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Dreborg, Sten
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Publications (10 of 24) Show all publications
Cardona, V., Demoly, P., Dreborg, S., Kalpaklioglu, A. F., Klimek, L., Muraro, A., . . . Hoffmann, H. J. (2018). Current practice of allergy diagnosis and the potential impact of regulation in Europe. Allergy. European Journal of Allergy and Clinical Immunology, 73(2), 323-327
Open this publication in new window or tab >>Current practice of allergy diagnosis and the potential impact of regulation in Europe
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2018 (English)In: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 73, no 2, p. 323-327Article in journal (Refereed) Published
Abstract [en]

In the European Union (EU), the regulatory framework regarding diagnostic allergen extracts is currently in the process of being implemented at the national level. Due to these regulations, the initial and periodic renewal expenses for the registration of diagnostic allergen extracts may render extract production unprofitable. Consequently, many extracts may be at risk of removal from the market. The current survey, which was conducted by a task force of the European Academy of Allergy and Clinical Immunology, aimed to assess the current practice of allergy diagnosis in Europe. This survey revealed that skin tests continue to be the main diagnostic procedure and are used as the first option in almost two-third of all types of allergic diseases and in 90% of individuals suffering from respiratory allergies. Therefore, there is a need to ensure the availability of high-quality allergen extracts to maintain the common diagnostic procedures used by EU professionals. To reach this goal, it is necessary to align efforts and establish active partnerships between manufacturers, relevant scientific societies, consumer organizations and authorities to maintain the availability of these diagnostic tools.

Place, publisher, year, edition, pages
WILEY, 2018
Keyword
allergen extracts, allergy diagnosis, regulation, skin tests
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-341562 (URN)10.1111/all.13306 (DOI)000419871000005 ()28905404 (PubMedID)
Available from: 2018-02-12 Created: 2018-02-12 Last updated: 2018-02-12Bibliographically approved
Epstein, T. G., Calabria, C., Cox, L. S. & Dreborg, S. (2017). Current Evidence on Safety and Practical Considerations for Administration of Sublingual Allergen Immunotherapy (SLIT) in the United States. Journal of Allergy and Clinical Immunology: In Practice, 5(1), 34-40
Open this publication in new window or tab >>Current Evidence on Safety and Practical Considerations for Administration of Sublingual Allergen Immunotherapy (SLIT) in the United States
2017 (English)In: Journal of Allergy and Clinical Immunology: In Practice, ISSN 2213-2198, E-ISSN 2213-2201, Vol. 5, no 1, p. 34-40Article, review/survey (Refereed) Published
Abstract [en]

Liquid sublingual allergen immunotherapy (SLIT) has been used off-label for decades, and Food and Drug Administration (FDA)-approved grass and ragweed SLIT tablets have been available in the United States since 2014. Potentially life-threatening events from SLIT do occur, although they appear to be very rare, especially for FDA-approved products. Practice guidelines that incorporate safety precautions regarding the use of SLIT in the United States are needed. This clinical commentary attempts to address unresolved issues including controversy regarding the FDA mandate for the prescription of epinephrine autoinjectors for patients on SLIT; how to approach polysensitized patients; optimal timing and duration of SLIT administration; how to address gaps in therapy; whether antihistamines can prevent local reactions, if certain patient populations (such as persistent asthmatics) should not receive SLIT; and when to instruct patients to self-administer epinephrine. Key points are that physicians should focus on educating patients regarding: (1) when not to administer SLIT; (2) how to recognize a potentially serious allergic reaction to SLIT; and (3) when to administer epinephrine and seek emergency care.

Keyword
Sublingual immunothrapy, adverse drug reaction
National Category
Respiratory Medicine and Allergy
Research subject
Pediatrics
Identifiers
urn:nbn:se:uu:diva-320015 (URN)10.1016/j.jaip.2016.09.017 (DOI)000396493400004 ()27815065 (PubMedID)
Available from: 2017-04-12 Created: 2017-04-12 Last updated: 2017-04-28Bibliographically approved
Dreborg, S., Wen, X., Kim, L., Tsai, G., Nevis, I., Potts, R., . . . Kim, H. (2017). Erratum to: Do epinephrine auto-injectors have an unsuitable needle length in children and adolescents at risk for anaphylaxis from food allergy?. Allergy, Asthma & Clinical Immunology, 13, Article ID 33.
Open this publication in new window or tab >>Erratum to: Do epinephrine auto-injectors have an unsuitable needle length in children and adolescents at risk for anaphylaxis from food allergy?
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2017 (English)In: Allergy, Asthma & Clinical Immunology, ISSN 1710-1484, E-ISSN 1710-1492, Vol. 13, article id 33Article in journal (Refereed) Published
Abstract [en]

This corrects the article DOI: 10.1186/s13223-016-0110-8

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-341407 (URN)10.1186/s13223-017-0205-x (DOI)28694830 (PubMedID)
Available from: 2018-02-08 Created: 2018-02-08 Last updated: 2018-02-22Bibliographically approved
Dreborg, S. (2016). Cow's milk protein allergy and common gastrointestinal symptoms in infants. Acta Paediatrica, 105(3), 253-254
Open this publication in new window or tab >>Cow's milk protein allergy and common gastrointestinal symptoms in infants
2016 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 105, no 3, p. 253-254Article in journal, Editorial material (Refereed) Published
Abstract [en]

In their review on the management of functional gastrointestinal disorders and cow's milk protein allergy (CMPA) in infants (1), Vandenplas et al discuss infantile colic, regurgitation and constipation and the relationship between these symptoms, which are common in infants, to CMPA. The group starts by stating that CMPA can only be diagnosed by a double blind placebo controlled food challenge. However, this can be replaced by an open challenge in infants as long as the challenge is performed under the supervision of an experienced team (2, 3). The authors acknowledge that sensitisation to cow's milk indicates possible CMPA and the need for a challenge to reach a proper diagnosis of CMPA. But then they make some some statements that I feel blur the message (1).

National Category
Pediatrics Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-270721 (URN)10.1111/apa.13311 (DOI)000370247700013 ()26666845 (PubMedID)
External cooperation:
Available from: 2016-01-03 Created: 2016-01-03 Last updated: 2017-12-01Bibliographically approved
Dreborg, S., Wen, X., Kim, L., Tsai, G., Nevis, I., Potts, R., . . . Kim, H. (2016). Do epinephrine auto-injectors have an unsuitable needle length in children and adolescents at risk for anaphylaxis from food allergy?. Allergy, Asthma & Clinical Immunology, 12, Article ID 11.
Open this publication in new window or tab >>Do epinephrine auto-injectors have an unsuitable needle length in children and adolescents at risk for anaphylaxis from food allergy?
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2016 (English)In: Allergy, Asthma & Clinical Immunology, ISSN 1710-1484, E-ISSN 1710-1492, Vol. 12, article id 11Article in journal (Refereed) Published
Abstract [en]

Background: Food allergy is the most common cause of anaphylaxis in children. Intramuscular delivery of epinephrine auto-injectors (EAI) is the standard of care for the treatment of anaphylaxis. We examined if children and adolescents at risk of anaphylaxis weighing 15-30 kg and >30 kg would receive epinephrine into the intramuscular space with the currently available EAI in North America and Europe. Methods: The distance from skin to muscle (STMD) and skin to bone (STBD) on the mid third anterolateral area of the right thigh was measured by ultrasound applying either high pressure ((max)) or slight pressure ((min)) in 102 children weighing 15-30 kg (group 1) and 100 children and adolescents, weighing more than 30 kg (group 2). Results: Using a high pressure EAI (HPEAI), Epipen Jr (R) and Auvi-Q (R)/Allerject (R) 0.15 mg, 11/102 (11 %) children in group 1 and 38/102 (38 %) using another HPEAI, Jext (R), had a STMDmax that showed a risk of intraosseous injection. There was a 1 % risk of subcutaneous injection with these devices. There was no risk of intraosseous injection using a low pressure EAI (LPEAI), Emerade (R). In group 2, the risk of intraosseous injection using a HPEAI was 3 % and no risk using a LPEAI. However, the risk of subcutaneous injection using HPEAI was 9 % and using LPEAI was 2 %. Conclusion: There is a risk of intraosseous injection using HPEAI (Epipen (R)/Epipen Jr (R), Auvi-Q (R)/Allerject (R) and especially Jext (R)) in children at risk of anaphylaxis. There was also a risk of subcutaneous injection using the currently available HPEAI in children and adolescents.

Keyword
Anaphylaxis, Food allergy, Epinephrine, Epinephrine auto-injector, Allergy, Skin to bone distance, Skin to muscle distance, Intramuscular, Subcutaneous, Epimysium
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-282806 (URN)10.1186/s13223-016-0110-8 (DOI)000371761600001 ()26949403 (PubMedID)
Available from: 2016-04-13 Created: 2016-04-07 Last updated: 2017-11-30Bibliographically approved
Dreborg, S., Holgersson, M. & Möller, C. (2016). Evaluation of changes in skin reactivity by skin prick test titration: -. Immunotherapy: open access, 2(2), Article ID 102.
Open this publication in new window or tab >>Evaluation of changes in skin reactivity by skin prick test titration: -
2016 (English)In: Immunotherapy: open access, ISSN 2471-9552, Vol. 2, no 2, article id 102Article in journal (Refereed) Published
Abstract [en]

Background: Parallel line bioassay (PLBA) has been acknowledged being the gold standard for estimation of changes in skin reactivity during (immuno-)therapy.

Objective: To study changes in skin prick test (SPT) estimated by skin prick test titration, wheal area and sum of wheal areas in relation to PLBA.

Methods: Data from a published immunotherapy trial using skin titration with half 10 log steps were evaluated using endpoint titration, wheal areas, histamine equivalent allergen concentration using PLBA as gold standard.

Results: Endpoint titration and PLBA correlated (r=0.76) and the slope of the correlation, b (0.8) was not significantly different from 1, i.e. expressed the same result, were interchangeable. Furthermore, the result was expressed in change in allergen concentration, Ca. The area of all wheals and the area of the wheal induced by the highest concentration also correlated, but to a lesser degree (b=0.36 and 0.41, respectively), to PLBA significantly different from 1, i.e. did not express the same result.

Conclusions: Estimation of the SPT during therapy expressed as change in endpoint concentration correlated to changes by PLBA. However, earlier described simple methods, expressing the change in skin sensitivity as change in histamine equivalent concentration, should be preferred.

Keyword
Skin prick test, Allergen, Histamine, Method, Allergy, Immunotherapy, Wheal area, Wheal diameter, Skin prick test titration
National Category
Respiratory Medicine and Allergy
Research subject
Pediatrics
Identifiers
urn:nbn:se:uu:diva-320012 (URN)10.4172/2471-9552.1000116 (DOI)
Available from: 2017-04-12 Created: 2017-04-12 Last updated: 2017-04-12Bibliographically approved
Dreborg, S., Basomba, A., Löfkvist, T., Holgersson, M. & Moller, C. (2016). Evaluation of skin reactivity during (immuno-) therapy: Validation of methods for estimation of changes in skin reactivity and correlation to shock organ sensitivity. Immunotherapy: Open Access, 2(1), Article ID 1000109.
Open this publication in new window or tab >>Evaluation of skin reactivity during (immuno-) therapy: Validation of methods for estimation of changes in skin reactivity and correlation to shock organ sensitivity
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2016 (English)In: Immunotherapy: Open Access, ISSN 2471-9552, Vol. 2, no 1, article id 1000109Article in journal (Refereed) Published
Abstract [en]

Background: Parallel line bioassay (PLBA) has been acknowledged to be the gold standard for estimation of changes in reactivity, e.g., in RAST and ELISA inhibition tests.

Objective: To study correlations between two simple methods for evaluation of changes in skin prick test (δSPT), using the slope of the allergen dose response (drra) in relation to PLBA. Methods: Skin prick test data from two published immunotherapy trials were used. In a D. farinae trial we used duplicate tests with three fixed ten-fold concentrations and in a P. judaica trial three tenfold individually chosen allergen concentrations causing wheals of similar size to that of histamine dihydrochloride 10 mg/mL, tenfold lower and tenfold higher concentration. Evaluation of the δSPT by PLBA, and two simple methods were correlated. In the D. farinae trial δSPT was compared to the change of conjunctival threshold concentration.

Results: The δSPT as measured by both the simple methods gave similar results to that of PLBA (p<0.001). The δSPT was around 30-fold, i.e., about 3% of the pre-treatment reactivity. The δSPT correlated with the δCPT threshold concentration.

Conclusions: Estimation of the δSPT during therapy expressed as change in concentration using simple methods based on the slope of the drra correlated well to changes by PLBA and CPT and should therefore be used both in clinical research and in practice.

Keyword
Skin prick test, Allergen, Histamine, Method, Allergy, Immunotherapy, Conjunctival provocation test, Threshold concentration, Wheal area, Wheal diameter, Dose response
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-244256 (URN)10.4172/2471-9552.1000109 (DOI)
Available from: 2015-02-13 Created: 2015-02-13 Last updated: 2016-11-28Bibliographically approved
Dreborg, S. (2015). Allergen skin prick test results should be adjusted to the histamine reactivity. International Archives of Allergy and Immunology, 166(1), 77-80
Open this publication in new window or tab >>Allergen skin prick test results should be adjusted to the histamine reactivity
2015 (English)In: International Archives of Allergy and Immunology, ISSN 1018-2438, E-ISSN 1423-0097, Vol. 166, no 1, p. 77-80Article in journal (Refereed) Published
Abstract [en]

Background: Skin prick test results are mostly reported as mean wheal diameter obtained with one concentration of allergen. Differences in technique between personnel causes variation in wheal size. The research question was whether the influence of differences in skin prick test technique among assistants and centers can be reduced by relating the allergen wheal response to that of histamine. Methods: Two methods for estimating skin reactivity, the method of Nordic Guidelines using histamine as a reference and the method of Brighton et al. [Clin Allergy 1979; 9: 591-596] not using histamine as a reference, were applied to data from two biological standardization trials, using the same batch of freeze-dried timothy pollen preparation. Results: The concentration defining the Nordic biological unit, defined as a concentration of allergen eliciting a wheal of the same size as that of histamine dihydrochloride 10 mg/ml, did not differ between the centers. When not using histamine as a reference, applying the method of Brighton et al., there was a 15-fold difference in the estimate of the biological activity between the trials that was eliminated by adjusting the allergen response to that of the histamine reference. Conclusions: To reduce the influence of differences in test technique among assistants and centers responses to allergen-induced skin prick tests should be compared to that of histamine.

National Category
Clinical Medicine Immunology in the medical area
Identifiers
urn:nbn:se:uu:diva-244238 (URN)10.1159/000371848 (DOI)000352280400009 ()
Available from: 2015-02-13 Created: 2015-02-13 Last updated: 2018-01-11Bibliographically approved
Kim, H., Dreborg, S., Kim, L. & Tsai, G. (2015). Auto-injector needle length may be inadequate to deliver epinephrine intramuscularly in women with confirmed food allergy: Comments to Letter by Song, T [Letter to the editor]. Allergy, Asthma & Clinical Immunology
Open this publication in new window or tab >>Auto-injector needle length may be inadequate to deliver epinephrine intramuscularly in women with confirmed food allergy: Comments to Letter by Song, T
2015 (English)In: Allergy, Asthma & Clinical Immunology, ISSN 1710-1484, E-ISSN 1710-1492Article in journal, Letter (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-244236 (URN)
Available from: 2015-02-13 Created: 2015-02-13 Last updated: 2017-12-04
Dreborg, S. (2015). Debates in allergy medicine: food intolerance does not exist.. World Allergy Organization Journal, 8(37)
Open this publication in new window or tab >>Debates in allergy medicine: food intolerance does not exist.
2015 (English)In: World Allergy Organization Journal, ISSN 1731-3317, E-ISSN 1939-4551, Vol. 8, no 37Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The term "intolerance" is not mentioned in the World Allergy Organization (WAO) document on allergy nomenclature. "Intolerance" has been used to describe some non-immunological diseases. However, pediatric gastroenterologists mix allergy and intolerance, e.g. by using the term "cow's milk protein allergy/intolerance (CMPA/I)", lumping together all types of mechanisms for not tolerating cow's milk. The basis for this mix is the fact that double-blind oral food challenges are time-consuming and expensive. Therefore, cow's milk exclusion and reintroduction is proposed to be used in primary care for the diagnosis of CMPA in children with common gastrointestinal (GI) problems such as colic and constipation. This may lead to a widespread use of hypoallergenic formulas in children without proven CMPA. In lay language, intolerance describes "not tolerating".

OBJECTIVE: To discuss the reasons why the term "intolerance" should not be used in the area of allergy.

RESULTS: Presently, intolerance is not part of the allergy nomenclature. It is used by lay persons to describe "not tolerating". Pediatricians use intolerance to describe non-immunological hypersensitivity such as lactose intolerance which is acceptable. However, using the mixed term CMPA/I describing a variety of gastrointestinal symptoms in children, should be avoided. The WAO Nomenclature does not clearly distinguish between non-IgE-mediated allergy and non-allergic hypersensitivity.

CONCLUSION: The term "intolerance" should not be used within the area of allergy. Intolerance should be better defined and the term restricted to some non-immunological/non-allergic diseases and not mixed with allergy, e.g. by using the term CMPA/I. A revision of the WAO nomenclature is proposed.

National Category
Medical and Health Sciences Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-270722 (URN)10.1186/s40413-015-0088-6 (DOI)000366259100003 ()26681998 (PubMedID)
Available from: 2016-01-03 Created: 2016-01-03 Last updated: 2017-12-01Bibliographically approved
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