Bibliothek

Notizen: Background  Population-based figures on skin cancer are essential for a realistic assessment of the personal disease burden, prevention modes and the need for caring. The Robert Koch Institute in Germany estimates the incidence of melanoma skin cancer as seven cases in 100 000 persons (age-standardized by the European standard rate). Population-based studies presumably show higher incidence rates of 10–16 cases in 100 000 persons. Few data exist for non-melanoma skin cancer (NMSC) as this is not systematically registered in Germany.Objectives  To present the first population-based results from the Schleswig-Holstein (Germany) Cancer Registry on incidence, stage distribution, clinical types and localization of skin cancer and to compare the results with other studies.Methods  The Cancer Registry of the Bundesland Schleswig-Holstein with 3500 registering institutions, 100 of which are dermatological institutions, investigates all notifiable incident cancer cases according to international standards. From the recorded data all melanoma and NMSC cases were identified and evaluated.Results  Between 1998 and 2001, 1784 malignant melanoma (MM) and 12 956 NMSC cases underwent diagnostic and analytical evaluation. For MM, age-standardized incidence rates were 12·3 and 14·8 in 100 000 men and women, respectively, and the mean age of men was greater than that of women (56·6 vs. 54·9 years, P 〈 0·05). Superficial spreading melanoma was the most frequent clinical type (39·1%). The tumours were predominantly located on the trunk in men (46·8%) in contrast to leg and hip in women (39·5%). For NMSC, the age-standardized incidence rates were 100·2 and 72·6 in 100 000 men and women, respectively. More than 80% of all tumours were basal cell carcinoma.Conclusions  The first population-based data from Schleswig-Holstein on the characteristics (age, sex, histological subtypes, localization and stage) of skin tumours agree well with the existing literature and may thus be regarded as representative. However, markedly higher incidences for MM and NMSC in the north of Germany compared with other parts of the country were observed. As the incidence rates from the north of Germany fit well into the European geographical pattern, we assume no regional increase. Therefore, the official German estimates on cutaneous tumours may largely depend on regional factors and may not be regarded as representative for all regions in Germany.

Notizen: Background:  Worm infestations may play a role in preventing allergies. There is a lack of epidemiological information from Western countries on the association between worm infestation and eczema.Objective:  To investigate the association between worm infestation and eczema in a proper temporal sequence and under consideration of allergic sensitization.Methods:  Two surveys were performed in East German school children. Questionnaire data included the history of eczema and worm infestation and their time of onset. Specific IgE antibodies to five common aeroallergens were measured and used to define nonatopic and atopic eczema. Logistic regression analyses were performed to control for relevant confounders (age, sex, parental school education and history of allergies). In order to confirm the findings a corresponding conditional regression analysis was applied on cases and controls matched by age and sex.Results:  A total of 4169 children participated (response 75 and 76%) who were, on average, 9.2 years old (47% girls). Overall 17.0% reported a prior worm infestation (Ascaris 44%, Oxyuris 33%) and 18.1% had a history of eczema. Eczema occurred significantly less frequent in children who had a worm infestation (prior to the onset of eczema) compared with children without such a history (8.1%vs 16.5%, ORadj: 0.45, 95% CI: 0.33–0.60). The finding was confirmed by the corresponding matched case–control analysis (ORadj: 0.57, 95% CI: 0.41–0.79). Atopic eczema was affected more by a prior worm infestation (ORadj: 0.31, 95% CI: 0.18–0.56) than the nonatopic eczema (ORadj: 0.58, 95% CI: 0.40–0.84). A total of 29.1% exhibited specific IgE antibodies to at least one aeroallergen. Sensitized children gave significantly less frequent a history of worm infestation (14.2%vs 18.3%, ORadj: 0.74, 95% CI: 0.60–0.92). Stratified analysis revealed that this effect most pronounced for a sensitization to house dust mite.Conclusions:  A worm infestation is associated with a reduced frequency of subsequent eczema, especially the atopic type. Furthermore allergic sensitization, especially to house dust mite, and worm infestation are negatively associated. The data support the concept that a lack of immune-stimulation by parasitic infections contributes to the development of allergies.

Notizen: Background:  There is evidence that the use of alternative medicine (AM) for allergies has increased. However, little is known from population-based studies about what determines its use. The objective of this study was to evaluate the patterns of use of AM for allergies. Methods:  A population-based nested case-control study was conducted in 2000–01 using computer-assisted telephone interviews. Three hundred and fifty-one adults participated (median age 46 years) with allergies including hay fever, asthma, atopic eczema, and food hypersensitivity. Information was obtained on demographics, prevalence, motivation, information, type of AM, provider, costs, willingness to pay, and subjective assessment of AM. Results:  26.5% of participants used AM because of their allergies. Compared to nonusers, this group of users was significantly younger (median age 43 vs 47; p =0.004) and better educated (school education 〉 8 year vs ≤ 8 year; odds ratio (OR) 2.17, 1.28–3.67) and was mostly motivated by the assumption of few side-effects (78.3%), by a wish to try everything (71.7%), and by unsatisfying results from conventional therapy (66.3%). Users also had more experience with conventional therapy than nonusers (94.6% vs 63.6%; OR 10.10, 4.00–25.72). Four procedures accounted for almost the entire usage: homeopathy (35.3%), autologous blood injection (28.1%), acupuncture (16.6%), and bioresonance (10.0%). The AM were mostly promoted (40.2%) and provided (60.9%) by medical doctors, and produced median costs for single and entire treatment of 4 € (15–205) and 205 € (15–1278)e. Reimbursement from insurance companies was received by 52.3%, in full (37.8%) or partial (14.5%). Most subjects (55.4%) admitted that they would pay more (median 153e) for the achieved result. Users scored the efficacy of conventional therapy significantly lower ( p 〈0.001) than nonusers, and assessed the results of AM as very good (28.6%) or rather good (53.8%). Conclusions:  AM is used widely for allergies by the general population and is associated with considerable costs. This has implications for the health care system and health policy.

Notizen: Background: We aimed to determine the prevalence of contact sensitization in the general population and to investigate associations with important sociodemographic and medical characteristics. Methods: Within a population-based nested, case-control study in Germany, we performed patch tests with 25 standard allergens in 1141 adults (50.4% female, age median 50 years). Additional information was obtained by a dermatologic examination, a standardized interview, and blood analysis. Results: At least one positive reaction was exhibited by 40.0% of the subjects, with reactions most frequently observed to fragrance mix (15.9%), nickel (13.1%), thimerosal (4.7%), and balsam of Peru (3.8%). Women were sensitized more often than men (50.2%vs 29.9%, OR 2.36, CI 1.84–3.03), and this was also significant for fragrance mix, nickel, turpentine, cobalt chloride, and thimerosal. Contact sensitization was more frequent in subjects who reported adverse skin reactions (53.8% vs. 32.6%; OR 2.41, CI 1.85–3.14), and this was particularly true for sensitization to nickel (45.5%vs 8.8%, OR 8.64, CI 5.67–13.17) and fragrance mix (29.0%vs 14.0%, OR 2.51, CI 1.60–3.91) and the corresponding intolerance of fashion jewelry and fragrances. Contact sensitization decreased with increasing degree of occupational training (unskilled 45.9%, apprenticeship 40.1%, technical college 40.4%, and school of engineering 12.5%; P=0.023; trend test P=0.042). Significant associations of contact sensitization and presence of allergen-specific IgE antibodies, atopic eczema, or psoriasis were not observed. Frequency estimates for the general adult population based on these findings were 28.0% for overall contact sensitization and 11.4% for fragrance mix, 9.9% for nickel, and 3.2% for thimerosal. Conclusions: It is concluded that contact allergy is influenced by sociodemographic parameters and plays an important role in the general population.

Notizen: Schäfer T, Ring J. Epidemiology of allergic diseases.The escalation of allergic diseases (hay fever, asthma, atopic eczema) over recent decades has been linked to an increase in environmental pollutants. The prevalence of hay fever is associated with genetic predisposition, and some reports show an association with urban areas, socioeconomic status, and combined high allergen and automobile exhaust exposure. In asthma, there is also some evidence for geographical variations in prevalence; exercise challenge tests prove positive more often in urban areas than in rural areas. Although genetic predisposition is the strongest single risk factor for atopic eczema, air pollutants may aggravate the condition by acting as unspecific irritants and immunomodulators, leading to increased immunoglobulin E expression. In a study of 678 pre-school children, the influence of maternal smoking habits on individual measures of atopy revealed a positive association between smoking during pregnancynactation, and a positive history of atopic eczema. An East-West German comparative study examining different types and levels of air pollution, i.e. sulphurous (industrial; East) and oxidising (urban; West), showed that the prevalence of atopic eczema was greatest in East Germany. When various direct and indirect parameters of air pollution exposure were measured, the greatest association with atopic eczema was found with NOx exposure (indoor use of gas without a cooker hood), and close proximity to roads with heavy traffic. The increased prevalence of atopic eczema cannot be explained by changes in study methodology over time, or conventional risk factors alone; environmental risk factors may be an important contributing factor.

Notizen: Background:  The study of partners can help to understand the impact of environmental influences on the development of allergies. We aimed to test the hypothesis that subjects whose partners have hay fever are at increased risk for the same disease and that the risk increases with the time subjects live together with an affected partner.Methods:  A nested unmatched case–control study was performed in a random sample of 4261 inhabitants, aged 25–74 years, of the City of Augsburg, Germany, and two adjacent counties. Using standardized computer-assisted face-to-face interviews, we determined the risk of doctor-diagnosed hay fever in subjects who lived together with a partner having the same disease as opposed to subjects living with an unaffected partner. Furthermore, the risk of doctor-diagnosed hay fever depending on the time the subjects had lived together with an affected partner was calculated.Results:  After adjustment for age, sex, parental predisposition and social status, the risk of hay fever was more than double in subjects who lived together with a partner having the same disease (odds ratio, ORadj., 2.41; 95% confidence interval, CI, 1.48–3.92). If subjects lived together with an affected partner, the risk of developing the disease increased with the time the partners lived together (1–11 years, OR 1; 12–23 years, OR 1.8; 24–35 years, OR 7.4; 36–54 years, OR 13.7).Conclusion:  The risk of developing hay fever is significantly elevated in subjects who live together with a partner having the same disease. The risk further increases with the time the partners live together. This points to important shared environmental influences or behaviours and raises speculations on a transmissible cause.