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101. Hazelnut allergy across Europe dissected molecularly: A EuroPrevall outpatient clinic survey

Author

Datema, M.R. Zuidmeer-Jongejan, L. Asero, R. Barreales, L. Belohlavkova, S. De Blay, F. Bures, P. Clausen, M. Dubakiene, R. Gislason, D. Jedrzejczak-Czechowicz, M. Kowalski, M.L. Knulst, A.C. Kralimarkova, T. Le, T.-M. Lovegrove, A. Marsh, J. Papadopoulos, N.G. Popov, T. Del Prado, N. Purohit, A. Reese, G. Reig, I. Seneviratne, S.L. Sinaniotis, A. Versteeg, S.A. Vieths, S. Zwinderman, A.H. Mills, C. Lidholm, J. Hoffmann-Sommergruber, K. Fernández-Rivas, M. Ballmer-Weber, B. Van Ree, R.

Subjects
food and beverages
Abstract

Background Hazelnut allergy is birch pollen-driven in Northern/Western Europe and lipid transfer protein-driven in Spain and Italy. Little is known about other regions and other allergens. Objective Establishing a molecular map of hazelnut allergy across Europe. Methods In 12 European cities, subjects reporting reactions to hazelnut (n = 731) were evaluated and sensitization to 24 foods, 12 respiratory allergen sources, and latex was tested by using skin prick test and ImmunoCAP. A subset (124 of 731) underwent a double-blind placebo-controlled food challenge to hazelnut. Sera of 423 of 731 subjects were analyzed for IgE against 7 hazelnut allergens and cross-reactive carbohydrate determinants by ImmunoCAP. Results Hazelnut allergy was confirmed in 70% of those undergoing double-blind placebo-controlled food challenges. Birch pollen-driven hazelnut sensitization (Cor a 1) dominated in most cities, except in Reykjavik, Sofia, Athens, and Madrid, where reporting of hazelnut allergy was less frequent anyhow. In Athens, IgE against Cor a 8 dominated and strongly correlated with IgE against walnut, peach, and apple and against Chenopodium, plane tree, and mugwort pollen. Sensitization to seed storage proteins was observed in less than 10%, mainly in children, and correlated with IgE to nuts, seeds, and legumes. IgE to Cor a 12, observed in all cities (10% to 25%), correlated with IgE to nuts, seeds, and pollen. Conclusions In adulthood, the importance of hazelnut sensitization to storage proteins, oleosin (Cor a 12), and Cor a 8 is diluted by the increased role of birch pollen cross-reactivity with Cor a 1. Cor a 8 sensitization in the Mediterranean is probably driven by diet in combination with pollen exposure. Hazelnut oleosin sensitization is prevalent across Europe; however, the clinical relevance remains to be established. © 2015 American Academy of Allergy, Asthma & Immunology.

Published
2015

102. Patch test results with fragrance markers of the baseline series - Analysis of the European Surveillance System on Contact Allergies (ESSCA) network 2009-2012

Author

Frosch, Pj1, 2, Duus Johansen J3, Schuttelaar, Ml4, Silvestre, Jf5, Sánchez Pérez J6, Weisshaar, E7, Uter, W8, ESSCA n. e. t. w. o. r. k. Aberer, W, Bircher, A, Simon, D, Ballmer Weber, B, Spring, P, Frosch, P, Fuchs, T, Brasch, J, Bauer, A, Elsner, P, John, Sm, Mahler, V, Weisshaar, E, Johansen, Jd, Giménez Arnau, A, Sánchez Pérez, J, Silvestre, Jf, García Gavín, J, Fernández Redondo, V, Amario Hita, Jc, Mercader, P, Ruiz, I, Jolanki, R, Pesonen, M, Rantanen, T, Ayala, F, Balato, A, PESERICO STECCHINI NEGRI DE SALVI, Andrea, Fortina, Ab, Filon, Fl, Corradin, Mt, Gallo, R, Valiukeviciene, S, Sliuziaviciene, G, Coenraads, Pj, Schuttelaar, Ml, Rustemeyer, T, Kręcicz, B, Kieć Świerczyńska, M, Spiewak, R, Sadowska, A, Czarnecka Operacz, M, Dugonik, A, Pandurovic, Mk, Kmecl, T, Vok, M, Godnic, S, Mesto, N, Lunder, T, Green, Cm, Wilkinson, M, Sansom, Je, King, Cm, Horne, Hl, English, Js, Johnston, Ga, Statham, Bn, Chowdhury, Mm, Stone, N, Cooper, S, Gawkrodger, Dj, Sabroe, R, Holden, C, Ormerod, A. d., BELLONI FORTINA, Anna, Frosch, Pj, Duus Johansen, J, Schuttelaar, Ml, Silvestre, Jf, Sánchez-Pérez, J, Weisshaar, E, Uter, W, Larese Filon, F., and Essca, Network

Subjects
Adult, Male, contact allergy, contact sensitization, fragrances, patch testing, regional differences, 2708, Immunology and Allergy, Allergic Contact, Petrolatum, Dermatitis, Prevalence, fragrance, Humans, Retrospective Studies, Medicine (all), Allergens, Patch Tests, Dermatitis, Allergic Contact, Europe, Female, Perfume, Population Surveillance, regional difference
Abstract

Contact allergy to fragrances is common, and impairs quality of life, particularly in young women. OBJECTIVE: To provide current results on the prevalences of sensitization to fragrance allergens used as markers in the baseline series of most European countries. METHODS: Data of patients consecutively patch tested between 2009 and 2012 in 12 European countries with fragrance allergens contained in the baseline series were collected by the European Surveillance System on Contact Allergies network and descriptively analysed. Four departments used the TRUE Test(®) system. RESULTS: The 'basic markers' were tested on 51 477 [fragrance mix II (FM II)] to 57 123 [Myroxylon pereirae, balsam of Peru] patients, and yielded positive reactions as follows: fragrance mix I 6.9%, Myroxylon pereirae 5.4%, FM II 3.8%, colophonium 2.6%, and hydroxyisohexyl 3-cyclohexene carboxaldehyde 1.7%, with some regional differences. Prevalences with TRUE Test(®) allergens were lower. Additional fragrances were tested on 3643 (trimethylbenzenepropanol) to 14 071 (oil of turpentine) patients, and yielded between 2.6% (Cananga odorata) and 0.7% (trimethylbenzenepropanol) positive reactions. CONCLUSIONS: Contact allergy to fragrances is common throughout Europe, with regional variation probably being explained by patch test technique, and differences in exposure and referral patterns. The current basic markers of fragrance sensitivity in the baseline series should be supplemented with additional fragrance allergens.

Published
2015

103. Medical, psychological and socio-economic implications of chronic hand eczema: a cross-sectional study

Author

Cazzaniga, S, Ballmer-Weber, B K, Gräni, N, Spring, P, Bircher, A, Anliker, M, Sonntag, A K, Piletta, P, Huber, C, Borradori, L, Diepgen, T, Apfelbacher, C, Simon, D, University of Zurich, and Simon, D

Subjects
2708 Dermatology, integumentary system, 10177 Dermatology Clinic, 610 Medicine & health, 2725 Infectious Diseases
Abstract

BACKGROUND Hand eczema (HE) is a common skin disease with major medical psychological and socio-economic implications. Onset and prognosis of HE are determined by individual as well as environmental factors. So far, most epidemiological data on HE have been reported from Scandinavian and recently German studies. OBJECTIVE To investigate the characteristics and medical care of patients with chronic HE (CHE) in Switzerland, and identify risk factors. METHODS In this cross-sectional study, data from patients with chronic HE were obtained by means of medical history, dermatological examination and patient questionnaires. Multiple logistic regression analysis was applied to identify risk factors for high severity and dermatology life quality index (DLQI). RESULTS In seven dermatology departments, 199 patients (mean age 40.4 years, 50.8% female) with CHE (mean duration 6.6 years) were enrolled. Moderate to severe HE was reported by 70.9% of patients, and was associated with age 50 years, localization of lesions and pruritus. Because of the CHE, 37.3% of patients were on sick leave over the past 12 months, 14.8% had changed or lost their job. Practically all patients applied topical therapy, 21% were treated with alitretinoin, and 21% with psoralen plus UVA light (PUVA). The effects on the health-related quality of life was moderate to large in 33.7% and 39.4% of CHE patients, respectively. Factors associated with a high impact on DLQI (mean 9.7 ± 5.8) were female sex, lesions on back of the hands and pruritus as well as mechanical skin irritation and wearing gloves. CONCLUSION In agreement with recent studies, the Swiss data demonstrate the high impact of CHE on medical well-being, patient quality of life and work ability. As it is associated with an intense use of health care services, high rate of sick leave, job loss and change, CHE may cause a high socio-economic burden.

Published
2015
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104. Further studies on the biological activity of hazelnut allergens

Author

Blanc, F. Bernard, H. Ah-Leung, S. Przybylski-Nicaise, L. Skov, P.S. Purohit, A. De Blay, F. Ballmer-Weber, B. Fritsche, P. Rivas, M.F. Reig, I. Sinaniotis, A. Vassilopoulou, E. Hoffmann-Sommergruber, K. Vieths, S. Rigby, N. Mills, C. Adel-Patient, K.

Subjects
food and beverages, respiratory system, respiratory tract diseases
Abstract

Background: Sensitization to hazelnut allergens vary depending on the geographic origin and age of the patients. The objective of this study was to further investigate the allergenic activity of hazelnut allergens using sera from patients recruited in various European regions and presenting different sensitization patterns to hazelnut proteins. Methods: Natural Cor a 11 and Cor a 9 were purified from hazelnut whereas Cor a 1 and Cor a 8 were produced as recombinant proteins (rCor a 1.04 and rCor a 8). Sera from hazelnut allergic patients were collected in France (n = 5), Switzerland (n = 2), Greece (n = 11) and Spain (n = 3), within the Europrevall project. Total and allergen-specific IgE were quantified by enzyme allergosorbent test and IgE immunoblot were performed using pooled sera from birch-pollen endemic region or from Greece. Histamine Release (HR) assays were performed with stripped basophils passively sensitized with individual sera and challenged by a hazelnut extract or the different hazelnut allergens. Results: As previously described, hazelnut allergic patients from Mediterranean countries are mainly sensitized to the nsLTP Cor a 8 whereas patients from France and Switzerland are sensitized to pollen-related allergens. Interestingly, an intermediate profile was evidenced in patients from Madrid. Hazelnut 7S globulin (Cor a 11) and 11S globulin (Cor a 9) were found to be minor allergens, recognized only by patients from Mediterranean countries. The biologic activity of the 4 tested allergens, analysed by HR assay, further confirmed the sensitization patterns, but also demonstrated the very high elicitation potency of Cor a 8. Conclusions: This work, extending previously published researches, represents a step towards the better understanding of the complexity of hazelnut allergy and provides new data on the biological activity of hazelnut allergens and extracts. © 2015 Blanc et al.

Published
2015

106. Soy allergy in perspective

Author

Ballmer-Weber, B K, Vieths, S, University of Zurich, and Ballmer-Weber, B K

Subjects
2403 Immunology, 2723 Immunology and Allergy, 10177 Dermatology Clinic, 610 Medicine & health
Published
2008
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107. BASALIT trial: double‐blind placebo‐controlled allergen immunotherapy with rBet v 1‐FV in birch‐related soya allergy

Author

Treudler, R., primary, Franke, A., additional, Schmiedeknecht, A., additional, Ballmer‐Weber, B., additional, Worm, M., additional, Werfel, T., additional, Jappe, U., additional, Biedermann, T., additional, Schmitt, J., additional, Brehler, R., additional, Kleinheinz, A., additional, Kleine‐Tebbe, J., additional, Brüning, H., additional, Ruëff, F., additional, Ring, J., additional, Saloga, J., additional, Schäkel, K., additional, Holzhauser, T., additional, Vieths, S., additional, and Simon, J. C., additional

Published
2017
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108. EAACI Molecular Allergology User's Guide

Author

Matricardi, P. M., Kleine-Tebbe, J., Hoffmann, H. J., Valenta, R., Hilger, C., Hofmaier, S., Aalberse, R. C., Agache, I., Asero, R., Ballmer-Weber, B., Barber, D., Beyer, K., Biedermann, T., Bilò, M. B., Blank, S., Bohle, B., Bosshard, P. P., Breiteneder, H., Brough, H. A., Caraballo, L., Caubet, J. C., Crameri, R., Davies, J. M., Douladiris, N., Ebisawa, M., EIgenmann, P. A., Fernandez-Rivas, M., Ferreira, F., Gadermaier, G., Glatz, M., Hamilton, R. G., Hawranek, T., Hellings, P., Hoffmann-Sommergruber, K., Jakob, T., Jappe, U., Jutel, M., Kamath, S. D., Knol, E. F., Korosec, P., Kuehn, A., Lack, G., Lopata, A. L., Mäkelä, M., Morisset, M., Niederberger, V., Nowak-Węgrzyn, A. H., Papadopoulos, N. G., Pastorello, E. A., Pauli, G., Platts-Mills, T., Posa, D., Poulsen, L. K., Raulf, M., Sastre, J., Scala, E., Schmid, J. M., Schmid-Grendelmeier, P., van Hage, M., van Ree, R., Vieths, S., Weber, R., Wickman, M., Muraro, A., Ollert, M., Matricardi, P. M., Kleine-Tebbe, J., Hoffmann, H. J., Valenta, R., Hilger, C., Hofmaier, S., Aalberse, R. C., Agache, I., Asero, R., Ballmer-Weber, B., Barber, D., Beyer, K., Biedermann, T., Bilò, M. B., Blank, S., Bohle, B., Bosshard, P. P., Breiteneder, H., Brough, H. A., Caraballo, L., Caubet, J. C., Crameri, R., Davies, J. M., Douladiris, N., Ebisawa, M., EIgenmann, P. A., Fernandez-Rivas, M., Ferreira, F., Gadermaier, G., Glatz, M., Hamilton, R. G., Hawranek, T., Hellings, P., Hoffmann-Sommergruber, K., Jakob, T., Jappe, U., Jutel, M., Kamath, S. D., Knol, E. F., Korosec, P., Kuehn, A., Lack, G., Lopata, A. L., Mäkelä, M., Morisset, M., Niederberger, V., Nowak-Węgrzyn, A. H., Papadopoulos, N. G., Pastorello, E. A., Pauli, G., Platts-Mills, T., Posa, D., Poulsen, L. K., Raulf, M., Sastre, J., Scala, E., Schmid, J. M., Schmid-Grendelmeier, P., van Hage, M., van Ree, R., Vieths, S., Weber, R., Wickman, M., Muraro, A., and Ollert, M.

Published
2016

109. EAACI Molecular Allergology User's Guide

Author

MS Dermatologie/Allergologie, CDL Celdiagnostiek, Infection & Immunity, Matricardi, P. M., Kleine-Tebbe, J., Hoffmann, H. J., Valenta, R., Hilger, C., Hofmaier, S., Aalberse, R. C., Agache, I., Asero, R., Ballmer-Weber, B., Barber, D., Beyer, K., Biedermann, T., Bilò, M. B., Blank, S., Bohle, B., Bosshard, P. P., Breiteneder, H., Brough, H. A., Caraballo, L., Caubet, J. C., Crameri, R., Davies, J. M., Douladiris, N., Ebisawa, M., EIgenmann, P. A., Fernandez-Rivas, M., Ferreira, F., Gadermaier, G., Glatz, M., Hamilton, R. G., Hawranek, T., Hellings, P., Hoffmann-Sommergruber, K., Jakob, T., Jappe, U., Jutel, M., Kamath, S. D., Knol, E. F., Korosec, P., Kuehn, A., Lack, G., Lopata, A. L., Mäkelä, M., Morisset, M., Niederberger, V., Nowak-Węgrzyn, A. H., Papadopoulos, N. G., Pastorello, E. A., Pauli, G., Platts-Mills, T., Posa, D., Poulsen, L. K., Raulf, M., Sastre, J., Scala, E., Schmid, J. M., Schmid-Grendelmeier, P., van Hage, M., van Ree, R., Vieths, S., Weber, R., Wickman, M., Muraro, A., Ollert, M., MS Dermatologie/Allergologie, CDL Celdiagnostiek, Infection & Immunity, Matricardi, P. M., Kleine-Tebbe, J., Hoffmann, H. J., Valenta, R., Hilger, C., Hofmaier, S., Aalberse, R. C., Agache, I., Asero, R., Ballmer-Weber, B., Barber, D., Beyer, K., Biedermann, T., Bilò, M. B., Blank, S., Bohle, B., Bosshard, P. P., Breiteneder, H., Brough, H. A., Caraballo, L., Caubet, J. C., Crameri, R., Davies, J. M., Douladiris, N., Ebisawa, M., EIgenmann, P. A., Fernandez-Rivas, M., Ferreira, F., Gadermaier, G., Glatz, M., Hamilton, R. G., Hawranek, T., Hellings, P., Hoffmann-Sommergruber, K., Jakob, T., Jappe, U., Jutel, M., Kamath, S. D., Knol, E. F., Korosec, P., Kuehn, A., Lack, G., Lopata, A. L., Mäkelä, M., Morisset, M., Niederberger, V., Nowak-Węgrzyn, A. H., Papadopoulos, N. G., Pastorello, E. A., Pauli, G., Platts-Mills, T., Posa, D., Poulsen, L. K., Raulf, M., Sastre, J., Scala, E., Schmid, J. M., Schmid-Grendelmeier, P., van Hage, M., van Ree, R., Vieths, S., Weber, R., Wickman, M., Muraro, A., and Ollert, M.

Published
2016

110. Can we identify patients at risk of life-threatening allergic reactions to food?

Author

Turner, P. J., Baumert, J. L., Beyer, K., Boyle, R. J., Chan, C. H., Clark, A. T., Crevel, R. W.R., DunnGalvin, A., Fernández-Rivas, M., Gowland, M. H., Grabenhenrich, L., Hardy, S., Houben, G. F., O'B Hourihane, J., Muraro, A., Poulsen, L. K., Pyrz, K., Remington, B. C., Schnadt, S., van Ree, R., Venter, C., Worm, M., Mills, E. N.C., Roberts, G., Ballmer-Weber, B. K., Turner, P. J., Baumert, J. L., Beyer, K., Boyle, R. J., Chan, C. H., Clark, A. T., Crevel, R. W.R., DunnGalvin, A., Fernández-Rivas, M., Gowland, M. H., Grabenhenrich, L., Hardy, S., Houben, G. F., O'B Hourihane, J., Muraro, A., Poulsen, L. K., Pyrz, K., Remington, B. C., Schnadt, S., van Ree, R., Venter, C., Worm, M., Mills, E. N.C., Roberts, G., and Ballmer-Weber, B. K.

Abstract

Anaphylaxis has been defined as a ‘severe, life-threatening generalized or systemic hypersensitivity reaction’. However, data indicate that the vast majority of food-triggered anaphylactic reactions are not life-threatening. Nonetheless, severe life-threatening reactions do occur and are unpredictable. We discuss the concepts surrounding perceptions of severe, life-threatening allergic reactions to food by different stakeholders, with particular reference to the inclusion of clinical severity as a factor in allergy and allergen risk management. We review the evidence regarding factors that might be used to identify those at most risk of severe allergic reactions to food, and the consequences of misinformation in this regard. For example, a significant proportion of food-allergic children also have asthma, yet almost none will experience a fatal food-allergic reaction; asthma is not, in itself, a strong predictor for fatal anaphylaxis. The relationship between dose of allergen exposure and symptom severity is unclear. While dose appears to be a risk factor in at least a subgroup of patients, studies report that individuals with prior anaphylaxis do not have a lower eliciting dose than those reporting previous mild reactions. It is therefore important to consider severity and sensitivity as separate factors, as a highly sensitive individual will not necessarily experience severe symptoms during an allergic reaction. We identify the knowledge gaps that need to be addressed to improve our ability to better identify those most at risk of severe food-induced allergic reactions.

Published
2016

111. EAACI molecular allergology user's guide

Author

Matricardi, P M, Kleine-Tebbe, J, Hoffmann, H.J., Valenta, R, Hilger, C, Hofmaier, S, Aalberse, R C, Agache, I, Asero, R, Ballmer-Weber, B, Barber, D, Beyer, K, Biedermann, T, Bilò, M B, Blank, S, Bohle, B, Bosshard, P P, Breiteneder, H, Brough, H A, Caraballo, L, Caubet, J C, Crameri, R, Davies, J M, Douladiris, N, Ebisawa, M, EIgenmann, P A, Fernandez-Rivas, M, Ferreira, F, Gadermaier, G, Glatz, M, Hamilton, R G, Hawranek, T, Hellings, P, Hoffmann-Sommergruber, K, Jakob, T, Jappe, U, Jutel, M, Kamath, S D, Knol, E F, Korosec, P, Kuehn, A, Lack, G, Lopata, A L, Mäkelä, M, Morisset, M, Niederberger, V, Nowak-Węgrzyn, A H, Papadopoulos, N G, Pastorello, E A, Pauli, G, Platts-Mills, T, Posa, D, Poulsen, L. K., Raulf, M, Sastre, J, Scala, E, Schmid, J M, Schmid-Grendelmeier, P, van Hage, M, van Ree, R, Vieths, S, Weber, R, Wickman, M, Muraro, A, Ollert, M., Matricardi, P M, Kleine-Tebbe, J, Hoffmann, H.J., Valenta, R, Hilger, C, Hofmaier, S, Aalberse, R C, Agache, I, Asero, R, Ballmer-Weber, B, Barber, D, Beyer, K, Biedermann, T, Bilò, M B, Blank, S, Bohle, B, Bosshard, P P, Breiteneder, H, Brough, H A, Caraballo, L, Caubet, J C, Crameri, R, Davies, J M, Douladiris, N, Ebisawa, M, EIgenmann, P A, Fernandez-Rivas, M, Ferreira, F, Gadermaier, G, Glatz, M, Hamilton, R G, Hawranek, T, Hellings, P, Hoffmann-Sommergruber, K, Jakob, T, Jappe, U, Jutel, M, Kamath, S D, Knol, E F, Korosec, P, Kuehn, A, Lack, G, Lopata, A L, Mäkelä, M, Morisset, M, Niederberger, V, Nowak-Węgrzyn, A H, Papadopoulos, N G, Pastorello, E A, Pauli, G, Platts-Mills, T, Posa, D, Poulsen, L. K., Raulf, M, Sastre, J, Scala, E, Schmid, J M, Schmid-Grendelmeier, P, van Hage, M, van Ree, R, Vieths, S, Weber, R, Wickman, M, Muraro, A, and Ollert, M.

Abstract

The availability of allergen molecules ('components') from several protein families has advanced our understanding of immunoglobulin E (IgE)-mediated responses and enabled 'component-resolved diagnosis' (CRD). The European Academy of Allergy and Clinical Immunology (EAACI) Molecular Allergology User's Guide (MAUG) provides comprehensive information on important allergens and describes the diagnostic options using CRD. Part A of the EAACI MAUG introduces allergen molecules, families, composition of extracts, databases, and diagnostic IgE, skin, and basophil tests. Singleplex and multiplex IgE assays with components improve both sensitivity for low-abundance allergens and analytical specificity; IgE to individual allergens can yield information on clinical risks and distinguish cross-reactivity from true primary sensitization. Part B discusses the clinical and molecular aspects of IgE-mediated allergies to foods (including nuts, seeds, legumes, fruits, vegetables, cereal grains, milk, egg, meat, fish, and shellfish), inhalants (pollen, mold spores, mites, and animal dander), and Hymenoptera venom. Diagnostic algorithms and short case histories provide useful information for the clinical workup of allergic individuals targeted for CRD. Part C covers protein families containing ubiquitous, highly cross-reactive panallergens from plant (lipid transfer proteins, polcalcins, PR-10, profilins) and animal sources (lipocalins, parvalbumins, serum albumins, tropomyosins) and explains their diagnostic and clinical utility. Part D lists 100 important allergen molecules. In conclusion, IgE-mediated reactions and allergic diseases, including allergic rhinoconjunctivitis, asthma, food reactions, and insect sting reactions, are discussed from a novel molecular perspective. The EAACI MAUG documents the rapid progression of molecular allergology from basic research to its integration into clinical practice, a quantum leap in the management of allergic patients.

Published
2016

112. Standardization of double blind placebo controlled food challenge with soy within a multicentre trial

Author

Treudler, R., primary, Franke, A., additional, Schmiedeknecht, A., additional, Ballmer-Weber, B. K., additional, Worm, M., additional, Werfel, T., additional, Jappe, U., additional, Biedermann, T., additional, Schmitt, J., additional, Brehler, R., additional, Kleinheinz, A., additional, Kleine-Tebbe, J., additional, Brüning, H., additional, Ruëff, F., additional, Ring, J., additional, Saloga, J., additional, Schäkel, K., additional, Holzhauser, T., additional, Vieths, St., additional, and Simon, J. C., additional

Published
2016
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113. A new framework for the documentation and interpretation of oral food challenges in population-based and clinical research

Author

Grabenhenrich, L. B., primary, Reich, A., additional, Bellach, J., additional, Trendelenburg, V., additional, Sprikkelman, A. B., additional, Roberts, G., additional, Grimshaw, K. E. C., additional, Sigurdardottir, S., additional, Kowalski, M. L., additional, Papadopoulos, N. G., additional, Quirce, S., additional, Dubakiene, R., additional, Niggemann, B., additional, Fernández-Rivas, M., additional, Ballmer-Weber, B., additional, van Ree, R., additional, Schnadt, S., additional, Mills, E. N. C., additional, Keil, T., additional, and Beyer, K., additional

Published
2016
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114. The conformational IgE epitope profile of soya bean allergen Gly m 4

Author

Husslik, F., primary, Nürnberg, J., additional, Seutter von Loetzen, C., additional, Mews, T., additional, Ballmer-Weber, B. K., additional, Kleine-Tebbe, J., additional, Treudler, R., additional, Simon, J.-C., additional, Randow, S., additional, Völker, E., additional, Reuter, A., additional, Rösch, P., additional, Vieths, S., additional, Holzhauser, T., additional, and Schiller, D., additional

Published
2016
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116. Can we identify patients at risk of life-threatening allergic reactions to food?

Author

Turner, P. J., primary, Baumert, J. L., additional, Beyer, K., additional, Boyle, R. J., additional, Chan, C.-H., additional, Clark, A. T., additional, Crevel, R. W. R., additional, DunnGalvin, A., additional, Fernández-Rivas, M., additional, Gowland, M. H., additional, Grabenhenrich, L., additional, Hardy, S., additional, Houben, G. F., additional, O'B Hourihane, J., additional, Muraro, A., additional, Poulsen, L. K., additional, Pyrz, K., additional, Remington, B. C., additional, Schnadt, S., additional, van Ree, R., additional, Venter, C., additional, Worm, M., additional, Mills, E. N. C., additional, Roberts, G., additional, and Ballmer-Weber, B. K., additional

Published
2016
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117. EAACI Molecular Allergology User's Guide

Author

Matricardi, P. M., primary, Kleine‐Tebbe, J., additional, Hoffmann, H. J., additional, Valenta, R., additional, Hilger, C., additional, Hofmaier, S., additional, Aalberse, R. C., additional, Agache, I., additional, Asero, R., additional, Ballmer‐Weber, B., additional, Barber, D., additional, Beyer, K., additional, Biedermann, T., additional, Bilò, M. B., additional, Blank, S., additional, Bohle, B., additional, Bosshard, P. P., additional, Breiteneder, H., additional, Brough, H. A., additional, Caraballo, L., additional, Caubet, J. C., additional, Crameri, R., additional, Davies, J. M., additional, Douladiris, N., additional, Ebisawa, M., additional, EIgenmann, P. A., additional, Fernandez‐Rivas, M., additional, Ferreira, F., additional, Gadermaier, G., additional, Glatz, M., additional, Hamilton, R. G., additional, Hawranek, T., additional, Hellings, P., additional, Hoffmann‐Sommergruber, K., additional, Jakob, T., additional, Jappe, U., additional, Jutel, M., additional, Kamath, S. D., additional, Knol, E. F., additional, Korosec, P., additional, Kuehn, A., additional, Lack, G., additional, Lopata, A. L., additional, Mäkelä, M., additional, Morisset, M., additional, Niederberger, V., additional, Nowak‐Węgrzyn, A. H., additional, Papadopoulos, N. G., additional, Pastorello, E. A., additional, Pauli, G., additional, Platts‐Mills, T., additional, Posa, D., additional, Poulsen, L. K., additional, Raulf, M., additional, Sastre, J., additional, Scala, E., additional, Schmid, J. M., additional, Schmid‐Grendelmeier, P., additional, van Hage, M., additional, van Ree, R., additional, Vieths, S., additional, Weber, R., additional, Wickman, M., additional, Muraro, A., additional, and Ollert, M., additional

Published
2016
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118. The Drug Ambassador Project - The diversity of diagnostic procedures for drug allergy around Europe

Author

Gomes, Eva Rebelo, Pichler, Werner J., Demoly, Pascal, Aberer, Werner, Frew, Anthony J., de Weck, Alain, Ballmer Weber, B. K., Barbaud, A., Bilo, B., Bircher, A., Birnbaum, J., Blanca, M., Blömecke, B., Brockow, K., Campi, P., Dzviga, C., Drouet, M., Eberlein König, B., Fernandez, J., Fuchs, T., Guéant, J. L., Gutgesell, C., Hertl, M., Kanny, G., Kapp, A., Kidon, M., Kowalski, M., Merk, H., Moneret Vaultrin, A. D., Pascual Marcos, C., Przybilla, B., Ring, J., Romano, A., Rueff, F., Sabbah, A., Sainte Laudy, J., Sanz, M., Tas, E., Torres, M. J., Vervloet, D., Wedi, B., Wüthrich, B., MARONE, GIANNI, Gomes, Eva Rebelo, Pichler, Werner J., Demoly, Pascal, Aberer, Werner, Frew, Anthony J., de Weck, Alain, Ballmer Weber, B. K., Barbaud, A., Bilo, B., Bircher, A., Birnbaum, J., Blanca, M., Blömecke, B., Brockow, K., Campi, P., Dzviga, C., Drouet, M., Eberlein König, B., Fernandez, J., Fuchs, T., Guéant, J. L., Gutgesell, C., Hertl, M., Kanny, G., Kapp, A., Kidon, M., Kowalski, M., Marone, Gianni, Merk, H., Moneret Vaultrin, A. D., Pascual Marcos, C., Przybilla, B., Ring, J., Romano, A., Rueff, F., Sabbah, A., Sainte Laudy, J., Sanz, M., Tas, E., Torres, M. J., Vervloet, D., Wedi, B., and Wüthrich, B.

Subjects
Immunology and Allergy, Standardization, Diagnosi, Drug hypersensitivity
Published
2005

120. Der Ablauf einer Epikutantestung

Author

Jenny, S, Ballmer-Weber, B K, and University of Zurich

Subjects
10177 Dermatology Clinic, 610 Medicine & health
Published
2014

121. Diagnosis of immediate allergic reactions to beta-lactam antibiotics

Author

Torres, Maria J, Blanca, M., Fernandez, J., Romano, A., De Weck, A., Aberer, W., Brockow, K., Pichler, Werner J., Demoly, Pascal, Ballmer Weber, B. K., Barbaud, A., Bilo, B., Bircher, A., Birmbaum, J., Blömecke, B., Campi, P., Dzviga, C., Drouet, M., Eberlein König, B., Frew, T., Fuchs, T., Guéant, J. L., Gutgesell, C., Hertl, M., Kanny, G., Kapp, A., Kidon, M., Kowalski, M., Merk, H., Moneret Vautrin, A. D., Pascual Marcos, C., Przybilla, B., Rebelo Gomes, E., Ring, J., Rueff, F., Sabbah, A., Sainte Laudy, J., Sanz, M., Tas, E., Vervloet, D., Wedi, B., Wüthrich, B., MARONE, GIANNI, Torres, Maria J, Blanca, M., Fernandez, J., Romano, A., De Weck, A., Aberer, W., Brockow, K., Pichler, Werner J., Demoly, Pascal, Ballmer Weber, B. K., Barbaud, A., Bilo, B., Bircher, A., Birmbaum, J., Blömecke, B., Campi, P., Dzviga, C., Drouet, M., Eberlein König, B., Frew, T., Fuchs, T., Guéant, J. L., Gutgesell, C., Hertl, M., Kanny, G., Kapp, A., Kidon, M., Kowalski, M., Marone, Gianni, Merk, H., Moneret Vautrin, A. D., Pascual Marcos, C., Przybilla, B., Rebelo Gomes, E., Ring, J., Rueff, F., Sabbah, A., Sainte Laudy, J., Sanz, M., Tas, E., Vervloet, D., Wedi, B., and Wüthrich, B.

Subjects
medicine.medical_specialty, Allergy, Clinical immunology, Immunology, beta-Lactams, Beta-lactam, Drug Hypersensitivity, chemistry.chemical_compound, Risk Factors, Clavulanic acid, medicine, Immunology and Allergy, Humans, Drug reaction, Child, Skin Tests, business.industry, medicine.disease, Dermatology, Anti-Bacterial Agents, chemistry, Interest group, business, Algorithms, medicine.drug, Beta lactam antibiotics
Abstract

Allergic reactions to betalactams are the most common cause of adverse drug reactions mediated by specific immunological mechanisms. Reactions may be induced by all betalactams currently available, ranging from benzylpenicillin (BP) to other more recently introduced betalactams, such as aztreonam or the related betalactamase-inhibitor clavulanic acid (Fig. 1) (1–5). Although the production process of betalactams has improved over the years, the number of reactions has not decreased, M. J. Torres, M. Blanca, J. Fernandez, A. Romano, A. de Weck, W. Aberer, K. Brockow, W. J. Pichler, P. Demoly for ENDA, and the EAACI interest group on drug hypersensitivity Allergy Service, Carlos Haya Hospital, Malaga, Spain; Allergy Service, University La Paz, Madrid, Spain; Allergy Section, Dept. Clin. Med., UMH, Elche, Spain; Allergy Service, Catholic University of Rome, Italy; Fondation Gerimmun, Beaumont 18, CH1700, Fribourg, Switzerland; Department of Environmental Dermatology, Graz, Austria; Klinik und Poliklinik f5r Dermatologie und Allergologie, Muenchen, Germany; Clinic for Rheumatology and Clinical Immunology/Allergy, Inselspital, Bern, Switzerland; Maladies Respiratoires-INSERM U454, Hopital Arnaud de Villeneuve, Montpellier, France

Published
2003

122. The EAACI/GA²LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria.

Author

Zuberbier, T., Aberer, W., Asero, R., Abdul Latiff, A. H., Baker, D., Ballmer‐Weber, B., Bernstein, J. A., Bindslev‐Jensen, C., Brzoza, Z., Buense Bedrikow, R., Canonica, G. W., Church, M. K., Craig, T., Danilycheva, I. V., Dressler, C., Ensina, L. F., Giménez‐Arnau, A., Godse, K., Gonçalo, M., and Grattan, C.

Subjects
TREATMENT of urticaria, DERMATOLOGY, SKIN inflammation, INDIVIDUALIZED medicine, CLINICAL immunology
Abstract

Abstract: This evidence‐ and consensus‐based guideline was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. The conference was held on 1 December 2016. It is a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the EU‐founded network of excellence, the Global Allergy and Asthma European Network (GA²LEN), the European Dermatology Forum (EDF) and the World Allergy Organization (WAO) with the participation of 48 delegates of 42 national and international societies. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell‐driven disease, presenting with wheals, angioedema, or both. The lifetime prevalence for acute urticaria is approximately 20%. Chronic spontaneous urticaria and other chronic forms of urticaria are disabling, impair quality of life and affect performance at work and school. This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors and pathomechanisms. In addition, it outlines evidence‐based diagnostic and therapeutic approaches for the different subtypes of urticaria. [ABSTRACT FROM AUTHOR]

Published
2018
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124. Kiwifruit allergy across Europe: Clinical manifestation and IgE recognition patterns to kiwifruit allergens

Author

Le, T.-M. Bublin, M. Breiteneder, H. Fernández-Rivas, M. Asero, R. Ballmer-Weber, B. Barreales, L. Bures, P. Belohlavkova, S. De Blay, F. Clausen, M. Dubakiene, R. Gislason, D. Van Hoffen, E. Jedrzejczak-Czechowicz, M. Kowalski, M.L. Kralimarkova, T. Lidholm, J. Dewitt, Å.M. Mills, C.E.N. Papadopoulos, N.G. Popov, T. Purohit, A. Van Ree, R. Seneviratne, S. Sinaniotis, A. Summers, C. Vázquez-Cortés, S. Vieths, S. Vogel, L. Hoffmann-Sommergruber, K. Knulst, A.C.

Abstract

Background: Kiwifruit is a common cause of food allergy. Symptoms range from mild to anaphylactic reactions. Objective: We sought to elucidate geographic differences across Europe regarding clinical patterns and sensitization to kiwifruit allergens. Factors associated with the severity of kiwifruit allergy were identified, and the diagnostic performance of specific kiwifruit allergens was investigated. Methods: This study was part of EuroPrevall, a multicenter European study investigating several aspects of food allergy. Three hundred eleven patients with kiwifruit allergy from 12 countries representing 4 climatic regions were included. Specific IgE to 6 allergens (Act d 1, Act d 2, Act d 5, Act d 8, Act d 9, and Act d 10) and kiwifruit extract were tested by using ImmunoCAP. Results: Patients from Iceland were mainly sensitized to Act d 1 (32%), those from western/central and eastern Europe were mainly sensitized to Act d 8 (pathogenesis-related class 10 protein, 58% and 44%, respectively), and those from southern Europe were mainly sensitized to Act d 9 (profilin, 31%) and Act d 10 (nonspecific lipid transfer protein, 22%). Sensitization to Act d 1 and living in Iceland were independently and significantly associated with severe kiwifruit allergy (odds ratio, 3.98 [P =.003] and 5.60 [P

Published
2013

128. Responsiveness of the major birch allergen Bet v 1 scaffold to the gastric environment: Impact on structure and allergenic activity

Author

Sancho, A I, Wangorsch, A, Jensen, B M, Watson, A, Alexeev, Y, Johnson, P E, Mackie, A R, Neubauer, A, Reese, G, Ballmer-Weber, B, Hoffmann-Sommergruber, K, Skov, P S, Vieths, S, Mills, E N C, University of Zurich, and Sancho, A I

Subjects
1305 Biotechnology, 10177 Dermatology Clinic, 610 Medicine & health, 1106 Food Science
Published
2011
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131. The EuroPrevall outpatient clinic study on food allergy : Background and methodology

Author

Fernández-Rivas, Montserrat, Barreales, L., Mackie, A. R., Fritsche, P., Vázquez-Cortés, S., Jedrzejczak-Czechowicz, M., Kowalski, M. L., Clausen, M., Gislason, D., Sinaniotis, A., Kompoti, E., Le, T. M., Knulst, A. C., Purohit, A., De Blay, F., Kralimarkova, T., Popov, T., Asero, R., Belohlavkova, S., Seneviratne, S. L., Dubakiene, R., Lidholm, J., Hoffmann-Sommergruber, K., Burney, P., Crevel, R., Brill, M., Fernández-Pérez, C., Vieths, S., Clare Mills, E. N., Van Ree, R., Ballmer-Weber, B. K., Fernández-Rivas, Montserrat, Barreales, L., Mackie, A. R., Fritsche, P., Vázquez-Cortés, S., Jedrzejczak-Czechowicz, M., Kowalski, M. L., Clausen, M., Gislason, D., Sinaniotis, A., Kompoti, E., Le, T. M., Knulst, A. C., Purohit, A., De Blay, F., Kralimarkova, T., Popov, T., Asero, R., Belohlavkova, S., Seneviratne, S. L., Dubakiene, R., Lidholm, J., Hoffmann-Sommergruber, K., Burney, P., Crevel, R., Brill, M., Fernández-Pérez, C., Vieths, S., Clare Mills, E. N., Van Ree, R., and Ballmer-Weber, B. K.

Published
2015

132. Erratum: IgE recognition patterns in peanut allergy are age dependent: Perspectives of the EuroPrevall study (Allergy (2015) 70 (391-406))

Author

MS Dermatologie/Allergologie, Infection & Immunity, Arts-assistenten Kinderen, Ballmer-Weber, B. K., Lidholm, J., Fernández-Rivas, M., Seneviratne, S., Hanschmann, K. M., Vogel, L., Bures, P., Fritsche, P., Summers, C., Knulst, A. C., Le, T. M., Reig, I., Papadopoulos, N. G., Sinaniotis, A., Belohlavkova, S., Popov, T., Kralimarkova, T., De Blay, F., Purohit, A., Clausen, M., Kowalski, M. L., Asero, R., Dubakiene, R., Barreales, L., Clare Mills, E. N., Van Ree, R., Vieths, S., MS Dermatologie/Allergologie, Infection & Immunity, Arts-assistenten Kinderen, Ballmer-Weber, B. K., Lidholm, J., Fernández-Rivas, M., Seneviratne, S., Hanschmann, K. M., Vogel, L., Bures, P., Fritsche, P., Summers, C., Knulst, A. C., Le, T. M., Reig, I., Papadopoulos, N. G., Sinaniotis, A., Belohlavkova, S., Popov, T., Kralimarkova, T., De Blay, F., Purohit, A., Clausen, M., Kowalski, M. L., Asero, R., Dubakiene, R., Barreales, L., Clare Mills, E. N., Van Ree, R., and Vieths, S.

Published
2015

133. Position paper of the EAACI: Food allergy due to immunological cross-reactions with common inhalant allergens

Author

MS Dermatologie/Allergologie, Infection & Immunity, Werfel, T., Asero, R., Ballmer-Weber, B. K., Beyer, K., Enrique, E., Knulst, A. C., Mari, A., Muraro, A., Ollert, M., Poulsen, L. K., Vieths, S., Worm, M., Hoffmann-Sommergruber, K., MS Dermatologie/Allergologie, Infection & Immunity, Werfel, T., Asero, R., Ballmer-Weber, B. K., Beyer, K., Enrique, E., Knulst, A. C., Mari, A., Muraro, A., Ollert, M., Poulsen, L. K., Vieths, S., Worm, M., and Hoffmann-Sommergruber, K.

Published
2015

134. The EuroPrevall outpatient clinic study on food allergy: Background and methodology

Author

Infection & Immunity, MS Dermatologie/Allergologie, Arts-assistenten Kinderen, Fernández-Rivas, Montserrat, Barreales, L., Mackie, A. R., Fritsche, P., Vázquez-Cortés, S., Jedrzejczak-Czechowicz, M., Kowalski, M. L., Clausen, M., Gislason, D., Sinaniotis, A., Kompoti, E., Le, T. M., Knulst, A. C., Purohit, A., De Blay, F., Kralimarkova, T., Popov, T., Asero, R., Belohlavkova, S., Seneviratne, S. L., Dubakiene, R., Lidholm, J., Hoffmann-Sommergruber, K., Burney, P., Crevel, R., Brill, M., Fernández-Pérez, C., Vieths, S., Clare Mills, E. N., Van Ree, R., Ballmer-Weber, B. K., Infection & Immunity, MS Dermatologie/Allergologie, Arts-assistenten Kinderen, Fernández-Rivas, Montserrat, Barreales, L., Mackie, A. R., Fritsche, P., Vázquez-Cortés, S., Jedrzejczak-Czechowicz, M., Kowalski, M. L., Clausen, M., Gislason, D., Sinaniotis, A., Kompoti, E., Le, T. M., Knulst, A. C., Purohit, A., De Blay, F., Kralimarkova, T., Popov, T., Asero, R., Belohlavkova, S., Seneviratne, S. L., Dubakiene, R., Lidholm, J., Hoffmann-Sommergruber, K., Burney, P., Crevel, R., Brill, M., Fernández-Pérez, C., Vieths, S., Clare Mills, E. N., Van Ree, R., and Ballmer-Weber, B. K.

Published
2015

135. Position paper of the EAACI:food allergy due to immunological cross-reactions with common inhalant allergens

Author

Werfel, T, Asero, R, Ballmer-Weber, B K, Beyer, K, Enrique, E, Knulst, A C, Mari, A, Muraro, A, Ollert, M, Poulsen, L K, Vieths, S, Worm, M, Hoffmann-Sommergruber, K, Werfel, T, Asero, R, Ballmer-Weber, B K, Beyer, K, Enrique, E, Knulst, A C, Mari, A, Muraro, A, Ollert, M, Poulsen, L K, Vieths, S, Worm, M, and Hoffmann-Sommergruber, K

Abstract

In older children, adolescents, and adults, a substantial part of all IgE-mediated food allergies is caused by cross-reacting allergenic structures shared by inhalants and foods. IgE stimulated by a cross-reactive inhalant allergen can result in diverse patterns of allergic reactions to various foods. Local, mild, or severe systemic reactions may occur already after the first consumption of a food containing a cross-reactive allergen. In clinical practice, clinically relevant sensitizations are elucidated by skin prick testing or by the determination of specific IgE in vitro. Component-resolved diagnosis may help to reach a diagnosis and may predict the risk of a systemic reaction. Allergy needs to be confirmed in cases of unclear history by oral challenge tests. The therapeutic potential of allergen immunotherapy with inhalant allergens in pollen-related food allergy is not clear, and more placebo-controlled studies are needed. As we are facing an increasing incidence of pollen allergies, a shift in sensitization patterns and changes in nutritional habits, and the occurrence of new, so far unknown allergies due to cross-reactions are expected.

Published
2015

136. Deactivation to antineoplastic agents

Author

Petrausch, U, Pircher, M, Reding, Daniel, Ballmer-Weber, B K, Pestalozzi, Bernhard C, Petrausch, U, Pircher, M, Reding, Daniel, Ballmer-Weber, B K, and Pestalozzi, Bernhard C

Published
2015

137. Further studies on the biological activity of hazelnut allergens

Author

Blanc, F, Bernard, H, Ah-Leung, S, Przybylski-Nicaise, L, Skov, P Stahl, Purohit, A, de Blay, F, Ballmer-Weber, B, Fritsche, P, Rivas, M Fernandez, Reig, I, Sinaniotis, A, Vassilopoulou, E, Hoffmann-Sommergruber, K, Vieths, S, Rigby, N, Mills, C, Adel-Patient, K, Blanc, F, Bernard, H, Ah-Leung, S, Przybylski-Nicaise, L, Skov, P Stahl, Purohit, A, de Blay, F, Ballmer-Weber, B, Fritsche, P, Rivas, M Fernandez, Reig, I, Sinaniotis, A, Vassilopoulou, E, Hoffmann-Sommergruber, K, Vieths, S, Rigby, N, Mills, C, and Adel-Patient, K

Abstract

BACKGROUND Sensitization to hazelnut allergens vary depending on the geographic origin and age of the patients. The objective of this study was to further investigate the allergenic activity of hazelnut allergens using sera from patients recruited in various European regions and presenting different sensitization patterns to hazelnut proteins. METHODS Natural Cor a 11 and Cor a 9 were purified from hazelnut whereas Cor a 1 and Cor a 8 were produced as recombinant proteins (rCor a 1.04 and rCor a 8). Sera from hazelnut allergic patients were collected in France (n = 5), Switzerland (n = 2), Greece (n = 11) and Spain (n = 3), within the Europrevall project. Total and allergen-specific IgE were quantified by enzyme allergosorbent test and IgE immunoblot were performed using pooled sera from birch-pollen endemic region or from Greece. Histamine Release (HR) assays were performed with stripped basophils passively sensitized with individual sera and challenged by a hazelnut extract or the different hazelnut allergens. RESULTS As previously described, hazelnut allergic patients from Mediterranean countries are mainly sensitized to the nsLTP Cor a 8 whereas patients from France and Switzerland are sensitized to pollen-related allergens. Interestingly, an intermediate profile was evidenced in patients from Madrid. Hazelnut 7S globulin (Cor a 11) and 11S globulin (Cor a 9) were found to be minor allergens, recognized only by patients from Mediterranean countries. The biologic activity of the 4 tested allergens, analysed by HR assay, further confirmed the sensitization patterns, but also demonstrated the very high elicitation potency of Cor a 8. CONCLUSIONS This work, extending previously published researches, represents a step towards the better understanding of the complexity of hazelnut allergy and provides new data on the biological activity of hazelnut allergens and extracts.

Published
2015

141. Therapiemöglichkeiten bei der IgE-vermittelten Nahrungsmittelallergie

Author

Lepp, U, Ballmer-Weber, B K, Beyer, K, Erdmann, S, Fuchs, T, Henzgen, M, Heratizadeh, A, Huttegger, I, Jappe, U, Kleine-Tebbe, J, Niggemann, B, Raithel, M, Reese, I, Saloga, J, Schäfer, C, Szépfalusi, Z, Vieths, S, Werfel, T, Zuberbier, T, Worm, M, and University of Zurich

Subjects
2723 Immunology and Allergy, 10177 Dermatology Clinic, 610 Medicine & health
Published
2010

149. Diagnostik

Author

Ballmer-Weber, B K, Wüthrich, B, University of Zurich, Jäger, L, and et al

Subjects
10177 Dermatology Clinic, 610 Medicine & health
Published
2008

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