Volume 10 (2026)
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Original
Achieving a normal life in hereditary angioedema: Quality of life and treatment gaps among German HAE patients
Markus Magerl, Thomas Buttgereit, Inmaculada Martinez-Saguer, Petra Staubach-Renz, Jens Greve, Emel Aygören-Pürsün, Lucia Schauf, and Kathrin Schön
Page No. 1
Abstract
Allergologie select, Vol. 10/2026 (1-10)
Achieving a normal life in hereditary angioedema: Quality of life and treatment gaps among German HAE patients
Markus Magerl1,2, Thomas Buttgereit1,2, Inmaculada Martinez-Saguer3, Petra Staubach-Renz4, Jens Greve5, Emel Aygören-Pürsün6, Lucia Schauf7, and Kathrin Schön1,2,7
1Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 2Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, 3HZRM Haemophilia Center Rhein Main, Frankfurt am Main, 4University Medical Center, Mainz, 5Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, 6University Hospital Frankfurt, Department for Children and Adolescents, Frankfurt, and 7HAE Vereinigung e.V., Germany
Background: Hereditary angioedema (HAE) is a rare genetic disease characterized by recurrent swelling attacks. Current guidelines for HAE management emphasize achieving complete disease control to normalize patients’ lives. Quality of life (QoL) differences between patients with 0 attacks and those with persistent attacks remain to be explored. Materials and methods: The German patient organization for individuals affected by hereditary angioedema, HAE Vereinigung e.V. conducted an online survey with 122 HAE patients in Germany in 2024. Participants were categorized according to their therapy – long-term prophylaxis (LTP) or on-demand therapy (ODT) – and according to their attack frequency over the last 6 months. Patient-reported outcomes for functional, emotional, and social impacts were analyzed to evaluate QoL. Results: Although 83% of patients expressed satisfaction with their treatment, 59% of patients still had attacks. Patients on LTP reported significantly fewer attacks (p < 0.001) and higher QoL compared to those on ODT (p < 0.001). Patients with 0 attacks consistently showed significantly better outcomes across all QoL domains than those with 1 or more attacks (p < 0.001). Conclusion: The findings highlight that even minimal residual disease activity can meaningfully reduce QoL. Achieving complete attack freedom, rather than partial control, is necessary to restore normalcy for patients with HAE. Hence, regular adjustments of the HAE management plans based on patient-reported outcomes are crucial to ensure that treatment strategies address both medical and QoL needs.Correspondence to:
Thomas Buttgereit, MD, Charité – Universitätsmedizin Berlin, Institute of Allergology, Hindenburgdamm 30, 12203 Berlin, Germany
Email: [email protected]
Case Report
Potential infliximab-induced Kounis syndrome in a patient with metastatic melanoma
Corsin Seeli, Dimitri Patriki, Omar Hasan Ali, Ann-Kathrin Blumenröther, Marie-Charlotte Brüggen, Andrea Nolting, and Carole Guillet
Page No. 11
Abstract
Allergologie select, Vol. 10/2026 (11-15)
Potential infliximab-induced Kounis syndrome in a patient with metastatic melanoma
Corsin Seeli1, Dimitri Patriki2, Omar Hasan Ali1, Ann-Kathrin Blumenröther1, Marie-Charlotte Brüggen1, Andrea Nolting1, and Carole Guillet1
1Department of Dermatology, and 2Department of Cardiology, University Hospital Zurich, Switzerland
Background: Kounis syndrome is a rare type of allergic or hypersensitivityinduced acute coronary syndrome. The release of numerous inflammatory mediators induces vasospasms and potential thrombosis leading to myocardial infarction. Case history: We present the case of a 65-year-old woman with metastatic melanoma who experienced chest tightness and dyspnea after her 3rd infliximab infusion and who had transitory ST elevations. Suspecting allergic reactions and acute coronary syndrome she was simultaneously treated for both conditions with complete resolution of symptoms and electrocardiographic alternations without the need for further percutaneous coronary intervention. Conclusion: This case highlights the importance of considering Kounis syndrome as a potentially life-threatening complication during monoclonal antibody infusion, even in the absence of a prior allergic history and typical skin manifestations.
Early recognition and treatment are crucial and spared our patient further invasive diagnostical and therapeutical interventions.Correspondence to:
Andrea Nolting, MD, Department of Dermatology, University Hospital of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
Email: [email protected]
Original
Quality-of-life assessment may support the correct diagnosis of adult wheat allergy
Florian Schusta, Anna Neyer, Sabine Dölle-Bierke, Josefine Grünhagen, Veronika Höfer, and Margitta Worm
Page No. 16
Abstract
Allergologie select, Vol. 10/2026 (16-27)
Quality-of-life assessment may support the correct diagnosis of adult wheat allergy
Florian Schusta, Anna Neyer, Sabine Dölle-Bierke, Josefine Grünhagen, Veronika Höfer, and Margitta Worm
Division of Allergy and Immunology, Department of Dermatology, Venereology and Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
Background: Wheat is a frequent cause of food-induced allergic reactions in adults. In this study we aimed to assess the diagnostic value of skin prick test (SPT), specific immunoglobulin E (sIgE), but also quality of life in wheat-sensitized and allergic patients. Materials and methods: In this prospective, clinical study 80 patients were screened for eligibility. Subsequently, 36 wheat-sensitized patients underwent oral food challenges (OFCs) with supraphysiological amounts of gluten at rest and in combination with exercise. The challenge was stopped when objective symptoms occurred. Prior to the challenge, sIgE measurement and a SPT were conducted. The Food Allergy Quality of Life Questionnaire (FAQLQ), Food Allergy Independent Measure (FAIM), and Beck Anxiety Inventory (BAI) were used to assess the quality of life, perceived disease severity, and anxiety of the patients. Results: The OFC was performed with increasing amounts of gluten reaching a supraphysiological level. 24 patients (67%) were OFC positive with 21 reacting at rest. 3 patients reacted after the implementation of exercise. 60% of patients with a self-reported exercise dependency reacted in the OFC at rest. 8 of 21 patients who reacted at rest were rechallenged with exercise and lower doses of gluten, of which 5 reacted again. Exercise lowered the reaction threshold by 50% in these 5 patients. OFC-positive patients had stronger sensitization to gluten and its constituents and showed higher impairment in their quality of life and perceived burden of disease than OFC-negative patients. The receiver operator characteristics model including gluten SPT, omega-5-gliadin sIgE, and the FAIM score to predict OFC positivity yielded a 95.2% sensitivity and 83.3% specificity. Males displayed a higher degree of sensitization, but females had higher FAQLQ and FAIM scores. Conclusion: Although a high rate of exercise dependency was reported, most reactions were elicited at rest when the amount of gluten was upscaled. However, the eliciting amount and reaction threshold was lowered in the presence of exercise. Food allergy-related quality-of-life data can indicate psychological impairment due to the disease but may also serve as a patient-reported outcome tool which can support the diagnostic accuracy of wheat allergy.Correspondence to:
Prof. Dr. med. Margitta Worm, Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergy, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
Email: [email protected]
Original
Experts’ perspectives on allergic reactions to emerging food sources, pollen and insects
Lea Faust, Sabine Dölle-Bierke, Veronika Höfer, and Margitta Worm
Page No. 28
Abstract
Allergologie select, Vol. 10/2026 (28-35)
Experts’ perspectives on allergic reactions to emerging food sources, pollen and insects
Lea Faust1, Sabine Dölle-Bierke1, Veronika Höfer1,2, and Margitta Worm1
1Division of Allergy and Immunology, Department Dermatology, Venereology and Allergy, Campus Charité Mitte, Universitätsmedizin Berlin, Berlin, Germany, and 2Division of Allergy, University Children’s Hospital and Children’s Research Center, University of Zurich (UZH), Zurich, Switzerland
The rising demand for sustainable diets has led to an increased consumption of alternative protein sources. While ecologically promising, these foods may pose new allergenic risks. We surveyed 127 European allergy experts regarding their clinical perception towards emerging allergenic food sources. Allergic reactions to non-priority allergenic foods were most frequently reported for legumes (83%), followed by hemp (33%), edible insects (21%), and jackfruit (20%). Experts highlighted risks related to cross-reactivity, particularly between edible insects and crustaceans or house dust mites, and between non-priority legumes and peanut, soy, or lupine. Legumes other than peanut, soy, and lupine, as well as edible insects and hempseeds/cannabis, were also rated as most clinically relevant for future practice. Experts also noted rising symptoms due to changes in pollen exposure and insect distribution linked to climate change. Our data underscore the need for the diagnosis of emerging allergenic sources.Correspondence to:
Prof. Dr. med. Margitta Worm, Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergy, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
Email: [email protected]
Review
Comparing pre- and post-COVID-19 chronic allergy prevalence in children using National Health and Nutrition Examination Survey in 2019 and 2021
Bomi Kim and Sunyeob Choi
Page No. 36
Abstract
Allergologie select, Vol. 10/2026 (36-48)
Comparing pre- and post-COVID-19 chronic allergy prevalence in children using National Health and Nutrition Examination Survey in 2019 and 2021
Bomi Kim1 and Sunyeob Choi2
1Department of Nursing, Honam University, Gwangju, and 2College of Nursing, Dongguk University WISE, Gyeongbuk, South Korea
Objective: To investigate changes in demographic characteristics, parental smoking habits, and the prevalence of asthma, atopic dermatitis, and rhinitis among children in South Korea before and after the COVID-19 pandemic. Materials and methods: A retrospective analysis of national health survey data from 2019 and 2021 was conducted, including children aged 3 – 18 years. Factors such as gender, age, location, housing type, family size, income, body mass index, subjective health status, influenza vaccination, family structure, and parental smoking habits were analyzed. Results: No significant differences were found in most demographic characteristics and parental features between 2019 and 2021, except for influenza vaccination rates and mothers’ age at first childbirth. The influenza vaccination rate increased from 69.3% in 2019 to 77.8% in 2021, and the average maternal age at first birth increased from 28.46 years to 29.22 years. Asthma diagnoses showed no significant differences between the 2 years after adjusting for general and parent-related characteristics. For atopic dermatitis, significant differences in gender distribution were observed in 2021. Rhinitis diagnoses showed significant differences in age, area, and breastfeeding status between the two years. Conclusion: The COVID-19 pandemic may have influenced certain demographic characteristics, such as influenza vaccination rates and mothers’ age at first childbirth, but the prevalence of asthma, atopic dermatitis, and rhinitis among children remained largely unchanged between 2019 and 2021. This study underscores the importance of monitoring the impact of social changes on children’s health, particularly during significant events like the COVID-19 pandemic. Further research is required to understand the long-term effects of these changes on child health.Correspondence to:
Sunyeob Choi, PhD, MSN, RN, Assistant Professor, College of Nursing, Dongguk University WISE, Youngsan Hall, 123 Dongdae-ro, Gyeongju, Gyeongbuk 38066, South Korea
Email: [email protected]
Case Report
A case of herpes zoster following the first dose of benralizumab
Kurtuluş Aksu, Onur Telli, Melis Yağdıran, Fatma Dindar Çelik, Hatice Çelik Tuğlu, and Özge Göktürk
Page No. 49
Abstract
Allergologie select, Vol. 10/2026 (49-51)
A case of herpes zoster following the first dose of benralizumab
Kurtuluş Aksu, Onur Telli, Melis Yağdıran, Fatma Dindar Çelik, Hatice Çelik Tuğlu, and Özge Göktürk
Division of Immunology and Allergy, Department of Chest Diseases, Ankara Atatürk Sanatoryum Training and Research Hospital, University of Health Sciences, Ankara, Turkiye
Introduction: Biological agents used in the treatment of rheumatic diseases and malignancies cause an increase in herpes zoster susceptibility. This may also be the case for monoclonal antibody treatments used in asthma based on recent pharmacovigilance data. Case report: Herpetic lesions occurred on the anterior chest wall of a 43-year-old patient who was initiated on benralizumab treatment for severe eosinophilic asthma. The patient received diagnosis of herpes zoster and showed significant clinical improvement with oral valacyclovir treatment. Since it was not certain whether the herpes eruption was directly related to benralizumab treatment, benralizumab treatment was continued at the patient’s request and with the approval of the dermatology department. The patient did not experience recurrent herpes eruptions or any other clinical problems with the repeated doses given.Correspondence to:
Prof. Kurtuluş Aksu, MD, Professor in Allergy and Pulmonology, Ankara Atatürk Sanatoryum Eğitim ve Araştırma Hastanesi, 06280, Keçiören, Ankara, Türkiye
Email: [email protected]
Review
The MRGPRX2 paradigm shift: Redefining mast cell activation pathways in chronic urticaria
Kun Wu and Junlin Liu
Page No. 52
Abstract
Allergologie select, Vol. 10/2026 (52-62)
The MRGPRX2 paradigm shift: Redefining mast cell activation pathways in chronic urticaria
Kun Wu and Junlin Liu
Department of Dermatology and Venereology, The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
Chronic urticaria (CU) is a skin disease characterized by recurrent episodes of vascular dilation and increased permeability of the cutaneous and mucosal microvasculature. Although antihistamines and omalizumab remain first-line and secondline therapies, respectively, a significant proportion of patients develop recalcitrant disease phenotypes, highlighting critical unmet needs for innovative therapeutic paradigms. In recent years, emerging insights into Mas-related G protein-coupled receptor X2 (MRGPRX2) have revealed transformative perspectives for elucidating the pathobiology of refractory CU. As a class A G protein-coupled receptor (GPCR) that is predominantly localized to mast cells, MRGPRX2 orchestrates non-IgE-mediated mast cell degranulation through its pluripotent ligand recognition capacity, engaging diverse exogenous cationic compounds, neuropeptides, and certain pharmacological agents. This comprehensive review evaluates recent advancements in deciphering the mechanistic contributions of MRGPRX2 to CU pathogenesis, with the ultimate aim of informing the development of precision diagnostic and therapeutic frameworks for CU management.Correspondence to:
Prof. Dr. Junlin Liu, Department of Dermatology and Venereology, The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
Email: [email protected]
Original
Prick tests and basophil activation tests in hypersensitivity to SARS-CoV-2 vaccines and components
Anna-Emilia Aust, Heidi Reh, and Bettina Wedi
Page No. 63
Abstract
Allergologie select, Vol. 10/2026 (63-72)
Prick tests and basophil activation tests in hypersensitivity to SARS-CoV-2 vaccines and components
Anna-Emilia Aust, Heidi Reh, and Bettina Wedi
Department of Dermatology and Allergy, Comprehensive Allergy Center, Hanover Medical School, Hannover, Germany
In collaboration with certified allergy centers (CACs) in Germany, a standardized procedure was developed for the allergologic evaluation of hypersensitivity reactions to SARS-CoV-2 vaccines. Our CAC prospectively evaluated 60 subjects with prior allergic reactions to SARS-CoV-2 vaccines or components. The investigations included a comprehensive medical history, in-vitro and skin tests. Prick tests were negative in all participants. Two positive basophil activation tests suggested a hypersensitivity to the component polyethylene glycol; however, no clinical relevance was found. Approximately 73% of the subjects reported symptoms during subsequent immunizations, which were milder than the reactions prior to the diagnostic procedures. Most index reactions manifested as non-specific symptoms. The results suggest that subsequent vaccinations following diagnostic procedures were well tolerated, underscoring the importance of careful allergological evaluation prior to vaccination.Correspondence to:
Professor Bettina Wedi, MD, Department of Dermatology and Allergy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
Email: [email protected]
Review
Decoding allergy in vitro: Challenges and clinical use of humoral and cellular methods
Bettina Wedi and Timo Buhl
Page No. 73
Abstract
Allergologie select, Vol. 10/2026 (73-85)
Decoding allergy in vitro: Challenges and clinical use of humoral and cellular methods
Bettina Wedi1 and Timo Buhl2
1Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hanover, and 2Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
In vitro assays are essential tools in diagnosing IgE-mediated allergic diseases and complement clinical history and skin testing across food, inhalant, venom, and drug allergies. This methodological review is intended for clinicians seeking a more detailed understanding of current laboratory-based allergy diagnostics. It summarizes current humoral and cellular diagnostic methods, including total IgE, singleplex and component-resolved specific IgE testing, multiplex IgE platforms, and functional cellular assays such as the basophil activation test and T-cell–based approaches. Humoral assays remain the quantitative foundation of molecular allergy diagnostics, while multiplex arrays broaden diagnostic scope and map sensitization profiles, although platform variability requires cautious interpretation. Cellular assays may add functional information in selected constellations but remain technically demanding, insufficiently standardized, and are best regarded as adjunctive tools in specialized or research settings, with evidence largely derived from selected cohorts. Additional areas – immunotherapy monitoring, mast cell disorders, contact allergy, and oncology – illustrate the broader methodological spectrum of in vitro methods. Persistent unmet needs include harmonization, validated reference standards, and robust interpretive frameworks. Disease-specific applications are discussed in companion articles in this issue.Correspondence to:
Timo Buhl, MD, University Medical Center Göttingen, Department of Dermatology, Venereology and Allergology, Robert Koch Str. 40, 37075 Göttingen, Germany
Email: [email protected]
Consensus paper
Expert consensus on the long-term use of lanadelumab in hereditary angioedema: Toward harmonized care
Emel Aygören-Pürsün, Jens Greve, Inmaculada Martinez-Saguer, Susanne Trainotti, Mathias Sulk, Bettina Wedi, Ellen Witte-Händel, and Markus Magerl
Page No. 86
Abstract
Allergologie select, Vol. 10/2026 (86-97)
Expert consensus on the long-term use of lanadelumab in hereditary angioedema: Toward harmonized care
Emel Aygören-Pürsün1, Jens Greve2, Inmaculada Martinez-Saguer3, Susanne Trainotti4, Mathias Sulk5, Bettina Wedi6, Ellen Witte-Händel7,8, and Markus Magerl7,9
1University Hospital Frankfurt, Goethe University, Frankfurt, 2Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, 3Haemophilia Centre Rhine Main, Frankfurt/Main, 4Technical University of Munich, TUM School of Medicine and Health, Department of Otorhinolaryngology, Head and Neck Surgery, TUM University Hospital, Munich, 5Department of Dermatology, University of Münster, Münster, 6Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover, 7Angioedema Center of Reference and Excellence (ACARE), Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 8Global Allergy and Asthma Excellence Network, ACARE/UCARE coordinating office, and 9Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
Background: Hereditary angioedema (HAE) is a rare, potentially life-threatening disease caused in most cases by C1 inhibitor deficiency. Lanadelumab, a monoclonal antibody targeting plasma kallikrein, is an effective long-term prophylactic (LTP) treatment for HAE. However, consensus on best practices remains lacking. Objectives: This study aimed to report consensus statements on key principles on long-term lanadelumab therapy for HAE in Germany developed at an HAE LTP Expert Meeting in the year 2024 in Frankfurt, Germany. Materials and methods: A multidisciplinary panel of seven German HAE experts participated in a consensus process to align current guidelines with real-world clinical practice. Following literature review and debate, keynotes were drafted, refined, and voted on. Consensus was defined as ≥ 70% agreement. Key domains included: shared decision-making; flexibility in initiating or adjusting prophylaxis; structured patient education; self-administration; individualized dosing; emergency medication availability; and proactive follow-up, including specific guidance for women of childbearing age. Results: Ten core consensus statements were developed, achieving unanimous (100%, n = 9/10 statements) or strong (≥ 85%, n = 1/10 statements) agreement. It is recommended that the decision to initiate long-term prophylaxis be made through shared decision-making and that the decision made can and should be adjusted again in the further course of treatment. It is advisable to train patients in the technique of self-injection and to start therapy with lanadelumab with a 2-week injection interval in accordance with the product information. The injection interval should be adjusted to the individual patient, and all well-controlled patients should be offered the option of extending the interval without compromising the goal of complete disease control. Even and especially when the prophylaxis is well tolerated, emergency medication must not be neglected. Conclusion: These consensus statements provide a practical, expert-endorsed framework for implementing lanadelumab LTP in clinical practice emphasizing individualized treatment aligned with international guidelines and patient needs.Correspondence to:
Markus Magerl, MD, Charité – Universitätsmedizin Berlin, Institute of Allergology, Hindenburgdamm 27, 12203 Berlin, Germany
Email: [email protected]
Case Report
Does the teicoplanin skin test predict IgE-mediated hypersensitivity?
Nur Betül Baştuğ İnan, Özge Göktürk, Yavuz Karahan, and Kurtuluş Aksu
Page No. 98
Abstract
Allergologie select, Vol. 10/2026 (98-100)
Does the teicoplanin skin test predict IgE-mediated hypersensitivity?
Nur Betül Baştuğ İnan, Özge Göktürk, Yavuz Karahan, and Kurtuluş Aksu
Division of Immunology and Allergy, Department of Chest Diseases, Ankara Atatürk Sanatoryum Training and Research Hospital, University of Health Sciences, Ankara, Türkiye
Various delayed-type hypersensitivity reactions have been reported following teicoplanin administration, including drug rash with eosinophilia and systemic symptoms (DRESS syndrome), and acute generalized exanthematous pustulosis (AGEP). Until recently, IgE-mediated hypersensitivity reactions to teicoplanin were considered to be rare. However, reports of such reactions have increased in recent years. These case reports also suggest that teicoplanin skin testing can predict IgE-mediated hypersensitivity reactions. In the present case, teicoplanin skin prick and intradermal tests were negative, yet an immediate skin reaction occurred during provocation.Correspondence to:
Kurtuluş Aksu, MD, Professor in Allergy and Pulmonology, Ankara Atatürk Sanatoryum Eğitim ve Araştırma Hastanesi, 06280, Keçiören, Ankara, Türkiye
Email: [email protected]
Case Report
Cefazolin as an alternative in patients with a history of penicillin or β-lactam antibiotic allergy: A case overview
Burkhard Kreft, Johannes Wohlrab, and Cord Sunderkötter
Page No. 101
Abstract
Allergologie select, Vol. 10/2026 (101-106)
Cefazolin as an alternative in patients with a history of penicillin or β-lactam antibiotic allergy: A case overview
Burkhard Kreft, Johannes Wohlrab, and Cord Sunderkötter
Department of Dermatology and Venereology, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Germany
Many patients with suspected or confirmed allergy to penicillin or β-lactam antibiotics are unnecessarily denied all β-lactam antibiotics (BLA) and instead given a less effective antibiotic with more side effects. However, cefazolin, a first-generation cephalosporin, is a safe and effective treatment option for these patients in most cases. Recent studies show that immunological cross-reactions among BLAs are primarily caused by structural similarities in the side chains and not by the common β-lactam ring. Cefazolin has unique R1 and R2 side chains that largely rule out cross-reactivity with other BLAs. In a case series, 21 patients with a history of alleged or confirmed allergy to BLAs were exposed to cefazolin under real-life conditions, and all but 1 patient (who developed an uncomplicated maculopapular rash) showed no reaction. Therefore, the use of cefazolin is acceptable under clinical supervision in cases of a previous uncomplicated delayed-type reaction. However, in cases of reported or documented clinical reactions to BLA that are indicative of a type I allergy (such as urticaria, angioedema, anaphylaxis), prior to (titrated) administration of cefazolin under appropriate monitoring measures, a diagnostic evaluation in accordance with guidelines, including a negative skin test for cefazolin, is advisable. This procedure avoids the use of less suitable reserve antibiotics and ensures effective treatment without incalculable risk for anaphylaxis.Correspondence to:
Dr. med. Burkhard Kreft, Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
Email: [email protected]
Review
T-cell mechanisms in atopic dermatitis
Phila Cara Baumann and Lennart Matthias Roesner
Page No. 107
Abstract
Allergologie select, Vol. 10/2026 (107-113)
T-cell mechanisms in atopic dermatitis
Phila Cara Baumann1 and Lennart Matthias Roesner1,2
1Department of Dermatology and Allergy, Hannover Medical School (MHH), and 2Cluster of Excellence RESIST (EXC 2155), Hannover Medical School, Hanover, Germany
This review provides an overview of recent advances in understanding Tcell inflammation in atopic dermatitis (AD), a common chronic inflammatory skin disease. After recognizing their cognate antigen in the acute phase of the disease, the homing of T cells from the circulation into the skin via cutaneous lymphocyte antigen (CLA) is the prerequisite to skin inflammation and subsequent systemic and local, tissue resident, memory (TRM) formation. Initial observations suggest that antigen presentation occurs in structures such as induced skin-associated lymphoid tissue (iSALT), in addition to lymphatic organs. Aside from environmental antigens, such as aeroallergens, other antigen sources also appear to play a role: humoral and cellular responses to microbial antigens and autoantigens are discussed to drive and shape skin inflammation in AD. In-depth characterization of differentiated, activated Th2 cells in AD shows their ability to recognize different signals from epithelial cells directly. The heterogeneity of patients with antigen sensitizations and T-cell phenotypes is believed to influence therapeutic success. This suggests that a more precise characterization of patient subgroups would enable targeted, individualized therapy.Correspondence to:
Dr. Lennart M. Roesner, Hannover Medical School (MHH), Carl-Neuberg-Str.1, 30625 Hannover, Germany
Email: [email protected]
Case Report
Resolution of childhood wheat allergy through evolution into WALDA? A case report
Charlotte J. Kiani, Valentina Faihs, Claudia Kugler, Julia F. Pilz, Tilo Biedermann, and Knut Brockow
Page No. 114
Abstract
Allergologie select, Vol. 10/2026 (114-119)
Resolution of childhood wheat allergy through evolution into WALDA? A case report
Charlotte J. Kiani1, Valentina Faihs1, Claudia Kugler1, Julia F. Pilz1, Tilo Biedermann1, and Knut Brockow1,2
1Department of Dermatology and Allergy, Technical University of Munich, TUM School of Medicine and Health, Munich, Germany, and 2Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
Background: Wheat allergy may present with different phenotypes. Childhood-onset wheat allergy is characterized by immediate-type IgE-mediated reactions to wheat ingestion alone. It typically affects atopic individuals and often resolves spontaneously. The predominant adult-onset phenotype is WALDA (wheat allergy dependent on augmentation factors), triggered only when wheat is consumed in combination with augmentation factors. Phenotypic transition between these forms is rarely described. Case report: We present the case of a 30-year-old atopic female patient with a history of wheat-induced anaphylaxis, who presented with three distinct stages, compatible with a phenotypic transition. In infancy, the patient was diagnosed with classical IgE-mediated wheat allergy. In early adulthood, she developed augmentation factor-dependent reactions compatible with WALDA. At the age of 30, comprehensive oral food challenge testing and serological analysis revealed full clinical tolerance and loss of sensitization. Conclusion: This case illustrates a possible transient clinical course of wheat allergy with WALDA as an intermediate stage prior to resolution. Such cases may be underreported, as patients with declining wheat allergy may not be identified as having WALDA reactions, but rather as having inconstant reactivity. Allergy reassessment in adult patients with food allergy in childhood is essential to detect phenotypic shifts or to confirm resolution.Correspondence to:
Dr. med. Valentina Faihs, Department of Dermatology and Allergy, Technical University of Munich, TUM School of Medicine and Health, Biedersteiner Str. 29, 80802 Munich, Germany
Email: [email protected]
Guideline
Update of the evidence- and consensus-based S3 guideline on atopic dermatitis: Systemic therapy with biologics or Janus kinase inhibitors and specific aspects of systemic therapy in pregnancy and lactation
Thomas Werfel, Annice Heratizadeh, Matthias Augustin, Christine Bangert, Andrea Bauer, Tilo Biedermann, Richard Brans, Nadine Domröse, Uwe Gieler, Oliver Gießler-Fichtner, Eckard Hamelmann, Selina Hampe, Ruben Heuer, Julia Kahle, Maria Kinberger, Markus Koch, Meike Köhler, Franz Legat, Katja Nemat, Irena Neustädter, Eva M. J. Peters, Susanne Radonjic-Hoesli, Imke Reese, Peter Schmid-Grendelmeier, Uta-Katharina Schmidt-Göhrich, Jochen Schmitt, Christina Schnopp, Thomas Schwennesen, Dagmar Simon, Kristina Stamos, Christian Termeer, Regina Treudler, Ralph von Kiedrowski, Iris Wagner, Anja Waßmann-Otto, Gesine Weckmann, Ricardo Niklas Werner, Andreas Wollenberg, Margitta Worm, and Hagen Ott
Page No. 120
Abstract
Allergologie select, Vol. 10/2026 (120-144)
Update of the evidence- and consensus-based S3 guideline on atopic dermatitis: Systemic therapy with biologics or Janus kinase inhibitors and specific aspects of systemic therapy in pregnancy and lactation
Thomas Werfel1, Annice Heratizadeh1, Matthias Augustin2, Christine Bangert3, Andrea Bauer4, Tilo Biedermann5, Richard Brans6, Nadine Domröse1, Uwe Gieler7, Oliver Gießler-Fichtner8, Eckard Hamelmann9, Selina Hampe10, Ruben Heuer11, Julia Kahle10, Maria Kinberger11, Markus Koch12, Meike Köhler13, Franz Legat14, Katja Nemat15,16, Irena Neustädter17, Eva M. J. Peters18, Susanne Radonjic-Hoesli19, Imke Reese20, Peter Schmid-Grendelmeier21, Uta-Katharina Schmidt-Göhrich22, Jochen Schmitt23, Christina Schnopp5, Thomas Schwennesen24, Dagmar Simon19, Kristina Stamos16, Christian Termeer25,26, Regina Treudler27, Ralph von Kiedrowski28, Iris Wagner24, Anja Waßmann-Otto29, Gesine Weckmann30, Ricardo Niklas Werner11, Andreas Wollenberg31,32, Margitta Worm33, and Hagen Ott13,34
1Department of Dermatology and Allergy, Hannover Medical School, Hannover, 2Competence Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany, 3Department of Dermatology, Medical University of Vienna, Vienna, Austria, 4Department of Dermatology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, 5TUM University Hospital, Department of Dermatology and Allergy, Munich, 6Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the Osnabrück University, Osnabrück, 7Department of Psychosomatic Medicine and Psychotherapy, University Hospital Gießen, Gießen, 8Gaißach Specialist Clinic of DRV Bayern Süd, Gaißach, 9Children’s Center, Evangelical Hospital Bethel, University Hospital OWL, University of Bielefeld, Bielefeld, 10German Allergy and Asthma Association (DAAB), Mönchengladbach, 11Department of Dermatology, Venereology and Allergology, Division of Evidence Based Medicine in Dermatology (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, 12Alpenklinik Santa Maria, Bad Hindelang, 13Section for Integrated Pediatric Dermatology (iKinD), Munich Center for Children with Medical and Developmental Complexity, LMU University Hospital, Munich, Germany, 14Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria, 15Practice for pediatric pneumology and allergology, Children’s Center Dresden-Friedrichstadt (Kid), 16Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, 17Hospital Hallerwiese, Cnopfsche Kinderklinik, Nuremberg, 18Psychoneuroimmunology Laboratory, Department of Psychosomatic Medicine and Psychotherapy, Justus-Liebig University Gießen, Gießen, Germany, 19Department of Dermatology, Inselspital Bern, Bern, Switzerland, 20Private Practice for Dietary Advice and Nutrition Therapy with Special Interest in Adverse Reactions to Food, Munich, Germany, 21Allergy Unit, Department of Dermatology, University Hospital Zurich and Christine Kuehne Center for Allergy Research and Education CK-CARE Davos, Switzerland, 22 Carus Family Practice at Dresden University Hospital, 23Center for Evidence-Based Healthcare (ZEGV), University Hospital Dresden and Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, 24German Eczema Association (DNB), Hamburg, 25Dermatology Practice at Löwenmarkt, Stuttgart-Weilimdorf, 26Department of Dermatology, University-Hospital Freiburg, Freiburg, 27Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, 28Selters Dermatology Practice, Selters, 29Mensing Derma MVZ, Hamburg, 30Weckmann Institute of Medical and Healthcare Education, Rostock, 31Department of Dermatology and Allergology, University Hospital Augsburg, Augsburg, 32Clinic and Polyclinic for Dermatology and Allergology, Ludwig Maximilian University, Munich, 33Department of Dermatology, Venereology, and Allergology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, and 34Department of Pediatric Surgery, Dr. Von Hauner Children’s Hospital, LMU University Hospital, Munich, Germany
This guideline is a partial update of the S3 guideline on atopic dermatitis (AWMF register no. 013-027) published in 2023. The chapters on systemic therapy with biologics and Janus kinase inhibitors as well as the chapter on pregnancy, breastfeeding and family planning in the context of systemic therapies for atopic dermatitis have been updated. This was prompted by new approvals (lebrikizumab, nemolizumab), approval extensions (abrocitinib from 12 years of age, baricitinib from 2 years of age) and new evidence on the use of biologics before and during pregnancy. In addition, a new chapter on treatment goals, treatment expectations and criteria for treatment adjustment (“treat-to-target”) in systemic therapies has been added to the guideline. This article only presents the updated and newly added chapters. The complete guideline is available on the AWMF website.Correspondence to:
PD Dr. Annice Heratizadeh, Department of Dermatology and Allergy, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
Email: [email protected]
Case Report
Contact allergy to a titanium port catheter: Diagnostic challenges and clinical resolution
Silas Fugger, Alexander Kauffmann, and Heinrich Dickel
Page No. 145
Abstract
Allergologie select, Vol. 10/2026 (145-150)
Contact allergy to a titanium port catheter: Diagnostic challenges and clinical resolution
Silas Fugger1, Alexander Kauffmann2, and Heinrich Dickel1
1Department of Dermatology, Venereology and Allergology, St. Josef Hospital, University Medical Center, Bochum, and 2Chair for Materials Science and Engineering, Institute for Materials, Faculty of Mechanical Engineering, Ruhr University Bochum, Bochum, Germany
Background: Titanium and its alloys are widely used in modern medical devices because of their favorable biocompatibility and mechanical properties. Allergic reactions to titanium-based implants are considered rare, and their diagnosis is hampered by the poor dermal penetration of metallic allergens. Case report: A 29-year-old female patient with seronegative myasthenia gravis requiring parenteral nutrition presented with persistent inflammatory dermatitis overlying a titanium port catheter (X-Port BARD Titan low-profile) 4 weeks after implantation in July 2023. Despite initial diagnostic uncertainty and sequential management modifications, her condition continued to deteriorate. Similar eruptions developed after re-implantation of the same titanium port model on the contralateral thorax. Rigorous patch testing incorporating standardized tape-stripping and extended reading intervals revealed positive sensitization to the titanium port body, while all other port components and an alternative plastic port system (BARD SlimPort M.R.I. Ultra Low-Profile) tested negative. Energy-dispersive X-ray spectroscopy confirmed the titanium body composition as a Ti-Al6-V4 alloy. Substitution with the plastic port catheter in February 2025 resulted in complete symptom resolution, with sustained clinical remission through July 2025. Conclusion: Although very uncommon, contact sensitization to titanium medical devices can occur and may present significant diagnostic and therapeutic challenges. Rigorous patch testing methodology, incorporating standardized tape-stripping and extended 168-hour readings, appears essential for detecting delayed-type hypersensitivity to metallic implants. Clinical resolution following biocompatible device substitution supports an allergic etiology in this case.Correspondence to:
Silas Fugger, Department of Dermatology, Venereology and Allergology, Ruhr University Bochum, Gudrunstraße 56, 44791 Bochum, Germany
Email: [email protected]
Review
In vitro IgE diagnostics in inhalant allergy: Plant and mold allergens
Regina Treudler
Page No. 151
Abstract
Allergologie select, Vol. 10/2026 (151-157)
In vitro IgE diagnostics in inhalant allergy: Plant and mold allergens
Regina Treudler
Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
Respiratory allergies represent one of the most prevalent immune-mediated disorders worldwide, such as allergic rhinitis and asthma. The advent of in vitro diagnostic methods, particularly those based on molecular allergology, has revolutionized the diagnostic approach to inhalant allergies by enabling precise identification of sensitizing allergens at the molecular level. This review presents an analysis of the current status of in vitro diagnostics in respiratory allergy to plants and molds, with emphasis on molecular diagnostics for key allergens from trees (e.g., birch/Betula verrucosa), grasses (Poaceae family), weeds (e.g.mugwort/Artemisia vulgaris, ragweed/Ambrosia artemisiifolia), and molds (e.g. Alternaria, Aspergillus). We discuss major allergenic proteins, diagnostic tools, implications for precision medicine, and integration with precision immunotherapy.Correspondence to:
Prof. Dr. Regina Treudler, Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Haus 2, Institute of Allergology, Hindenburgdamm 30, 12203 Berlin, Germany
Email: [email protected]
Original
Choosing and switching biologics for patients with severe asthma: Real-world data from the German Asthma Net (GAN)
Alexandra Lenoir, Roland Buhl, Carlo Muemmler, Jürgen Behr, Rainer Ehmann, Eckard Hamelmann, Anette Holtdirk, Marco Idzko, Margret Jandl, Frank Kaessner, Olaf Schmidt, Christian Schulz, Dirk Skowasch, Hendrik Suhling, Christian Taube, Stephanie Korn, Katrin Milger; and GAN investigators
Page No. 158
Abstract
Allergologie select, Vol. 10/2026 (158-169)
Choosing and switching biologics for patients with severe asthma: Real-world data from the German Asthma Net (GAN)
Alexandra Lenoir1, Roland Buhl2, Carlo Muemmler1,16, Jürgen Behr1, Rainer Ehmann3, Eckard Hamelmann4, Anette Holtdirk5, Marco Idzko6, Margret Jandl7, Frank Kaessner8, Olaf Schmidt9, Christian Schulz10, Dirk Skowasch11, Hendrik Suhling12, Christian Taube13, Stephanie Korn14, Katrin Milger1,15; and GAN investigators
1Department of Medicine V, LMU University Hospital, Comprehensive Pneumology Center (CPC), Member of the German Center of Lung Research (DZL), LMU Munich, Munich, 2Mainz University Hospital, Pulmonary Department, Mainz, 3Ambulante Pneumologie mit Allergiezentrum, Stuttgart, 4Kinderzentrum Bethel, Evangelisches Klinikum Bethel, University Bielefeld, Bielefeld, 5RQMplus Germany, Ahlen, Germany, 6Department of Pneumology, University Hospital Vienna AKH, Medical University of Vienna, Vienna, Austria, 7Hamburger Institut für Therapieforschung GmbH, Hamburg, 8Ambulantes Zentrum für Lungenkrankheiten und Schlafmedizin, Cottbus, 9Pneumologie Mittelrhein und Studienzentrum KPPK, Bendorf am Rhein, 10Clinic and Polyclinic of Internal Medicine, Department of Pneumology, University Hospital Regensburg, University of Regensburg, Regensburg, 11Department of Internal Medicine II - Pneumology, University Hospital Bonn, Bonn, 12Pneumologicum Hannover, Hanover, 13Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Essen, 14IKF Pneumologie Mainz and Thoraxklinik Heidelberg, Mainz and Heidelberg, Germany, 15Division of Respiratory Medicine, Department of Internal Medicine, Lung Research Cluster, Medical University of Graz, Graz, Austria, and 16Institute of Lung Health and Immunity (LHI), Comprehensive Pneumology Center (CPC), Helmholtz Munich, Member of the German Center of Lung Research (DZL), Munich, Germany
With six biologics available to treat severe asthma in 2025, choosing the optimal initial therapy and deciding to which other biologic to switch in case of insufficient benefit is challenging. To better understand patients’ characteristics depending on the chosen biologic and patterns of switch, we evaluated adult patients with severe asthma from the GAN registry who were biologic-naïve at baseline. Between 2011 and 2024, 2,649 patients with severe asthma newly received a biologic, 26% anti-interleukin-5 receptor (IL5R), 25% anti-IL5, 16% anti-IL4R, 24% anti-immunoglobulin E (IgE), and 9% anti-thymic stromal lymphopoietin (TSLP). Distribution of biologics varied between time periods, reflecting their availability over time. Patients treated with anti-IgE were youngest at asthma diagnosis (mean 26 years) and had the highest rates of allergic comorbidities (80%). Blood eosinophils were highest in patients receiving anti-IL5R (median 433/µL) and lowest in those receiving anti-TSLP (median 159/µL), while FeNO was highest in patients treated with anti-IL5, anti-IL5R, or anti-IL4R (median 39, 38, and 35 ppb, respectively). 14.3% (n = 378) of patients were switched from the first biologic to a different one. The most frequent switch constellations were anti-IL5 to anti-IL5R, anti-IL5R to anti-IL4R, and anti-IL5 to anti-IL4R. After a switch, depending on the constellation up to 46% of patients reached remission. Phenotyping patients with severe asthma determines the choice of biologic therapy in real-world practice. Choice and switch of biologic have evolved over time influenced by availability of different drugs. Our analysis supports the practice of switching to a different biologic in case of insufficient initial response.Correspondence to:
Katrin Milger, MD, Division of Respiratory Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
Email: [email protected]
Review
Allergens from plant-based food allergen sources and their clinical and diagnostic relevance
Eva-Maria Rick, Melanie Plum, Marua Abu Risha, and Uta Jappe
Page No. 170
Abstract
Allergologie select, Vol. 10/2026 (170-191)
Allergens from plant-based food allergen sources and their clinical and diagnostic relevance
Eva-Maria Rick1, Melanie Plum1, Marua Abu Risha1, and Uta Jappe1,2
1Division of Clinical and Molecular Allergology, Priority Research Area Chronic Lung Diseases, Research Center Borstel, Leibniz Lung Center, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Borstel, and 2Interdisciplinary Allergy Outpatient Clinic, Department of Pneumology, UKSH and University of Lübeck, Lübeck, Germany
Lately, a rise of plant-related food allergies could be observed following the increase of plant-based food consumption. This narrative review provides an overview of important plant allergens from the most common allergen sources including the “Big 9”, and those gaining more clinical significance such as legumes (other than peanuts) or fruits. Both commercially available and unavailable allergens for in vitro (i.e., specific IgE) and ex vivo (e.g., basophil activation test) diagnostics described in the literature to date are included in this work. In addition, gaps in the commercially available test panels (e.g., oleosins) as well as a lack of knowledge about the clinical relevance of some allergens are highlighted using the latest publications. Furthermore, practical applications are provided in exemplary case reports. In conclusion, molecular allergology provides important tools to advance precision diagnostics of allergic diseases and consequently, patient care.Correspondence to:
Prof. Uta Jappe, Division of Clinical and Molecular Allergology, Research Center Borstel, Leibniz Lung Center, Parkallee 35, 23845 Borstel, Germany
Email: [email protected]
Case Report
Anaphylaxis to duck and goose eggs with preserved tolerance to hen’s eggs: A case report
Alice Botta, Lea Caron, Matteo Cavara, Alessandra Chiei Gallo, Eleonora Bono, Christian P. Ratti, Sara Pasqualetti, Enrico Iemoli, and Valeria Ortolani
Page No. 192
Abstract
Allergologie select, Vol. 10/2026 (192-196)
Anaphylaxis to duck and goose eggs with preserved tolerance to hen’s eggs: A case report
Alice Botta1, Lea Caron1, Matteo Cavara1, Alessandra Chiei Gallo1, Eleonora Bono1, Christian P. Ratti1, Sara Pasqualetti2,3, Enrico Iemoli1, and Valeria Ortolani1
1Allergy and Clinical Immunology Unit, L. Sacco Hospital, 2Clinical Pathology Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, and 3Department of Biomedical and Clinical Sciences “Luigi Sacco”, Università degli Studi di Milano, Milan, Italy
Background: Selective allergy to eggs from specific avian species, while maintaining tolerance to hen’s eggs, is rare and may present diagnostic challenges. Case report: We report the case of a 75-year-old woman with no history of atopic disease who experienced episodes of anaphylaxis after consuming duck and goose eggs, while tolerating hen’s eggs. Skin prick tests with commercial hen’s egg extracts were negative. Serum testing revealed very low total IgE levels (5 kU/L) and low specific IgE to ovomucoid (Gal d 1), with negative results for other egg proteins. Prick-to-prick testing showed positive reactions to raw duck and goose egg white, whereas results were negative for cooked duck and goose eggs and for both raw and cooked hen’s and quail eggs. An oral food challenge confirmed tolerance to hen’s eggs. Conclusion: This case highlights a rare presentation of selective allergy to eggs from the Anseriformes order with preserved tolerance to hen’s eggs. Comprehensive allergy evaluation – including skin testing, specific IgE measurement, and oral food challenges – may be essential to identify selective sensitizations and to provide appropriate dietary recommendations.Correspondence to:
Dr. Alice Botta, Allergy and Clinical Immunology Unit, Sacco Hospital, Via Giovanni Battista Grassi, 74, 20157, Milan, Italy
Email: [email protected]
Review
In vitro diagnostics in hymenoptera venom allergy: Current concepts and perspectives
Thilo Jakob, Timo Buhl, and Jörg Fischer
Page No. 197
Abstract
Allergologie select, Vol. 10/2026 (197-208)
In vitro diagnostics in hymenoptera venom allergy: Current concepts and perspectives
Thilo Jakob1, Timo Buhl2, and Jörg Fischer3
1Department of Dermatology and Allergy, University Medical Center Gießen, Justus Liebig Universität Gießen, Gießen, 2Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, and 3Department of Dermatology and Allergology, Augsburg University Hospital, Augsburg, Germany
Background: Hymenoptera venom allergy (HVA) is a leading cause of anaphylaxis in adults and requires precise diagnostic work-up to guide venom immunotherapy (VIT). However, the high prevalence of asymptomatic sensitization and frequent double sensitization complicate the identification of clinically relevant allergens. Materials and methods: This narrative review summarizes current concepts and recent advances in in vitro diagnostics of HVA, including conventional IgE testing, component-resolved diagnostics (CRD), IgE ratio analysis, and cellular assays and biomarkers for risk stratification. Emphasis is placed on their diagnostic performance, limitations, and clinical applicability. Results: Measurement of venom-specific IgE remains the cornerstone of HVA diagnosis, offering high sensitivity for clinically relevant HVA. CRD using recombinant, CCD-free allergens improves discrimination between primary sensitization and cross-reactivity, particularly in patients with double sensitization to honeybee and yellow jacket venoms. However, incomplete allergen panels, especially in honeybee venom allergy, limit sensitivity. IgE ratio analysis has emerged as a complementary tool to identify the most likely culprit venom, although it may be influenced by recent sting exposure. Cellular assays such as the basophil activation test provide functional information and may support diagnosis in complex cases but are restricted to specialized centers. In addition, biomarkers such as basal serum tryptase and KIT p.D816V mutation are important for risk stratification. Conclusion: Modern in vitro diagnostics substantially enhance the precision of HVA diagnosis but cannot replace clinical history. An integrated approach combining serology, molecular diagnostics, ratio analysis and, where appropriate, functional assays, is essential for accurate identification of the relevant venom and optimal patient management.Correspondence to:
Thilo Jakob, MD, Department of Dermatology and Allergy, University Medical Center Gießen, Justus Liebig Universität Gießen, Gaffkystrasse 14, 35392 Gießen, Germany
Email: [email protected]
Review
In vitro diagnostics of drug hypersensitivity reactions
Christian Möbs, Sophie C. Hermann Lang, Valerie Härtel, and Wolfgang Pfützner
Page No. 209
Abstract
Allergologie select, Vol. 10/2026 (209-218)
In vitro diagnostics of drug hypersensitivity reactions
Christian Möbs1,2, Sophie C. Hermann Lang1,2, Valerie Härtel1,2, and Wolfgang Pfützner1,2
1Clinical & Experimental Allergology, Department of Dermatology and Allergology, Philipps-Universität Marburg, and 2Allergy Section, Department of Dermatology and Allergology, Allergy Center Hesse, University Hospital Marburg, Marburg, Germany
In vitro diagnostics of drug hypersensitivity reactions comprises different tests that can add important information for identifying the culprit drug. Depending on the patients’ clinical history and underlying immune mechanisms, these tests can be classified into immediate-type and late-type in vitro assays. While they are currently mostly not part of routine diagnostics, knowledge of when to apply which test and what distinct benefits and specific limitations each assay carries, can be helpful when considering the referral of patients with adverse drug reactions for appropriate further testing to specialized centers.Correspondence to:
Prof. Dr. med. Wolfgang Pfützner, Department of Dermatology and Allergology, Philipps-Universität Marburg, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany
Email: [email protected]
Review
The involvement of human breastmilkderived extracellular vesicles in the development of infant atopic sensitization
Tinevimbo Weidner Baricholo, Amiq Gazdhar, Matthias V. Kopp, and Emilie Seydoux
Page No. 219
Abstract
Allergologie select, Vol. 10/2026 (219-225)
The involvement of human breastmilkderived extracellular vesicles in the development of infant atopic sensitization
Tinevimbo Weidner Baricholo1,2, Amiq Gazdhar1,3, Matthias V. Kopp1, and Emilie Seydoux1,2
1Lung Precision Medicine (LPM), Department for Biomedical Research (DBMR), 2Division of Pediatric Respiratory Medicine and Allergology, Department of Pediatrics, and 3Department for Pulmonary Medicine, Allergology and Clinical Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
Breastmilk, with its unique biological components, is the optimal source of neonatal nutrition, and WHO global feeding guidance recommends that all infants are exclusively breastfed for the first 6 months. The composition of human milk depends on multiple factors such as maternal diet, exposure to pathogens, metabolic or autoimmune disorders, smoking, mental health, and genetics. Breastfeeding not only transfers nutrients to the child, but it also influences the infant immune function, through the transfer of immune cells, antibodies, microbiota from the mother, cytokines, or growth factors. Among these, human milkderived extracellular vesicles (hMEVs) are emerging as key yet understudied elements in neonatal growth, development, and immunity. This review explores their structure, formation, uptake, and roles in supporting development, modulating immune responses during early life, and influencing allergic outcomes, highlighting their potential significance in infant health.Correspondence to:
Dr. Emilie Seydoux, Lung Precision Medicine, Department for Biomedical Research, University of Bern, Murtenstrasse 28, 3008 Bern, Switzerland
Email: [email protected]
Original
Olfactory dysfunction in children is associated with atopic dermatitis and allergic rhinitis, but not bronchial asthma
Elisabeth C. Lohrer, Janine Gellrich, M. Antonia Hinkelmann, Rene F. Drosdek, Christian Vogelberg, and Valentin A. Schriever
Page No. 226
Abstract
Allergologie select, Vol. 10/2026 (226-233)
Olfactory dysfunction in children is associated with atopic dermatitis and allergic rhinitis, but not bronchial asthma
Elisabeth C. Lohrer1,2, Janine Gellrich1, M. Antonia Hinkelmann1, Rene F. Drosdek1, Christian Vogelberg2, and Valentin A. Schriever3
1Department of Neuropediatrics, Department of Pediatrics, 2Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, and 3Goethe University Frankfurt, Department of Pediatrics, Division of Pediatric Neurology, Neurometabolics and Prevention, Frankfurt (Main), Germany
Aims: To investigate associations between olfactory dysfunction and atopic dermatitis (AD), allergic rhinitis (AR), and bronchial asthma (BA) in children. Materials and methods: In a prospective study, 250 children (6 – 17 years) with AD, AR, BA, combined atopy, or healthy controls (n = 50 each) were assessed using olfactory tests (“Sniffin’ Sticks”, “U-Sniff”), questionnaires, prick tests, and spirometry. Results: Atopic patients showed poorer odor identification than controls. Children with AD had impaired odor identification. AR patients displayed more hyposmia in threshold testing, but mean scores did not differ significantly. BA patients showed no significant impairment, though lung function correlated positively with olfactory performance. Conclusion: Pediatric AD and AR are associated with specific olfactory dysfunctions, whereas BA is not. Awareness of olfactory deficits in these groups is warranted; further studies should assess neurodevelopmental aspects in AD.Correspondence to:
Dr. Janine Gellrich, Department of Neuropediatrics, Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
Email: [email protected]
