Papers by Magdalena Czarnecka-operacz
Specific immunotherapy in the treatment of patients with atopic dermatitis
Revue Française d'Allergologie et d'Immunologie Clinique, 1999
ABSTRACT
Airbone dermatitis. A new problem in dermatology
Revue Française d'Allergologie et d'Immunologie Clinique, 1999
Results of skin prick tests and evaluation of serum antigen specific immunoglobulin E in patients with atopic dermatitis and airborne allergy with regards to the type of sensitising allergens and seasonal course of the disease
Polski merkuriusz lekarski: organ Polskiego Towarzystwa Lekarskiego
Atopic dermatitis (AD) is a chronic inflammatory skin disease associated with sensitivity to comm... more Atopic dermatitis (AD) is a chronic inflammatory skin disease associated with sensitivity to common airborne allergens. The aim of the study was to evaluate immediate type of immunological reaction initiated by main types of airborne allergens in the pathomechanism of atopic dermatitis. The exacerbation of skin inflammation of patients with AD in relation to the seasons was also evaluated. 529 patients with AD aged (0.5-60 years) who fulfilled basic Hanifin and Rajka criteria and 60 healthy volunteers in the control group were investigated. In order to evaluate IgE-mediated allergy to common airborne allergens skin prick tests (SPT) were performed (26 airborne allergens) and concentration of serum antigen specific IgE (asIgE) was measured. Evaluation of exacerbation of skin inflammation of patient with AD in for patient with monovalent allergy of airborne allergens. Our results indicated predominance of grass pollen (63.2%) and house dust mite (57.0%) allergens of all patients sensitive to airborne allergens (n-405). In the group of patients sensitive to pollen allergens seasonal exacerbation of skin inflammation was predominant (over 90% of patients) and in the groups of patients sensitive to house dust mite and animal allergens the clinical manifestation of allergy for the whole year was observed in the most patients (77.1% and 57.1%). We conclude, that house dust mite and plant pollen allergens play an important role in the pathomechanism of atopic dermatitis.
[Efficacy of specific immunotherapy in the treatment of children and youngsters suffering from atopic dermatitis Part II. Evaluation of skin reactivity and concentration of serum antigen specific immunoglobulin E directed against selected airborne allergens]
Wiadomości lekarskie (Warsaw, Poland: 1960)
Despite undoubted progress in the field of allergology and clinical immunology we still lack an e... more Despite undoubted progress in the field of allergology and clinical immunology we still lack an effective and secure therapeutic methods in many cases of atopic dermatitis. The aim of the study was to evaluate efficacy of specific immunotherapy performed for the time period of 3 years with Novo-Helisen Depot allergy vaccines in the group of 36 children and youngsters with atopic dermatitis, allergic to house dust mites (24 patients) and grass pollen allergens (12 patients). The control group consisted of 20 patients with atopic dermatitis and analogous IgE-mediated airborne allergy treated with conventional methods. Clinical evaluation of patients was performed before treatment and after 36 months of therapy and was based on severity and extensiveness of skin inflammation in atopic dermatitis index: W-AZS. Clinical efficacy of specific immunotherapy was significantly higher than efficacy of conventional methods (p < 0.001). It was concluded that in selected patients with atopic dermatitis with IgE-mediated airborne allergy this method of treatment could be a promising alternative.
Bacterial flora of leg ulcers in patients admitted to Department of Dermatology, Poznań University of Medical Sciences, during the 1998-2002 period
Acta dermatovenerologica Croatica: ADC / Hrvatsko dermatolosko drustvo
Venous leg ulcers are an important cause of morbidity in a significant percentage of the world po... more Venous leg ulcers are an important cause of morbidity in a significant percentage of the world population. The percentage of leg ulceration, either active or healed, in the European population is about 1%-2%. The aim of this study was to analyze the rate of colonization and qualitative composition of the bacterial flora isolated from leg ulcers in patients admitted to Dermatology Department, Poznań University of Medical Sciences, during the 1998-2002 period, with special reference to the infection risk factors. Bacteriological diagnosis of 175 wound swabs was performed in compliance with compulsory laboratory methods. In 173 positive results, the predominant culture composition included Staphylococcus aureus (56.57%), Pseudomonas aeruginosa (37.14%), Enterococcus faecalis (22.29%), Proteus mirabilis (13.71%) and Escherichia coli (12.57%). There was a significant increase in the incidence of Pseudomonas aeruginosa, Enterococcus faecalis and Escherichia coli, along with a decrease in the incidence of Staphylococcus aureus isolation during the study period. The rate of yeast-like fungi strains, mainly Candida albicans, recorded in culture composition showed a systematic increase. Changes in the qualitative and quantitative composition of bacterial flora, presence of multiple isolates, and concomitant diseases that may influence the characteristics of leg ulcer disease were closely monitored.
Specific immunotherapy in atopic dermatitis - Four-year treatment in different age and airborne allergy type subgroups
Acta dermatovenerologica Croatica: ADC / Hrvatsko dermatolosko drustvo
Atopic dermatitis (AD) is a common inflammatory disease involving the skin and frequently other o... more Atopic dermatitis (AD) is a common inflammatory disease involving the skin and frequently other organs and systems such as respiratory system. The recently recognized atopic nature of the skin inflammation in AD has raised a growing interest in the treatment with allergen-specific immunotherapy (SIT). In this study, the efficacy of SIT was evaluated in a group of 37 AD patients aged 5-44 years: 14 allergic to house dust mites (HDM), 17 to grass pollen allergens, and 6 allergic to grass and mugwort pollen allergens. IgE-mediated airborne allergy was well documented in all cases. SIT was performed with Novo Helisen Depot allergy vaccines of appropriate composition. Control group included 29 patients with AD and confirmed IgE-mediated airborne allergy to analogous allergens: HDM, 14 patients; grass pollen allergens, 11 patients; and grass and mugwort pollen allergens, 4 patients. Conventional methods of AD treatment were used in the control group. Clinical evaluation of patients was performed with W-AZS index after 12, 24, 36 and 48 months of therapy. SIT was found to be an efficacious and safe method of treatment for selected patients with AD and IgE-mediated airborne allergy. The efficacy of this therapeutic method was significantly higher than that recorded by conventional methods used in the control group in all 3 age subgroups and all 3 types of airborne allergy (HDM, grass pollen, and grass and mugwort pollen). It is concluded that SIT may be highly promising method of controlling skin inflammation in AD with the potential to prevent the development of AD into respiratory allergy.
The new scoring system for evaluation of skin inflammation extent and severity in patients with atopic dermatitis
Acta dermatovenerologica Croatica: ADC / Hrvatsko dermatolosko drustvo
The new scoring system for assessment of the extent and severity of skin inflammation index in at... more The new scoring system for assessment of the extent and severity of skin inflammation index in atopic dermatitis patients, W-AZS, is presented. The system provides detailed assessment of both subjective and objective signs and symptoms of atopic dermatitis. With the use of W-AZS, acute and chronic skin manifestations of inflammatory process are appropriately evaluated and scored. It also enables the practitioner to assess various localizations of skin lesions at different time points. W-AZS is a relatively easy and rapid index to perform, and it seems very beneficial for clinicians. Other scoring systems used in atopic dermatitis are also presented, analyzed and compared, e.g., Atopic Dermatitis Area and Severity Index (ADASI), SCORing Atopic Dermatitis (SCORAD), Eczema Area and Severity Index (EASI), Six Area, Six Sign Atopic Dermatitis (SASSAD), and Three-Item Severity score (TIS). There is a strong necessity to standardize clinical evaluation of the extent and severity of skin diseases such as atopic dermatitis, as laboratory techniques and parameters are not really of great use for practitioners.
Analysis of antibiotic susceptibility and resistance of leg ulcer bacterial flora in patients hospitalized at Dermatology Department, Poznań University Hospital
Acta dermatovenerologica Croatica: ADC / Hrvatsko dermatolosko drustvo
Effective treatment of frequently infected, poorly healing wounds such as leg ulcers due to chron... more Effective treatment of frequently infected, poorly healing wounds such as leg ulcers due to chronic venous insufficiency poses a major clinical problem. Antibiotic resistance in dermatology patients, especially those with non-healing leg ulcers, is a widespread phenomenon. Various antibiotics, mainly broad-spectrum agents, are frequently and sometimes inappropriately prescribed, which often leads to the selection of antibiotic-resistant bacteria strains. The aim of this study was to analyze antibiotic susceptibility and resistance of bacterial isolates cultured from leg ulcers. Wound swabs were obtained from patients admitted to Dermatology Department, Poznań University of Medical Sciences, during the 1998-2002 period. Bacteriologic diagnosis of 175 wound swabs was performed in compliance with compulsory laboratory methods. The analysis yielded 173 positive results, predominated by Staphylococcus aureus, Pseudomonas aeruginosa, Enterococcus faecalis, Proteus mirabilis and Escherichia coli. Bacterial isolates were evaluated for resistance to commonly used antibiotics, taking into consideration the presence of methicillin resistant Staphylococcus aureus strains. Antibiotic resistance profiles were compared between the years 1998 and 2002, with detailed account of clinical characteristics and history of leg ulcers disease. The study pointed to an increasing tendency of antibiotic resistance in the study group of patients.
Atopy patch test reaction to airborne allergens in the diagnosis of atopic dermatitis
Acta dermatovenerologica Croatica: ADC / Hrvatsko dermatolosko drustvo
The aim of the study was to evaluate the possible use of atopy patch test in the diagnosis of ato... more The aim of the study was to evaluate the possible use of atopy patch test in the diagnosis of atopic dermatitis and to characterize an optimal standardized system for atopy patch test in terms of allergen concentrations and time of allergen exposure. The study included 36 patients with atopic dermatitis and IgE-mediated airborne allergy. Patients presented positive results of skin prick tests and serum antigen specific IgE against house dust mite allergens and/or selected grass pollen allergens. Control groups consisted either of patients with allergic rhinitis (control group 1) or healthy volunteers with no signs or symptoms of atopy (control group 2). Allergologic diagnostic workup consisted of skin prick test, serum antigen specific IgE and total IgE evaluation, atopy patch test with selected airborne allergens of different concentrations (0.1xSPT, 1xSPT and 10xSPT), time of allergen exposure (8, 24 and 48 h), and readings of the results (8, 24, 48 and 72 h). Positive results of atopy patch test with airborne allergens were obtained in 47.2% of atopic dermatitis patients and none of control subjects. Contact reaction itself and the intensity of reaction were demonstrated to correlate with allergen concentration and time of allergen exposure on atopy patch test. The dose and time response analysis showed the optimal concentration of allergens for atopy patch test to be 10xSPT, 500000 SBE/ml, and optimal evaluation time 24 and 48 h of allergen application. There was no correlation between atopy patch test results and mean serum concentrations of total or antigen specific IgE. Atopy patch test results did not correlate with localization of skin lesions, severity and extensiveness of skin inflammation. A significantly higher contact reactivity to airborne allergens was recorded in the group of atopic dermatitis patients with polyvalent allergy in comparison with atopic dermatitis patients allergic to only one aeroallergen. It is concluded that atopy patch test is the only provocation test currently available with clinical relevance for contact IgE-mediated sensitization in atopic dermatitis patients. Using petrolatum as a vehicle, allergen concentration of 500000 SBE/ml and evaluation time of 24 and 48 h of allergen application may lead to improved atopy patch test results.
[Evaluation of skin prick tests and serum concentration of antigen-specific immunoglobulin E in patients with atopic dermatitis sensitive to airborne allergens in relation to the type of allergens and age of patients]
Polski merkuriusz lekarski: organ Polskiego Towarzystwa Lekarskiego
Atopic dermatitis (AD) is a chronic inflammatory skin disease associated with sensitivity to comm... more Atopic dermatitis (AD) is a chronic inflammatory skin disease associated with sensitivity to common airborne allergens. The aim of the study was to evaluate the immediate type of immunological reaction initiated by main types of airborne allergens in the pathomechanism of atopic dermatitis in relation to the age of patients. 529 patients with AD aged (0.5-60 years) who fulfilled basic Hanifin and Rajka criteria and 60 healthy volunteers in the control group were investigated. In order to IgE-mediated allergy to common airborne allergens skin prick tests (SPT) were performed (26 airborne allergens) and concentration of serum antigen specific IgE (asIgE) was measured. Our results indicated increasing prevalence to sensitisation to airborne allergens in patients with AD in relation to the age of these patients (age 0.5-4--17 cases; 5-12 years--127 cases; 13-18 years--88 cases; above 18 of age--173 cases). The sensitisation to grass pollen and house dust mite allergens was predominant. We conclude, that predominance to sensitization to airborne allergens tends to increase with the age of patients.
Specific immunotherapy in atopic dermatitis
Acta dermatovenerologica Croatica: ADC / Hrvatsko dermatolosko drustvo
Despite the existence of various scientific research on the beneficial effect of specific immunot... more Despite the existence of various scientific research on the beneficial effect of specific immunotherapy with specific airborne allergens in the treatment of atopic dermatitis, this method has not been easily accepted, as the methodology and the valuation of the studies were heterogeneous. Over the last few years, meta-analysis technology has been developed as a useful tool to globally value the results of different research trials related to one specific scientific problem. When meta-analyses are carried out correctly, they are accepted as the most appropriate way to express the results obtained from different studies. Not many studies have been published in the case of atopic dermatitis and specific immunotherapy. In this paper, we attempt to present and discuss results obtained by various authors on this topic, beginning with the publication of Strauss and Kligman in 1957. It should be noted that for patients with IgE-mediated airborne allergy, especially children, specific immunotherapy as an early treatment in cases of atopic dermatitis could have an additionally preventive nature in terms of protection against the development of a respiratory atopic problem. Specific immunotherapy should therefore be at least considered in the treatment of selected cases of atopic dermatitis patients presenting airborne IgE-mediated allergy.
Selected eosinophil proteins as markers of inflammation in atopic dermatitis patients
Acta dermatovenerologica Croatica: ADC / Hrvatsko dermatolosko drustvo
Atopic dermatitis (AD) is an inflammatory skin disease characterized by chronic and recurrent cou... more Atopic dermatitis (AD) is an inflammatory skin disease characterized by chronic and recurrent course, beginning primarily in early childhood. The etiopathogenesis of AD has not yet been fully understood, although various types of inflammatory cells including eosinophils may be involved in its pathomechanism. The basic aim of the study was to evaluate the usefulness of selected eosinophil proteins in serum and urine of AD patients, as markers of disease severity. The study also aimed to analyze correlations between the level of examined proteins and parameters such as skin prick test (SPT) results, serum concentration of total IgE, and coexistence of symptoms of other atopic diseases. The study included 30 AD patients and two control groups: 30 patients suffering from chronic urticaria and 30 healthy individuals. The mean level of eosinophil proteins measured in serum and urine of AD patients was higher than that in controls, although a significant difference was only recorded for serum and urine level of eosinophil protein X (EPX). Patients with very severe/severe AD presented higher levels of eosinophil proteins than patients presenting with mild/moderate AD, although no significant difference was found between these two groups. AD patients with positive SPT results and detectable specific IgE in serum, and with coexisting symptoms of other atopic diseases presented with higher mean levels of serum and urine eosinophil proteins than AD cases with negative SPT results and without any symptoms of other atopic diseases. In children suffering from AD, serum eosinophil cationic protein level, EPX level and urine EPX level were higher than those in healthy children, however, without statistical significance. Study results suggested a significant role of eosinophils in the etiopathogenesis of AD. Serum and urine levels of selected eosinophil proteins may serve as an important part of diagnostic approach to AD patients, especially in differentiation of allergic and non-allergic forms of AD. The results are also promising for the usefulness of selected eosinophil proteins in the diagnosis of AD in children, however, thorough analysis on a larger group of patients is needed.
Clinical characteristics of chronic venous insufficiency in patients with chronic venous leg ulcers. Part I. Clinical characteristics
Immunological parameters in the sera of patients with atopic dermatitis and airborne allergy treated with allergy vaccines
Acta dermatovenerologica Croatica: ADC / Hrvatsko dermatolosko drustvo
Patients with atopic disorders present an increased production of IgE, which is usually limited t... more Patients with atopic disorders present an increased production of IgE, which is usually limited to specific antibodies against various environmental allergens. It has also been suggested that the production of these antibodies may be influenced by effective specific immunotherapy (SIT). Of course, a decline of serum antigen specific IgE in the course of such a treatment cannot explain the clinical efficacy of SIT and is probably not a key mechanism. However, SIT may at least participate in the final clinical result. In this study, 37 patients with atopic dermatitis were treated with allergy vaccines (Novo-Helisen Depot) for a time period of 48 months. The control group consisted of 29 patients with atopic dermatitis who were treated with classical methods. The clinical score (W-AZS), total IgE and antigen specific IgE (asIgE) in the sera of patients were assessed before treatment and after 24 and 48 months of therapy (FEIA CAP System, Pharmacia). There was a significant difference between the two investigated groups from both the clinical and immunological standpoints after 2 and 4 years of observation. There was a significant decrease of serum total IgE and asIgE (directed against airborne allergens) in the course of specific immunotherapy. In the control group, the total IgE level tended to increase, and this tendency was also recorded in case of asIgE measurements. We also evaluated the influence of specific immunotherapy on the serum level of IFN-G, sIL-2R, IL-4, IL-5 and IL-10 before treatment and after 4 years of therapy with the quantitative 2-step colorimetric sandwich ELISA method (R and D Systems). In the group of patients treated with allergy vaccines, a significant decrease of the serum sIL-2R level was observed after 48 months of therapy (p<0.01). In the control group, a significant increase of serum IL-4 (p<0.01) as well as IL-5 (p<0.05) was registered at the end of the observation period. There was no significant correlation between the clinical score and serum level of any of the investigated cytokines in either group of patients before the treatment or after 48 months of therapy.
Principles of dermatologic ultrasound diagnostics
Acta dermatovenerologica Croatica: ADC / Hrvatsko dermatolosko drustvo
Ultrasound is a valuable diagnostic tool widely used in medicine. Recently, high-frequency ultras... more Ultrasound is a valuable diagnostic tool widely used in medicine. Recently, high-frequency ultrasonography has been introduced to dermatology owing to technical advances. Currently, the most often used frequency for skin imaging is between 20 and 25 MHz. Ultrasound images can be generated in different modes, i.e. one-dimensional A mode, two-dimensional B mode and C mode. This type of skin imaging is known as a noninvasive, reproducible and quantitative method, which can be used to evaluate skin characteristics in a variety of dermatologic diseases. It can found application in the assessment of skin tumors, morphea, psoriasis, lipodermatosclerosis, skin aging and photodamage, hypertrophic scars, wound healing processes and allergic reactions. Although skin ultrasonography and its clinical applications are still being explored, most probably it will be implemented in the routine dermatologic diagnosis in the forthcoming future.
Contact allergy to glucocorticosteroids in patients with chronic venous leg ulcers, atopic dermatitis and contact allergy
Acta dermatovenerologica Croatica: ADC / Hrvatsko dermatolosko drustvo
The aim of the study was to assess the prevalence of contact allergy to glucocorticosteroids in p... more The aim of the study was to assess the prevalence of contact allergy to glucocorticosteroids in patients with chronic venous leg ulcers (CVLU), atopic dermatitis (AD) and contact dermatitis (CD), and in a group of healthy individuals; and to estimate differences among these patient groups. Patch tests with the European standard series, antibiotics, glucocorticosteroid contact allergy screening markers and ointment vehicles were performed in a population of 140 patients. Positive patch tests results were recorded in 80% and contact allergy to glucocorticosteroids in 40% of CVLU patients. In the group of AD patients, the respective figures were 30% and 3%. In the group of CD patients, allergic type of disease was detected in 80% and positive patch tests for glucocorticosteroids in 20% of patients. In healthy individuals, allergic contact reaction was observed in 17% of cases. Statistically significant differences among patient groups were found according to the prevalence of contact a...
Oral allergy syndrome in patients with airborne pollen allergy treated with specific immunotherapy
According to literature, approximately 20%-70% of patients sensitized to pollen allergens experie... more According to literature, approximately 20%-70% of patients sensitized to pollen allergens experience oral allergy syndrome (OAS) symptoms after eating raw fruits and vegetables. There is no standard treatment established for OAS except avoiding implicated food. However, in patients with airborne pollen allergy treated with specific immunotherapy (SIT), an improvement of OAS symptoms has been reported in 30% to even 84% of individuals examined. The aim of the present study was to evaluate the prevalence of OAS symptoms in patients with various manifestations of pollen airborne allergy (atopic dermatitis (AD), asthma, allergic rhinitis) treated with subcutaneous type of SIT. In addition, the most common patterns of cross-reactivity in OAS were analyzed and correlations between OAS symptoms and patient age, type of sensitizing pollen allergens and atopy manifestations investigated. Also, the relationship between SIT duration and clinical improvement of both OAS symptoms and pollen alle...
Non-allergic type of atopic dermatitis among patients of Allergic Diseases Diagnostic Center, University of Medical Sciences in Poznań
Przegla̧d lekarski
Atopic dermatitis (AD) is a chronic inflammatory skin disease of unclear etiopathogenesis. It bel... more Atopic dermatitis (AD) is a chronic inflammatory skin disease of unclear etiopathogenesis. It belongs to the group of atopic diseases and an IgE-mediated uptake and antigen focusing of environmental allergens by IgE-bearing dendritic cells is assumed to be a central immunopathogenetic event resulting in clinical appearance of AD. In case of non-allergic (intrinsic) type of AD, non IgE-related factors are involved in the process. Potential immunological and clinical differences between allergic and non-allergic type of the disease are still being investigated. The aim of our study was to evaluate prevalence of non-allergic and allergic type of AD among patients of Allergic Diseases Diagnostic Center, University of Medical Sciences in Poznań between 2001 and 2002. We investigated 161 patients with AD and selected factors influencing course of the disease such as age, gender, month of birth, population of the region and characteristics of sensitizing allergens were analyzed. Allergolog...
[Corticosteroid phobia in patients with atopic dermatitis]
Wiadomości lekarskie (Warsaw, Poland: 1960)
Topical corticosteroid phobia is an interesting phenomenon recently mentioned often in the litera... more Topical corticosteroid phobia is an interesting phenomenon recently mentioned often in the literature. It is characterized by an irrational fear and anxiety of patients about using topical corticosteroid preparations and may be associated with confusion and lack of knowledge regarding potency and indications for use of various groups of these widely used in dermatological practice topical drugs. So called "steroid phobia" may be additionally augmented by media. The aim of this study was to investigate the problem of corticosteroid phobia in atopic dermatitis (AD) patients, attending Allergic Diseases Diagnostic Center of the Department of Dermatology, University of Medical Sciences in Poznań. The study revealed confusion and anxiety among the AD patients about topical corticosteroid therapy. More than half of AD patients felt uncertain about using topical steroid preparations and had little knowledge regarding their potency and side effects, especially in case of drugs use...
Acta dermatovenerologica Alpina, Panonica, et Adriatica
A 74-year-old patient, suffering for 20 years from polycythemia rubra vera, was treated with hydr... more A 74-year-old patient, suffering for 20 years from polycythemia rubra vera, was treated with hydroxyurea for 2 years. Intensive xerosis (ichthyosis-like) and violaceous papules on the dorsal hand surfaces were observed. There was also reddish purple periorbital erythema resembling "heliotrope erythema". Such a disease pattern has been described as "hydroxyurea-induced dermatomyositis-like eruption" - a drug-adverse reaction associated with hydroxyurea therapy. The reaction has typical dermal features of dermatomyositis without any systemic symptoms (in the case of our patient, antinuclear antibodies absent and creatine phosphokinase within the normal range). The above reaction is associated with chronic hydroxyurea uptake and, after withdrawing the drug, alleviation of skin lesions usually takes place after 10 days to 18 months with no recurrences. In the case of our patient, we observed clinical improvement after 3 months; xerosis decreased, heliotrope erythema ...
Uploads
Papers by Magdalena Czarnecka-operacz