune system disorders that underly allergic diseases may help improve the treatment, prevention, and thus long-term prognosis. It seems that the development of knowledge on Treg CD4+CD25+ cells will enable the development of new therapeutic strategies, so important especially in relation to food allergy, as the first manifestation of atopy in children. © Alergia Astma Immunologia 2010.


Wasowska-Krolikowska K.,Klinika Alergologii | Kroculska A.,Klinika Alergologii
Family Medicine and Primary Care Review | Year: 2013

Food allergy (FA) is a widespread and growing disease, especially in children and adolescents. Proper diagnosis of FA plays a crucial role, especially in children. FA diagnosis is difficult and is still imperfect. The basic diagnostic tools for FA include: history, elimination diet, physical examination, assessment of specific IgE in vivo and in vitro and oral food challenges, that consistently over the years have remained the gold standard diagnostic tool. In this paper the authors present new opportunities for diagnostics using recombinant allergens, microarray test, test cell activation, atopy patch tests etc. © by Wydawnictwo Continuo.


Kostrzewska M.,Klinika Alergologii | Toporowska-Kowalska E.,Klinika Alergologii | Wasowska-Krolikowska K.,Klinika Alergologii
Pediatria Wspolczesna | Year: 2011

Introductions: The inflammatory bowel disease (IBD) are the group of autoimmunological diseases involving in pathogenesis TH-1 type lymphocytes. Crucial role in the mucosal destructive process plays the migration and activation of immunocompetent cells, especially chemokines. The chromosomal location of the IBD-susceptibility locus on 3p21 coincides with an location of the CCR5 gene. A 32-bp deletion (Δ32) in the CCR5-gene results in a nonfunctional receptor and changes the infiltration of the TH1-cells. It has been shown that Δ32 mutation may influence on the progression and development of the other complex diseases. Aim of the study: The aim of the study was to investigate the presence of the CCR5Δ32 allele in the IBD children and in the healthy controls and to analyze the clinical features of the TBD patients according to CCR5 Δ32 genotype. Material and methods: The study included 31 children (11 girls and 20 boys) aged from one to eighteen years (average 11±5,18 years) in whom inflammatory bowel disease had been diagnosed. Results: In the group of 31 children with diagnosed IBD the frequency of the Δ32 allele was 13% (4/31). All the patient were heterozygous for the CCR5Δ32 mutation. There were no homozygouse for the CCR5Δ32 allele. The presence of the CCR5Δ32 allele was not the risk factor for IBD (odds ratio 0.54; 95% Cl 0.162-1.801). Furthermore the children with IBD with one CCR5Δ32 allele were much younger at the diagnosis then children without mutation (5.75±5.5 yr vs. 11.81±4.72 yr) p <0.05. The stratification according to the gender have shown that 2/3 of the boys with the CCR5Δ32 mutation were very young (below 5 years old) at the diagnosis, p <0.05. Conclusions: Analysis of the clinical features of IBD patients with presence of CCR5Δ32 allele showed no correlation between CCR5Δ32 genotype and the severity, treatment. There was found to be more frequent location of the histopathology process in the ileitis in boys with CCRΔ32 allele. © 2011 Cornetis.

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