Conception and pilot testing of a self-management health application for patients with pollen-related allergic rhinitis and allergic asthma-the APOLLO app.

It has been shown that pollen information services are an important self-management tool for patients with pollen-related allergic rhinitis (AR) and allergic asthma (AA). This study aimed to design an online application for patients with AR and AA, which supports patients to better manage their disease as well as to evaluate the app and present the first results of the pilot study. The pollen data were obtained from the electronic pollen information network of Bavaria, Germany. Participants were asked to fill in their allergy-related complaints in the app over a 60-day period. Subsequently, the app was evaluated. Indices and diagrams visualized the participants' individual complaints as well as the daily pollen concentration in the air. In order to motivate participants to complete the app on a daily basis, we used elements of gamification. Two thirds of the participants (N = 46) reported feeling better informed about pollen counts and their allergy when using the app. The app's simple and comprehensible design was rated positively. More than 80% of the participants would recommend the app to their family and friends. The app can be a tool for patients with AR and AA to better understand their disease.

[Atypical celiac disease in a patient with type 1 diabetes mellitus and Hashimoto's thyreoiditis]. / Atypische Sprue bei einem Patienten mit Diabetes mellitus Typ 1 und Hashimoto-Thyreoiditis.

HISTORY AND ADMISSION FINDINGS: A 49-year-old man presented with a four-week history of fatigue and physical weakness. He was of slender build (BMI 19,5 kg/m (2)) and pale. He also had vitiligo. Diabetes mellitus type 1 and Hashimoto thyreoiditis had been previously diagnosed. INVESTIGATIONS: Laboratory tests revealed iron deficiency anemia with depleted iron reserves (hemoglobin 5,9 g/dl; normal range 14,0 - 18,0). Vitamin B (12) and folic acid were also low. A probable cause was thought to be malabsorption. Antibodies against endomysium and tissue transglutaminase were elevated. Esophagogastroduodenoscopy and videocapsule endoscopy showed villous atrophy in the duodenum and jejunum. Histomorphological findings were compatible with celiac disease (Marsh stage 3a). Osteodensitometry showed significantly lowered bone density. DIAGNOSIS, TREATMENT AND COURSE: These investigations indicated atypical celiac disease with malabsorption, anemia and osteoporosis. The patient received nutritional counseling and was put on a gluten-free diet. Supplementary iron, folic acid and vitamin B (12) were prescribed. A bloodtransfusion was given for the symptomatic anemia. The osteoporosis was treated with calcium and vitamin D3. A follow-up examination after four months revealed complete remission of the abnormal clinical and laboratory findings with partial remission of endoscopic and histologic changes (reduced to Marsh stage 2). CONCLUSION: Because of the lack of gastrointestinal symptoms, the diagnosis of atypical celiac disease is often made only at an advanced stage and advanced age. The disease is often associated with other autoimmune disorders.