Volume 6 (2022)
Free open-access journal.
|
| Price of the complete print-issue: 0.00$ |
Add to Cart
|
Review
Cutaneous mastocytosis in childhood
Katja Nemat and Susanne Abraham
Page No. 1
Abstract
Allergologie select, Vol. 6/2022 (1-10)
Cutaneous mastocytosis in childhood
Katja Nemat1,2 and Susanne Abraham2,3
1Praxis für Kinderpneumologie/Allergologie am Kinderzentrum Dresden (Kid), 2Interdisziplinäre Pädiatrisch-dermatologische Sprechstunde, Universitäts AllergieCentrum (UAC) Dresden, and 3Klinik für Dermatologie, Universitätsklinikum Carl Gustav Carus Dresden, Germany
Mastocytoses are characterized by clonal proliferation of mast cells in various tissues. In childhood, cutaneous mastocytosis (CM) occurs almost exclusively. It is confined to the skin, and has a good prognosis. The most common form is the maculopapular cutaneous mastocytosis (MPCM), formerly called urticaria pigmentosa. A distinction is made between a monomorphic variant of MPCM with multiple small, roundish maculopapular skin lesions and the – more common – polymorphic variant with larger lesions of variable size. One quarter of CM diagnosed in childhood are mastocytomas, which often occur solitary or at multiple sites. The diffuse variant of CM (DCM), which affects 5% of children with CM, should be distinguished from these forms. Systemic mastocytoses (SM) with mast cell infiltrates in the bone marrow or other extracutaneous tissues, such as the gastrointestinal tract, occur predominantly in adults. The diagnosis of CM is usually made clinically: Manifestation in infancy, typical morphology and distribution, pathognomonic Darier sign. Basal serum tryptase is determined if DCM or systemic mastocytosis are to be diagnosed. Children with mastocytosis should be managed in a specialized outpatient clinic. For affected families, detailed information about the clinical picture including prognosis assessment is essential. Mast cell mediated symptoms are controlled by oral non-sedating antihistamines if needed.Correspondence to:
Dr. med. Katja Nemat, Praxis für Kinderpneumologie/Allergologie, Kinderzentrum Dresden-Friedrichstadt (Kid), Friedrichstraße 38-40, 01067 Dresden
Email: [email protected]
Review
Hypersensitivity to non-β-lactam antibiotics
Hans F. Merk and David R. Bickers
Page No. 11
Abstract
Allergologie select, Vol. 6/2022 (11-17)
Hypersensitivity to non-β-lactam antibiotics
Hans F. Merk1 and David R. Bickers2
1Department of Dermatology and Allergology, RWTH Aachen University, Aachen, Germany, and 2Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA
Most allergic reactions to antibiotics are caused by β-lactam antibiotics; however non-β-lactam antibiotics are also capable of causing both immediate allergic reactions as well as late-type reactions to these drugs. This is especially true for fluoroquinolones and sulfonamides. Of these, the combination of sulfamethoxazole with trimethoprim (Cotrimoxazol, e.g., Bactrim) is most important. However, there are certain types of reactions to non-β-lactam antibiotics that are not associated with β-lactam antibiotics. These include photosensitivity to sulfonamides, tetracyclines, and fluoroquinolones as well as different patterns of drug metabolism and associations with HLA alleles that may influence their prevalence. This review is focused on recent findings regarding the pathogenesis of allergic reactions to non-β-lactam antibiotics.Correspondence to:
Univ.-Prof. Dr. med. Hans F. Merk, Dohlenfeld 8, 45479 Mülheim an der Ruhr, Germany
Email: [email protected]
Review
Contact allergies to topical antibiotic applications
Burkhard Kreft and Johannes Wohlrab
Page No. 18
Abstract
Allergologie select, Vol. 6/2022 (18-26)
Contact allergies to topical antibiotic applications
Burkhard Kreft and Johannes Wohlrab
University Hospital Halle (Saale), Department of Dermatology and Venereology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
Despite limited evidence on clinical efficacy and increasing resistance problems, topical antibiotics are still used in everyday clinical practice. However, topical antiseptic agents such, as octenidine and polyhexanide, often have a broader efficacy spectrum. They also have a broader target tropism because of their non-specific cellular mechanisms of action. Repeated use of topical antibiotics also carries the risk of contact sensitization, which could limit potential subsequent use as systemic antibiotics. Contact allergy is a clinically relevant problem, particularly in patients with barrier-damaged skin, pre-existing dermatosis, or occupational exposure. It can be concluded that with the use of modern antiseptics, topical antibiotic therapy is rarely indicated and should be avoided, not only because of the risk of contact sensitization but also because of the unfavorable and potentially consequential resistance problem.Correspondence to:
Burkhard Kreft, MD, University Hospital Halle (Saale), Department of Dermatology and Venereology, Martin Luther University HalleWittenberg, Ernst-Grube-Str. 40, D-06120 Halle (Saale)
Email: [email protected]
Review
Suspected allergy to Beta-Lactam antibiotics: An infectiological perspective
Cord Sunderkötter
Page No. 27
Abstract
Allergologie select, Vol. 6/2022 (27-32)
Suspected allergy to Beta-Lactam antibiotics: An infectiological perspective
Cord Sunderkötter
Department of Dermatology and Venereology, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle, Germany
The administration of alternative broad-spectrum antibiotics because of a suspected allergy to beta-lactam antibiotics (BLA) is one reason for the increase in bacterial resistance to antibiotics and results in further problems, such as reduced efficiency against the causative bacteria, longer hospital stays, higher prices, and more adverse events. Patients with documented BLA allergy experience Clostridium difficile infections and postoperative surgical-site infections more frequently than patients without this label. Yet, in cases of documented and even proven IgE-mediated allergy to a BLA, such as penicillin or cephalosporin, the careful application of a different BLA with dissimilar core and side chains is possible. Cefazolin, e.g., would often be a candidate for skin and soft-tissue infections (e.g., cellulitis) or for perioperative prophylaxis, because it does not share a common side chain with any other BLA and tackles most causative bacteria. In case of severe cellulitis, a carbapenem would be a candidate. After type IV-reactions (benign maculopapular rash), an infectiologist’s choice would be to apply another narrow-spectrum BLA. In cases where a long-lasting therapy with penicillin is indicated (e.g., for late syphilis or prophylaxis of erysipelas) in presence of a proven IgE-mediated allergy, desensitization would be the infectiologist’s choice.Correspondence to:
Prof. Dr. Cord Sunderkötter, Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06120 Halle (Saale)
Email: [email protected]
Review
Patients with questionable penicillin (beta-lactam) allergy: Causes and solutions
Knut Brockow, Gerda Wurpts, and Axel Trautmann
Page No. 33
Abstract
Allergologie select, Vol. 6/2022 (33-41)
Patients with questionable penicillin (beta-lactam) allergy: Causes and solutions
Knut Brockow1, Gerda Wurpts2, and Axel Trautmann3
1Department of Dermatology and Allergology Biederstein, Faculty of Medicine, Technical University of Munich, Munich, 2Clinic for Dermatology and Allergology, Aachen Comprehensive Allergy Center (ACAC), University Hospital of RWTH Aachen, and 3Department of Dermatology and Allergology, Allergy Center Mainfranken, University Hospital Würzburg, Germany
Background: In Europe, North America, and Australia, 5% to 10% of the population are now classified as penicillin (β-lactam) allergic. Only ~ 10% of these questionable diagnoses, mostly made in childhood, can be confirmed by allergy diagnostics. Materials and methods: The aim of this review is to show causes and consequences as well as recommendations for dealing with the often questionable diagnosis of penicillin (β-lactam) allergy (BLA). Results: An incorrect BLA diagnosis may negatively impact antibiotic treatment needed in the future, by using a less effective antibiotic or using a broad-spectrum antibiotic, for example, further exacerbating the problem of increasing antibiotic resistance. Accordingly, there is growing pressure from antibiotic stewardship programs to critically challenge the BLA diagnosis. Conservatively, a suspected BLA is reviewed by an allergist using medical history, skin testing, laboratory testing, and provocation. This clarification is costly and is not remunerated in the German health care system; that is the reason why this testing is only offered in a few specialized clinics and practically not at all in general practice. In view of thousands of affected patients, additional strategies are needed to treat patients with a low risk of hypersensitivity reaction despite suspected allergy with a β-lactam antibiotic. In recent years, various methods have been proposed to eliminate suspected allergy as promptly as possible and directly before necessary treatment with a β-lactam antibiotic, including standardized history (also in the form of an algorithm), skin test with immediate reading after 15 minutes, or administration of a small test dose. Investigations of small case series and also multi-center studies to date have yielded promising results in terms of feasibility and safety. Conclusion: Of the large number of patients with (questionable) BLA, most have never been tested and – if antibiotic treatment becomes necessary – simply receive an alternative antibiotic. The diagnosis of BLA therefore requires new approaches besides classical allergy testing to critically question BLA. Correspondence to:
Prof. Dr. Knut Brockow, Department of Dermatology and Allergology Biederstein, Faculty of
Medicine, Technical University of Munich, Biedersteiner Str. 29, 80802 Munich, Germany
Email: [email protected]
Original
Descriptive analysis of adverse drug reaction reports for hypersensitivity reactions stratified in relation to different beta-lactam antibiotics
Diana Dubrall, Maike Schulz, Matthias Schmid, and Bernhardt Sachs
Page No. 42
Abstract
Allergologie select, Vol. 6/2022 (42-60)
Descriptive analysis of adverse drug reaction reports for hypersensitivity reactions stratified in relation to different beta-lactam antibiotics
Diana Dubrall1,2, Maike Schulz3, Matthias Schmid1, and Bernhardt Sachs2,4
1Institute of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany, 2Research Department, Federal Institute for Drugs and Medical Devices (BfArM), Bonn, Germany, 3Central Institute for the Provision of Health Care by Statutory Health Insurance Physicians in the Federal Republic of Germany, Berlin, Germany, 4Clinic for Dermatology and Allergology, University Hospital RWTH Aachen, Aachen, Germany
β-lactam antibiotics (BLA) are commonly reported to induce hypersensitivity reactions. However, β-lactam antibiotic-stratified analyses are rare. In the presented study, β-lactam antibiotic associated hypersensitivity reactions were analyzed in the European adverse drug reaction (ADR) database. 923, 38, 222, and 99 hypersensitivity reports for penicillins and first-, second- and third-generation cephalosporins were reported. Differences with regard to demographical parameters, seriousness and types of hypersensitivity reactions, as well as in the number of hypersensitivity reports per outpatient prescriptions were observed between the different β-lactam antibiotics. The number of ADR reports classified as serious was higher for all generations of cephalosporins compared to penicillins. Additionally, anaphylactic reactions were more often reported for first- and second-generation cephalosporins compared to third-generation cephalosporins and penicillins, while bullous reactions were more often reported for first- and third-generation cephalosporins as opposed to second-generation cephalosporins and penicillins. The observed differences may be caused by differences between β-lactam antibiotics and their routes of administration (oral, intravenous), the patient populations, or the reporting of ADRs. Due to the methodological limitations of ADR database analysis, no conclusions can be drawn whether and to what extent the aforementioned factors influenced our results.Correspondence to:
Dr. Diana Dubrall, Institute for Medical Biometry, Informatics and Epidemiology, University Hospital of Bonn, Venusberg Campus 1, Building 11, 53127 Bonn, Germany
Email: [email protected]
Guideline
S3 Guideline Allergy Prevention
Matthias V. Kopp, Cathleen Muche-Borowski, Michael Abou-Dakn, Birgit Ahrens, Kirsten Beyer, Katharina Blümchen, Petra Bubel, Adam Chaker, Monika Cremer, Regina Ensenauer, Michael Gerstlauer, Uwe Gieler, Inga-Marie Hübner, Fritz Horak, Ludger Klimek, Berthold V. Koletzko, Sybille Koletzko, Susanne Lau, Thomas Lob-Corzilius, Katja Nemat, Eva M.J. Peters, Antonio Pizzulli†, Imke Reese, Claudia Rolinck-Werninghaus, Elien Rouw, Bianca Schaub, Sebastian Schmidt, Jens-Oliver Steiß, Anne Kathrin Striegel, Zsolt Szépfalusi, Dietmar Schlembach, Thomas Spindler, Christian Taube, Valérie Trendelenburg, Regina Treudler, Ulrich Umpfenbach, Christian Vogelberg, Martin Wagenmann, Anke Weißenborn, Thomas Werfel, Margitta Worm, Helmut Sitter, and Eckard Hamelmann
Page No. 61
Abstract
Allergologie select, Vol. 6/2022 (61-97)
S3 Guideline Allergy Prevention
Matthias V. Kopp1, Cathleen Muche-Borowski2, Michael Abou-Dakn3, Birgit Ahrens4, Kirsten Beyer5, Katharina Blümchen4, Petra Bubel6, Adam Chaker7, Monika Cremer8, Regina Ensenauer9, Michael Gerstlauer10, Uwe Gieler11, Inga-Marie Hübner12, Fritz Horak13, Ludger Klimek14, Berthold V. Koletzko15, Sybille Koletzko16, Susanne Lau5, Thomas Lob-Corzilius17, Katja Nemat18, Eva M.J. Peters11, Antonio Pizzulli†19, Imke Reese20, Claudia Rolinck-Werninghaus21, Elien Rouw22, Bianca Schaub23, Sebastian Schmidt24, Jens-Oliver Steiß25, Anne Kathrin Striegel26, Zsolt Szépfalusi27, Dietmar Schlembach28, Thomas Spindler29, Christian Taube30, Valérie Trendelenburg5, Regina Treudler31, Ulrich Umpfenbach32, Christian Vogelberg33, Martin Wagenmann34, Anke Weißenborn35, Thomas Werfel36, Margitta Worm37, Helmut Sitter38, and Eckard Hamelmann39
1Airway Research Center North, University of Lübeck, Member of Deutsches Zentrum für Lungenforschung, Universitätsklinik für Kinderheilkunde, Inselspital, Bern, Schweiz, 2Institut für Allgemeinmedizin, University Medical Center Hamburg-Eppendorf, Hamburg, Deutschland, 3Clinic for Gynecology and Obstetrics, St. Joseph-Krankenhaus Berlin-Tempelhof, Deutschland, 4Children’s Hospital, University Hospital Frankfurt, Deutschland, 5Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Deutschland, 6HNO-Facharztpraxis, Eisleben, Deutschland, 7HNO-Klinik, Klinikum rechts der Isar, Technical University of Munich, Munich, Deutschland, 8Ökotrophologin, Journalistin, Idstein/Taunus, Deutschland, 9Institut für Kinderernährung, Max Rubner-Institut, Karlsruhe, Deutschland, 10Kinderklinik, Universitätsklinikum Augsburg, Deutschland, 11Klinik für Psychosomatik und Psychotherapie des UKGM, Universitätsklinik, Giessen, Deutschland, 12Arbeitsgemeinschaft Dermatologiche Prävention e.V., Hamburg, Deutschland, 13Allergiezentrum Wien West, Wien, Österreich, 14Zentrum für Rhinologie und Allergologie, Wiesbaden, Deutschland, 15Integriertes Sozialpädiatrisches Zentrum, Dr. von Haunerschen Kinderspital, LMU Klinikum der Universität München, München, Deutschland, 16Abteilung für Stoffwechsel und Ernährung, Dr. von Haunersches Kinderspital, LMU Klinikum der Universität München, München, Deutschland, 17Kinder- und Jugendmedizin, Christliches Kinderhospital Osnabrück, Deutschland, 18Kinderzentrum Dresden-Friedrichstadt, Dresden, Deutschland, 19Schwerpunktpraxis für Allergologie und Lungenheilkunde im Kinder- und Jugendalter, Berlin, Deutschland, 20Ernährungsberatung und -therapie mit Schwerpunkt Allergologie, München, Deutschland, 21Praxis für Kinder- und Jugendmedizin, Teltow, Deutschland, 22Kinderarztpraxis, Bühl, Deutschland, 23Asthma- und Allergieambulanz, Dr. von Haunersches Kinderspital, LMU Klinikum der Universität, München, Deutschland, 24Allgemeine Pädiatrie, Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsmedizin Greifswald, Greifswald, Deutschland, 25Facharztpraxis für Kinder- und Jugendmedizin, Fulda, Deutschland, 26Kinder- und Jugendmedizin, Universitätsklinikum, Köln, Deutschland, 27Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich, 28Klinik für Geburtsmedizin, Vivantes Klinikum Neukölln, Berlin, 29Hochgebirgsklinik Davos, Schweiz, 30Klinik für Pneumologie, Ruhrlandklinik, Westdeutsches Lungenzentrum am Universitätsklinikum, Essen, Deutschland, 31Klinik für Dermatologie, Venerologie und Allergologie, Leipziger Allergie-Centrum LICA – CAC, Universitätsmedizin, Leipzig, Deutschland, 32Praxis für Kinder- und Jugendmedizin, Dülken, Deutschland, 33Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus an der Technischen Universität, Dresden, Deutschland, 34HNO-Klinik, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland, 35German Federal Institute for Risk Assessment, Berlin, Deutschland, 36Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover, Hannover, Deutschland, 37Klinik für Dermatologie, Allergologie und Venerologie, Campus Charité Mitte, Universitätsmedizin Berlin, Berlin, Deutschland, 38Institut für Chirurgische Forschung, Philipps-Universität, Marburg, Deutschland, and 39Kinder-Zentrum Bethel, Evangelisches Klinikum Bethel, Universitätsklinik für Kinder- und Jugendmedizin, Universitätsklinikum OWL, Universität Bielefeld, Bielefeld, Deutschland
Background: The persistently high prevalence of allergic diseases in Western industrial nations and the limited possibilities of causal therapy make evidence-based recommendations for primary prevention necessary. Methods: The recommendations of the S3 Guideline Allergy Prevention, published in its last version in 2014, were revised and consented on the basis of a current systematic literature search. The evidence search was conducted for the period 06/2013 – 11/2020 in the electronic databases Cochrane and MEDLINE, as well as in the reference lists of current reviews and through references from experts. The literature found was screened in two filtering processes, first by title and abstract, and the remaining papers were screened in the full text for relevance. The studies included were sorted by level of evidence, and the study quality was indicated in terms of potential bias (low/high). The revised recommendations were formally agreed and consented upon with the participation of representatives of the relevant professional societies and (self-help) organizations (nominal group process). Of 5,681 hits, 286 studies were included and assessed. Results: Recommendations on maternal nutrition during pregnancy and breastfeeding as well as on infant nutrition in the first months of life again play an important role in the updated guideline: Many of the previous recommendations were confirmed by the current data. It was specified that breastfeeding should be exclusive for the first 4 – 6 months after birth, if possible, and that breastfeeding should continue with the introduction of complementary foods. A new recommendation is that supplementary feeding of cow’s milk-based infant formula should be avoided in the first days of life if the mother wishes to breastfeed. Furthermore, it was found that the evidence for a clear recommendation for hydrolyzed infant formula in nonbreastfed infants at risk of atopic diseases is currently insufficient. It is therefore recommended to check whether an infant formula with proven efficacy, demonstrated in allergy prevention studies, is available until the introduction of complementary feeding. Finally, based on the EAACI guideline, recommendations were made for the prevention of hen’s egg allergy by introducing and regularly giving thoroughly heated (e.g., baked or hard-boiled) but not “raw” hen’s egg (also no scrambled egg) with the complementary food. The recommendation to introduce peanut in complementary feeding was formulated cautiously for the German-speaking countries: In families with regular peanut consumption, the regular administration of peanut-containing foods in ageappropriate form (e.g., peanut butter) with the complementary diet can be considered for the primary prevention of peanut allergy in infants with atopic dermatitis (AD). Before introduction, a clinically relevant peanut allergy must be ruled out, especially in infants with moderate to severe AD. There is still insufficient evidence for an allergy-preventive efficacy of prebiotics or probiotics, vitamin D, or other vitamins in the form of supplements so that recommendations against their supplementation were adopted for the first time in the current guideline. Biodiversity plays an important role in the development of immunological tolerance to environmental and food allergens: there is clear evidence that growing up on a farm is associated with a lower risk of developing asthma and allergic diseases. This is associated with early non-specific immune stimulation due to, among other things, the greater microbial biodiversity of house dust in this habitat. This aspect is also reflected in the recommendations on animal husbandry, on which a differentiated statement was made: In families without a recognizable increased allergy risk, pet keeping with cats or dogs should not generally be restricted. Families with an increased allergy risk or with children with already existing AD should not acquire a new cat – in contrast, however, dog ownership should not be discouraged. Interventions to reduce exposure to dust mite allergens in the home, such as the use of mite allergen-proof mattress covers (“encasings”), should be restricted to patients with already proven specific sensitization against house dust mite allergen. Children born by caesarean section have a slightly increased risk of asthma – this should be taken into account when advising on mode of delivery outside of emergency situations. Recent work also supports the recommendations on air pollutants: Active and passive exposure to tobacco smoke increase the risk of allergies, especially asthma, and should therefore be avoided. Exposure to nitrogen oxides, ozone, and small particles (PM 2.5) is associated with an increased risk, especially for asthma. Therefore, exposure to emissions of nitrogen oxides, ozone, and small particles (PM 2.5) should be kept low. The authors of this guideline are unanimously in favor of enacting appropriate regulations to minimize these air pollutants. There is no evidence that vaccinations increase the risk of allergies, but conversely there is evidence that vaccinations can reduce the risk of allergies. All children, including children at risk, should be vaccinated according to the current recommendations of the national public health institutes, also for allergy prevention. Conclusion: The consensus of recommendations in this guideline is based on an extensive evidence base. The update of the guideline enables evidence-based and up-to-date recommendations for the prevention of allergic diseases including asthma and atopic dermatitis.Correspondence to:
Prof. Dr. med. Matthias Kopp, Medizinbereich Kinder und Jugendliche, Insel Gruppe AG, Inselspital, Universität Bern, Freiburgstraße 15, 3010 Bern,
or
Prof. Dr. med. Eckard Hamelmann, Kinder-Zentrum Bethel, Evangelisches Klinikum Bethel, Universität Bielefeld, Burgsteig 13, 33617 Bielefeld
Email: [email protected]
Original
Nickel and cobalt: Underestimated contact allergens in hairdressers?
Cara Symanzik, Christoph Skudlik, and Swen Malte John
Page No. 98
Abstract
Allergologie select, Vol. 6/2022 (98-103)
Nickel and cobalt: Underestimated contact allergens in hairdressers?
Cara Symanzik1,2, Christoph Skudlik1,2, and Swen Malte John1,2
1Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany 2Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany
Introduction: Nickel and cobalt were not regarded as pertinent contact allergens in the hairdressing trade for the last decades. It was even stated that the relevance of nickel allergy in the hairdressing trade has been overestimated for several years. Recently, nickel and cobalt release from a multitude of metal tools in the German hairdressing trade was documented in two field studies. Methods: Review of two field studies. Results: In 2019, nickel release from 9.2% of 229 tested metallic hairdressing tools was evidenced, and in 2021, nickel release from 27.6% as well as cobalt release from 2.1% of 475 tested tools was detected in overall 30 North German hairdressing salons. Tweezers, sectioning clips, hair clips, and straight razors were identified as nickel as well as cobalt releasing tools. Crochet hooks and tail combs were identified as only nickel releasing tools. Discussion: A variety of metallic tools – which are used daily by hairdressers – release nickel and/or cobalt in allergologically relevant amounts. This circumstance has to be considered problematic with regard to the development of work-related allergic contact dermatitis. Thus, nickel and cobalt should possibly receive greater attention as potential contact allergens in the hairdressing trade. Conclusion: The proven nickel and cobalt release from metallic hairdressing tools might entail legal ramifications in terms of insurance law. In case of nickel and cobalt allergies within the occupational group of hairdressers, metal tools might be considered as feasible sources for nickel and cobalt exposure.Correspondence to:
Dr. rer. nat. Cara Symanzik, B.Sc., M.Ed., Institut für interdisziplinäre, Dermatologische Prävention und Rehabilitation (iDerm) und Abteilung Dermatologie, Umweltmedizin und Gesundheitstheorie an der Universität Osnabrück, Am Finkenhügel 7a, 49076 Osnabrück
Email: [email protected]
Review
The role of LPS and CpG in the farm effect against allergies, and beyond
Vivian I.V. Gerretsen and Martijn J. Schuijs
Page No. 104
Abstract
Allergologie select, Vol. 6/2022 (104-110)
The role of LPS and CpG in the farm effect against allergies, and beyond
Vivian I.V. Gerretsen1,2,3 and Martijn J. Schuijs1,2
1Department of Internal Medicine and Pediatrics, Ghent University, 2Laboratory of Immunoregulation and Mucosal Immunology, VIB Center for Inflammation Research, Ghent, Belgium, and 3Department of Pulmonary Medicine, Erasmus MC, Rotterdam, The Netherlands
The prevalence of allergic disease has increased significantly over the past decades. Although allergies are inherently multifactorial and heterogenous; environmental, maternal, and early-life microbial exposures could strongly modify disease risk. The effects of environmental microbiota are illustrated by the “farm effect”, showing protection against asthma when children grow up on traditional farms. Recent studies have further revealed an important role for early-life exposure to a microbe-rich environment imposing lung and gut microbiome maturation and immune education, preventing allergic disease in childhood. Advances are made in the field of immunology and microbiome research, which identified entire microbial taxa, as well as specific microbial metabolites and bacterial products associated with reducing disease risk. Here we discuss the cross-talk between the microbiota and the pathogenesis of allergic disease, including bacterial products as lipopolysaccharide and CpG, in the farm effect.Correspondence to:
Martijn J. Schuijs, PhD, VIB-IRC, Technologiepark 71, 9052, Ghent, Belgium
Email: [email protected]
Review
The extended farm effect: The milk protein β-lactoglobulin in stable dust protects against allergies
Hanna Mayerhofer, Katharina Zednik, and Isabella Pali-Schöll
Page No. 111
Abstract
Allergologie select, Vol. 6/2022 (111-117)
The extended farm effect: The milk protein β-lactoglobulin in stable dust protects against allergies
Hanna Mayerhofer1, Katharina Zednik1, and Isabella Pali-Schöll1,2
1Interuniversity Messerli Research Institute of the University of Veterinary Medicine Vienna and Medical University Vienna, and 2Institute of Pathophysiology and Allergy Research, Medical University Vienna, Vienna, Austria
Background: The allergy- and asthma-protective farm effect is mediated by numerous factors. Especially dust from cattle stables and raw cow’s milk show beneficial properties, suggesting a bovine protein to be involved. As a major milk protein and member of the lipocalin family, β-lactoglobulin (BLG) binds small, hydrophobic ligands and thereby modulates the immune response. Empty BLG promotes allergy development, whereas BLG in association with ligands shows allergy-preventive as well as allergy-reducing effects in vivo and in vitro. Results: BLG has been identified as a major protein in stable dust (therein bound to zinc) as well as in the air around cattle stables. This association with zinc favors an allergy-protective immune profile. Conclusion: Its immune-modulating, allergy-protective characteristics together with its presence in raw cow’s milk as well as in stable dust and ambient air render BLG an essential contributor to the farm effect.Correspondence to:
Isabella Pali-Schöll, PhD, Interuniversity Messerli Research Institute, University of Veterinary Medicine Vienna and Medical University Vienna, Veterinärplatz 1, 1210 Vienna, Austria
Email: [email protected]
Original
What should be tested in patients with suspected mold exposure? Usefulness of serological markers for the diagnosis
Sabine Kespohl, Verena Liebers, Silke Maryska, Ursula Meurer, Claudia Litzenberger, Rolf Merget, and Monika Raulf
Page No. 118
Abstract
Allergologie select, Vol. 6/2022 (118-132)
What should be tested in patients with suspected mold exposure? Usefulness of serological markers for the diagnosis
Sabine Kespohl, Verena Liebers, Silke Maryska, Ursula Meurer, Claudia Litzenberger, Rolf Merget, and Monika Raulf
Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
The associations of mold exposure, IgE-mediated sensitization, inflammatory markers, and respiratory symptoms were analyzed in 46 exposed and 23 nonexposed individuals. Both exposure and clinical symptoms were assessed by questionnaire. Specific (s)IgE to mold mixture (mx1) was significantly higher and found more frequently in exposed (41%) than non-exposed individuals (17%), which was not observed for sIgG to mold mix (Gmx6). Notably, exposed asthmatics were more frequently sensitized to molds (55%) compared to exposed non-asthmatics (18%). In addition, the serum concentrations of club cell protein (CC16) were significantly lower in exposed subjects, especially in asthmatics. Positive associations were observed among mold sensitization, asthma, and mold exposure, but not in subjects with predominantly environmental sensitizations without mold sensitization. Thus, sIgE to mx1 but not sIgG to Gmx6 is a useful diagnostic marker to verify mold-associated respiratory symptoms.Correspondence to:
Dr. rer. nat. Sabine Kespohl, Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Deutsche Gesetzliche Unfallversicherung e.V. (DGUV), Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
Email: [email protected]
Original
Is in vitro cytokine release a suitable marker to improve the diagnosis of suspected mold-related respiratory symptoms? A proof-of-concept study
Verena Liebers, Sabine Kespohl, Gerda Borowitzki, Heike Stubel, and Monika Raulf
Page No. 133
Abstract
Allergologie select, Vol. 6/2022 (133-141)
Is in vitro cytokine release a suitable marker to improve the diagnosis of suspected mold-related respiratory symptoms? A proof-of-concept study
Verena Liebers, Sabine Kespohl, Gerda Borowitzki, Heike Stubel, and Monika Raulf
Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Germany
Indoor mold infestation can lead to a variety of adverse health effects, including allergic and non-allergic respiratory complaints. Especially if no evidence of an allergic reaction can be found for the complaints, diagnostic tools that might explain mold-associated health problems are missing. As a proof-of-concept, in the present study whole blood assay (WBA) was used to determine cellular response by measuring cytokine release (IL-1β and IL-8) after in vitro stimulation. Blood was available from a total of 48 subjects. By questionnaire, complaints and possible mold exposure were documented. Specific in vitro blood stimulation was tested with Escherichia coli endotoxin and extracts of different molds (Aspergillus fumigatus, Penicillium chrysogenum, Aspergillus versicolor, and Cladosporium herbarum). To characterize the relevance of WBA in describing the mold-induced immune response, we compared the following groups: asthmatics vs. non-asthmatics, mx1-sensitized vs. non-mx1-sensitized, mold-exposed vs. non-mold-exposed. In response to endotoxin stimulation, a significantly higher IL-1β release was found in mx1-sensitized than in non-mx1-sensitized subjects. Furthermore, the blood of asthmatics showed significantly higher IL-8 and IL-1β release after stimulation with Penicillium chrysogenum and endotoxin, respectively, compared to non-asthmatics. However, no significant difference in the level of cytokine release was observed between the mold-exposed and non-exposed group, neither after endotoxin nor mold stimulation. In conclusion, the WBA used in this study is not a suitable tool for clinical routine diagnostic workup. Our data suggests that WBA reflects cellular differences that are disease-related but not directly attributable to mold exposure. However, in combination with further data, WBA will be a helpful und interesting tool in research, e.g., in description of the complex immune response to molds.Correspondence to:
Dr. rer. nat. Verena Liebers, Institut für Prävention und Arbeitsmedizin, der Deutschen Gesetzlichen Unfallversicherung, Institut der Ruhr-Universität Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
Email: [email protected]
Original
State of the art in AIT: The patients’ perspective
Sabine Jossé and Kymble Spriggs
Page No. 142
Abstract
Allergologie select, Vol. 6/2022 (142-147)
State of the art in AIT: The patients’ perspective
Sabine Jossé1 and Kymble Spriggs2
1MeinAllergiePortal, Kronberg, Germany, and 2Department of Medicine, The University of Melbourne, Melbourne, Australia
Background: On the occasion of the 110th anniversary of allergen-specific immunotherapy (AIT), the question arises of “how do patients feel about AIT?”. Materials and methods: Informed by questions and feedback provided to MeinAllergiePortal, an online survey with a target of 130 responses was devised and offered for completion by readers. All visitors of MeinAllergiePortal categories addressing inhalant allergies were invited to participate in the survey. Participants were grouped and analyzed by their AIT completion status. The survey was ended once target was met. Results: 121 of 132 participants were familiar with AIT. 1) A majority of patients who completed AIT would choose the therapy again; 2) Physicians do not seem to discuss AIT with all patients with significant symptoms; 3) Adverse reactions appear to be a major reason why patients terminate AIT prematurely; 4) Lack of time, or early response, as often supposed, does not seem to be a major factor leading to discontinuation of AIT. Conclusion: Patients’ experience and understanding of symptoms (both related to allergic disease, or expected AIT-related adverse events) appear to be key factors related to AIT engagement and adherence. Given the importance of adherence for AIT efficacy, improved education and support strategies may assist patients achieve their treatment goals.Correspondence to:
Sabine Jossé, MA, MeinAllergiePortal, Guaitastrase 15, 61746, Kronberg, Germany
Email: [email protected]
Review
Epithelial immune regulation of inflammatory airway diseases: Chronic rhinosinusitis with nasal polyps (CRSwNP)
Ludger Klimek, Jan Hagemann, Hans-Jürgen Welkoborsky, Mandy Cuevas, Ingrid Casper, Ulrike Förster-Ruhrmann, Felix Klimek, Constantin A. Hintschich, Tilman Huppertz, Christoph Bergmann, Peter-Valentin Tomazic, and Sven Becker
Page No. 148
Abstract
Allergologie select, Vol. 6/2022 (148-166)
Epithelial immune regulation of inflammatory airway diseases: Chronic rhinosinusitis with nasal polyps (CRSwNP)
Ludger Klimek1,2, Jan Hagemann2, Hans-Jürgen Welkoborsky3, Mandy Cuevas4, Ingrid Casper1, Ulrike Förster-Ruhrmann5, Felix Klimek1, Constantin A. Hintschich6, Tilman Huppertz2, Christoph Bergmann7, Peter-Valentin Tomazic8, and Sven Becker9
1Center for Rhinology and Allergology, Wiesbaden, 2Clinic and Polyclinic for Otolaryngology, University Medical Center Mainz, Mainz, 3Clinic for Ear, Nose and Throat Medicine, Head and Neck Surgery, Nordstadt Clinic of the KRH, Hannover, 4Clinic and Polyclinic for Otolaryngology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, 5HNO-University Clinic Charité, Berlin, 6Clinic and Polyclinic for Ear, Nose and Throat Medicine, University Hospital Regensburg, Regensburg, 7HNO RKM740 Interdisciplinary Specialist Clinic, Düsseldorf, Germany, 8HNO-University Clinic Graz, Medical University Graz, Austria, and 9HNO-University Clinic Tübingen, Germany
Background: The epithelial immune regulation is an essential and protective feature of the barrier function of the mucous membranes of the airways. Damage to the epithelial barrier can result in chronic inflammatory diseases, such as chronic rhinosinusitis (CRS) or bronchial asthma. Thymic stromal lymphopoietin (TSLP) is a central regulator in the epithelial barrier function and is associated with type 2 (T2) and non-T2 inflammation. Materials and methods: The immunology of chronic rhinosinusitis with polyposis nasi (CRSwNP) was analyzed in a literature search, and the existing evidence was determined through searches in Medline, Pubmed as well as the national and international study and guideline registers and the Cochrane Library. Human studies or studies on human cells that were published between 2010 and 2020 and in which the immune mechanisms of TSLP in T2 and non-T2 inflammation were examined were considered. Results: TSLP is an epithelial cytokine (alarmin) and a central regulator of the immune reaction, especially in the case of chronic airway inflammation. Induction of TSLP is implicated in the pathogenesis of many diseases like CRS and triggers a cascade of subsequent inflammatory reactions. Conclusion: Treatment with TSLP-blocking monoclonal antibodies could therefore open up interesting therapeutic options. The long-term safety and effectiveness of TSLP blockade has yet to be investigated.Correspondence to:
Prof. Dr. med. L. Klimek, Zentrum für Rhinologie und Allergologie Wiesbaden, An den Quellen 10, 65183 Wiesbaden, Germany
Email: [email protected]
Guideline
Guideline on allergen immunotherapy in IgE-mediated allergic diseases
Oliver Pfaar, Tobias Ankermann, Matthias Augustin, Petra Bubel, Sebastian Böing, Randolf Brehler, Peter A. Eng, Peter J. Fischer, Michael Gerstlauer, Eckard Hamelmann, Thilo Jakob, Jörg Kleine-Tebbe, Matthias Volkmar Kopp, Susanne Lau, Norbert Mülleneisen, Christoph Müller, Katja Nemat, Wolfgang Pfützner, Joachim Saloga, Klaus Strömer, Peter Schmid-Grendelmeier, Antje Schuster, Gunter Johannes Sturm, Christian Taube, Zsolt Szépfalusi, Christian Vogelberg, Martin Wagenmann, Wolfgang Wehrmann, Thomas Werfel, Stefan Wöhrl, Margitta Worm, and Bettina Wedi
Page No. 167
Abstract
Allergologie select, Vol. 6/2022 (167-232)
Guideline on allergen immunotherapy in IgE-mediated allergic diseases
Oliver Pfaar1, Tobias Ankermann2, Matthias Augustin3, Petra Bubel4, Sebastian Böing5, Randolf Brehler6, Peter A. Eng7, Peter J. Fischer8, Michael Gerstlauer9, Eckard Hamelmann10, Thilo Jakob11, Jörg Kleine-Tebbe12, Matthias Volkmar Kopp13, Susanne Lau14, Norbert Mülleneisen15, Christoph Müller16, Katja Nemat17,18, Wolfgang Pfützner19, Joachim Saloga20, Klaus Strömer21, Peter Schmid-Grendelmeier22, Antje Schuster23, Gunter Johannes Sturm24, Christian Taube25, Zsolt Szépfalusi26, Christian Vogelberg27, Martin Wagenmann28, Wolfgang Wehrmann29, Thomas Werfel30, Stefan Wöhrl31, Margitta Worm32, and Bettina Wedi30
1Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, 2Department of Pediatrics, Städtisches Krankenhaus Kiel, Kiel, 3Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg, Hamburg, 4ENT practice Dr. Bubel, Eisleben, 5Specialized Practice in Pneumology, Allergology and Sleep Medicine, Düsseldorf/Meerbusch, 6Department of Dermatology, University Hospital Münster, Münster, Germany, 7Section of Pediatric Pulmonology and Allergy Children’s Hospital, Aarau, Switzerland, 8Practice for Pediatric and Adolescent Medicine m.S. Allergology and Pediatric Pneumology, Schwäbisch Gmünd, 9Paediatric Pulmonology and Allergology, University Medical Center Augsburg, Augsburg, 10Department of Paediatrics, Children‘s Center Bethel, University Bielefeld, Bielefeld, 11Department of Dermatology and Allergology, University Medical Center, Justus Liebig University Gießen, Gießen, 12Allergy & Asthma Center Westend, Outpatient Clinic & Research Center, Berlin, Germany, 13Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland, 14Charité Universitätsmedizin Berlin, Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Berlin, 15Asthma-Allergiezentrum Leverkusen, 16Medical Center – University of Freiburg, Center for Pediatrics, Department of General Pediatrics, Adolescent Medicine and Neonatology, Freiburg, 17Pediatric Pneumology and Allergology (medical practice), Children’s Center Dresden-Friedrichstadt (Kid), Dresden, 18University AllergyCenter Dresden, University Hospital Dresden (UKD), Dresden, 19Department of Dermatology and Allergology, University Clinic, Philipps-Universität Marburg, Marburg, 20Department of Dermatology, University Medical Center, Johannes Gutenberg-University, Mainz, 21Private Office Dermatology, Ahaus, Germany, 22Allergy Unit, Dept. Of Dermatology, University Hospital of Zurich, Zurich, Switzerland, 23Department of Pediatrics, Düsseldorf University Hospital, Düsseldorf, Germany, 24Department of Dermatology and Venerology, Medical University of Graz, Allergy Outpatient Clinic Reumannplatz, Vienna, Austria, 25Department of Pulmonary Medicine, University Hospital Essen – Ruhrlandklinik, Essen, Germany, 26Department of Pediatrics and Adolescent Medicine, Division of Pediatric Pulmonology, Allergology and Endocrinology, Comprehensive Center Pediatrics, Medical University of Vienna, Vienna, Austria, 27Department of Pediatric Pneumology and Allergology, University Hospital Carl Gustav Carus Dresden, Technical, University Dresden, Dresden, 28Department of Otorhinolaryngology (HNO-Klinik), Düsseldorf University Hospital (UKD), Düsseldorf, 29MVZ Dermatology and Dermatological Surgery Münster, Münster, 30Department of Dermatology & Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover, Germany, 31Floridsdorf Allergy Center (FAZ), Vienna, Austria, 32Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Dermatology and Allergy, Berlin
Correspondence to:
Prof. Dr. med. Oliver Pfaar, Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Baldingerstraße, 35043 Marburg
Email: [email protected]
Review
FPIES: Data for Germany in international comparison
Sunhild Gernert, Antje Finger, and Lars Lange
Page No. 233
Abstract
Allergologie select, Vol. 6/2022 (233-240)
FPIES: Data for Germany in international comparison
Sunhild Gernert1, Antje Finger1,2, and Lars Lange1
1GFO Kliniken Bonn, St. Marien-Hospital, Department of Pediatrics, Bonn, and 2Helios University Hospital Wuppertal, Center for Pediatric and Adolescent Medicine, Wuppertal, Germany
Food protein-induced enterocolitis syndrome (FPIES) is a rare, non-IgEmediated food allergy. The triggering foods differ significantly from the typical triggers of an IgE-mediated food allergy. Until recently, there were no data on triggers of FPIES in Germany. In order to create an advisory basis for the care of German patients, a large multicenter study was initiated and published at the end of 2021. This revealed clear differences in international comparisons. The most frequent triggers for FPIES in Germany are cow’s milk, fish, vegetables, and meat. Most children (84%) react to only one food. The prognosis is usually good, depending on the trigger. Regional data should be used for counseling patients with FPIES. Specific recommendations for this are given in this article.Correspondence to:
Dr. Sunhild Gernert, Abteilung für Pädiatrie, GFO-Kliniken Bonn, Sr. Marien-Hospital, Robert-Koch-Str. 1, 53115 Bonn
Email: [email protected]
Review
Non-IgE mediated food allergies in breastfed children: A clinical challenge
Rosan Meyer and Imke Reese
Page No. 241
Abstract
Allergologie select, Vol. 6/2022 (241-247)
Non-IgE mediated food allergies in breastfed children: A clinical challenge
Rosan Meyer1,2,3 and Imke Reese4
1Department Medicine, Imperial College London, London, 2Department Nutrition and Dietetics, Winchester University, Winchester, Great Britain, 3Faculty of Medicine, KU Leuven, Belgium, 4Nutrition therapy, Munich, Germany
The prevalence of non-immunoglobulin E (IgE) mediated food allergy is poorly established outside of cow’s milk allergy, with a challenge-proven adjusted incidence ranging between 0.13 and 0.72%. The presence and presentation of non-IgE mediated allergy in exclusively breastfed infants is highly debated. The dilemma this poses for healthcare professionals and parents, is on the one hand the unwarranted elimination and therefore health risk to the breastfeeding mother and on the other hand under-recognition of a food allergen being a culprit in the non-IgE mediated symptoms of breastfed infants. Current international guidelines recommend exclusive breastfeeding ideally until ~ 6 months of age and the German guidelines 4 – 6 months. It is also acknowledged that breastfeeding should be promoted also within the population of food-allergic infants. This review paper aims to assess non-IgE mediated food allergies in breastfed infants using an evidence-based approach and provides clinicians working with these patients with practical guidance.Correspondence to:
Rosan Meyer, RD, MSc Nutrition, PhD, Department Medicine, Imperial College London, Lpndon, GB
Email: [email protected]
Review
111 years of allergen-immunotherapy: A long and successful history of the only available disease-modifier in allergic diseases
Jan Gutermuth, Martine Grosber, Oliver Pfaar, Karl Christian Bergmann, and Johannes Ring
Page No. 248
Abstract
Allergologie select, Vol. 6/2022 (248-258)
111 years of allergen-immunotherapy: A long and successful history of the only available disease-modifier in allergic diseases
Jan Gutermuth1, Martine Grosber1, Oliver Pfaar2, Karl Christian Bergmann3, and Johannes Ring4
1Department of Dermatology, University Hospital Free University Brussels, Brussels, Belgium, 2Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, 3Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, and 4Department of Dermatology and Allergology Biederstein, Technical University Munich, Munich, Germany
The great milestones in medicine almost always have their precursors, which help the great event to break through. So it was with allergen-specific immunotherapy (AIT) and the great work of Noon and Freeman and their world-renowned publication in 1911. In this article, we want to outline AIT’s long journey, from early attempts to achieve tolerance to allergens in the environment. Many very different methods were used; from homeopathy to the use of recombinant allergens. Initially, the allergen extracts were given only subcutaneously, but then also through other routes, such as nasal, rectal, intradermal, epicutaneous, in lymph nodes, or oral. It was the great merit of Bill Franklin, whom many of us still experienced as active participants in congresses, to point out that the effect of AIT must be documented not only by clinical observation but in a controlled form including placebo injections. AIT was thus transferred to evidence-based medicine, which we successfully apply today. We would like to express our gratitude to Bill Franklin himself and all others involved in the development of AIT with this summary of 111 years of immunotherapy.Correspondence to:
Prof. Dr. med. K.-Ch. Bergmann, Charité – Universitätsmedizin Berlin, Ambulanz: Campus Benjamin Franklin, Haus 2, Hindenburgdamm 30, 12200 Berlin, Germany
Email: [email protected]
Review
Mechanisms in AIT: Insights 2021
Pattraporn Satitsuksanoa, Alba Angelina, Oscar Palomares, and Mübeccel Akdis
Page No. 259
Abstract
Allergologie select, Vol. 6/2022 (259-266)
Mechanisms in AIT: Insights 2021
Pattraporn Satitsuksanoa1, Alba Angelina2, Oscar Palomares2, and Mübeccel Akdis1
1Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland, and 2Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University of Madrid, Spain
Background: Allergen-specific immunotherapy (AIT) is currently the only treatment with potential long-term diseasemodifying effects for patients suffering from allergic diseases such as allergic rhinitis, allergic asthma, venom allergy, or IgE-mediated food allergy. A better understanding of the molecular mechanisms underlying immune responses during successful AIT is of utmost importance and it may help to develop more effective and safer treatments. Materials and methods: PubMed literature review was performed using keywords such as allergen-specific immunotherapy; regulatory T cells; regulatory B cells; regulatory innate lymphoid cells; and allergen-specific antibody from years 2018 to 2021. Results: The proposed mechanism of long-term tolerance induction in AIT, even upon treatment discontinuation, involves basophils, mast cells, innate lymphoid cells, dendritic cells, allergen-specific regulatory T and B cells, downregulation of effector type 2 responses, decrease in the production of IgE and increase in production of allergen-specific blocking antibodies, such as IgG2 and IgG4. Conclusion: We summarize the most recent advances related to mechanisms involved in the restoration of healthy immune responses to allergens during AIT. Our knowledge in this regard has significantly improved over the last years, which might well contribute to design novel and improved therapeutic approaches.Correspondence to:
Oscar Palomares, PhD, Avenida Complutense s/n, School of Chemistry, Complutense University of Madrid, Madrid 28040, Spain, and Mübeccel Akdis, MD, PhD, Herman Burchard Strasse 9, CH-7265, Davos Wolfgang, Switzerland
Email: [email protected]
Review
Biomarkers of AIT: Models of prediction of efficacy
Tiak Ju Tan, María I. Delgado-Dolset, María M. Escribese, Domingo Barber, Janice A. Layhadi, and Mohamed H. Shamji
Page No. 267
Abstract
Allergologie select, Vol. 6/2022 (267-275)
Biomarkers of AIT: Models of prediction of efficacy
Tiak Ju Tan1, María I. Delgado-Dolset1,2, María M. Escribese2, Domingo Barber2, Janice A. Layhadi1, and Mohamed H. Shamji1
1Immunomodulation and Tolerance Group, Department of National Heart and Lung Institute, Imperial College London, London, UK, and 2Institute of Applied Molecular Medicine (IMMA), Department of Basic Medical Sciences, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, Boadilla del Monte, Madrid, Spain
Allergic rhinitis is an IgE-mediated inflammation that remains a clinical challenge, affecting 40% of the UK population with a wide range of severity from nasal discomfort to life-threatening anaphylaxis. It can be managed by pharmacotherapeutics and in selected patients by allergen immunotherapy (AIT), which provides long-term clinical efficacy, especially during peak allergy season. However, there are no definitive biomarkers for AIT efficacy. Here, we aim to summarize the key adaptive, innate, humoral, and metabolic advances in biomarker identification in response to AIT. Mechanisms of efficacy consist of an immune deviation towards TH1-secreting IFN-γ, as well as an induction of IL10+ cTFR and TREG have been observed. TH2 cells undergo exhaustion after AIT due to chronic allergen exposure and correlates with the exhaustion markers PD-1, CTLA-4, TIGIT, and LAG3. IL10+ DCREG expressing C1Q and STAB are induced. KLRG1+ IL10+ ILC2 were shown to be induced in AIT in correlation with efficacy. BREG cells secreting IL-10, IL-35, and TGF-β are induced. Blocking antibodies IgG, IgA, and IgG4 are increased during AIT; whereas inflammatory metabolites, such as eicosanoids, are reduced. There are multiple promising biomarkers for AIT currently being evaluated. A panomic approach is essential to better understand cellular, molecular mechanisms and their correlation with clinical outcomes. Identification of predictive biomarkers of AIT efficacy will hugely impact current practice allowing physicians to select eligible patients that are likely to respond to treatment as well as improve patients’ compliance to complete the course of treatment.Correspondence to:
Dr. Mohamed H. Shamji, Immunomodulation and Tolerance Group, Allergy & Clinical Immunology, Inflammation, Repair and Development, National Heart & Lung Institute, Imperial College London, 1st Floor, Room 111, Sir Alexander Fleming Building, South Kensington Campus, London SW7 2AZ, UK
Email: [email protected]
Review
Adherence in allergen immunotherapy: Current situation and future implications
Francesca Gehrt, Qingqing Xu, Ilaria Baiardini, Giorgio Walter Canonica, and Oliver Pfaar
Page No. 276
Abstract
Allergologie select, Vol. 6/2022 (276-284)
Adherence in allergen immunotherapy: Current situation and future implications
Francesca Gehrt1, Qingqing Xu2,3, Ilaria Baiardini4,5, Giorgio Walter Canonica4,5, and Oliver Pfaar1
1Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-University Marburg, Marburg, Germany, 2Department of Allergy, Beijing Tong Ren Hospital, Capital Medical University, 3Department of Otolaryngology Head and Neck Surgery, Beijing Tong Ren Hospital, Capital Medical University, Beijing, PR China, 4Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, and 5Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
Allergen immunotherapy (AIT) is the only disease-modifying treatment in allergy. However clinical trials as well as reallife studies revealed poor treatment adherence. This article is intended to provide an overview of the current literature of the last 10 years, to outline reasons for poor treatment adherence in AIT and to provide possible solutions for improving adherence.Correspondence to:
Prof. Dr. med. Oliver Pfaar, Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-University Marburg, Marburg, Germany
Email: [email protected]
Review
Allergen immunotherapy for food allergy: Evidence and outlook
Antonella Muraro, Angelo Tropeano, and Mattia Giovannini
Page No. 285
Abstract
Allergologie select, Vol. 6/2022 (285-292)
Allergen immunotherapy for food allergy: Evidence and outlook
Antonella Muraro1, Angelo Tropeano2, and Mattia Giovannini3
1Food Allergy Referral Centre Department of Mother and Child Health, University of Padua, Padua, 2Department of Human Pathology of Childhood and Adulthood, University of Messina, Messina, and 3Allergy Unit, Department of Pediatrics, Meyer Children’s University Hospital, Florence, Italy
Food allergy represents a significant health issue characterized by a sizeable epidemiological burden, involving up to 5% of adults and up to 8% of children in the Western world. The elimination diet of the trigger food is the cornerstone of food allergy management. However, novel treatment options are most wanted to provide alternative strategies for this potentially fatal medical condition. Allergen immunotherapy for food allergy (FA-AIT) is considered an immunomodulatory intervention where regular exposure to increasing doses of food is performed in the context of an allergist’s supervised protocol. The main objective is to decrease reactivity, attenuate life-threatening allergic episodes and reduce frequent access to the emergency department. Achieving food tolerance off-treatment is, however, the ultimate aim. In this review, we aim to summarize FA-AIT evidence and outlook.Correspondence to:
Antonella Muraro, MD, PhD, Food Allergy Referral Centre Department of Mother and Child Health, University of Padua, Padua, Italy
Email: [email protected]
Review
Digital health for allergen immunotherapy
Stephanie Dramburg, Paolo Maria Matricardi, Oliver Pfaar, and Ludger Klimek
Page No. 293
Abstract
Allergologie select, Vol. 6/2022 (293-298)
Digital health for allergen immunotherapy
Stephanie Dramburg1, Paolo Maria Matricardi1, Oliver Pfaar2, and Ludger Klimek3
1Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité – Universitätsmedizin Berlin, Berlin, 2Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, and 3Center for Rhinology and Allergology Wiesbaden, Wiesbaden, Germany
In the recent past, digital healthcare technologies are experiencing a significant leap in development, with an additional unforeseen acceleration in implementation due to the SARS-CoV-2 pandemic. The increased use of mobile applications as well as communication technologies to search for services and support hold particular advantages for the management of chronic diseases requiring medium- to longterm treatments and regular follow-up visits. Allergen immunotherapy (AIT), requiring regular application of treatment, represents an optimal scenario for feasible digital support. From patient stratification and care pathways, over personalized decision support for complex clinical scenarios, towards a close and flexible patient-doctor communication in blended care settings: the current article summarizes the latest knowledge on the use and potential of digital health technologies in the area of AIT.Correspondence to:
Stephanie Dramburg, MD, Department of Pediatric Respiratory Care, Immunology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
Email: [email protected]
Case Report
Alpha-gal syndrome and delayed anaphylaxis after ingestion of red meat: A case report
Lea Caron, Valeria G.R. Ortolani, Eleonora Bono, Christian P. Ratti, and Enrico Iemoli
Page No. 299
Abstract
Allergologie select, Vol. 6/2022 (299-303)
Alpha-gal syndrome and delayed anaphylaxis after ingestion of red meat: A case report
Lea Caron, Valeria G.R. Ortolani, Eleonora Bono, Christian P. Ratti, and Enrico Iemoli
Allergy and Clinical Immunology Unit, ASST FBF Sacco, Milan, Italy
α-gal syndrome (AGS) is caused by the intake of products containing α-gal (galactose-α-1,3-galactose) like mammalian meat. Over the last decade, scientific literature about AGS has been increasing, but the true burden of cases is still unknown [1, 2]. In the USA (University of Virginia Allergy Clinic), the number of confirmed cases of AGS was 24 in 2009 [3] and increased to 34,000 in the entire USA by 2019 [4]. As shown in surveys, in Italy AGS is present throughout the country [5]. The literature suggests that a previous tick bite can cause AGS, but in our case it was not possible to demonstrate this association as the patient did not recall any tick bite, even in childhood. After eating red meat, a 56-year-old male patient had developed symptoms such as a generalized urticaria, diarrhea, and faintness, requiring admission to the Emergency Department. The diagnosis was verified using blood CAP-FEIA test and prick-to-prick test. After completing the diagnostic process, we provided the patient with emergency therapy, and autoinjectable adrenaline was prescribed. Despite the diagnosis, the patient ate red meat once again which resulted in severe urticaria 2 hours after the meal, requiring a second visit to the Emergency Room. Now the patient is under follow-up at our Department of Allergy and Clinical Immunology.Correspondence to:
Dr. Enrico Iemoli, Allergy and Clinical Immunology Unit, ASST FBF Sacco, Via Giovanni
Battista Grassi 74, 20157 Milan, Italy
Email: [email protected]
