Allergologie select最新文献

{"title":"Registries in allergy: Structure, target groups, and key findings of allergy-focused registries in Germany.","authors":"Marie Farkic, Philipp Globig, Aikaterina Alexiou, Margitta Worm","doi":"10.5414/ALX02536E","DOIUrl":"https://doi.org/10.5414/ALX02536E","url":null,"abstract":"<p><p>In allergology, clinical registries fill knowledge gaps of epidemiology, mechanisms of allergic diseases, and real-world treatment outcomes. Considering the continuous rise of allergic diseases worldwide, registries become increasingly important for the optimization and harmonization of patient care. In the current review, we present four ongoing allergy-focused registries initiated in Germany. We conducted a focused literature search and discussed their structure, main purposes, and findings. Registries included are the \"Information Network of Departments of Dermatology\", the \"European Anaphylaxis Registry\", the \"GAN Severe Asthma Registry\", and \"TREATgermany\". Despite differences in scope and operation, all registries gather harmonized real-world data that is indispensable for evidence-based decision making in clinical practice and ultimately improves patient care in allergology.</p>","PeriodicalId":101298,"journal":{"name":"Allergologie select","volume":"8 ","pages":"425-433"},"PeriodicalIF":0.0,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11706230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142961078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Occupational anaphylaxis: A Position Paper of the German Society of Allergology and Clinical Immunology (DGAKI).","authors":"Regina Treudler, Margitta Worm, Andrea Bauer, Heinrich Dickel, Guido Heine, Uta Jappe, Ludger Klimek, Monika Raulf, Bettina Wedi, Dorothea Wieczorek, Wojciech Francuzik, Thilo Jakob, Oliver Pfaar, Johannes Ring, Franziska Rueff, Sabine Schnadt, Thomas Werfel, Gerda Wurpts, Julia Zarnowski, Torsten Zuberbier, Knut Brockow","doi":"10.5414/ALX02543E","DOIUrl":"10.5414/ALX02543E","url":null,"abstract":"<p><strong>Background: </strong>Anaphylaxis is a systemic allergic reaction that is potentially life-threatening. Occupational anaphylaxis is an anaphylaxis that occurs in an occupational context. In this position paper, we propose diagnostic criteria for occupational anaphylaxis and provide an overview of the current state of knowledge in terms of prevalence, triggers, prevention, and management.</p><p><strong>Results: </strong>The most common triggers of occupational anaphylaxis include Hymenoptera venoms, followed by food and drugs. Chemicals, bites or contact with animals (mammals/snakes/insects) and natural rubber latex are far less common. Occupations at risk for occupational anaphylaxis are therefore beekeepers, outdoor workers, or those who handle food as well as healthcare workers. The route of contact, intensity, and frequency of exposure, type of allergen, and the simultaneous occurrence of co-factors determine the clinical manifestation. A detailed medical history is required to confirm the diagnosis of anaphylaxis and to identify the trigger. Both skin tests and the determination of specific IgE are recommended, but only very few commercially available and quality-tested allergens are available that can be examined using both test methods. Preventive measures are based on avoiding further exposure or, if necessary, replacing a working substance. A written emergency plan and the prescription of an adrenaline autoinjector as well as instructions for its use are mandatory. Allergen immunotherapy is recommended for systemic Hymenoptera venom allergy. Depending on the national healthcare systems, patients with occupational anaphylaxis must be reported to the accident insurance.</p><p><strong>Conclusion: </strong>Occupational anaphylaxis is very rare. We recommend educational measures and generally standardized recording of occupational anaphylaxis for occupations with an increased risk of anaphylaxis.</p>","PeriodicalId":101298,"journal":{"name":"Allergologie select","volume":"8 ","pages":"407-424"},"PeriodicalIF":0.0,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11629776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biologics in allergology and clinical immunology: Update on therapies for atopic diseases, urticaria, and angioedema and on safety aspects focusing on hypersensitivity reactions.","authors":"Uta Jappe, Karl-Christian Bergmann, Folke Brinkmann, Valentina Faihs, Askin Gülsen, Ludger Klimek, Harald Renz, Sebastian Seurig, Christian Taube, Stephan Traidl, Regina Treudler, Martin Wagenmann, Thomas Werfel, Margitta Worm, Thorsten Zuberbier","doi":"10.5414/ALX02533E","DOIUrl":"10.5414/ALX02533E","url":null,"abstract":"<p><p>The development of targeted therapies for atopic diseases, urticaria, and angioedema with biologics is progressing rapidly: New \"targets\" of clinical-therapeutic relevance have been identified, the corresponding targeted antibodies developed, tested in clinical trials, and approved for therapy. These include the anti-IgE antibody omalizumab (also effective and approved for the treatment of urticaria), the anti-IL-4/13 receptor-specific antibody dupilumab, the two anti-IL-13 antibodies lebrikizumab and tralokinumab, the anti-TSLP antibody tezepelumab, the two anti-IL-5 antibodies mepolizumab and reslizumab, and the anti-IL5 receptor-specific antibody benralizumab for the treatment of atopic diseases. For the treatment of hereditary angioedema, C1 inhibitor and the antibody lanadelumab (directed against kallikrein) have also long been approved as biologics in addition to low-molecular substances. Other therapeutic antibodies are in various stages of development. Furthermore, the range of indications for some very effective biologics has been successfully expanded to include additional diseases. In this context, the first results on biologic therapy of food allergy and eosinophilic esophagitis are interesting. Biologics that address different target structures are also increasingly being administered in combination, either simultaneously or sequentially, in order to achieve optimal efficacy. A developing area is the use of biologics in children and the observation of immunological and non-immunological side effects. In some cases, new unexpected side effects and hypersensitivity reactions have emerged, which in turn raise pathomechanistic questions, such as conjunctivitis with dupilumab therapy, which only appears to occur in the treatment of atopic dermatitis but not in the treatment of other atopic diseases. In dermatology, paradoxical reactions have been described under therapy with some biologics. And immune reactions of type alpha to epsilon to biologics (hypersensitivity reactions) continue to be a clinically relevant problem, whereby the selection of an alternative therapeutic agent is a challenge and the diagnostics that support this have not yet been sufficiently incorporated into routine work.</p>","PeriodicalId":101298,"journal":{"name":"Allergologie select","volume":"8 ","pages":"365-406"},"PeriodicalIF":0.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11590746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142735498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dietary and physical trigger factors in hereditary angioedema: Self-conducted investigation and literature overview.","authors":"Julia Zarnowski, Regina Treudler","doi":"10.5414/ALX02523E","DOIUrl":"10.5414/ALX02523E","url":null,"abstract":"<p><strong>Background: </strong>In hereditary angioedema (HAE), numerous factors are known to trigger an attack. The possible influence of diet or recreational sports has been given little consideration in studies. The aim of our work was to investigate the influence of nutrition and physical activity in patients with HAE at the Leipzig ACARE Center.</p><p><strong>Materials and methods: </strong>Patients with HAE were given a self-designed questionnaire inquiring for family history, disease progression, and encountered burden due to HAE, current therapy, and disease control (angioedema control test (AECT)) as well as the influence of diet and/or recreational sports on HAE attacks.</p><p><strong>Results: </strong>Inclusion of 30 patients (23 female, 77%) with a mean age of 49.5 ± 16.9 years and mean body mass index of 25.1 ± 6.4 kg/m². 60% received prophylactic treatment, and 37% received exclusively on-demand therapy. The mean AECT score was 10.9 ± 5.1 and patients reported 15.5 ± 26.9 days of absence due to HAE attacks in the last 12 months. 33% reported an association with food intake, in particular worsening of abdominal symptoms (n = 7), swelling of the extremities (n = 3), face, larynx, or genital area (n = 1 each). 70% reported regular exercise, most commonly cycling (n = 11), running or walking (n = 10), or strength training (n = 10). 62% reported a worsening of HAE due to recreational exercise.</p><p><strong>Conclusion: </strong>Dietary factors and physical activity frequently led to an aggravation of HAE in our cohort and should be taken into consideration when counseling patients with regard to trigger avoidance.</p>","PeriodicalId":101298,"journal":{"name":"Allergologie select","volume":"8 ","pages":"358-364"},"PeriodicalIF":0.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11575680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The international HAE guideline under real-life conditions: From possibilities to limits in daily life - current real-world data of 8 German angioedema centers.","authors":"Jens Greve, Robin Lochbaum, Susanne Trainotti, Eva-Vanessa Ebert, Thomas Buttgereit, Antonia Scherer, Lisa Knipps, Anna Smola, Sebastian Volc, Andreas Recke, Katharina Marlies Duda, Mathias Sulk, Janina Hahn","doi":"10.5414/ALX02530E","DOIUrl":"10.5414/ALX02530E","url":null,"abstract":"<p><strong>Background and objectives: </strong>Patients with rare diseases like hereditary angioedema (HAE) are usually referred to an angioedema center to ensure guideline-compliant and experience-based therapy. Even though there are established guidelines and several approved therapeutics, there are still open questions and situations in the daily care of HAE patients, where an exchange between centers is needed.</p><p><strong>Materials and methods: </strong>A survey was conducted among physicians from German angioedema centers regarding challenges and issues in everyday HAE treatment. The main focus was on the topic of long-term prophylaxis (LTP). For rarer subcategories of angioedema, the centers conducted a literature review to discuss open questions.</p><p><strong>Results: </strong>The responses of 12 physicians from 8 angioedema centers were analyzed in the survey. The attack frequency was the most important criterion for deciding to initiate LTP in HAE patients (100%). Two centers no longer generally recommend the initiation of pre-interventional prophylaxis in HAE patients under LTP. The therapeutic concepts of acquired angioedema due to C1 inhibitor deficiency and HAE in children were two associated specialized areas that were discussed in more detail.</p><p><strong>Conclusion: </strong>The current guideline serves as the foundation for daily practice in treating HAE at specialized centers. Thus, for rare conditions like HAE, an exchange among the treating centers is essential to adequately address specific issues and rare subgroups.</p>","PeriodicalId":101298,"journal":{"name":"Allergologie select","volume":"8 ","pages":"346-357"},"PeriodicalIF":0.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11575681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hereditary angioedema (HAE) in children and adolescents: New treatment options.","authors":"Maria Fasshauer, Bettina Wedi","doi":"10.5414/ALX02532E","DOIUrl":"10.5414/ALX02532E","url":null,"abstract":"<p><p>Modern management of hereditary angioedema (HAE) due to reduced C1 inhibitor (C1-INH) function or concentration (HAE-C1-INH) focuses on individualized therapeutic strategies to address the specific needs of children and adolescents as well as the severity of the disease. Psychosocial factors such as the burden of disease and therapy on quality of life and participation play an important role. New medications have already significantly improved the prognosis and health related quality of life in HAE patients, but not all of these therapies have yet been approved for children. Further treatment options that inhibit bradykinin effects are currently being investigated. They target factor XIIa, prekallikrein, plasma kallikrein, or the bradykinin B2 receptor. Modern research focuses on oral options or long-acting parenteral therapy approaches to further optimize care and, in particular, the needs of children. There are also initial developments in the field of gene therapy, which could represent a causal treatment option for HAE in the future. This article focuses on the presentation and treatment of HAE type I (reduced C1-INH concentration) and HAE type II (impaired C1-INH function) in children and adolescents. Acquired AE and HAE with normal C1-INH are rare in the pediatric age group and are not discussed in detail here.</p>","PeriodicalId":101298,"journal":{"name":"Allergologie select","volume":"8 ","pages":"336-345"},"PeriodicalIF":0.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142585439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term tolerance and efficacy of venom immunotherapy after an episode of Crohn's disease and ankylosing spondylitis after up-dosing.","authors":"Marius Winkler, Franziska Ruëff, Silvan Lange, Annett Walker, Eva Oppel","doi":"10.5414/ALX02526E","DOIUrl":"https://doi.org/10.5414/ALX02526E","url":null,"abstract":"<p><p>Hymenoptera stings can cause severe anaphylactic reactions in patients with an underlying Hymenoptera venom allergy (HVA). In such cases, venom immunotherapy (VIT) is a highly effective measure to prevent future anaphylaxis. The management of patients with a clear allergological indication for VIT and contraindications to VIT (e.g., autoimmune diseases) remains a clinical challenge. We report the case of a 54-year-old male gardener who experienced life-threatening anaphylaxis after being stung by wasps in the head and neck region. After confirmation of a Vespula venom allergy (VVA) by intradermal test and VV-specific serum IgE antibodies, VIT was started using a rush protocol. One month after reaching the maintenance dose, the patient experienced a worsening of his pre-existing Crohn's disease and ankylosing spondylitis. VIT was stopped, and the autoimmune diseases were treated with systemic steroids and sulfasalazine. As the patient wished to remain in his profession, and in view of the previous severe anaphylaxis, we restarted VIT after the autoimmune diseases had resolved, using a slower up-dosing protocol. This approach was tolerated without side effects, and the patient tolerated a sting challenge and several field stings without anaphylactic symptoms.</p>","PeriodicalId":101298,"journal":{"name":"Allergologie select","volume":"8 ","pages":"332-335"},"PeriodicalIF":0.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hen's egg ladder: Therapy option for the gradual introduction of hen's eggs in cases of hen's egg allergy.","authors":"Amely Brückner, Petra Funk-Wentzel, Stephanie Hompes","doi":"10.5414/ALX02517E","DOIUrl":"https://doi.org/10.5414/ALX02517E","url":null,"abstract":"<p><p>More than 10 years ago, the British Society for Allergy and Clinical Immunology (BSACI) published guidelines for the management of egg allergy [1]. For the first time, these included a stepwise plan for the reintroduction of egg for egg-allergic children who could already tolerate well-cooked egg, such as cakes and cookies. Since then, various egg ladders have been developed [2, 3, 4, 5, 6, 7, 8, 9]. In the past 3 years, several studies have been published suggesting that a gradual introduction of highly processed to less processed egg containing foods contribute to the acceleration of tolerance development [2, 3, 4, 5]. However, depending on the study and egg ladder, the egg products vary in their level of processing (wheat matrix, degree, and location of heating (e.g., oven, pan, pot), egg quantity, and egg protein). In the UK, the introduction of the egg ladder is recommended at the age of 12 months or if the last reaction occurred 6 months before. The benefits of introducing egg at home include an early increase in the variety of foods, reduction of food fears, improved nutrient intake, and the avoidance of hospitalization fears in children [10]. Children with mild reactions in the past can start with small amounts of baked goods at home. Food challenges in an inpatient setting to exclude or reconfirm the allergy should be conducted if the patients have previously had severe allergic reactions, i.e., anaphylaxis, or if the smallest amounts triggered an allergic reaction or if existing asthma is poorly controlled [10, 11]. The present work includes, in addition to the evaluation of study results, a presentation of the recent studies regarding egg ladders. From these, a new egg ladder as therapeutic option for the German-speaking region has been developed. As already done for the milk ladder a detailed step-by-step plan, selection criteria, a recipe collection, and also ideas for commercial prepackaged food items can be found in the appendices [11].</p>","PeriodicalId":101298,"journal":{"name":"Allergologie select","volume":"8 ","pages":"324-331"},"PeriodicalIF":0.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11500597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid identification of primary atopic disorders (PAD) by a clinical landmark-guided, upfront use of genomic sequencing.","authors":"Tim Niehues, Sandra von Hardenberg, Eunike Velleuer","doi":"10.5414/ALX02520E","DOIUrl":"https://doi.org/10.5414/ALX02520E","url":null,"abstract":"<p><p>Primary atopic disorders (PAD) are monogenic disorders caused by pathogenic gene variants encoding proteins that are key for the maintenance of a healthy skin barrier and a well-functioning immune system. Physicians face the challenge to find single, extremely rare PAD patients/families among the millions of individuals with common allergic diseases. We describe case scenarios with signature PAD. We review the literature and deduct specific clinical red flags for PAD detection. They include a positive family history and/or signs of pathological susceptibility to infections, immunodysregulation, or syndromic disease. Results of conventional laboratory and most immunological lab studies are not sufficient to make a definitive diagnosis of PAD. In the past, multistep narrowing of differential diagnoses by various immunological and other laboratory tests led to testing of single genes or gene panel analyses, which was a time-consuming and often unsuccessful approach. The implementation of whole-genomic analyses in the routine diagnostics has led to a paradigm shift. Upfront genome-wide analysis by whole genome sequencing (WGS) will shorten the time to diagnosis, save patients from unnecessary investigations, and reduce morbidity and mortality. We propose a rational, clinical landmark-based approach for deciding which cases pass the filter for carrying out early WGS. WGS result interpretation requires a great deal of caution regarding the causal relationship of variants in PAD phenotypes and absence of proof by adequate functional tests. In case of negative WGS results, a re-iteration attitude with re-analyses of the data (using the latest data base annotation)) may eventually lead to PAD diagnosis. PAD, like many other rare genetic diseases, will only be successfully managed, if physicians from different clinical specialties and geneticists interact regularly in multidisciplinary conferences.</p>","PeriodicalId":101298,"journal":{"name":"Allergologie select","volume":"8 ","pages":"304-323"},"PeriodicalIF":0.0,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11460323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142396601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic measures in patients with severe insect sting reactions and elevated baseline serum tryptase levels.","authors":"Silvan Lange, Eva Oppel, Marius Winkler, Franziska Ruëff","doi":"10.5414/ALX02524E","DOIUrl":"https://doi.org/10.5414/ALX02524E","url":null,"abstract":"<p><p>Mastocytosis or an elevated basal serum tryptase (bST) level are known risk factors for patients with insect venom allergy. We report on 3 patients with a history of severe anaphylactic insect sting reactions who underwent a detailed workup for insect venom allergy before starting venom immunotherapy. In addition to insect venom sensitization, an elevated concentration of bST (15.5, 20.8, and 23.2 µg/L) was found in all cases. There was no evidence of mastocytosis in the skin (MIS). Further testing revealed hereditary α-hypertryptasemia (HαT) in 2 patients and a D816V mutation by liquid biopsy in 1 patient, which is a minor diagnostic criterion for indolent systemic mastocytosis. Even without iliac crest puncture, causes of elevated bST can be narrowed down with minimally invasive diagnostic measures. As this has practical implications, patients with elevated bST should always undergo further work-up to determine the cause of this abnormal finding.</p>","PeriodicalId":101298,"journal":{"name":"Allergologie select","volume":"8 ","pages":"299-303"},"PeriodicalIF":0.0,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11361272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}