Showing papers by "Allan Linneberg published in 2007"

The epidemiology of contact allergy in the general population – prevalence and main findings

Abstract: A substantial number of studies have investigated the prevalence of contact allergy in the general population and in unselected subgroups of the general population. The aim of this review was to determine a median prevalence and summarize the main findings from studies on contact allergy in the general population. Published research mainly originates from North America and Western Europe. The median prevalence of contact allergy to at least 1 allergen was 21.2% (range 12.5-40.6%), and the weighted average prevalence was 19.5%, based on data collected on all age groups and all countries between 1966 and 2007. The most prevalent contact allergens were nickel, thimerosal, and fragrance mix. The median nickel allergy prevalence was 8.6% (range 0.7-27.8%) and demonstrates that nickel was an important cause of contact allergy in the general population and that it was widespread in both men and women. Numerous studies demonstrated that pierced ears were a significant risk factor for nickel allergy. Nickel was a risk factor for hand eczema in women. Finally, heavy smoking was associated with contact allergy, mostly in women. Population-based epidemiological studies are considered a prerequisite in the surveillance of national and international contact allergy epidemics.

The link between the epidemics of obesity and allergic diseases: does obesity induce decreased immune tolerance?

Abstract: There is increasing epidemiological evidence that obesity increases the risk of asthma, atopic, and autoimmune diseases. We hypothesize that the increase in these diseases is caused, at least in part, by decreased immunological tolerance as a consequence of immunological changes induced by adipokines (e.g. leptin and adiponectin) and cytokines [e.g. interleukin 6 (IL6) and tumor necrosis factor alpha (TNFalpha)] secreted by white adipose tissue. The increasing body weight increases the levels of circulating IL6, leptin, and TNFalpha. IL6 and leptin down-regulate the activity of regulatory T-lymphocytes (Tregs). Additionally, adiponectin, which decreases with increasing obesity, down-regulates the secretion of IL10 from macrophages and adipocytes. These changes in IL6, leptin, and IL10 decrease the regulatory effect of Tregs resulting in decreased immunological tolerance to antigens. In pregnant women, these obesity-induced immunological changes might be transmitted to the fetus by epigenetic inheritance thereby increasing the risk of atopic disease. We propose that obesity results in immunological changes resulting in decreased immunological tolerance to antigens and skewing of the immune system towards a Th2 cytokine profile increasing the risk of allergy and other immune-mediated diseases. Furthermore, this hypothesis offers a unifying explanation for the observation that older siblings appear to confer protection against atopic diseases, preeclampsia, and certain autoimmune diseases. More studies are definitely needed to explore further the immunological effects of obesity and its possible effects on allergic disease.

Temporal trends of aeroallergen sensitization over twenty-five years.

Abstract: Summary Background Little is known about time trends of allergic respiratory disease in adults, in particular in older adults. Furthermore, few trend studies have used objective measurements of IgE sensitization against inhalant allergens. Objectives To investigate time trends of aeroallergen sensitization in adults over a 25-year period. Methods The study includes a total of 7820 persons, aged 30, 40, 50, and 60 years, who participated in three repeated cross-sectional studies of the general population of Copenhagen, Denmark, in 1976–1977, 1982–1984, and 1999–2001, respectively. Respiratory allergy was assessed by determination of specific IgE aeroallergen sensitization in stored serum samples. Results Over this 25-year period, a marked and statistically significant increase in the prevalence of aeroallergen sensitization had occurred. This increase was seen in all age-groups challenging the notion that the allergy epidemic only affects generations born 1960 onwards. For example, in 40-year-olds the prevalence (with 95% confidence intervals) of aeroallergen sensitization was 14.9% (12.7–17.1), 19.7% (17.1–22.3), and 27.6% (25.1–30.1) in 1976–1977, 1982–1984, and 1999–2001, respectively. Conclusions Our results support that the allergy epidemic has spread to older adults resulting in a continuing increase in the overall prevalence of aeroallergen sensitization and an increase in the mean age of allergic patients.

10-year prevalence of contact allergy in the general population in Denmark estimated through the CE-DUR method.

Abstract: The prevalence of contact allergy in the general population has traditionally been investigated through population-based epidemiological studies. A different approach is the combination of clinical epidemiological (CE) data and the World Health Organization-defined drug utilization research (DUR) method. The CE-DUR method was applied in Denmark to estimate the prevalence of contact allergy in the general population and compare it with the prevalence estimates from the Glostrup allergy studies. Contact allergy prevalence estimates ranging from very liberal ('worst case') to conservative ('best case') assumptions were based on patch test reading data in combination with an estimate of the number of persons eligible for patch testing each year based on sales data of the 'standard series'. The estimated 10-year prevalence of contact allergy ranged between 7.3% and 12.9% for adult Danes older than 18 years. The 10-year prevalence of contact allergy measured by CE-DUR was slightly lower than previous prevalence estimates from the Glostrup allergy studies. This could probably be explained by a decrease in nickel allergy. The CE-DUR approach holds the potential of being an efficient and easy monitoring method of contact allergy prevalence.

Prevalence of self-reported hypersensitivity symptoms following intake of alcoholic drinks.

Abstract: UNLABELLED BACKGROUND; Although hypersensitivity symptoms following alcoholic drink consumption are common in asthmatics, the prevalence of such symptoms in the general population is not known. OBJECTIVE To assess the prevalence of hypersensitivity symptoms following alcoholic drink consumption in an adult Northern European general population and the association of these symptoms with the prevalence of allergic rhinitis (AR) and asthma. METHODS In 2006, a postal questionnaire was sent to a random sample of 18-69-year-olds living in Copenhagen, the capital of Denmark. The response rate was 70.7% (4242/6000). RESULTS The prevalence of alcohol-induced symptoms from the upper airways, lower airways, and skin was 7.6% [95% confidence interval (CI): 6.8-8.4%], 3.2% (95% CI: 2.7-3.8%), and 7.2% (95% CI: 6.4-8.9%), respectively. A total of 13.9% (95% CI: 12.9-15.0%) had ever experienced alcohol-induced symptoms from at least one of the three regions (upper airways, lower airways, or skin), and 9.9% (95% CI: 9.0-10.8%) had experienced symptoms in the last 12 months. All types of beverages were commonly reported as triggers of hypersensitivity symptoms, red wine being the most common. Alcohol-induced hypersensitivity symptoms from the upper and lower airways were significantly more prevalent in persons with AR and asthma (odds ratios between 3.0 and 8.1, P-value <0.001 for all associations). CONCLUSIONS In this Northern European general population, self-reported hypersensitivity symptoms following the intake of alcoholic drinks are common. These symptoms were markedly more prevalent in persons with AR and asthma. The underlying mechanisms and the clinical significance of these symptoms remain to be elucidated.

Sensitization to cross-reactive carbohydrate determinants in relation to alcohol consumption.

Abstract: Summary Background Alcohol consumption is associated with increased serum IgE of unknown specificity. Objective To investigate the prevalence of specific IgE to cross-reactive carbohydrate determinants (CCDs) in adults, and its relation to alcohol consumption. Methods Population-based survey of 457 adults (218 abstainers, 195 light-to-moderate drinkers, 44 heavy drinkers). Specific IgE determinations included a CCD (MUXF 3 , the N-glycan of bromelain), pollens (Lolium perenne and Olea europaea), Hymenoptera venoms (Apis mellifera and Vespula spp.), and a mite (Dermatophagoides pteronyssinus). We replicated these studies in an additional sample of alcoholics (n=138). Inhibition assays were performed in selected cases. Results In the general population, 5.6% of individuals (95% confidence interval 3.5‐7.6%) showed positive (X0.35kU/L) CCD-specific IgE. The levels of CCD-specific IgE were particularly high in heavy drinkers, who also showed a high prevalence of positive IgE to pollens and Hymenoptera venoms, doubling (at least) the prevalence found in alcohol abstainers and light-to-moderate drinkers. The presence of IgE to pollens and Hymenoptera venoms was closely correlated with the presence of CCD-specific IgE. These features were confirmed in the additional sample of alcoholics. Inhibition studies indicated a role of CCD interference in IgE positivity to pollen and Hymenoptera allergens in alcoholics. Conclusions CCD-specific IgE is prevalent in heavy drinkers, and is associated with positive IgE to pollens and Hymenoptera venoms. Specific IgE results should be interpreted with caution in heavy drinkers.

Is there a risk of active sensitization to PPD by patch testing the general population

Abstract: Para-phenylenediamine (PPD), a constituent of permanent hair dyes, may cause contact allergy in exposed individuals. It has previously been questioned whether a patch testing with PPD in population-based epidemiological studies is entirely safe. The Glostrup allergy studies patch tested the same cohort twice. In 1990, 567 persons were patch-tested and only one person had a (+) positive reaction to PPD. In 1998, 540 persons were re-invited to a new patch test and 365 (participation rate 68%) were re-tested. There were no positive reactions to PPD. These studies indicate that patch testing with PPD in individuals with no previous positive reactions to PPD or with only one previous positive reaction does not cause active sensitization and can be performed with minimal risk.

The association between alcohol consumption and contact sensitization in Danish adults: the Glostrup Allergy Study.

Abstract: Summary Background Population-based epidemiological studies have indicated that alcohol consumption is associated with IgE-mediated immune diseases (i.e. allergic rhinitis, asthma and urticaria). These studies have been strongly supported by several immunological studies. Furthermore, an inhibitory effect of alcohol consumption on the development of delayed-type hypersensitivity has been shown in healthy controls. However, a possible association between contact sensitization and alcohol consumption in a general population has never been reported. Objectives To investigate whether alcohol consumption is associated with contact sensitization in a general population. Methods In 1990, self-reported consumption of alcohol and patch testing results were assessed in 1112 subjects, aged 15–69 years, participating in a population-based cross-sectional study in Glostrup, Denmark. In 1998, they were invited to a follow-up and 734 were re-examined (participation rate 69·0%). Adjustment for potential confounders was performed by using logistic regression analyses. Results Women who reported no consumption of alcoholic drinks per week were more likely to develop contact sensitization (adjusted odds ratio 2·12, 95% confidence interval 0·98–4·61) during a 8-year follow-up period. A positive trend among women was detected (P = 0·045). Conclusions These data support the hypothesis that alcohol consumption leads to IgE-mediated immune responses rather than delayed-type hypersensitivity reactions. It is probable that alcohol consumption prevents the development of contact sensitization. Further epidemiological studies are warranted.

Association between alcohol consumption and skin prick test reactivity to aeroallergens.

Abstract: Background A few studies have indicated a positive association between consumption of alcohol and allergic sensitization in age and socioeconomically heterogeneous populations. Objective To investigate the association between consumption of alcohol and allergic sensitization in a young homogenous population of high social class (a group with a suspected high prevalence of sensitization). Methods A total of 1,668 students aged 18 to 35 years recruited from universities in Copenhagen, Denmark, underwent skin prick testing (SPT) in October or November 2002 and completed a questionnaire about respiratory disease and lifestyle habits, including alcohol consumption. SPT positivity was defined as a positive reaction (≥3 mm) against at least 1 of 10 common inhalant allergens. Results Before and after adjustment for sex, age, smoking, atopic predisposition, and pet keeping, no significant association was found between alcohol consumption (including type of beverage) and SPT positivity. Increasing alcohol consumption was significantly negatively associated with asthma symptoms and hay fever symptoms. Conclusions Alcohol consumption does not favor SPT positivity, but cumulated effects were not addressed in the present study. Individuals with asthma or hay fever symptoms seem to reduce alcohol intake (a healthy drinkers' effect).

The use of grass pollen-specific immunotherapy among grass pollen allergic rhinitis in the general population.

Abstract: Calamine lotion for reliving pruritus were also prescribed. The progression of the skin rashes was stopped on the third day of oral prednisolone therapy. Of note, the original pink–red plaques regressed to multiple dusky target lesions 4–6 days after the prednisolone therapy. The dose of prednisolone was tapered to 5 mg t.i.d. for the second week, and then 5 mg b.i.d. for the third week. The skin eruptions completely subsided without sequelae in 3 weeks. The clinical diagnosis of erythema multiforme was confirmed by skin biopsy that showed a moderate perivascular mononuclear cell dermal infiltrate. There was no recurrence of skin rash in 1-year follow-up thereafter. Erythema multiforme is an acute, self-limited and sometimes recurring skin condition considered to be a hypersensitivity reaction associated with certain infections (e.g. herpes simplex virus, Mycoplasma pneumoniae, fungal infection, varicella zoster virus, hepatitis C, cytomegalovirus and human immunodeficiency virus etc.) and medications [e.g. barbiturates, hydantoins, nonsteroidal anti-inflammatory drugs, penicillins, phenothiazines, sulfonamides, candesartan cilexetil (Atacand), rofecoxib (Vioxx), metformin (Glucophage), adalimumab (Humira), bupropion (Wellbutrin) and ciprofloxacin (Cipro) etc.] (1, 2). However, it has never been associated with vancomycin. Vancomycin-induced hypersensitivity syndrome (i.e. drug rash with eosinophilia and systemic symptoms) with cutaneous manifestation mimicking erythema multiforme (3), erythema multiforme major (now revised as Stevens–Johnson syndrome) (4, 5), and toxic epidermal necrolysis have been reported (5). To our best knowledge, however, isolated erythema multiforme to vancomycin without other systemic symptoms, as our case, has never been reported in the literatures. Clinicians should be alerted that vancomycin might induce severe delayed erythema multiforme, even after its administration for a long period up to 6 weeks. The time delay between vancomycin administration and clinical symptoms in this patient is really unusual, which may be related to immune dysregulation in uremia and dialysis patients.