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Abstract: Background: Cold urticaria (ColdU), i.e. the occurrence of wheals or angioedema in response to cold exposure, is classified into typical and atypical forms. The diagnosis of typical ColdU relies on whealing in response to local cold stimulation testing (CST). It can also manifest with cold-induced anaphylaxis (ColdA). We aimed to determine risk factors for ColdA in typical ColdU. Methods: An international, cross-sectional study COLD-CE was carried out at 32 urticaria centers of reference and excellence (UCAREs). Detailed history was taken and CST with an ice cube and/or TempTest® performed. ColdA was defined as an acute cold-induced involvement of the skin and/or visible mucosal tissue and at least one of: cardiovascular manifestations, difficulty breathing, or gastrointestinal symptoms. Results: Of 551 ColdU patients, 75% (n=412) had a positive CST and ColdA occurred in 37% (n=151) of the latter. Cold-induced generalized wheals, angioedema, acral swelling, oropharyngeal/laryngeal symptoms, and itch of earlobes were identified as signs/symptoms of severe disease. ColdA was most commonly provoked by complete cold water immersion and ColdA caused by cold air was more common in countries with a warmer climate. Ten percent (n=40) of typical ColdU patients had a concomitant chronic spontaneous urticaria (CSU). They had a lower frequency of ColdA than those without CSU (4% vs 39%, p=0.003). We identified the following risk factors for cardiovascular manifestations: previous systemic reaction to a Hymenoptera sting, angioedema, oropharyngeal/laryngeal symptoms, and itchy earlobes. Conclusion: ColdA is common in typical ColdU. High-risk patients require education about their condition and how to use an adrenaline autoinjector.
Keywords: adrenaline autoinjector, cold urticaria, COLD-CE, risk factors, systemic reactions, epinephrine, therapeutic use, self administration, injections, intramuscular, methods
Published in DKUM: 06.08.2024; Views: 139; Downloads: 8
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Abstract: This doctoral dissertation represents a comprehensive treatment of the many facets of macroprudential policy. We start by delving into the notions of macroprudential policy, systemic risk and financial stability, describe the macroprudential policy transmission mechanism, systemic financial crises and contagion channels, as well as the Modigliani-Miller theorem and its violations. We proceed by illustrating a multitude of available macroprudential policy instruments, attempt to clarify whether capital controls can be considered a macroprudential policy instrument, describe the use and calibration of macroprudential policy instruments, and elaborate on the changes to the EU macroprudential policy framework after the enactment of the Capital Requirements Regulation II and Capital Requirements Directive V. Next, we describe interactions between macroprudential policy and other policies, in particular microprudential, monetary, fiscal and structural policies. We attempt to answer the question of whether macroprudential policy should be entrusted to a central bank, a financial supervisory authority, or the government. Furthermore, we investigate whether countries should reciprocate each other’s macroprudential policy stance. Moreover, we review the existing research regarding the impact of macroprudential policy instruments on financial stability. We attempt to answer the question of whether the existence of a macroprudential policy framework could have prevented the Global Financial Crisis of 2007. Last but not least, we conduct our own empirical assessment of the impact of macroprudential policy instruments on financial stability in six euro area countries (Belgium, Cyprus, Germany, Spain, Ireland and Netherlands) over sixteen quarters (from 2015 Q1 (inclusive) to 2018 Q4 (inclusive)) by using the quantitative research method of panel econometrics. We tested three hypotheses: H1: Macroprudential policy instruments (common equity tier 1 ratio; loans to deposits ratio; non-deposit funding as percentage of total funding; leverage ratio; interconnectedness ratio; and coverage ratio for non-performing exposures) enhance financial stability, as measured by credit growth. H2: Macroprudential policy instruments (common equity tier 1 ratio; loans to deposits ratio; non-deposit funding as percentage of total funding; leverage ratio; interconnectedness ratio; and coverage ratio for non-performing exposures) enhance financial stability, as measured by house price growth. H3: Macroprudential policy instruments (common equity tier 1 ratio; loans to deposits ratio; non-deposit funding as percentage of total funding; leverage ratio; interconnectedness ratio; and coverage ratio for non-performing exposures) reduce cyclical fluctuations of the economy, as measured by the amplitude of the deviations of the actual economic growth rate from its long-run trend, thereby contributing to financial stability. Our empirical results suggest that, of the investigated macroprudential policy instruments, common equity tier one ratio, coverage ratio, and interconnectedness ratio exhibit the predicted impact on credit growth rate and on the deviation of the actual economic growth rate from its long-run trend. Furthermore, common equity tier one ratio, loans to deposits ratio, and leverage ratio exhibit the predicted impact on house price growth rate. The non-deposit funding ratio does not exhibit the expected impact on any of the response variables. Hence, we can only partly confirm hypotheses 1, 2 and 3. Our conclusions are in line with contemporary research on macroprudential policy. Taking into account the existing empirical research, combined with our findings as presented in this dissertation, a case can be made for the usage of carefully crafted macroprudential policy instruments which target selected financial and macroeconomic variables with the ultimate goal of attaining financial stability of the financial system as a whole.
Keywords: Macroprudential policy, macroprudential instruments, systemic risk, financial stability
Published in DKUM: 03.05.2022; Views: 926; Downloads: 90
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Abstract: We tested for the significance of macroeconomic variables that condition non-performing loan ratios. Our estimates for Bulgaria and Romania support the hypothesis that the growth of available finance might harm banking performance and deteriorate NPL dynamics, most probably due to the overheatingof economies. Since we confirmed that the dynamics of net exports of these economies deteriorated the NPL ratio, the weakening of growth in export-oriented industries could lead to economic contraction with a direct impact on the sustainability of banking-sector results in these countries. Large current account deficits are typical for emerging markets and do not pose a problem as long as they are caused by the importing of capital goods, and, if future export growth is strong enough to reimburse foreign debt. Structural dependence on external financing - which is in part a by-product of the effect of low levels of internal saving - have led to large current account deficits and financial instability.
Keywords: cyclicality, non-performing loans, systemic risk, asset quality, economic growth
Published in DKUM: 24.07.2017; Views: 1100; Downloads: 112
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