Carsten Bindslev‐Jensen

University of Southern Denmark

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Charlotte G. Mørtz

University of Southern Denmark

126

Torsten Zuberbier

Charité - Universitätsmedizin Berlin

Lars K. Poulsen

Gentofte Hospital

Esben Eller

Odense University Hospital

Per Stahl Skov

Odense University Hospital

Jean Bousquet

Charité - Universitätsmedizin Berlin

Nikolaos G. Papadopoulos

University of Manchester

Giorgio Walter Canonica

Humanitas University

Claus Bachert

Ghent University Hospital

Marcus Maurer

Humboldt-Universität zu Berlin

Cooperative Institutions

Odense University Hospital

399

Charité - Universitätsmedizin Berlin

264

Inserm

235

Hospital Del Mar

201

Municipal Institute for Medical Research

201

ENT and Allergy

198

University of Southern Denmark

162

University of Copenhagen

156

New York Proton Center

152

University of Debrecen

152

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A consensus protocol for the determination of the threshold doses for allergenic foods: how much is too much?

Clinical & Experimental Allergy (2004)

Steve L. Taylor S.L. Hefle Carsten Bindslev‐Jensen Fred M. Atkins C. André

Summary Background While the ingestion of small amounts of an offending food can elicit adverse reactions in individuals with IgE‐mediated food allergies, little information is known regarding these threshold doses for specific allergenic foods. While low‐dose challenge trials have been conducted on an appreciable number of allergic individuals, a variety of different clinical protocols were used making the estimation of the threshold dose very difficult. Objective A roundtable conference was convened to develop a consensus clinical protocol for low‐dose challenge trials for the estimation of threshold doses for specific allergenic foods. Methods In May 2002, 20 clinical allergists and other interested parties were invited to participate in a roundtable conference to develop consensus of the key elements of a clinical protocol for low‐dose challenge trials. Results A consensus protocol was developed. Patients with convincing histories of food allergies and supporting diagnostic evidence including past challenge trials or high CAP–RAST scores can be enrolled in low‐dose challenge trials. Care must be taken with younger patients to assure that they have not outgrown their food allergy. An approach was developed for the medication status of patients entering such trials. Challenge materials must be standardized, for example, partially defatted peanut flour composed of equal amounts of the three major varieties of peanuts (Florunner, Virginia, Spanish). Challenge materials must be appropriately blinded with sensory evaluation used to confirm the adequacy of blinding. A double‐blind, placebo‐controlled design should be used for low‐dose challenge trials. Low‐dose challenge trials would begin at doses of 10 μg of the allergenic food and would continue with doses of 100 μg and 1 mg followed by specific higher doses up to 100 mg depending upon the expert judgement of the physician; even higher doses might be applied to assure that the patient is indeed reactive to the particular food. A 30‐min time interval would be used between doses, and reactive doses would be expressed as both discrete and cumulative doses. The goal of each challenge would be to develop objective symptoms; trials should not be discontinued on the basis of subjective symptoms only. Statistically, a minimum of 29 patients would be enrolled in low‐dose challenge trials for each allergenic food because 0 reactors out of 29 patients at a particular dose allow the conclusion that there is 95% certainty that 90% of allergic individuals will not react to that dose. Conclusion A consensus protocol was developed. Using this protocol, it will be possible to estimate threshold doses for allergenic foods, the lowest amount that elicits mild, objective symptoms in highly sensitive individuals.

Blinding

Oral food challenge

Clinical study design

10.1111/j.1365-2222.2004.1886.x

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Citations (208)

FS02.6 Patch test reactivity to nickel sulphate and fragrance mix in unselected children

Contact Dermatitis (2004)

H Jøhnke LA Norberg Werner Vach Carsten Bindslev‐Jensen Arne Høst

Objectives: Study patch test reactivity to nickel sulphate and fragrance mix in a population of unselected infants with focus on reproducibility, clinical relevance, and nickel patch test concentration. Method: The data presented is part of a clinical epidemiological study of allergic diseases in newborns followed prospectively with questionnaire, clinical examination and testing at 0, 3, 6, 12 and 18 months of age. TRUE Test patches were used with nickel sulphate in 3 concentrations: 200, 66, 22 ìg/cm 2 and fragrance mix 430 ìg/cm 2 . A positive reaction suggesting sensitisation was defined as at least palpable erythema present at both the 12 and 18 months follow‐up visits. Results: A total of 543 children (268 girls, 275 boys) were patch tested at least once, 304 children were tested at both 12 and 18 months. The prevalence of a reproducible positive reaction to nickel sulphate 200 ìg/cm 2 was 8.6%(20 girls, 6 boys). A transient reactivity was observed in 111 children (53 girls, 58 boys). A clinical relevance to nickel was found in only one child. There was no association between number of patch test procedures performed and reactions to nickel sulphate. Reproducible reactivity to fragrance mix was not found. Conclusion: A high proportion of transient patch test reactivity to nickel sulphate 200 ìg/cm 2 was found. Patch testing with nickel in concentrations used for adults cannot be recommended in infants. The interpretation of a singular positive nickel patch test in small children must be assessed with caution. Allergic reactions to fragrance mix were not found in this age group.

Patch test

Patch Testing

Reactivity

Nickel allergy

Erythema

10.1111/j.0105-1873.2004.0309x.x

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Citations (3)

Dansk allergiforskning går helt i fisk

Carsten Bindslev‐Jensen

Source

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EAACI/GA²LEN/EDF guideline: management of urticaria

Allergy (2005)

Torsten Zuberbier Carsten Bindslev‐Jensen Giorgio Walter Canonica Clive Grattan Malcolm W. Greaves

This guideline is the result of a consensus reached during a panel discussion at the second International Consensus Meeting on Urticara, Urticaria 2004 , a joint initiative of the EAACI Dermatology Section and GA 2 LEN. Urticaria has a profound impact on the quality of life, and effective treatment is therefore required. The recommended first line treatment are nonsedating H 1 antihistamines. They have proven to be effective in double‐blind controlled studies, but dosages increased up to fourfold over the recommended doses may be necessary. However, for different urticaria subtypes and in view of individual variation in the course of the disease and response to treatment, additional or alternative therapies may be required. Immunosuppressive drugs like cyclosporin A and corticosteroids are not recommended for long‐term treatment due to unavoidable severe adverse effects. This guideline was, in addition, accepted by the European Dermatology Forum (EDF) and formally approved by the European Union of Medical Specialists (UEMS).

Guideline

10.1111/j.1398-9995.2005.00962.x

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Citations (473)

Assessing severity of anaphylaxis: a data-driven comparison of 23 instruments

Clinical and Translational Allergy (2018)

Esben Eller Antonella Muraro Ronald Dahl Charlotte G. Mørtz Carsten Bindslev‐Jensen

The severity of an allergic reaction can range from mild local symptoms to anaphylactic shock. To score this, a number of instruments have been developed, although heterogeneous in design and purpose. Severity scoring algorithms are therefore difficult to compare, but are frequently used beyond their initial purpose. Our objective was to compare the most used severity scoring instruments by a data-driven approach on both milder reactions and anaphylaxis.All positive challenges to foods or drugs (n = 2828) including anaphylaxis (n = 616) at Odense University Hospital, Denmark from 1998 to 2016 were included and severity was scored according to Sampson5. Based on recommendations from an expert group, the symptoms and values from Sampson5 were for all reactions and anaphylaxis only translated and compared by kappa statistics with 22 instruments, ranging from 3 to 6 steps.For milder reactions, there was a significant correlation between the number of steps in an instrument and the number of challenges that could be translated, whereas all instruments were good to identify food anaphylaxis. Some instruments scored reactions more severely than Sampson5, other scored them milder and some scored food and drug challenges differently. Instruments for hymenoptera reactions were difficult to apply on food and drug reactions, and thus distributed severity differently. Algorithms hampered the translation between instruments, and 7 instruments were poor concerning drug anaphylaxis, including the only instrument developed specifically for drug reactions.The distributions of severity differed between the 23 instruments in both food and drug allergy, and thus rendering translation especially between scoring systems with 3 and 5 grades difficult. Fine-graded and simple instruments are preferred for comparison especially among milder reactions, and instruments applied to non-intended situations may not reflect a true severity picture.

Drug allergy

10.1186/s13601-018-0215-x

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Citations (50)

Contributor contact details

Elsevier eBooks (2007)

E. N. Clare Mills Harry J. Wichers Karin Hoffmann‐Sommergruber Montserrat Fernández-Rivas P.D. Barbara Ballmer-Weber

10.1016/b978-1-84569-028-1.50021-6

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Three cases of anaphylaxis following injection of a depot corticosteroid with evidence of IgE sensitization to macrogols rather than the active steroid

Clinical and Translational Allergy (2017)

Nicolaj Brandt Lene H. Garvey U. Bindslev‐Jensen Henrik Fomsgaard Kjær Carsten Bindslev‐Jensen

We present three cases with anaphylaxis after injection of a depot corticosteroid. First, the steroid was suspected as the elicitor, but after evaluation the excipient macrogol was found to be the elicitor. One of the patients had reactions to several unrelated drugs. Increased awareness of anaphylaxis to excipients such as macrogols is needed, especially when allergy tests for the active drug is negative and in patients with a history of repeated anaphylaxis to seemingly unrelated drugs. To establish the correct diagnosis it is important to test with the exact formulation of the culprit drug, as well as all the ingredients including excipients.

Culprit

Drug allergy

Excipient

10.1186/s13601-016-0138-3

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Citations (17)

Front & Back Matter

Dermatology (2012)

Stéphane Dalle Laurent Parmentier Elvira Moscarella Alice Phan Giuseppe Argenziano

10.1159/000339779

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