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Augustin M.,University of Hamburg | Franzke N.,University of Hamburg | Beikert F.C.,University of Hamburg | Stadler R.,Johannes Wesling Clinic | And 2 more authors.
JDDG - Journal of the German Society of Dermatology | Year: 2013

Background During the recent decades allergies have become more frequent all over the world. However, it is unclear how important the topic of allergies is for the general German population and how appropriately patients with allergies are treated. Patients and methods A telephone survey was performed on a representative random sample of n = 1,004 adults in Germany. The survey was performed by the Forsa Institute for Social Research and Statistical Analysis, Berlin, Germany, in the period from 31 January to 2 February 2012. Results Of the interviewees 52% responded that the topic of allergies concerned them; in 33% actually an allergy had been diagnosed by a physician. The proportion of allergies in the population correlated with the level of school education and was higher among people with a higher educational status. No differences in allergy rates were found between Eastern and Western Germany. Among allergic persons, 53% reported to be burdened by their allergy, 48% suffered from impaired performance because of their allergic symptoms. Among people suffering from pollen allergy, only 28% received sublingual immune therapy, with which 70% were satisfied. While 58% practiced self-medication, only 21% of the allergic persons were treated with anti-allergic drugs during their allergy flares. Conclusions Allergic diseases are a common, often burdensome problem in the German population, but nevertheless the medical treatment of people affected is still insufficient. The proportion of patients receiving sublingual immune therapy as causal treatment is comparatively low. Active steps are needed to improve the utilization behavior of patients, e. g. to take advice of an allergy specialist. © Blackwell Verlag GmbH, Berlin. Source

Schirmer J.H.,University Medical Center Schleswig Holstein and Klinikum Bad Bramstedt | Wright M.N.,University of Lubeck | Vonthein R.,University of Lubeck | Herrmann K.,University Medical Center Schleswig Holstein and Klinikum Bad Bramstedt | And 10 more authors.
Rheumatology (United Kingdom) | Year: 2016

Objective. To evaluate the clinical presentation and long-term outcome of a vasculitis centre cohort of patients with microscopic polyangiitis (MPA) with respect to organ manifestations, treatment, chronic damage and mortality. Methods. We performed a retrospective chart review at our vasculitis referral centre. MPA patients admitted between 1991 and 2013 classified by a modified European Medicines Agency algorithm were diagnosed and treated according to a standardized interdisciplinary approach. Results. Comprehensive data from standardized interdisciplinary workups was available for 144 patients (median follow-up 72 months). The overall standardized mortality ratio was 1.40 (95% CI 0.91, 2.07; P = 0.13). We observed a higher mortality [hazard ratio (HR) 4.04 (95% CI 1.21, 13.45), P = 0.02] in 17 patients with MPA-associated fibrosing interstitial lung disease (ILD) and 56 patients with peripheral nervous system involvement [HR 5.26 (95% CI 1.10, 25.14), P = 0.04] at disease onset. One hundred and fifteen patients (79.9%) responded to the initial treatment. Sixty-one (42.3%) achieved complete remission and 54 (37.5%) achieved partial remission. Twenty (13.9%) showed a refractory disease course. Conclusion. MPA patients at our tertiary rheumatology referral centre seemed to have a less severe phenotype resulting in a less severe disease course and better outcome than reported in other cohorts. Fibrosing ILD was significantly associated with mortality in this cohort. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. Source

Bertsias G.K.,University of Crete | Tektonidou M.,National and Kapodistrian University of Athens | Amoura Z.,University Pierre and Marie Curie | Aringer M.,University Medical Center Carl Gustav Carus | And 27 more authors.
Annals of the Rheumatic Diseases | Year: 2012

Objectives: To develop recommendations for the management of adult and paediatric lupus nephritis (LN). Methods: The available evidence was systematically reviewed using the PubMed database. A modi fied Delphi method was used to compile questions, elicit expert opinions and reach consensus. Results: Immunosuppressive treatment should be guided by renal biopsy, and aiming for complete renal response (proteinuria <0.5 g/24 h with normal or near-normal renal function). Hydroxychloroquine is recommended for all patients with LN. Because of a more favourable ef ficacy/toxicity ratio, as initial treatment for patients with class III-IVA or A/C (±V) LN according to the International Society of Nephrology/Renal Pathology Society 2003 classification, mycophenolic acid (MPA) or low-dose intravenous cyclophosphamide (CY) in combination with glucocorticoids is recommended. In patients with adverse clinical or histological features, CY can be prescribed at higher doses, while azathioprine is an alternative for milder cases. For pure class V LN with nephrotic-range proteinuria, MPA in combination with oral glucocorticoids is recommended as initial treatment. In patients improving after initial treatment, subsequent immunosuppression with MPA or azathioprine is recommended for at least 3 years; in such cases, initial treatment with MPA should be followed by MPA. For MPA or CY failures, switching to the other agent, or to rituximab, is the suggested course of action. In anticipation of pregnancy, patients should be switched to appropriate medications without reducing the intensity of treatment. There is no evidence to suggest that management of LN should differ in children versus adults. Conclusions: Recommendations for the management of LN were developed using an evidence-based approach followed by expert consensus. Source

Groessl M.,Max Planck Institute of Molecular Cell Biology and Genetics | Luksch H.,University Medical Center Carl Gustav Carus | Rosen-Wolff A.,University Medical Center Carl Gustav Carus | Shevchenko A.,Max Planck Institute of Molecular Cell Biology and Genetics | Gentzel M.,Max Planck Institute of Molecular Cell Biology and Genetics
Proteomics | Year: 2012

The immune response to pathogens or injury relies on the concerted release of cytokines and proteins with biological activity important for host protection, host defense, and wound healing. Consequently, the secretome of immune cells provides a promising resource for discovery of specific molecular markers and targets for pharmacological intervention. Here, we employ label-free MS for unbiased, quantitative profiling of the human monocytic cell secretome under different proinflammatory stimuli. The quantitative secretome profiles reveal the highly stimulus-dependent cellular response and differential, specific secretion of more than 200 proteins, including important proinflammatory proteins and cytokines. © 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim. Source

Avouac J.,University of Paris Descartes | Fransen J.,Radboud University Nijmegen | Walker U.A.,University of Basel | Riccieri V.,University of Rome La Sapienza | And 117 more authors.
Annals of the Rheumatic Diseases | Year: 2011

Objective: To identify a core set of preliminary items considered as important for the very early diagnosis of systemic sclerosis (SSc). Methods: A list of items provided by European League Against Rheumatism (EULAR) Scleroderma Trial and Research(EUSTAR) centres were subjected to a Delphi exercise among 110 experts in the field of SSc. In round 1, experts were asked to choose the items they considered as the most important for the very early diagnosis of SSc. In round 2, experts were asked to reconsider the items accepted after the first stage. In round 3, the clinical relevance of selected items and their importance as measures that would lead to an early referral process were rated using appropriateness scores. Results: Physicians from 85 EUSTAR centres participated in the study and provided an initial list of 121 items. After three Delphi rounds, the steering committee, with input from external experts, collapsed the 121 items into three domains containing seven items, developed as follows: skin domain (puffy fingers/puffy swollen digits turning into sclerodactily);vascular domain (Raynaud's phenomenon, abnormal capillaroscopy with scleroderma pattern) and laboratory domain (antinuclear, anticentromere and antitopoisomerase-I antibodies). Finally, the whole assembly of EUSTAR centres ratified with a majority vote the results in a final face-to-face meeting. Conclusion: The three Delphi rounds allowed us to identify the items considered by experts as necessary for the very early diagnosis of SSc. The validation of these items to establish diagnostic criteria is currently ongoing in a prospective observational cohort. Source

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