TY - JOUR A1 - Hasenpusch, Claudia A1 - Matterne, Uwe A1 - Tischer, Christina A1 - Hrudey, Ilona A1 - Apfelbacher, Christian T1 - Development and content validation of a comprehensive health literacy survey instrument for use in individuals with asthma during the COVID-19 pandemic JF - International Journal of Environmental Research and Public Health N2 - Individuals with chronic conditions have been faced with many additional challenges during the COVID-19 pandemic. Individual health literacy (HL) as the ability to access, understand, evaluate, and apply pandemic-related information has thus become ever more important in these populations. The purpose of this study was to develop and content-validate a comprehensive HL survey instrument for people with asthma based on an integrated framework, and on previous surveys and other instruments for use in the general population and vulnerable groups. Beside HL, assumed determinants, mediators, and health outcomes were embraced in the framework. A mixed-method design was used. A comprehensive examination of the available literature yielded an initial pool of 398 single items within 20 categories. Based on content validity indices (CVI) of expert ratings (n = 11) and the content analysis of cognitive interviews with participants (n = 9), the item pool was reduced, and individual items/scales refined or modified. The instrument showed appropriate comprehensibility (98.0%), was judged relevant, and had an acceptable CVI at scale level (S-CVI/Ave = 0.91). The final version comprises 14 categories measured by 38 questions consisting of 116 single items. In terms of content, the instrument appears a valid representation of behavioural and psychosocial constructs pertaining to a broad HL understanding and relevant to individuals with asthma during the COVID-19 pandemic. Regular monitoring of these behavioural and psychosocial constructs during the course of the pandemic can help identify needs as well as changes during the course of the pandemic, which is particularly important in chronic disease populations. KW - SARS-CoV-2 KW - COVID-19 KW - asthma KW - survey instrument KW - questionnaire development KW - health literacy Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-262146 SN - 1660-4601 VL - 19 IS - 4 ER - TY - JOUR A1 - Forchert, Leandra A1 - Potapova, Ekaterina A1 - Panetta, Valentina A1 - Dramburg, Stephanie A1 - Perna, Serena A1 - Posa, Daniela A1 - Resch‐Marat, Yvonne A1 - Lupinek, Christian A1 - Rohrbach, Alexander A1 - Grabenhenrich, Linus A1 - Icke, Katja A1 - Bauer, Carl‐Peter A1 - Hoffman, Ute A1 - Forster, Johannes A1 - Zepp, Fred A1 - Schuster, Antje A1 - Wahn, Ulrich A1 - Keil, Thomas A1 - Lau, Susanne A1 - Vrtala, Susanne A1 - Valenta, Rudolf A1 - Matricardi, Paolo Maria T1 - Der p 23‐specific IgE response throughout childhood and its association with allergic disease: A birth cohort study JF - Pediatric Allergy and Immunology N2 - Background The Dermatophagoides pteronyssinus molecule Der p 23 is a major allergen whose clinical relevance has been shown in cross‐sectional studies. We longitudinally analysed the trajectory of Der p 23‐specific IgE antibody (sIgE) levels throughout childhood and youth, their early‐life determinants and their clinical relevance for allergic rhinitis and asthma. Methods We obtained sera and clinical data of 191 participants of the German Multicentre Allergy Study, a prospective birth cohort. Serum samples from birth to 20 years of age with sIgE reactivity to Der p 23 in a customised semiquantitative microarray were newly analysed with a singleplex quantitative assay. Early mite exposure was assessed by measuring the average content of Der p 1 in house dust at 6 and 18 months. Results Der p 23‐sIgE levels were detected at least once in 97/191 participants (51%). Prevalence of Der p 23 sensitisation and mean sIgE levels increased until age 10 years, plateaued until age 13 years and were lowest at age 20 years. Asthma, allergic rhinitis (AR) and atopic dermatitis (AD) were more prevalent in Der p 23‐sensitised children, including those with monomolecular but persistent sensitisation (11/97, 11%). A higher exposure to mites in infancy and occurrence of AD before 5 years of age preceded the onset of Der p 23 sensitisation, which in turn preceded a higher incidence of asthma. Conclusions Der p 23 sensitisation peaks in late childhood and then decreases. It is preceded by early mite exposure and AD. Asthma and AR can occur in patients persistently sensitised to Der p 23 as the only mite allergen, suggesting the inclusion of molecular testing of Der p 23‐sIgE for subjects with clinical suspicion of HDM allergy but without sIgE to other major D.pt. allergens. KW - asthma KW - birth cohort KW - childhood KW - Der p 23 KW - house dust mite allergy KW - IgE Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-287181 VL - 33 IS - 7 ER - TY - JOUR A1 - Bousquet, Jean A1 - Anto, Josep M. A1 - Bachert, Claus A1 - Haahtela, Tari A1 - Zuberbier, Torsten A1 - Czarlewski, Wienczyslawa A1 - Bedbrook, Anna A1 - Bosnic‐Anticevich, Sinthia A1 - Walter Canonica, G. A1 - Cardona, Victoria A1 - Costa, Elisio A1 - Cruz, Alvaro A. A1 - Erhola, Marina A1 - Fokkens, Wytske J. A1 - Fonseca, Joao A. A1 - Illario, Maddalena A1 - Ivancevich, Juan‐Carlos A1 - Jutel, Marek A1 - Klimek, Ludger A1 - Kuna, Piotr A1 - Kvedariene, Violeta A1 - Le, LTT A1 - Larenas‐Linnemann, Désirée E. A1 - Laune, Daniel A1 - Lourenço, Olga M. A1 - Melén, Erik A1 - Mullol, Joaquim A1 - Niedoszytko, Marek A1 - Odemyr, Mikaëla A1 - Okamoto, Yoshitaka A1 - Papadopoulos, Nikos G. A1 - Patella, Vincenzo A1 - Pfaar, Oliver A1 - Pham‐Thi, Nhân A1 - Rolland, Christine A1 - Samolinski, Boleslaw A1 - Sheikh, Aziz A1 - Sofiev, Mikhail A1 - Suppli Ulrik, Charlotte A1 - Todo‐Bom, Ana A1 - Tomazic, Peter‐Valentin A1 - Toppila‐Salmi, Sanna A1 - Tsiligianni, Ioanna A1 - Valiulis, Arunas A1 - Valovirta, Erkka A1 - Ventura, Maria‐Teresa A1 - Walker, Samantha A1 - Williams, Sian A1 - Yorgancioglu, Arzu A1 - Agache, Ioana A1 - Akdis, Cezmi A. A1 - Almeida, Rute A1 - Ansotegui, Ignacio J. A1 - Annesi‐Maesano, Isabella A1 - Arnavielhe, Sylvie A1 - Basagaña, Xavier A1 - D. Bateman, Eric A1 - Bédard, Annabelle A1 - Bedolla‐Barajas, Martin A1 - Becker, Sven A1 - Bennoor, Kazi S. A1 - Benveniste, Samuel A1 - Bergmann, Karl C. A1 - Bewick, Michael A1 - Bialek, Slawomir A1 - E. Billo, Nils A1 - Bindslev‐Jensen, Carsten A1 - Bjermer, Leif A1 - Blain, Hubert A1 - Bonini, Matteo A1 - Bonniaud, Philippe A1 - Bosse, Isabelle A1 - Bouchard, Jacques A1 - Boulet, Louis‐Philippe A1 - Bourret, Rodolphe A1 - Boussery, Koen A1 - Braido, Fluvio A1 - Briedis, Vitalis A1 - Briggs, Andrew A1 - Brightling, Christopher E. A1 - Brozek, Jan A1 - Brusselle, Guy A1 - Brussino, Luisa A1 - Buhl, Roland A1 - Buonaiuto, Roland A1 - Calderon, Moises A. A1 - Camargos, Paulo A1 - Camuzat, Thierry A1 - Caraballo, Luis A1 - Carriazo, Ana‐Maria A1 - Carr, Warner A1 - Cartier, Christine A1 - Casale, Thomas A1 - Cecchi, Lorenzo A1 - Cepeda Sarabia, Alfonso M. A1 - H. Chavannes, Niels A1 - Chkhartishvili, Ekaterine A1 - Chu, Derek K. A1 - Cingi, Cemal A1 - Correia de Sousa, Jaime A1 - Costa, David J. A1 - Courbis, Anne‐Lise A1 - Custovic, Adnan A1 - Cvetkosvki, Biljana A1 - D'Amato, Gennaro A1 - da Silva, Jane A1 - Dantas, Carina A1 - Dokic, Dejan A1 - Dauvilliers, Yves A1 - De Feo, Giulia A1 - De Vries, Govert A1 - Devillier, Philippe A1 - Di Capua, Stefania A1 - Dray, Gerard A1 - Dubakiene, Ruta A1 - Durham, Stephen R. A1 - Dykewicz, Mark A1 - Ebisawa, Motohiro A1 - Gaga, Mina A1 - El‐Gamal, Yehia A1 - Heffler, Enrico A1 - Emuzyte, Regina A1 - Farrell, John A1 - Fauquert, Jean‐Luc A1 - Fiocchi, Alessandro A1 - Fink‐Wagner, Antje A1 - Fontaine, Jean‐François A1 - Fuentes Perez, José M. A1 - Gemicioğlu, Bilun A1 - Gamkrelidze, Amiran A1 - Garcia‐Aymerich, Judith A1 - Gevaert, Philippe A1 - Gomez, René Maximiliano A1 - González Diaz, Sandra A1 - Gotua, Maia A1 - Guldemond, Nick A. A1 - Guzmán, Maria‐Antonieta A1 - Hajjam, Jawad A1 - Huerta Villalobos, Yunuen R. A1 - Humbert, Marc A1 - Iaccarino, Guido A1 - Ierodiakonou, Despo A1 - Iinuma, Tomohisa A1 - Jassem, Ewa A1 - Joos, Guy A1 - Jung, Ki‐Suck A1 - Kaidashev, Igor A1 - Kalayci, Omer A1 - Kardas, Przemyslaw A1 - Keil, Thomas A1 - Khaitov, Musa A1 - Khaltaev, Nikolai A1 - Kleine‐Tebbe, Jorg A1 - Kouznetsov, Rostislav A1 - Kowalski, Marek L. A1 - Kritikos, Vicky A1 - Kull, Inger A1 - La Grutta, Stefania A1 - Leonardini, Lisa A1 - Ljungberg, Henrik A1 - Lieberman, Philip A1 - Lipworth, Brian A1 - Lodrup Carlsen, Karin C. A1 - Lopes‐Pereira, Catarina A1 - Loureiro, Claudia C. A1 - Louis, Renaud A1 - Mair, Alpana A1 - Mahboub, Bassam A1 - Makris, Michaël A1 - Malva, Joao A1 - Manning, Patrick A1 - Marshall, Gailen D. A1 - Masjedi, Mohamed R. A1 - Maspero, Jorge F. A1 - Carreiro‐Martins, Pedro A1 - Makela, Mika A1 - Mathieu‐Dupas, Eve A1 - Maurer, Marcus A1 - De Manuel Keenoy, Esteban A1 - Melo‐Gomes, Elisabete A1 - Meltzer, Eli O. A1 - Menditto, Enrica A1 - Mercier, Jacques A1 - Micheli, Yann A1 - Miculinic, Neven A1 - Mihaltan, Florin A1 - Milenkovic, Branislava A1 - Mitsias, Dimitirios I. A1 - Moda, Giuliana A1 - Mogica‐Martinez, Maria‐Dolores A1 - Mohammad, Yousser A1 - Montefort, Steve A1 - Monti, Ricardo A1 - Morais‐Almeida, Mario A1 - Mösges, Ralph A1 - Münter, Lars A1 - Muraro, Antonella A1 - Murray, Ruth A1 - Naclerio, Robert A1 - Napoli, Luigi A1 - Namazova‐Baranova, Leyla A1 - Neffen, Hugo A1 - Nekam, Kristoff A1 - Neou, Angelo A1 - Nordlund, Björn A1 - Novellino, Ettore A1 - Nyembue, Dieudonné A1 - O'Hehir, Robyn A1 - Ohta, Ken A1 - Okubo, Kimi A1 - Onorato, Gabrielle L. A1 - Orlando, Valentina A1 - Ouedraogo, Solange A1 - Palamarchuk, Julia A1 - Pali‐Schöll, Isabella A1 - Panzner, Peter A1 - Park, Hae‐Sim A1 - Passalacqua, Gianni A1 - Pépin, Jean‐Louis A1 - Paulino, Ema A1 - Pawankar, Ruby A1 - Phillips, Jim A1 - Picard, Robert A1 - Pinnock, Hilary A1 - Plavec, Davor A1 - Popov, Todor A. A1 - Portejoie, Fabienne A1 - Price, David A1 - Prokopakis, Emmanuel P. A1 - Psarros, Fotis A1 - Pugin, Benoit A1 - Puggioni, Francesca A1 - Quinones‐Delgado, Pablo A1 - Raciborski, Filip A1 - Rajabian‐Söderlund, Rojin A1 - Regateiro, Frederico S. A1 - Reitsma, Sietze A1 - Rivero‐Yeverino, Daniela A1 - Roberts, Graham A1 - Roche, Nicolas A1 - Rodriguez‐Zagal, Erendira A1 - Rolland, Christine A1 - Roller‐Wirnsberger, Regina E. A1 - Rosario, Nelson A1 - Romano, Antonino A1 - Rottem, Menachem A1 - Ryan, Dermot A1 - Salimäki, Johanna A1 - Sanchez‐Borges, Mario M. A1 - Sastre, Joaquin A1 - Scadding, Glenis K. A1 - Scheire, Sophie A1 - Schmid‐Grendelmeier, Peter A1 - Schünemann, Holger J. A1 - Sarquis Serpa, Faradiba A1 - Shamji, Mohamed A1 - Sisul, Juan‐Carlos A1 - Sofiev, Mikhail A1 - Solé, Dirceu A1 - Somekh, David A1 - Sooronbaev, Talant A1 - Sova, Milan A1 - Spertini, François A1 - Spranger, Otto A1 - Stellato, Cristiana A1 - Stelmach, Rafael A1 - Thibaudon, Michel A1 - To, Teresa A1 - Toumi, Mondher A1 - Usmani, Omar A1 - Valero, Antonio A. A1 - Valenta, Rudolph A1 - Valentin‐Rostan, Marylin A1 - Pereira, Marilyn Urrutia A1 - van der Kleij, Rianne A1 - Van Eerd, Michiel A1 - Vandenplas, Olivier A1 - Vasankari, Tuula A1 - Vaz Carneiro, Antonio A1 - Vezzani, Giorgio A1 - Viart, Frédéric A1 - Viegi, Giovanni A1 - Wallace, Dana A1 - Wagenmann, Martin A1 - Wang, De Yun A1 - Waserman, Susan A1 - Wickman, Magnus A1 - Williams, Dennis M. A1 - Wong, Gary A1 - Wroczynski, Piotr A1 - Yiallouros, Panayiotis K. A1 - Yusuf, Osman M. A1 - Zar, Heather J. A1 - Zeng, Stéphane A1 - Zernotti, Mario E. A1 - Zhang, Luo A1 - Shan Zhong, Nan A1 - Zidarn, Mihaela T1 - ARIA digital anamorphosis: Digital transformation of health and care in airway diseases from research to practice JF - Allergy N2 - Digital anamorphosis is used to define a distorted image of health and care that may be viewed correctly using digital tools and strategies. MASK digital anamorphosis represents the process used by MASK to develop the digital transformation of health and care in rhinitis. It strengthens the ARIA change management strategy in the prevention and management of airway disease. The MASK strategy is based on validated digital tools. Using the MASK digital tool and the CARAT online enhanced clinical framework, solutions for practical steps of digital enhancement of care are proposed. KW - ARIA KW - asthma KW - CARAT KW - digital transformation of health and care KW - MASK KW - rhinitis Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-228339 VL - 76 IS - 1 SP - 168 EP - 190 ER - TY - JOUR A1 - Roßberg, Siri A1 - Keller, Theresa A1 - Icke, Katja A1 - Siedmann, Valentina A1 - Lau, Imke A1 - Keil, Thomas A1 - Lau, Susanne T1 - Orally applied bacterial lysate in infants at risk for atopy does not prevent atopic dermatitis, allergic rhinitis, asthma or allergic sensitization at school age: Follow‐up of a randomized trial JF - Allergy N2 - Background The allergy preventive effects of gut immune modulation by bacterial compounds are still not fully understood. Objective We sought to evaluate the effect of bacterial lysate applied orally from the second until seventh months of life on the prevalence of allergic diseases at school age. Methods In a randomized, placebo‐controlled trial, 606 newborns with at least one allergic parent received orally a bacterial lysate consisting of heat‐killed Gram‐negative Escherichia coli Symbio and Gram‐positive Enterococcus faecalis Symbio or placebo from week 5 until the end of month 7. A total of 402 children were followed until school age (6‐11 years) for the assessment of current atopic dermatitis (AD), allergic rhinitis (AR), asthma and sensitization against aeroallergens. Results AD was diagnosed in 11.0% (22/200) of children in the active and in 10.4% (21/202) of children in the placebo group. AR was diagnosed in 35% (70/200) of children in the active and in 38.1% (77/202) children in the placebo group. Asthma was diagnosed in 9% (18/199) of children in the active and in 6.6% (13/197) of children in the placebo group. Sensitization occurred in 46.5% (66/142) of participants in the active and 51.7% (76/147) in the placebo group. Conclusion An oral bacterial lysate of heat‐killed Gram‐negative Escherichia coli and Gram‐positive Enterococcus faecalis applied during the first 7 months of life did not influence the development of AD, asthma and AR at school age. KW - asthma KW - atopic dermatitis KW - prevention KW - rhinitis Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-213456 VL - 75 IS - 8 SP - 2020 EP - 2025 ER - TY - JOUR A1 - Bousquet, J. A1 - Anto, J. M. A1 - Akdis, M. A1 - Auffray, C. A1 - Keil, T. A1 - Momas, I. A1 - Postma, D. S. A1 - Valenta, R. A1 - Wickman, M. A1 - Cambon-Thomsen, A. A1 - Haahtela, T. A1 - Lambrecht, B. N. A1 - Lodrup Carlsen, K. C. A1 - Koppelman, G. H. A1 - Sunyer, J. A1 - Zuberbier, T. A1 - Annesi-Maesano, I. A1 - Arno, A. A1 - Bindslev-Jensen, C. A1 - De Carlo, G. A1 - Forastiere, F. A1 - Heinrich, J. A1 - Kowalski, M. L. A1 - Maier, D. A1 - Melen, E. A1 - Palkonen, S. A1 - Smit, H. A. A1 - Standl, M. A1 - Wright, J. A1 - Asarnoj, A. A1 - Benet, M. A1 - Ballardini, N. A1 - Garcia-Aymerich, J. A1 - Gehring, U. A1 - Guerra, S. A1 - Hohman, C. A1 - Kull, I. A1 - Lupinek, C. A1 - Pinart, M. A1 - Skrindo, I. A1 - Westman, M. A1 - Smagghe, D. A1 - Akdis, C. A1 - Albang, R. A1 - Anastasova, V. A1 - Anderson, N. A1 - Bachert, C. A1 - Ballereau, S. A1 - Ballester, F. A1 - Basagana, X. A1 - Bedbrook, A. A1 - Bergstrom, A. A1 - von Berg, A. A1 - Brunekreef, B. A1 - Burte, E. A1 - Carlsen, K.H. A1 - Chatzi, L. A1 - Coquet, J.M. A1 - Curin, M. A1 - Demoly, P. A1 - Eller, E. A1 - Fantini, M.P. A1 - Gerhard, B. A1 - Hammad, H. A1 - von Hertzen, L. A1 - Hovland, V. A1 - Jacquemin, B. A1 - Just, J. A1 - Keller, T. A1 - Kerkhof, M. A1 - Kiss, R. A1 - Kogevinas, M. A1 - Koletzko, S. A1 - Lau, S. A1 - Lehmann, I. A1 - Lemonnier, N. A1 - McEachan, R. A1 - Makela, M. A1 - Mestres, J. A1 - Minina, E. A1 - Mowinckel, P. A1 - Nadif, R. A1 - Nawijn, M. A1 - Oddie, S. A1 - Pellet, J. A1 - Pin, I. A1 - Porta, D. A1 - Rancière, F. A1 - Rial-Sebbag, A. A1 - Schuijs, M.J. A1 - Siroux, V. A1 - Tischer, C.G. A1 - Torrent, M. A1 - Varraso, R. A1 - De Vocht, J. A1 - Wenger, K. A1 - Wieser, S. A1 - Xu, C. T1 - Paving the way of systems biology and precision medicine in allergic diseases: the MeDALL success story Mechanisms of the Development of ALLergy; EUFP7-CP-IP; Project No: 261357; 2010-2015 JF - Allergy N2 - MeDALL (Mechanisms of the Development of ALLergy; EU FP7-CP-IP; Project No: 261357; 2010-2015) has proposed an innovative approach to develop early indicators for the prediction, diagnosis, prevention and targets for therapy. MeDALL has linked epidemiological, clinical and basic research using a stepwise, large-scale and integrative approach: MeDALL data of precisely phenotyped children followed in 14 birth cohorts spread across Europe were combined with systems biology (omics, IgE measurement using microarrays) and environmental data. Multimorbidity in the same child is more common than expected by chance alone, suggesting that these diseases share causal mechanisms irrespective of IgE sensitization. IgE sensitization should be considered differently in monosensitized and polysensitized individuals. Allergic multimorbidities and IgE polysensitization are often associated with the persistence or severity of allergic diseases. Environmental exposures are relevant for the development of allergy-related diseases. To complement the population-based studies in children, MeDALL included mechanistic experimental animal studies and in vitro studies in humans. The integration of multimorbidities and polysensitization has resulted in a new classification framework of allergic diseases that could help to improve the understanding of genetic and epigenetic mechanisms of allergy as well as to better manage allergic diseases. Ethics and gender were considered. MeDALL has deployed translational activities within the EU agenda. KW - asthma KW - birth cohort KW - atopic-dermatitis KW - immune-responses KW - IgE KW - multimorbidity KW - polysensitization KW - rhinitis KW - chronic respiratory-diseases KW - childhood asthma KW - immunological reactivity KW - IgE sensitazion KW - immunoglobulin-e KW - integraed care Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-186858 VL - 71 IS - 11 ER - TY - JOUR A1 - Hohmann, Cynthia A1 - Pinart, Mariona A1 - Tischer, Christina A1 - Gehring, Ulrike A1 - Heinrich, Joachim A1 - Kull, Inger A1 - Melén, Eric A1 - Smit, Henriette A. A1 - Torrent, Maties A1 - Wijga, Alet H. A1 - Wickman, Magnus A1 - Bachert, Claus A1 - Lødrup Carlsen, Karin C. A1 - Carlsen, Kai-Håkon A1 - Bindslev-Jensen, Carsten A1 - Eller, Esben A1 - Esplugues, Ana A1 - Fantini, Maria Pia A1 - Annesi-Maesano, Isabella A1 - Momas, Isabelle A1 - Porta, Daniela A1 - Vassilaki, Maria A1 - Waiblinger, Dagmar A1 - Sunyer, Jordi A1 - Antó, Josep M. A1 - Bousquet, Jean A1 - Keil, Thomas T1 - The Development of the MeDALL Core Questionnaires for a Harmonized Follow-Up Assessment of Eleven European Birth Cohorts on Asthma and Allergies JF - International Archives of Allergy and Immunology N2 - Background: Numerous birth cohorts have been initiated in the world over the past 30 years using heterogeneous methods to assess the incidence, course and risk factors of asthma and allergies. The aim of the present work is to provide the stepwise proceedings of the development and current version of the harmonized MeDALL-Core Questionnaire (MeDALL-CQ) used prospectively in 11 European birth cohorts. Methods: The harmonization of questions was accomplished in 4 steps: (i) collection of variables from 14 birth cohorts, (ii) consensus on questionnaire items, (iii) translation and back-translation of the harmonized English MeDALL-CQ into 8 other languages and (iv) implementation of the harmonized follow-up. Results: Three harmonized MeDALL-CQs (2 for parents of children aged 4-9 and 14-18, 1 for adolescents aged 14-18) were developed and used for a harmonized follow-up assessment of 11 European birth cohorts on asthma and allergies with over 13,000 children. Conclusions: The harmonized MeDALL follow-up produced more comparable data across different cohorts and countries in Europe and will offer the possibility to verify results of former cohort analyses. Thus, MeDALL can become the starting point to stringently plan, conduct and support future common asthma and allergy research initiatives in Europe. KW - harmonization KW - MeDALL KW - european birth cohorts KW - asthma KW - allergy KW - questionnaire assessment Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-196594 SN - 1018-2438 SN - 1423-0097 VL - 163 IS - 3 ER - TY - JOUR A1 - Sonnenschein-van der Voort, Agnes M. M. A1 - Arends, Lidia R. A1 - de Jongste, Johan C. A1 - Annesi-Maesano, Isabella A1 - Arshad, S. Hasan A1 - Barros, Henrique A1 - Basterrechea, Mikel A1 - Bisgaard, Hans A1 - Chatzi, Leda A1 - Corpeleijn, Eva A1 - Correia, Sofia A1 - Craig, Leone C. A1 - Devereux, Graham A1 - Dogaru, Cristian A1 - Dostal, Miroslav A1 - Duchen, Karel A1 - Eggesbø, Merete A1 - van der Ent, C. Kors A1 - Fantini, Maria P. A1 - Forastiere, Francesco A1 - Frey, Urs A1 - Gehring, Ulrike A1 - Gori, Davide A1 - van der Gugten, Anne C. A1 - Hanke, Wojciech A1 - Henderson, A. John A1 - Heude, Barbara A1 - Iñiguez, Carmen A1 - Inskip, Hazel M. A1 - Keil, Thomas A1 - Kelleher, Cecily C. A1 - Kogevinas, Manolis A1 - Kreiner-Møller, Eskil A1 - Kuehni, Claudia E. A1 - Küpers, Leanne K. A1 - Lancz, Kinga A1 - Larsen, Pernille S. A1 - Lau, Susanne A1 - Ludvigsson, Johnny A1 - Mommers, Monique A1 - Andersen, Anne-Marie Nybo A1 - Palkovicova, Lubica A1 - Pike, Katherine C. A1 - Pizzi, Constanza A1 - Polanska, Kinga A1 - Porta, Daniela A1 - Richiardi, Lorenzo A1 - Roberts, Graham A1 - Schmidt, Anne A1 - Sram, Radim J. A1 - Sunyer, Jordi A1 - Thijs, Carel A1 - Torrent, Maties A1 - Viljoen, Karien A1 - Wijga, Alet H. A1 - Vrijheid, Martine A1 - Jaddoe, Vincent W. V. A1 - Duijts, Liesbeth T1 - Preterm birth, infant weight gain, and childhood asthma risk: A meta-analysis of 147,000 European children JF - The Journal of Allergy and Clinical Immunology N2 - Background Preterm birth, low birth weight, and infant catch-up growth seem associated with an increased risk of respiratory diseases in later life, but individual studies showed conflicting results. Objectives We performed an individual participant data meta-analysis for 147,252 children of 31 birth cohort studies to determine the associations of birth and infant growth characteristics with the risks of preschool wheezing (1-4 years) and school-age asthma (5-10 years). Methods First, we performed an adjusted 1-stage random-effect meta-analysis to assess the combined associations of gestational age, birth weight, and infant weight gain with childhood asthma. Second, we performed an adjusted 2-stage random-effect meta-analysis to assess the associations of preterm birth (gestational age <37 weeks) and low birth weight (<2500 g) with childhood asthma outcomes. Results Younger gestational age at birth and higher infant weight gain were independently associated with higher risks of preschool wheezing and school-age asthma (P < .05). The inverse associations of birth weight with childhood asthma were explained by gestational age at birth. Compared with term-born children with normal infant weight gain, we observed the highest risks of school-age asthma in children born preterm with high infant weight gain (odds ratio [OR], 4.47; 95% CI, 2.58-7.76). Preterm birth was positively associated with an increased risk of preschool wheezing (pooled odds ratio [pOR], 1.34; 95% CI, 1.25-1.43) and school-age asthma (pOR, 1.40; 95% CI, 1.18-1.67) independent of birth weight. Weaker effect estimates were observed for the associations of low birth weight adjusted for gestational age at birth with preschool wheezing (pOR, 1.10; 95% CI, 1.00-1.21) and school-age asthma (pOR, 1.13; 95% CI, 1.01-1.27). Conclusion Younger gestational age at birth and higher infant weight gain were associated with childhood asthma outcomes. The associations of lower birth weight with childhood asthma were largely explained by gestational age at birth." KW - gestational age KW - low birth weight KW - infant growth KW - wheezing KW - asthma KW - epidemiology KW - cohort studies KW - children Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-120714 VL - 133 IS - 5 ER - TY - JOUR A1 - Held, Matthias A1 - Mittnacht, Maria A1 - Kolb, Martin A1 - Karl, Sabine A1 - Jany, Berthold T1 - Pulmonary and Cardiac Function in Asymptomatic Obese Subjects and Changes following a Structured Weight Reduction Program: A Prospective Observational Study JF - PLOS ONE N2 - Background The prevalence of obesity is rising. Obesity can lead to cardiovascular and ventilatory complications through multiple mechanisms. Cardiac and pulmonary function in asymptomatic subjects and the effect of structured dietary programs on cardiac and pulmonary function is unclear. Objective To determine lung and cardiac function in asymptomatic obese adults and to evaluate whether weight loss positively affects functional parameters. Methods We prospectively evaluated bodyplethysmographic and echocardiographic data in asymptomatic subjects undergoing a structured one-year weight reduction program. Results 74 subjects (32 male, 42 female; mean age 42±12 years) with an average BMI 42.5±7.9, body weight 123.7±24.9 kg were enrolled. Body weight correlated negatively with vital capacity (R = −0.42, p<0.001), FEV1 (R = −0.497, p<0.001) and positively with P 0.1 (R = 0.32, p = 0.02) and myocardial mass (R = 0.419, p = 0.002). After 4 months the study subjects had significantly reduced their body weight (−26.0±11.8 kg) and BMI (−8.9±3.8) associated with a significant improvement of lung function (absolute changes: vital capacity +5.5±7.5% pred., p<0.001; FEV1+9.8±8.3% pred., p<0.001, ITGV+16.4±16.0% pred., p<0.001, SR tot −17.4±41.5% pred., p<0.01). Moreover, P0.1/Pimax decreased to 47.7% (p<0.01) indicating a decreased respiratory load. The change of FEV1 correlated significantly with the change of body weight (R = −0.31, p = 0.03). Echocardiography demonstrated reduced myocardial wall thickness (−0.08±0.2 cm, p = 0.02) and improved left ventricular myocardial performance index (−0.16±0.35, p = 0.02). Mitral annular plane systolic excursion (+0.14, p = 0.03) and pulmonary outflow acceleration time (AT +26.65±41.3 ms, p = 0.001) increased. Conclusion Even in asymptomatic individuals obesity is associated with abnormalities in pulmonary and cardiac function and increased myocardial mass. All the abnormalities can be reversed by a weight reduction program. KW - pulmonary hypertension KW - echocardiography KW - morbid obesity KW - asthma KW - pulmonary function KW - weight loss KW - body weight KW - obesity Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-119239 VL - 9 IS - 9 ER - TY - JOUR A1 - Steppuhn, Henriette A1 - Langen, Ute A1 - Scheidt-Nave, Christa A1 - Keil, Thomas T1 - Major comorbid conditions in asthma and association with asthma-related hospitalizations and emergency department admissions in adults: results from the German national health telephone interview survey (GEDA) 2010 JF - BMC Pulmonary Medicine N2 - Background: It remains unclear to what extent asthma in adults is linked to allergic rhinitis (AR), gastroesophageal reflux disease (GERD), and acetylsalicylic acid exacerbated respiratory disease (AERD), and how these comorbidities may affect asthma outcomes in the general population. We therefore aimed to assess the prevalence of these major comorbidities among adults with asthma and examine their impact on asthma exacerbations requiring hospital care. Methods: A total of 22,050 adults 18 years and older were surveyed in the German National Health Telephone Interview Survey (GEDA) 2010 using a highly standardized computer-assisted interview technique. The study population comprised participants with self-reported physician-diagnosed asthma, among which the current (last 12 months) prevalence of AR and GERD-like symptoms (GERS), and life-time prevalence of AERD was estimated. Weighted bivariate analyses and logistic regression models were applied to assess the association of each comorbid condition with the asthma outcome (any self-reported asthma-related hospitalization and/or emergency department (ED) admission in the past year). Results: Out of 1,136 adults with asthma, 49.6% had GERS and 42.3% had AR within the past 12 months; 14.0% met the criteria of AERD, and 75.7% had at least one out of the three conditions. Overall, the prevalence of at least one exacerbation requiring emergency room or hospital admission within the past year was 9.0%. Exacerbation prevalence was higher among participants with comorbidities than among those without (9.8% vs. 8.2% for GERS; 11.2% vs. 7.6% for AR, and 22.2% vs. 7.0% for AERD), but only differences in association with AERD were statistically significant. A strong association between asthma exacerbation and AERD persisted in multivariable logistic regression analyses adjusting for sex, age group, level of body mass index, smoking status, educational attainment, and duration of asthma: odds ratio (OR) = 4.5, 95% confidence interval (CI) = 2.5-8.2. Conclusions: Data from this large nation-wide study provide evidence that GERS, AR and AERD are all common comorbidities among adults with asthma. Our data underline the public health and clinical impact of asthma with complicating AERD, contributing considerably to disease-specific hospitalization and/or ED admission in a defined asthma population, and emphasize the importance of its recognition in asthma care. KW - management KW - update KW - impact KW - risk KW - severity KW - prevalence KW - clinical-practice KW - aspirin sensitivity KW - allergic rhinitis KW - exacebrated respiratory-disease KW - gastroesophageal reflux disease KW - gastroesophageal reflux KW - hospitalization KW - national health survey KW - acetylsalicylic acid exacerbated respiratory disease KW - adult KW - aspirin-induced asthma KW - asthma Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-122121 VL - 13 IS - 46 ER - TY - THES A1 - Heller, Julia T1 - Rezidive bei Polyposis nasi nach operativer Therapie - ätiologische und prognostische Faktoren T1 - Recurrence rates of chronic polypoid sinusitis after surgery of the nasal sinuses - ätiologic and prognostic factors N2 - Kurzfassung in Deutsch: Trotz intensivster Forschung in den letzten Jahrzehnten, bleiben letztlich Äthiologie und Pathogenese der Polyposis nasi weitgehend ungeklärt. In der Behandlung fehlt daher ein kausaler Therapieansatz, die Therapie der Wahl besteht bislang in der chirurgischen Sanierung der betroffenen Nasennebenhöhlen. Die hohen Rezidivraten nach operativer Therapie stellen jedoch ein großes Problem dar. Die Polyposis nasi scheint eine hohe Assoziation zu zeigen mit den Begleiterkrankungen Asthma bronchiale, Aspirin- Intoleranz und Allergien. Um herauszufinden inwieweit diese den postoperativen Heilungsverlauf und die Rezidivhäufigkeit beeinflussen, wurden in dieser Arbeit 54 Patienten, die in den Jahren 1991 bis einschließlich 1993 an der Würzburger Universitätsklinik für Hals-, Nasen- und Ohrenkrankheiten aufgrund der Primärdiagnose Polyposis nasi operiert worden waren mittels der Daten aus den Krankenakten sowie eines speziell entwickelten Fragebogens über einen Zeitraum von mindestens zehn Jahren postoperativ nachbeobachtet. Neben den drei Begleiterkrankungen wurden die Risikofaktoren Nikotin- und Alkoholkonsum sowie die postoperative Verwendung topischer Kortikoide mit den Daten zu Geschlecht, Alter, postoperativen Beschwerden, der Rezidivhäufigkeit und der Gesamtzahl der Operationen pro Patient korreliert. Im untersuchten Patientengut war überwiegend das männliche Geschlecht betroffen, die Patienten zumeist mindestens dreißig Jahre alt. Innerhalb von zehn Jahren traten Rezidive bei 22% der Patienten auf. Etwa jeder 5. Polypenpatient (22%) litt unter Asthma bronchiale, 17% der Patienten unter einer Aspirin- Intoleranz. In unserer Auswertung zeigten beider Erkrankungen keinen negativen Einfluss auf die postoperative Rezidivwahrscheinlichkeit. Über die Hälfte der Patienten litten unter Allergien, bei diesen Personen traten Rezidive seltener auf, als bei den Nichtallergikern. Dieses Ergebniss unterstützt die aktuellen Thesen in der Literatur, dass Allergien keine negative Auswirkung auf die chronisch polypöse Sinusitis zeigen. Unsere Daten zur postoperativen Lokaltherapie können die Angaben aus der Literatur bestätigen, dass topisch verabreichte Kortikosteroide eine Ausheilung der Nasenpolypen begünstigen und Rezidive vermindern. Da bei einem Viertel unserer Patienten die Nasenpolypen familiär gehäuft auftraten, lässt sich eine genetische Komponente in der Pathogenese der Nasenpolypen vermuten. Unter den Alkoholkonsumenten fanden wir deutlich höhere Rezidivraten als unter den Patienten, die dies verneinten. In histologischen Arbeiten wurde bereits von einer Störung der mukoziliären Clearance der respiratorischen Schleimhaut durch Alkohol berichteten, möglicherweise könnte Alkoholgenuss über diesen Mechanismus eine Polypenbildung begünstigen. Nikotin hatte in unserer Arbeit keinen Einfluss auf die Polypenbildung. Aufgrund unserer Ergebnisse wird die Hypothese aufgestellt, dass Alkoholkonsum und hereditäre Faktoren eine relevante Rolle in der Pathogenese der Polyposis nasi spielen. Da eine familiäre Häufung, Alkohol- und Nikotinkonsum bislang in der Forschung nur unzureichend Beachtung fanden, sollte in prospektiven Studien ihre Auswirkung auf die Polypenbildung und insbesondere die Ergebnisse nach operativer Therapie ausführlich untersucht werden. Aufgrund unserer Ergebnisse wird die Hypothese aufgestellt, dass Alkoholkonsum und hereditäre Faktoren eine relevante Rolle in der Pathogenese der Polyposis nasi spielen. Da eine familiäre Häufung, Alkohol- und Nikotinkonsum bislang in der Forschung nur unzureichend Beachtung fanden, sollte in prospektiven Studien ihre Auswirkung auf die Polypenbildung und insbesondere die Ergebnisse nach operativer Therapie ausführlich untersucht werden. N2 - Englische Kurzfassung: In spite of intensive research in tue last decades, the ethiology and pathogenesis of chronic polypoid sinusitis remaines in the end widely unknown. Therefore a causal approach in the treatment is still missing, up to now the therapy of choice is the surgery of the affected nasal sinuses. However the high recurrence rates after surgical therapy show a big problem. A high association seems to be between the chronic polypoid sinusitis and accompanying illnesses like bronchial asthma ,aspirin intolerance and allergy. With the objective to detect which extent these influences have on the post surgical healing course and the recurrence rates, we observed in this study 54 patients who have been operated in the years 1991 up to and including 1993 in the university hospital for ear-, nose-, throat illnesses in Würzburg due to the primary diagnosis of nasal polyposis. The evaluation was done by the data from the patients files as well as by an especially developed questionnaire after a period of at least ten years post surgically. Beside the three accompanying illnesses the risk factors nicotine consumption and consumption of alcohol as well as the post surgical use of topical corticosteroids were correlated to tue datas of gender, age, post surgical symptoms, recurrence rates and the total number of operations per patient. In the examined patient's property the male gender was concerned predominantly, the patients were mostly at least thirty years old. Within ten years after surgery recurrence of nasal polyposis appeared in 22% of the patients. Approximately every 5-th patient with nasal polyposis (22%) suffered from bronchial asthma, 17% of the patients from aspirin intolerance. In our survey both illnesses showed no negative influence on the post surgical recurrence probability. About half of the patients were allergic subjekts, though recurrence of nasal polyposis in these persons occurs less frequently than in the non-allergic patients. This result supports the topical theses in the literature that allergies show no negative effect on chronic polypoid sinusitis. Our data to the post surgical local therapy with corticosteroids can confirm the information from the literature that topic given corticosteroids favour the healing of the nasal polyps and decrease recurrence rates. Because at a quarter of our patients the nasal polyps arose in at least one more family member, a genetic component can be supposed in the pathogenesis of the nasal polyposis. Among the fraction with the consumption of alcohol we clearly found higher recurrence rates than among the patients which denied this. In histologic works was already reported from a disturbance of the mucociliar clearance in the respiratory mucous membrane by alcohol. By this mechanism the use of alcohol could possibly favour the polyp growth. In our study nicotine had no influence on the polyp developement. On account of our results the hypothesis is put up that consumption of alcohol as well as hereditary factors play a major role in the pathogenesis of the chronic polypoid sinusitis. Because the cumulative familiar incidence of nasal polyps as well as the consumption of alcohol and nicotine found only insufficient attention up to now in the current literature, their effects should be examined in further prospective studies. KW - Nasennebenhöhlenentzündung KW - Bronchialasthma KW - Allergie KW - Rezidiv KW - Nasennebenhöhlenentzündung KW - Bronchialasthma KW - Allergie KW - Rezidiv KW - sinusitis KW - recurrence KW - asthma KW - allergy Y1 - 2008 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-27190 ER - TY - THES A1 - Gogishvili, Tea T1 - Immunotherapy of allergic disorders in a mouse model of allergic airway inflammation T1 - Immuntherapie allergischer Erkrankungen in einem Mausmodell für allergische Atemwegsentzündungen N2 - Allergische Erkrankungen sind Störungen, bei denen es zu Immunfehlregulationen kommt und die bei empfänglichen Individuen zur Entstehung von Allergen spezifischen T-Helfer 2 (TH2) Immunantworten führen. Neuere Untersuchungen deuten darauf hin, dass die für Soforttypallergien charakteristischen TH2 Immunantworten sowohl durch natürlich vorkommende CD4+CD25+ regulatorische T Zellen (Treg) als auch durch Antigen induzierte IL-10-secreting CD4+ regulatorische T Zellen kontrolliert werden können. Weiterhin gibt es Hinweise, dass eine erfolgreiche Allergen spezifische Immuntherapie über die Induktion von IL-10 sezernierenden T reg Zellen vermittelt wird. In ersten Teil der Arbeit wird die Effizienz einer Allergen spezifischen Immuntherapie (SIT) in einem Mausmodel für allergische Atemwegsentzündung demonstriert. Als Allergieparameter wurden Allergen spezifisches IgE im Serum, verschiedene TH1 und TH2 Cytokine in der brochoalveolären Lavage Flüssigkeit und nach in vitro Restimulation in Milzzellen untersucht. Weiterhin wurden Histologien von Lungengewebe angefertigt, um das eosinophile Entzündungsinfiltrat und die Asthma typische Becherzellmetaplasie darzustellen. Weiterhin wurden durch FACS Untersuchungen regulatorische T Zellen nachgewiesen. Es konnte gezeigt werden, dass im Mausmodell die intranasale Applikationsform der SIT die allergischen Symptome effizienter bekämpfen konnte, als die beim Menschen etablierte subcutane Applikationsform. Um Mechanismen zu definieren die eine SIT effizienter machen könnten wurde ein IL-4/IL13 Inhibitor (QY) als Adjuvans für die SIT benutzt. Für den Zytokininhibitor konnte gezeigt werden, dass bei einer Applikation während der allergischen Sensibilisierung die Entstehung einer TH2 Immunantwort und die Ausbildung allergischer Symptome verhindert wird. Die Applikation des Inhibitors zusammen mit einer SIT zeigte jedoch keine zusätzlichen signifikanten antiallergischen Effekte im Vergleich zur Durchführung der SIT als Monotherapie. Diese Ergebnisse deuten möglicherweise daraufhin , dass der bekannte Wechsel einer TH2 Immunantwort zu einer TH1 Antwort während der SIT nicht der Schlüsselmechanismus zu einer erfolgreichen Behandlung ist. Insbesondere weil unter der SIT auch in unserem Mausmodell die Induktion von IL-10 sezernierenden CD4+ T regulatorischen Zellen mit der Suppression der allergischen Atemwegsentzüdnung vergesellschaftet waren, so dass möglicherwiese diese Zellen für den Therapieerfolg relevant sind . Um die Rolle regulatorischer T Zellen im Allergiemodell näher zu beleuchten wurde im 2. Teil der Arbeit ein monoklonaler superagonistischer anti-CD28 Antikörper benutzt, von dem bekannt ist dass T regulatorische Zellen in vivo induziert werden. Es konnte gezeigt werden, dass die Applikation des Antikörpers während der allergischen Sensibilisierung die Etablierung einer TH2 Immunantwort verstärkte. Im Gegensatz dazu wurden durch die therapeutische Applikation des anti CD28 Antikörpers in einer etablierten Allergie, IL-10 sezernierende CD4+CD25+ T Zellen induziert, welches mit einer Abschwächung der gemessenen Allergieparameter einherging. N2 - Allergic disease are inflammatory disorders in which aberrant immune regulation occurs, and susceptible individuals mount allergen specific T helper 2 (Th2) responses, which drives disease pathology. Recent studies indicate that Th2 responses that are characteristic of allergic manifestations can be regulated by both naturally occurring CD4+CD25+ regulatory (Treg) cells and antigen-driven IL-10-secreting CD4+ regulatory T cells. Evidence is also emerging that successful Allergen specific immunotherapy (SIT) might work through the induction of IL-10-secreting regulatory T cells. In the first part of this work, I demonstrated the efficiency of allergen specific immunotherapy in the mouse model for allergic airway inflammation. Here I could show that intranasal administration of SIT abrogates allergic symptoms more efficiently, than the subcutaneous treatment. Furthermore, an IL-4/IL-13 (QY) inhibitor was used as an adjuvant for SIT, which has been demonstrated to have an anti-allergic potential, when administered prophylactically during allergic sensitization. However, the combination therapy with SIT and the inhibitory molecule QY did not show any significant enhancement in regards to all measured allergic parameters, when compared to monotherapy with SIT. These results provide the evidence, that shift from Th2 to Th1 cytokine profile might not be a key event in successful SIT. Subsequently, the investigation of immune mechanisms under successful SIT demonstrate that the increase of IL-10 secreting CD4+ T regulatory cells is associated with the suppression of airway inflammation in our mouse system, suggesting that these T cell subsets might be involved in the regulatory mechanisms of allergic disorders. In agreement with these findings is the second part of this work, where superagonistic a-CD28 mAb´s were used for the expansion of T regulatory cell subsets in our murine model for allergic airway inflammation. Here I could show, that the application of a-CD28 mAb during allergic sensitization, resulted in the establishment of a Th2 state, rather than a stimulation of a Treg cell population, supporting the Th2 promoting role of a-CD28 mAb together with TCR engagement. However, interesting findings were obtained by application of the superagonistic a-CD28 mAb in the challenge phase in established allergy. Conversely to the previous experiment, therapeutic administration of a-CD28 mAb lead to the generation of IL-10 secreting CD4+CD25+ T cell population in line with the induction of anti-allergic effects. Taking together the results of this study argue for the anti-inflammatory properties of T regulatory cells in allergic disease and highlights importance of these T cell subsets in the suppression of Th2 cell-driven response to allergen. Moreover, these observations suggest that the induction of IL-10 in vivo by T regulatory cells may represent a novel treatment strategy for allergic disorders. KW - Bronchialasthma KW - Allergie KW - Maus KW - Immuntherapie KW - Allergy KW - asthma KW - IL-4/IL-13 inhibitor KW - Mouse model of allergic airway inflammation Y1 - 2006 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-19304 ER - TY - THES A1 - Thern, Julia T1 - Pharmazeutische Betreuung von Kindern mit Asthma bronchiale in ambulanter Therapie T1 - Pharmaceutical care for children with asthma in ambulatory care N2 - Bisherige Projekte zur Pharmazeutischen Betreuung haben sich auf Erwachsene konzentriert. Daraus ergab sich die Fragestellung, inwiefern Kinder und Jugendliche von einer Pharmazeutischen Betreuung profitieren. In der vorliegenden Arbeit wurde diese Frage an der Modellkrankheit Asthma bronchiale untersucht. Zur Pharmazeutischen Betreuung von erwachsenen Asthmatikern lagen bereits einige Studien vor. Kinder wurden jedoch noch in keiner der Untersuchungen, die in Europa durchgeführt wurden, eingeschlossen. Folglich eröffnete sich die Möglichkeit, erstmals einen Beitrag zur Pharmazeutischen Betreuung von asthmakranken Kindern und Jugendlichen im Rahmen von öffentlichen Apotheken in Deutschland zu liefern. Der Effekt der Pharmazeutischen Betreuung von Kindern und Jugendlichen mit Asthma bronchiale wurde im Rahmen einer Studie untersucht, die in Kooperation mit Offizinapothekern durchgeführt wurde. Hauptzielkriterium der Studie war die gesundheitsbezogene Lebensqualität der asthmakranken Kinder und Jugendlichen sowie deren Eltern. Des Weiteren wurden klinische, ökonomische und intermediäre Zielkriterien erfasst. Die Pharmazeutische Betreuung erfolgte gemäß eines für die Untersuchung erarbeiteten, modifizierten TOM-Schemas. Die Treffen zwischen Apotheker und Patient fanden alle sechs bis acht Wochen über einen Zeitraum von einem Jahr statt. Es konnte eine repräsentative Patientenpopulation von 28 Kindern und Jugendlichen mit Asthma bronchiale rekrutiert werden. Da keine Kontrollgruppe erhoben werden konnte, wurde die Untersuchung als Prä-Post Studie ausgewertet. Die angestrebte Patientenzahl von 35 Patienten wurde allerdings nicht erreicht, weshalb die Untersuchung als Pilotstudie angesehen werden muss. Dennoch konnte ein statistisch und klinisch signifikanter Effekt der Pharmazeutischen Betreuung auf die gesundheitsbezogene Lebensqualität der Eltern gezeigt werden: Der Gesamtwert des PACQLQ verbesserte sich von einem Median (Interquartil) von 5,1 (3,9–6,3) an der Basislinie auf 6,2 (5,1-6,8) (p=0,016) nach einem Jahr Pharmazeutischer Betreuung. Der für diesen Fragebogen definierte Schwellenwert für eine klinisch signifikante Verbesserung wurde von acht der vierzehn Eltern erreicht oder überschritten. Für die gesundheitsbezogene Lebensqualität der asthmakranken Kinder und Jugendlichen, die mit einem generischen Fragebogen erfasst wurde, wurde keine statistisch signifikante Entwicklung beobachtet. Die Asthmakontrolle befand sich mit einem medianen Wert von 0,7 Punkten per ACQ schon an der Basislinie auf einem für Kinder und Jugendliche mit Asthma bronchiale untypisch hohem Niveau. Entsprechend konnte für diesen Endpunkt kein statistisch signifikanter Effekt der Pharmazeutischen Betreuung festgestellt werden. Bei der vorliegenden Studie handelt es sich um die erste Erhebung zur Pharmazeutischen Betreuung von Asthmatikern, in der die gesundheitsbezogene Lebensqualität der Eltern der asthmakranken Kinder bzw. Jugendlichen erfasst wurde. Dagegen sollte für die Messung der gesundheitsbezogenen Lebensqualität der asthmakranken Kinder und Jugendlichen auf einen krankheitsspezifischen Fragebogen zurückgegriffen werden, da diese veränderungssensitiver sind als generische Fragebögen. Für Studien zur Pharmazeutischen Betreuung von Asthmatikern ist aufgrund der Ergebnisse der vorliegenden Studie zu überlegen, ob anhand des seit kurzem vorliegenden Schwellenwertes für den ACQ schwerpunktmäßig Patienten mit nicht ausreichend kontrolliertem Asthma rekrutiert werden sollten. Ein weiteres Ziel der Arbeit bestand darin, den potentiellen Stellenwert des 8-iso Prostaglandin F2 alpha, das als Marker für die Bestimmung des Entzündungsgrades diskutiert wird, für die Therapieoptimierung im Rahmen von Studien zur Pharmazeutischen Betreuung von asthmakranken Kindern und Jugendlichen zu evaluieren. Voraussetzung für die Verwendung eines Markers im Rahmen von Studien bzw. von Routinediagnostik und –monitoring bei Kindern ist, ein möglichst nicht-invasiv zugängliches Spezimen zu finden, in dem der Marker zuverlässig bestimmt werden kann. Hierfür wurden im Rahmen einer Querschnittsstudie erstmals von gesunden Kindern sowie von Kindern mit Asthma bzw. Cystischer Fibrose Atemkondensat, Speichel, Serum und Urin gesammelt. Die Konzentrationen des 8-iso Prostaglandin F2 alpha, die bestimmt wurden, waren im Bereich des Detektionslimits des verwendeten ELISA und es stellte sich heraus, dass die Ergebnisse nicht reproduzierbar waren. Zudem war im Rahmen der Pilotstudie keine Korrelation zwischen den Konzentrationen in den verschiedenen Spezimen nachweisbar und es bestand kein offensichtlicher Unterschied zwischen den Konzentrationen bei gesunden und erkrankten Kindern. Folglich erscheint die Erfassung des 8-iso Prostaglandin F2 alpha für Studien zur Pharmazeutischen Betreuung von asthmakranken Kindern und Jugendlichen zum jetzigen Zeitpunkt weniger geeignet. Als Alternative ist die Messung des exhalierten NO in Erwägung zu ziehen. N2 - Projects on Pharmaceutical Care have focused on adults. Thus, the impact of Pharmaceutical Care on children remains to be determined. In the present thesis, asthma was chosen as model illness, as it is the most prevalent chronic disease in childhood in Europe and North America. The effect of Pharmaceutical Care for adults with asthma has already been shown to be positive in several trials. Children, however, had not been included in any of the trials that had been carried out in Europe. Accordingly, there was a need for a contribution to Pharmaceutical Care of children and adolescents with asthma in outpatient care in Germany. The effect of Pharmaceutical Care for children and adolescents with asthma was studied in the scope of a trial that was carried out in cooperation with community pharmacists. Primary outcome of the trial was health-related quality of life of the children as well as of their parents. Besides, clinical, economic and intermediate outcomes were assessed. The Pharmaceutical Care was structured according to a modified therapeutic outcomes monitoring (TOM) model. Meetings of pharmacists and patients within the scope of Pharmaceutical Care took place every six to eight weeks over a period of one year. A representative patient population (n = 28) was recruited. As no control group could be enlisted, data were analyzed pre-post. The required number of 35 patients according to the power analysis for pre-post design was not met, so that the present trial has to be regarded as a pilot study. Despite that, a statistical and clinical significance of Pharmaceutical Care on quality of life of caregivers could be shown: The total score of PACQLQ improved from a median (interquartile range) of 5,1 (3,9 – 6,3) at baseline to 6,2 (5,1 – 6,8) after one year of Pharmaceutical Care (p = 0,016). Eight out of fourteen parents met or exceeded the threshold for minimal important improvement that had been established for that questionnaire. For health-related quality of life of children and adolescents, which was assessed with a generic questionnaire, no statistically significant difference was observed. With a median of 0.7 points on ACQ, the level of asthma control at baseline was atypically high for an asthma population. No further improvement of the level of asthma control could be achieved. The present study is the first trial on Pharmaceutical Care that assessed health-related quality of life of caregivers as an outcome. It is highly advisable that further studies on Pharmaceutical Care for children and adolescents stick to this outcome. Based on the results of this work, disease-specific questionnaires should be preferred to generic questionnaires for assessing quality of life of parents as well as of children and adolescents in studies on Pharmaceutical Care. Recently, a threshold for inadequately controlled asthma was established for the asthma control questionnaire that was utilized in the present trial. This threshold may help to focus on patients with inadequately controlled asthma in further trials on Pharmaceutical Care for asthma patients. An additional goal of the present work was to evaluate the utility of 8-iso prostaglandin F2 alpha, a potential marker of inflammation, for optimizing therapy in the scope of trials with Pharmaceutical Care for children and adolescents with asthma. In order to be able to employ a marker in the framework of a study or in the scope of routine diagnosis and monitoring, it is necessary to establish a valid measurement of the marker in a preferentially non-invasively obtained specimen. Accordingly, a cross-sectional pilot study was realized, in the scope of which the specimen breath condensate, saliva, serum and urine were collected from healthy children as well as from children with asthma or cystic fibrosis. Levels of 8-iso Prostaglandin F2 alpha, in breath condensate were close to the limit of detection of the EIA and turned out to be non-reproducible, and no correlation between 8-iso Prostaglandin F2 alpha levels in different specimen could be proven. Additionally, there was no obvious difference between levels measured in healthy children and children with inflammatory disease. At present, it is less advisable to employ 8-iso prostaglandin F2 alpha in long-term trials. Alternatively, exhaled NO may be considered as a guide to optimize therapy of asthma. KW - Gesundheitsberatung KW - Kind KW - Jugend KW - Bronchialasthma KW - Ambulante Behandlung KW - Pharmazeutische Betreuung KW - Kinder KW - Jugendliche KW - Asthma KW - pharmaceutical care KW - children KW - adolescents KW - asthma Y1 - 2006 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-21726 ER - TY - THES A1 - Hohaus, Andreas T1 - Intranasale versus intraperitoneale Applikation eines IL-4/IL-13-Antagonisten am murinen Asthmamodell T1 - Intranasal versus intraperitoneal application of an IL-4/IL-13-Antagonist in a mouse model for allergic asthma N2 - Asthma bronchiale ist eine chronische, entzündliche Erkrankung der Atemwege, charakterisiert durch bronchiale Hyperreaktivität und variable Atemwegs-obstruktion. Die Interleukine 4 und 13 sind entscheidend an den pathophysiologischen Vor-gängen beim allergischen Asthma bronchiale beteiligt. IL-4 gilt als spezifisches Zytokin für die Differenzierung von nativen T-Helferzellen zu TH2-Zellen. Gemeinsam mit IL-13 führt es zum Immunglobulinklassenswitch der B-Zellen. Ziel dieser Arbeit war es, in einem etablierten Mausmodell für allergisches Asthma verschiedene Applikationsformen des IL-4/IL-13-Antagonisten QY in ihrer Wirkung während der allergischen Sensibilisierung zu vergleichen. Dazu wurden Balb/c-Mäuse über einen Zeitraum von 6 Wochen wöchentlich mit 50µg OVA sensibilisiert. In zwei Therapiegruppen wurden zu jeder Sensibilisierung jeweils 10µg QY intranasal bzw. intraperitoneal verabreicht. Wöchentlich wurde das Serum der Versuchstiere auf allergenspezifische Antikörper untersucht. Nach sechs Wochen wurde eine bronchoalveoläre Lavage durchgeführt, um den Zytokingehalt und die allergeninduzierte Eosinophilie zu bestimmen. Sowohl die intranasale als auch die intraperitoneale Gabe von QY resultierte in einer signifikanten Abnahme allergenspezifischer IgE-Antikörper im Serum der Versuchstiere. Ebenso konnten die Zahl der inflammativen eosinophilen Granu-lozyten und der IL-5-Spiegel in der BAL signifikant gesenkt werden. Zusammenfassend wurde gezeigt, dass die prophylaktische Behandlung mit dem IL-4/IL-13-Antagonisten QY zuverlässig eine allergische Sensibilisierung der Versuchstiere verhindert. Die intranasale und intraperitoneale Applikation unterscheiden sich hierbei praktisch nicht in ihrer Wirksamkeit. N2 - IL-4 and IL-13 are considered as key regulators for the development of allergic asthma. This study compares intranasal versus intraperitoneal application of an IL-4/IL-13-Antagonist in a murine model for allergic asthma. In summary there is no significant difference between intranasal or intraperitoneal application. KW - Allergie KW - Asthma KW - Interleukin 4 KW - Interleukin 13 KW - Interleukinantagonist QY KW - allergy KW - asthma KW - interleukin 4 KW - interleukin 13 KW - interleukin antagonist Y1 - 2006 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-21533 ER - TY - THES A1 - Meinhardt, Julia T1 - Asthmatherapie im Mausmodell : Allergen spezifische Immuntherapie in Kombination mit einer Immunmodulation durch einen IL-4/IL-13 Antagonisten T1 - Inhibition of IL-4/IL-13 does not enhance efficacy of allergen immunotherapy in murine allergic airway inflammation N2 - Die allergenspezifische Immuntherapie ist derzeit die einzige kausale Behandlungsmöglichkeit von Soforttypallergien. Trotzdem ist weiterhin unklar, welcher Parameter für den Behandlungserfolg einer spezifischen Immuntherapie (SIT) pathogenetisch bedeutsam ist. Zusammenfassend zeigte sich, dass für eine pulmonale Soforttypallergie in einem Asthmamodell in der Maus erfolgreich eine SIT etabliert werden konnte, die in einer Reihe von Parametern mit einer SIT im Menschen vergleichbar ist. Dies ist das erste Modell einer pulmonalen Soforttypallergie in der Maus, an dem neben den Wirkprinzipien der SIT auch neue Therapiestrategien untersucht werden können. Eine Behandlung mit SIT in Kombination mit einem immunmodulatorisch wirksamen IL-4/IL-13 Antagonisten zeigte jedoch keinen zusätzlichen therapeutischen Nutzen, welches die scheinbar untergeordnete Rolle der Zytokine IL-4 und IL-13 bei etablierten Allergien untermauert. N2 - Successful allergen specific immunotherapy (SIT) is associated with a reduced Th2 cytokine produktion and the induction of IL-10 producing regulatory T-cells. In order to improve treatment efficacy we investigateed the impact of an IL-4/IL-13 inhibitor during SIT.. BALB/c mice were sensitized intranasally with Ovalbumin for 4 weeks. Subsequently, they were subjected to intranasal SIT, where Ovalbumin was supplied with increasing doses from 1µg - 1mg over 3 weeks together or without an IL-4/IL-13 inhibitor. Bronchoalveolar lavages (BAL) were performed and checked for airway eosinophilia. Cytokines were detected in BAL luids and in mediastinal lymphnodes suspensions. Furthermore OVA specific antibodies were measured. Intranasal OVA sensitization resulted in persisting IgE synthesis and an eosinophil rich airway inflammation. This was combined with increased IL-4 and IL-5 levels. Intranasal SIT could efficiently reverse the allergic phenotype by reducing OVA specific IgE synthesis and airway eosinophilia singnificantly in comparison to untreated OVA sensitized animals. This was associated with decreased IL-4 and IL-5 levels and an increased IFN-y and IL-10 production. Mice treated with the IL-4/IL-13 inhibitor during SIT, however, did not show any significant differences in all measured parameters, when compared to mice treated with SIT alone. The use of an IL-4/IL-13 inhibitor as adjuvant for SIT did not enhance anti allergic effects. Thus, the observed shift from Th2 to Th1 cytokines by allergen specific immunotherapy may not be the key event in successful SIT rather than other factors such as IL-10 producing regulatory T-cells. KW - Asthma KW - Allergie KW - Mausmodell KW - Immunmodulation KW - SIT KW - allergy KW - asthma KW - mouse model KW - cytokine inhibitor KW - SIT Y1 - 2005 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-20789 ER - TY - THES A1 - Noskov, Andrey T1 - Structural and functional studies of the Interleukin-5 receptor system T1 - Struktur und Funktionsanalyse des Interleukin-5 Rezeptor Systems N2 - The aim of current work was contribution to the long-term ongoing project on developing human IL-5 agonists/antagonists that intervene with or inhibit IL-5 numerous functions in cell culture and/or in animal disease models. To facilitate design of an IL-5 antagonist variant or low-molecular weight mimetics only capable of binding to the specific receptor alpha chain, but would lack the ability to attract the receptor common β-chain and thus initiate receptor complex activation it is necessary to gain the information on minimal structural and functional epitopes. Such a strategy was successfully adopted in our group on example of Interleukin 4. To precisely localize minimal structural epitope it is essential to have structure of the ligand in its bound form and especially informative would be structure of complex of the ligand and its specific receptor alpha chain. For this purpose large quantities (tens of milligrams), retaining full biological activity IL-5 and extracellular domain of IL-5 specific receptor α-chain were expressed in a bacterial expression system (E.coli). After successful refolding proteins were purified to 95-99% Stable and soluble receptor:ligand complex was prepared. Each established purification and refolding procedures were subjected to optimization targeting maximal yields and purity. Produced receptor:ligand complex was applied to crystallization experiments. Microcrystals were initially obtained with a flexible sparse matrix screening methodology. Crystal quality was subsequently improved by fine-tuning of the crystallization conditions. At this stage crystals of about 800x150x30µm in size can be obtained. They possess desirable visible characteristics of crystals including optical clarity, smooth facecs and sharp edges. Crystals rotate plane polarized light reflecting their well internal organization. Unfortunately relative slimness and sometimes cluster nature of the produced crystals complicates acquisition of high-resolution dataset and resolution of the structure. With some of obtained crystals diffraction to a resolution up to 4Å was observed. N2 - Das Ziel der vorliegenden Arbeit war, einen Beitrag zum langfristigen Projekt der Entwicklung humaner IL-5 Agonisten/Antagonisten zu leisten, die im tierischen Krankheitsmodell oder in der Zellkultur in die verschiedenen Funktionen des IL-5 eingreifen oder sie inhibieren. Um das Design eines IL-5 Antagonisten oder einer Mimetika mit geringem Molekulargewicht zu vereinfachen, die nur an die spezifische α-Rezeptorkette bindet, nicht jedoch an die gemeinsame β-Kette und somit die Aktivierung des Rezeptorkomplexes initiieren, ist es notwendig, Informationen über minimale strukturelle und funktionelle Epitope zu erhalten. Diese Strategie wurde in unserer Arbeitsgruppe erfolgreich am Beispiel von Interleukin 4 angewandt. Um minimale strukturelle Epitope präzise zu lokalisieren, ist es es notwendig, die Struktur des Liganden in seiner gebundenen Form zu kennen. Besonders informativ wäre die Struktur des Komplexes aus Ligand und spezifischer Rezeptor α-Kette. Zu diesem Zweck wurden große Mengen (einige 10 mg) IL-5 mit vollständiger biologischer Funktionaltät und der extrazellulären Domäne der IL-5 spezifischen Rezeptor α-Kette in einem bakteriellen Expressionssystem (E. coli) exprimiert. Nach erfolgreicher Faltung wurden die Proteine zu einer Reinheit von 95-99% aufgereinigt und ein stabiler und löslicher Rezeptor:Ligandenkomplex erzeugt. Die erfolgreiche Aufreinigung und Faltungsprozedur wurde bezüglich maximaler Menge und Reinheit optimiert. Mit den produzierten Rezeptor:Ligandenkomplexen wurden Kristallisationsexperimente durchgeführt. Zunächst wurden mit einer flexiblen Sparse-Matrix Screening Methode Mikrokristalle erzeugt. Die Qualität der Kristalle wurde dann durch Feinabstimmung der Kristallisationsbedingungen verbessert. In diesem Stadium wurden Kristalle von etwa 800x150x30µm Größe erzeugt, die die gewünschten optischen Eigenschaften wie glatte Oberflächen und scharfe Kanten besaßen. Die Kristalle drehen die Polarisationsebene linear polarisierten Lichtes, was ihren gleichmäßigen Aufbau zeigt. Leider verkompliziert die geringe Dicke und das teilweise Auftreten von Clustern die Aufnahme hochauflösender Daten und damit Auflösung der Struktur. Mit einigen der erhaltenen Kristalle wurde eine Beugung bis zur Auflösung von 4 Å beobachtet. KW - Interleukin 5 KW - Rezeptor KW - Struktur KW - Interleukin-5 KW - Rezeptor KW - Asthma KW - X-ray KW - Protein-Kristallisierung KW - Interleukin-5 KW - receptor KW - asthma KW - X-ray KW - protein crystallization Y1 - 2003 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-8195 ER - TY - THES A1 - Kneuer, Janine T1 - Therapie der obstruktiven Atemwegserkrankungen nach Stufenplan: Empfehlung und Realität T1 - Therapy of obstructive pulmonary disease according to the therapy plan: recommendation and reality N2 - Die vorliegende Studie beruht auf Daten von 254 Patienten, die im Zeitraum von 1990 bis 1998 stationär in die MedizinischeKlinik des Klinikums der Ludwig- Maximilians- UniversitätWürzburg eingewiesen worden sind. Die Patientengruppe bestand aus 120 Patienten mit der Entlassungsdiagnose Asthma und aus 134 Patienten mit der Entlassungsdiagnose COPD. Mittels Fragebögen wurden die Krankengeschichte sowie das aktuelle Krankheitsgeschehen erfaßt und statistisch ausgewertet. Das Hauptaugenmerk galt hierbei den verordneten Medikamenten. Als Basis diente der 1993 in einem Konsenspapier veröffentlichte Stufenplan der deutschen Atemwegsliga sowie der 1998 überarbeitete und auf die COPD Therapie erweiterte Stufenplan. In Bezug auf die Asthmatherapie stellte sich heraus, daß 55 % der Asthmapatienten zum Zeitpunkt ihrer stationären Aufnahme entsprechend des seit 1993 gültigen Stufenplanes behandelt worden sind. 32 % erhielten eine unzureichende und 10 % eine unsinnige bzw. unnötige Wirkstoffkombination. Mittels statistischer Methoden konnte eindeutig nachgewiesen werden, daß Patienten, die entsprechend des Stufenplanes behandelt worden sind, ein signifikant geringeres Risiko haben einen Status asthmaticus zu bekommen als Patienten ohne diese Therapie. Darüber hinaus hatten diese Patienten ein signifikant geringeres Rückfallrisiko. N2 - This study based on 254 in-patients, who were admitted between 1990 and 1998 into the Ludwig-Maximilian-University Hospital of Wuerzburg. This group was composed of 120 patients with the discharged diagnosis: asthma and 134 patients with the discharged diagnosis COPD. It was made an audit about the medical history and about the acute disease itself. This has been evaluated statistically. The main interest was aimed at the prescribed remedies compared with the therapy plan published in 1993 and revised in 1998 corresponding to the respective asthma stage. The result of this study was that 55% of the asthma patients were treated as demanded by the therapy plan of 1993. And 32% received an insufficient and 10% a useless medication. By means of statistical methods it was clearly proved that patients who were treate according to the therapy plan have a lower risk of being hit by a status asthmaticus than patients who were treated without this medication. And above all they have a lower recurrence risk. KW - Asthma KW - COPD KW - Stufenplan KW - Medikamente KW - asthma KW - COPD KW - therapy plan KW - drugs Y1 - 2002 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-5882 ER -