Clinical relevance is associated with allergen-specific wheal size in skin prick testing.

BACKGROUND: Within a large prospective study, the Global Asthma and Allergy European Network (GA(2) LEN) has collected skin prick test (SPT) data throughout Europe to make recommendations for SPT in clinical settings. OBJECTIVE: To improve clinical interpretation of SPT results for inhalant allergens by providing quantitative decision points. METHODS: The GA(2) LEN SPT study with 3068 valid data sets was used to investigate the relationship between SPT results and patient-reported clinical relevance for each of the 18 inhalant allergens as well as SPT wheal size and physician-diagnosed allergy (rhinitis, asthma, atopic dermatitis, food allergy). The effects of age, gender, and geographical area on SPT results were assessed. For each allergen, the wheal size in mm with an 80% positive predictive value (PPV) for being clinically relevant was calculated. RESULTS: Depending on the allergen, from 40% (blatella) to 87-89% (grass, mites) of the positive SPT reactions (wheal size ≥ 3 mm) were associated with patient-reported clinical symptoms when exposed to the respective allergen. The risk of allergic symptoms increased significantly with larger wheal sizes for 17 of the 18 allergens tested. Children with positive SPT reactions had a smaller risk of sensitizations being clinically relevant compared with adults. The 80% PPV varied from 3 to 10 mm depending on the allergen. CONCLUSION: These 'reading keys' for 18 inhalant allergens can help interpret SPT results with respect to their clinical significance. A SPT form with the standard allergens including mm decision points for each allergen is offered for clinical use.

GA(2)LEN skin test study I: GA(2)LEN harmonization of skin prick testing: novel sensitization patterns for inhalant allergens in Europe.

BACKGROUND: Skin prick testing is the standard for diagnosing IgE-mediated allergies. However, different allergen extracts and different testing procedures have been applied by European allergy centres. Thus, it has been difficult to compare results from different centres or studies across Europe. It was, therefore, crucial to standardize and harmonize procedures in allergy diagnosis and treatment within Europe. AIMS: The Global Asthma and Allergy European Network (GA(2)LEN), with partners and collaborating centres across Europe, was in a unique position to take on this task. The current study is the first approach to implement a standardized procedure for skin prick testing in allergies against inhalant allergens with a standardized pan-European allergen panel. METHODS: The study population consisted of patients who were referred to one of the 17 participating centres in 14 European countries (n = 3034, median age = 33 years). Skin prick testing and evaluation was performed with the same 18 allergens in a standardized procedure across all centres. RESULTS: The study clearly shows that many allergens previously regarded as untypical for some regions in Europe have been underestimated. This could partly be related to changes in mobility of patients, vegetation or climate in Europe. CONCLUSION: The results of this large pan-European study demonstrate for the first time sensitization patterns for different inhalant allergens in patients across Europe. The standardized skin prick test with the standardized allergen battery should be recommended for clinical use and research. Further EU-wide monitoring of sensitization patterns is urgently needed.

GA(2)LEN skin test study II: clinical relevance of inhalant allergen sensitizations in Europe.

BACKGROUND: Skin prick testing is the standard for diagnosing IgE-mediated allergies. A positive skin prick reaction, however, does not always correlate with clinical symptoms. A large database from a Global Asthma and Allergy European Network (GA(2)LEN) study with data on clinical relevance was used to determine the clinical relevance of sensitizations against the 18 most frequent inhalant allergens in Europe. The study population consisted of patients referred to one of the 17 allergy centres in 14 European countries (n = 3034, median age = 33 years). The aim of the study was to assess the clinical relevance of positive skin prick test reactions against inhalant allergens considering the predominating type of symptoms in a pan-European population of patients presenting with suspected allergic disease. METHODS: Clinical relevance of skin prick tests was recorded with regard to patient history and optional additional tests. A putative correlation between sensitization and allergic disease was assessed using logistic regression analysis. RESULTS: While an overall rate of >or=60% clinically relevant sensitizations was observed in all countries, a differential distribution of clinically relevant sensitizations was demonstrated depending on type of allergen and country where the prick test was performed. Furthermore, a significant correlation between the presence of allergic disease and the number of sensitizations was demonstrated. CONCLUSION: This study strongly emphasizes the importance of evaluating the clinical relevance of positive skin prick tests and calls for further studies, which may, ultimately, help increase the positive predictive value of allergy testing.

GA2LEN skin test study III: minimum battery of test inhalent allergens needed in epidemiological studies in patients.

BACKGROUND: The number of allergens to be tested in order to identify sensitized patients is important in order to have the most cost-effective approach in epidemiological studies. OBJECTIVE: To define the minimal number and the type of skin prick test (SPT) allergens required to identify a patient as sensitized using results of the new Pan-European GA(2)LEN skin prick test study. METHOD: In a large Pan-European multicenter (17 centers in 14 countries) patient based study, a standardized panel of 18 allergens has been prick tested using a standardized procedure. Conditional approach allowed to determine the allergens selection. RESULT: Among the 3034 patients involved, 1996 (68.2%) were sensitized to at least one allergen. Overall, eight allergens (grass pollen, Dermatophagoides pteronyssinus, birch pollen, cat dander, Artemisia, olive pollen, Blatella and Alternaria) allowed to identified more than 95% of sensitized subjects. However, differences were observed between countries, two allergens being sufficient for Switzerland (grass pollen and cat dander) as opposed to nine for France (grass pollen, Dermatophagoides pteronyssinus, olive pollen, cat dander, Blatella, cypress, dog dander, alder and [Artemisia or Alternaria]). According to country, up to 13 allergens were needed to identify all sensitized subjects. CONCLUSION: Eight to ten allergens allowed the identification of the majority of sensitized subjects. For clinical care of individual patients, the whole battery of 18 allergens is needed to appropriately assess sensitization across Europe.

Inhibitory grids and the assignment problem.

A family of symmetric neural networks that solve a simple version of the assignment problem (AP) is analyzed. The authors analyze the suboptimal performance of these networks and compare the results to optimal answers obtained by linear programming techniques. They then use the interactive activation model to define the network dynamics-a model that is closely related to the Hopfield-Tank model. A systematic analysis of hypercube corner stability and eigenspaces of the connection strength matrix leads to network parameters that give feasible solutions 100% of the time and to a projection algorithm that significantly improves performance. Two formulations of the problem are discussed: (i) nearest corner: encode the assignment numbers as initial activations, and (ii) lowest energy corner: encode the assignment numbers as external inputs.

The effects on teeth of radiotherapy for nasal endodermal sinus tumor (yolk sac tumor) in childhood.

A rare case of a 10-year-old girl with an endodermal sinus tumor that occurred in the nasal cavity is presented. She received chemotherapy and radiotherapy at the age of 4. The subsequent abnormal development of the maxillary teeth is described and discussed in the light of the known effects of radiotherapy.

Correcting two-dimensional kinematic errors for chick embryonic movements in ovo.

In motor behavior studies of chick embryos in ovo, kinematic recording is limited to a single camera system and produces kinematic data that are distorted if out-of-plane movements are not considered. CONVERT is a rule based algorithm designed to calculate 3D limb movements given 2D kinematic data. CONVERT's calculations are based on a stationary reference point, limited translation of the chick embryo's trunk point, a multi-linked model of the body, and approximate limb segment lengths. Simulations indicate CONVERT calculates joint movements from 2D data with a maximum error of 6 degrees compared to a maximum error of 79 degrees if out-of-plane considerations are ignored. The approach used to correct two-dimensional kinematic measurement errors can be readily applied to other experimental conditions that restrict video recording to single camera systems.

[Allergic inflammatory markers in upper respiratory allergies]. / Az allergiás gyulladás aktivációs markerei felsölégúti allergiában.

The inflammatory mediators of allergy were investigated in symptomatic patients suffering from upper respiratory tract allergy. The serum tryptase level as an indicator of mast cell activation and serum eosinophil cationic protein level as an indicator of eosinophil activation were measured. They did not find any alteration in the serum level of tryptase. The level of eosinophil cationic protein significantly increased in symptomatic patients comparing to normal healthy controls. There was not any correlation to the severity of symptoms and to the absolute eosinophil count in the peripheral blood. The different activation possibilities of the eosinophil granulocytes are discussed, highlighting the role of Th2-helper lymphocytes.

[Eosinophil activation markers in status asthmaticus]. / Eosinophil aktivációs markerek status asthmaticusban.

Eosinophil activation markers-eosinophil cationic protein, eosinophil protein-X-were investigated in acute severe asthma. The elevation of the eosinophil activity markers were found in every cases at the time of admission. The measurements were repeated eight days later. The eosinophil cationic protein and eosinophil protein-X levels were increased at the time of the admission, and a decreasing tendency was detected eight days later. The peak expiratory flow rates were monitored during the period of the hospital staying. It is important to note that, the size of the bronchial obstruction did not show any similarity in all cases comparing to the elevation or decrease of eosinophil activity markers. The authors proved the eosinophil activation in vivo in acute severe asthma. The continuous monitor of the eosinophil activity markers might have a practical value in searching of the optimal therapeutic modalities in the asthmatic patients.

[Brief history of the Fédération Dentaire Internationale (FDI)]. / A Fédération Dentaire Internationale (FDI) rövid története.

FDI was founded in 1900, Paris, 95 years ago. At this International Dental Congress professors József Arkövy and Lajos Ottófy both held lectures. The Hungarian Dental Association (HDA) could join FDI, however, only in 1966. Today close contacts and collaboration are developing between HDA and FDI.

[Incidence of structural disorders of teeth in hereditary epidermolysis bullosa]. / A fogak szerkezeti rendellenességének elöfordulása epidermolysis bullosa hereditariában.

Authors present a 12-year old boy, whose diagnosis was epidermolysis bullosa. Beside the general characteristics of the illness they discuss the dental status of the patient and sum up the literary references together with other anomalies occurring in epidermolysis bullosa hereditaria.

[Langerhans cell histiocytosis]. / Langerhans-sejtes histiocytosis.

The authors describe a case of a 4 years old boy. In connection with this case they discuss the latest classification of histiocytosis accepted by the Histiocytosis Society, and the stomatological aspects of the disease (severe gingivitis, necrosis of the gingivae, ulceration, and high degree of tooth mobility). The new classes of the disease: Langerhans cell's histiocytosis, Non-Langerhans cell's histiocytosis, malignant histiocytosis.

[The state of dentistry education in Europe]. / A fogászati szakképzés helyzete Európában.

In order to find out what branches of Dentistry are recognized in Europe as Dental specialties a questionnaire was designed and sent to various Associations and groups across Europe. It contained eight main questions covering the various specialties that were recognised or were to be recognised. Responses were obtained from 28 countries, 15 EU member states and 13 non member states. The results from the questionnaire indicated that there was a broad agreement on many of the questions but a considerable variety of opinions. There seems to be a desire to harmonize standards across Europe for the benefit of the profession and the public.

[Frequency of supernumerary teeth and possibilities of treatment]. / A maradó számfeletti fogak elófordulási gyakorisága és kezelésük lehetóségei.

According to dental literature, the frequency of supernumerary teeth is 1-3%. The authors analyzed the orthopantomograms of 1875 children and adolescents aged between 6 and 18 years to determine the frequency of supernumerary teeth at the Department of Dentistry for Children and Orthodontics. The frequency was found to be 1.92%. The sequence of frequency of supernumerary teeth was: mesiodens, lateral incisor, central incisor. 77.8% of the supernumerary teeth occurred in the maxilla, 97.2% in the frontal region. Besides the data found, two successful cases of surgical and orthodontic treatment are also presented.