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Abstract

Allergologie select, Vol. 8/2024 (1-5)

Asthma therapy concepts through the ages

Marek Lommatzsch

Department of Pneumology, Rostock University Medical Centre, University of Rostock, Rostock, Germany
The development and approval of DMAADs (“disease-modifying anti-asthmatic drugs”), in particular inhaled steroids (alone or in combination with long-acting bronchodilators), biologics and modern allergen immunotherapies, has fundamentally changed the asthma therapy concept from symptom control to symptom prevention. This concept is linked to the new asthma treatment goal of asthma remission: long-term absence of symptoms (good asthma control), absence of exacerbations, and stable lung function, without the use of systemic steroids for asthma therapy. Three types of asthma remission are distinguished: spontaneous remission (e.g., childhood asthma), remission “off treatment” (e.g., after successful allergen immunotherapy), and remission “on treatment” (e.g., during inhaled therapy or biologic therapy). A treat-to-target approach is used, as in rheumatoid arthritis or chronic inflammatory bowel disease: The goal is to achieve asthma remission, through individually tailored treatment with highly effective drugs with minimal side effects. However, this requires precise phenotyping of the patient, including detailed history taking, pulmonary function diagnostics, allergological diagnostics, and measurement of type 2 biomarkers.Correspondence to:
Prof. Dr. Marek Lommatzsch, Department of Pneumology, Center for Internal Medicine,
Rostock University Medical Center, Ernst-Heydemann-Straße 6, 18057 Rostock, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 8/2024 (6-11)

Allergen immunotherapy for allergic asthma

J. Christian Virchow¹, Oliver Pfaar², and Marek Lommatzsch¹

¹Department of Pneumology, Rostock University Medical Centre, University of Rostock, Rostock, and ²Clinic for Ear, Nose and Throat Medicine, University Hospital Giessen and Marburg GmbH, Marburg site, Philipps University Marburg, Marburg
Remission is the goal of modern asthma treatment. Allergen immunotherapy (AIT) is an essential component in the armamentarium of personalized asthma therapy. Subcutaneous AIT (SCIT) or sublingual AIT (SLIT) offer the possibility to prevent asthma in patients with allergic rhinitis (reduction of the risk of developing asthma) and the possibility to achieve remission in patients with allergic asthma. Accordingly, AIT should always be considered in patients with asthma and a documented, clinically relevant allergy. However, precise phenotyping of the patient is an essential prerequisite for a success of AIT in asthma.Correspondence to:
Prof. Dr. Marek Lommatzsch, Leitender Oberarzt und Stellvertretender Klinikdirektor, Department of Pneumology, Center for Internal Medicine, Rostock University Medical Center, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 8/2024 (12-17)

Role of FEF25–75 in characterizing outpatients with asthma in clinical practice

Giorgio Ciprandi¹ and Irene Schiavetti²

¹Allergy Clinic, Department of Outpatients, Casa di Cura Villa Montallegro, and ²Health Science Department, University of Genoa, Genoa, Italy
Background: Asthma is characterized by variable airflow limitation. FEF_25–75 has been proposed as a reliable marker for bronchial obstruction, especially when FEV and FEV/FVC are normal. Objectives: To investigate the role of FEF_25–75 in patients with asthma seen in clinical settings. Materials and methods: The cross-sectional study included 439 (181 females and 255 males; mean age 39 years) outpatients with asthma who consecutively visited an allergy clinic for a routine assessment. History, physical examination, asthma control, and spirometry were evaluated. Results: FEF_25–75 was impaired (< 65% of predicted) in 136 (31%) outpatients. Considering only subjects with normal FEV and FEV/FVC, FEF_25–75 was impaired in 71 (19.6%) subjects. In this subset, impaired FEF_25–75 was associated with low FEV and FEV/FVC values (OR 0.91 and 0.85, respectively), and presence of asthma symptoms (OR 2.19). Conclusion: FEF_25–75 deserves adequate and careful consideration in patients with asthma and normal FEV and FEV/FVC, as the presence of impaired FEF_25–75 in this subset suggests a more specific approach.Correspondence to:
Giorgio Ciprandi, Allergy Clinic, Department of Outpatients, Casa di Cura Villa Montallegro, Genoa, Italy
Email: [email protected]

Abstract

Allergologie select, Vol. 8/2024 (18-25)

EGPA: Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome) as a special presentation of chronic rhinosinusitis with nasal polyps (CRSwNP)

Jan Hagemann¹,⁵, Martin Laudien², Sven Becker³, Mandy Cuevas⁴, Felix Klimek⁵, Roya Kianfar⁵, Ingrid Casper⁵, and Ludger Klimek⁵

¹Clinic for Ear, Nose and Throat Medicine, Mainz University Medical Center, Mainz, ²Clinic for Ear, Nose and Throat Medicine, University Medicine Kiel, Kiel, ³Clinic and Polyclinic for ENT Medicine, University Hospital Tübingen, Tübingen, ⁴Clinic and Polyclinic for ENT Medicine, Carl Gustav Carus University Hospital, TU Dresden, Dresden, and ⁵Center for Rhinology and Allergology, Wiesbaden, Germany
Introduction: Eosinophilic granulomatosis with polyangiitis (EGPA) was formerly known as Churg-Strauss syndrome. The condition is characterized by disseminated necrotizing vasculitis with extravascular granulomas associated with hypereosinophilia. The vasculitides affect small vessels and are associated with antineutrophil cytoplasmic antibodies (ANCAs) detectable in the blood. Distinguishing between type 2-mediated chronic airway inflammation such as chronic rhinosinusitis with nasal polyps (CRSwNP) without vasculitis can be clinically challenging and should be considered. Materials and methods: Immunological background, diagnosis, and therapy of EGPA were identified through literature searches in Medline, PubMed, as well as national and international studies (ClinicalTrials.gov) and the Cochrane Library. Human studies published up to and including 10/2023 on the topic were considered. Results: In cases of deteriorating general health with previously known eosinophilic inflammation of the upper and lower airways, EGPA and its interdisciplinary investigation should be considered. Various types of eosinophilic inflammation and syndromes must be considered differentially. Conclusion: Characterization of mucosal airway inflammation through biomarker determination is meaningful and occasionally makes the difference for targeted therapy.Correspondence to:
Dr. med. Jan Hagemann, Center for Rhinology and Allergology, An den Quellen 10, 65183 Wiesbaden, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 8/2024 (26-39)

Monitoring mepolizumab treatment in chronic rhinosinusitis with nasal polyps (CRSwNP): Discontinue, change, continue therapy?

Ludger Klimek¹, Ulrike Förster-Ruhrmann², Heidi Olze², Achim G. Beule³,⁴, Adam M. Chaker⁵,⁶, Jan Hagemann⁷, Tilman Huppertz⁷, Thomas K. Hoffmann⁸, Stefan Dazert⁹, Thomas Deitmer¹⁰, Sebastian Strieth¹¹, Holger Wrede¹², Wolfgang W. Schlenter¹³, Hans-Jürgen Welkoborsky¹⁴, Barbara Wollenberg⁵, Sven Becker¹⁵, Fredericke Bärhold¹⁵, Felix Klimek¹, Ingrid Casper¹, Jaron Zuberbier², Claudia Rudack³, Mandy Cuevas¹⁶, Constantin A. Hintschich¹⁷, Orlando Guntinas-Lichius¹⁸, Timo Stöver¹⁹, Christoph Bergmann²⁰, Pascal Werminghaus²¹, Oliver Pfaar²², Jan Gosepath²³, Moritz Gröger²⁴, Caroline Beutner²⁵, Martin Laudien²⁶, Rainer K. Weber²⁷, Tanja Hildenbrand²⁸, Anna S. Hoffmann²⁹, and Claus Bachert³⁰

¹Center for Rhinology and Allergology, Wiesbaden, ²HNO-University Clinic Charité, Berlin, ³Clinic for Otorhinolaryngology, Münster University Hospital, ⁴Clinic for Otorhinolaryngology, Head and Neck Surgery at Greifswald University Medical Center, ⁵Department of Otolaryngology - Head and Neck Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, ⁶Center of Allergy and Environment (ZAUM) of the Technical University of Munich, ⁷Clinic and Polyclinic for Otolaryngology, University Medical Center Mainz, Mainz, ⁸Department of Otorhinolaryngology, Head and Neck Surgery, University of Ulm, Ulm, ⁹Clinic for Otorhinolaryngology, Head and Neck Surgery, Ruhr University Bochum, St. Elisabeth Hospital, ¹⁰German Society for Otorhinolaryngology, Head and Neck Surgery, Bonn, ¹¹Clinic and Polyclinic for Otorhinolaryngology, University Hospital Bonn, ¹²Ear, nose and throat specialist, Herford, ¹³Medical Association of German Allergists, Wiesbaden, ¹⁴Clinic for Ear, Nose and Throat Medicine, Head and Neck Surgery, Nordstadt Clinic of the KRH, Hannover, ¹⁵HNO-University Clinic Tübingen, ¹⁶K Clinic and Polyclinic for Otolaryngology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, ¹⁷Clinic and Polyclinic for Ear, Nose and Throat Medicine, University Hospital Regensburg, Regensburg, ¹⁸Clinic for Otorhinolaryngology, Jena University Hospital, ¹⁹Otorhinolaryngology University Clinic Frankfurt am Main, ²⁰HNO RKM⁷⁴⁰ Interdisciplinary Specialist Clinic, Düsseldorf, Germany, ²¹Praxis für Hals-, Nasen-, Ohrenheilkunde und Allergologie, Düsseldorf, ²²Kl Clinic for Ear, Nose and Throat Medicine, University Hospital Giessen and Marburg GmbH, Marburg site, Philipps University Marburg, Marburg, ²³Clinic for Otorhinolaryngology, HSK Wiesbaden, ²⁴Clinic and Polyclinic for Otorhinolaryngology, University Hospital LMU Munich, ²⁵K Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Germany Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen, ²⁶Department of Otorhinolaryngology, Head and Neck Surgery, Kiel University, University Medical Centre Schleswig-Holstein, Kiel, ²⁷Clinic for Otorhinolaryngology, Karlsruhe Municipal Hospital, ²⁸Department of Ear, Nose and Throat Medicine, Freiburg University Medical Center, ²⁹Clinic for Ear, Nose and Throat Medicine, University Medical Center Hamburg-Eppendorf, ³⁰Kli Upper Airways Research Laboratory and Department of Oto-Rhino-Laryngology, Ghent University and Ghent, University Hospital, Ghent, Belgien
Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial inflammatory disease of the mucous membranes of the nose and sinuses. Eosinophilic inflammation is described as a common endotype. The anti-IL-5 antibody mepolizumab was approved in November 2021 as an add-on therapy to intranasal glucocorticosteroids for the treatment of adults with severe chronic rhinosinusitis with nasal polyps when systemic glucocorticosteroids or surgery do not provide adequate disease control. While national and international recommendations exist for the use of mepolizumab in CRSwNP, it has not yet been adequately specified how this therapy should be monitored, what follow-up documentation is necessary, and when it should be discontinued if necessary. Materials and methods: A literature search was performed to analyze previous data on the treatment of CRSwNP with mepolizumab and to determine the available evidence by searching Medline, Pubmed, the national and international trial and guideline registries, and the Cochrane Library. Human studies published in the period up to and including 10/2022 were considered. Results: Based on the international literature and previous experience by an expert panel, recommendations for follow-up, adherence to therapy intervals, and possible therapy breaks as well as discontinuation of therapy when using mepolizumab for the indication CRSwNP in the German healthcare system are given on the basis of a documentation sheet. Conclusion: Understanding the immunological basis of CRSwNP opens up new non-surgical therapeutic approaches with biologics for patients with severe, uncontrolled courses. Here, we provide recommendations for follow-up, adherence to therapy intervals, possible therapy pauses, or discontinuation of therapy when mepolizumab is used as add-on therapy with intranasal glucocorticosteroids to treat adult patients with severe CRSwNP that cannot be adequately controlled with systemic glucocorticosteroids and/or surgical intervention.Correspondence to:
Professor Dr. med. L. Klimek, Zentrum für Rhinologie und Allergologie Wiesbaden, An den Quellen 10, 65183 Wiesbaden, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 8/2024 (40-50)

Eosinophil granulocytes in chronic inflammatory respiratory diseases and CRSwNP: Function, immunological basis, and clinical significance

Felix Klimek¹, Christoph Bergmann², Jan Hagemann³, Mandy Cuevas⁴, Sven Becker⁵, Oliver Pfaar⁶, Ingrid Casper¹, and Ludger Klimek¹

¹Center for Rhinology and Allergology, Wiesbaden, ²Practice for Ear, Nose and Throat disease, Clinic RKM ⁷⁴⁰, Düsseldorf, ³Department for Otolaryngology, University Medical Center Mainz, Mainz, ⁴Department for Otolaryngology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, ⁵Department for Otolaryngology, University Hospital Tübingen, Tübingen, and ⁶Section of Rhinology and Allergy, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
Introduction: Eosinophils play an important regulatory and immunomodulatory role in airway mucosa and have antiparasitic and antiviral properties as well as pro-inflammatory effects that may also cause persistence of inflammation with tissue remodeling. The number of eosinophils and the detection of specific mediators in biological samples from, e.g., blood, nasal secretions, and bronchial fluid can serve as biomarkers that reflect the underlying pathophysiology of certain diseases, predict treatment success, and detect therapy effects. Materials and methods: A literature search was conducted to determine the immunologic basis, mode of action, clinical significance, and available evidence for therapeutic approaches using eosinophil-targeted monoclonal antibodies by searching Medline, Pubmed, and the national and international trial database (ClinicalTrials.gov) and guideline registries as well as the Cochrane Library. Human studies published on the topic in the period up to and including 10/2023 were considered. Results: Based on the international literature and previous experience, the results are summarized, and recommendations are given. Conclusion: The important role of eosinophils in immunological processes in the airway mucosa is comprehensively analyzed and can serve as a basis for current and future treatment approaches.Correspondence to:
Professor Dr. med. L. Klimek, Center for Rhinology and Allergology, An den Quellen 10, 65183 Wiesbaden, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 8/2024 (51-63)

Animal exposure, sensitization, and allergic symptoms in first-year veterinary medicine students

Eva Zahradnik, Christoph Nöllenheidt, Ingrid Sander, Alexandra Beine, Martin Lehnert, Frank Hoffmeyer, and Monika Raulf

Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany
The AllergoVet study longitudinally examines the influence of animal exposure on the development of sensitization and allergic diseases among veterinary medicine students. In this group, contact to animals usually existed long before the study began. Therefore, the aim of this analysis was to investigate lifelong animal species-specific exposure and the prevalence of sensitizations and allergic symptoms already existing before the start of the study. Questionnaire data, including exposure history, were summarized to determine the duration and intensity of animal-related exposure as well as the prevalence of allergic symptoms to animals. Serologically, specific IgE was determined against ubiquitous inhalant allergens (atopy screen sx1) and against animal allergens using ImmunoCAP. The association between animal-specific sensitization, allergic symptoms, and exposure was analyzed using Fisher’s exact test or Cochran-Armitage trend test. All study participants (n = 313) had previous contact with animals, with dogs mentioned most frequently (91.1%) followed by cats (89.5%) and horses (72.2%). Sensitization to ubiquitous allergens (positive sx1 value) was detected in 38.4% of subjects. Approximately 11%, 7%, and 5% were sensitized to cats, dogs, and horses, respectively. Only a small proportion of these sensitizations were associated with self-reported symptoms (41% for cat, 9% for dog, and 13% for horse). While no significant association between animal-specific exposure and sensitization was found for cats and horses, a clear trend emerged for dogs. With increasing duration of exposure to dogs, the number of dog-specific sensitizations decreased significantly (p = 0.0069). Furthermore, a decreasing trend in sx1 sensitization was noted with increasing cat (p = 0.0288) and dog (p = 0.0107) exposure. None of the subjects who grew up on a farm (n = 40) had any sensitization to animals. The sensitization prevalence determined among first-year students in veterinary medicine roughly corresponds to that in the general population. Most animal sensitizations were not clinically relevant. In this collective, a protective effect of increasing exposure to animals in childhood and adolescence was found on sensitization, which was particularly pronounced during contact with dogs.Correspondence to:
Eva Zahradnik, Dipl. Biol., Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 8/2024 (64-69)

Hypoallergenic animals: A promise of hope for allergic patients?

Christiane Hilger, Bente Janssen-Weets, and Kyra Swiontek

Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur Alzette, Luxembourg
Furry pets are beloved companion animals; horse riding is a popular leisure activity. So-called hypoallergenic animals have gained high interest as sensitization to animal dander and allergy to furry animals are widespread. Allergen immunotherapy to furry animals is still limited, and allergen avoidance in addition to symptomatic pharmaceutical treatment is often the only available option. Patients with an existing allergy to furry animals or with an atopic background are seeking for a hypoallergenic alternative. This review summarizes current knowledge and discusses future strategies.Correspondence to:
Christiane Hilger, PhD, Department of Infection and Immunity, Luxembourg Institute of Health, 29, rue Henri Koch, L-4354 Esch-sur Alzette, Luxembourg
Email: [email protected]

Abstract

Allergologie select, Vol. 8/2024 (70-77)

Individual wearable air purifier protects against pollen, house dust mite, and cat allergens: Report from an allergen exposure chamber

Karl-Christian Bergmann¹,², Teresa Hartung², and Torsten Zuberbier¹

¹Institute of Allergology, Charité-Universitätsmedizin Berlin, and ²European Center Allergy Research Foundation, Berlin, Germany
Purpose: Evaluation of a new individual wearable air purifier (Respiray Wear A+) for birch pollen, house dust mite (HDM), and cat-allergic rhinoconjunctivitis (ARC) patients in a standardized allergen exposure chamber (AEC). Materials and methods: Eligible allergic patients were exposed to birch pollen, HDM raw material, and cat allergen in an AEC for 60 minutes without (V1) and with (V3) the use of the Respiray device. Nasal, ocular, bronchial, and other symptoms were rated by the patients every 10 minutes, and their wellbeing, peak nasal inspiratory flow (PNIF), and lung function parameters were assessed every 30 minutes. The primary endpoint was the change in the median of the total symptom score (TSS) at V3 compared to V1 at 60 minutes of exposure. The secondary endpoints consisted of the total nasal symptom score (TNSS) and total eye symptom score (TESS). Results: 23 patients with birch pollen allergy, 37 patients with HDM allergy, and 41 patients with cat allergy were included in the analysis. Significant reduced symptom scores of ~ 49% were observed when using Respiray Wea A+ under birch pollen exposure (p < 0.05) in the primary endpoint TSS (V3 2.43 compared to V1 4.78). An 48% reduction of symptoms was seen in TSS in case of HDM exposure (V3 3.59; V1 6.92, (t-test: p < 0.01)) and the highest reduction of TSS (60%) under Respiray A+ using cat allergens (V3 2.95, V1 7.44, (t-test p < 0.01) after 60 minutes of exposure. The personal wellbeing revealed clinically meaningful improvements over time in all three studies which manifested in a lower symptom increase during the final allergen exposures. Conclusion: The individual wearable air purifier Respiray Wear A+ protects significantly against airborne pollen, HDM, and cat allergens and may be a very useful device for avoiding indoor allergens in a new way.Correspondence to:
Prof. Karl-Christian Bergmann, Institute of Allergology, Charité-Universitätsmedizin Berlin, or European Centre For Allergy Research Foundation, Berlin, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 8/2024 (78-81)

Rapid response to dupilumab in an adult patient with eosinophilic esophagitis and allergic asthma

Benjamin Klein¹,² and Regina Treudler¹,³

¹Leipzig Comprehensive Allergy Center LICA-CAC, Department of Dermatology, Venereology and Allergology, University of Leipzig, Leipzig, Germany, ²Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA, and ³Institute of Allergology, Charité Universitätsmedizin Berlin, Berlin, Germany
Background: Eosinophilic esophagitis (EoE) is an inflammatory disease of the esophagus that belongs to the spectrum of Th2-mediated diseases. It is often associated with atopic comorbidities such as allergic asthma (AA) and poses a therapeutic challenge. Case report: We report on a 43-year-old patient with EoE and AA who did not show sufficient therapeutic control despite standard therapy. We started treatment with dupilumab, whereupon both EoE and AA rapidly improved and complete symptom resolution could be documented. The response to dupilumab was assessed by laboratory monitoring and gastroscopy, which showed a reduction of markers of type II inflammation and eosinophilic infiltrates in the esophagus. Summary: Our report emphasizes the effective and safe use of dupilumab as a treatment option for EoE with concomitant beneficial effects on AA.Correspondence to:
Prof. Dr. Regina Treudler, Institute of Allergology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 8/2024 (82-89)

Patch testing in occupational dermatology: Practical aspects in relation to the conditions in Germany

Richard Brans¹,² and Christoph Skudlik¹,²

¹Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the Osnabrück University, and ²Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany
Allergic contact dermatitis is one of the most frequent occupational skin diseases. Targeted allergen avoidance can only be achieved by identification of the causative allergen. Therefore, patch testing is of utmost importance in occupational dermatology, not only in terms of assessing causal relationships but also regarding the implementation of prevention measures and evaluation of the legal criteria for an occupational skin disease in Germany (statutory occupational disease BK 5101). The lack of commercial patch test preparations poses a great diagnostic challenge. Patch testing of patient’s own materials from their workplace is therefore very important to reduce diagnostic gaps. The performance and documentation of the patch test should be in line with current guidelines and recommendations to ensure the necessary test quality and comprehensibility of the test results.Correspondence to:
Prof. Dr. med. Richard Brans, Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm) an der Universität Osnabrück, Institut für Gesundheitsforschung und Bildung (IGB), Abteilung Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück, Am Finkenhügel 7a, 49076 Osnabrück, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 8/2024 (90-198)

AWMF mold guideline “Medical clinical diagnostics for indoor mold exposure” – Update 2023 AWMF Register No. 161/001

Julia Hurraß¹,a,b, Birger Heinzow²,a, Sandra Walser-Reichenbach³,a,b, Ute Aurbach⁴,⁵,a, Sven Becker⁶,a, Romuald Bellmann⁷,a, Karl-Christian Bergmann⁸,a,b, Oliver A. Cornely⁹,a, Steffen Engelhart¹⁰,a,b, Guido Fischer¹¹,a, Thomas Gabrio¹²,a, Caroline E.W. Herr³,¹³,a,b, Marcus Joest¹⁴,a, Christian Karagiannidis¹⁵,¹⁶,a, Ludger Klimek¹⁷,a,b, Martin Köberle¹⁸,a,b, Annette Kolk¹⁹,a, Herbert Lichtnecker²⁰,a, Thomas Lob-Corzilius²¹,a,b, Norbert Mülleneisen²²,a,b, Dennis Nowak²³,a,b, Uta Rabe²⁴,a,b, Monika Raulf²⁵,a,b, Jörg Steinmann²⁶,a, Jens-Oliver Steiß²⁷,²⁸,a,b, Jannik Stemler⁹,a, Ulli Umpfenbach²⁹,a, Kerttu Valtanen³⁰,a, Barbora Werchan³¹,a, Birgit Willinger³²,a,b, and Gerhard A. Wiesmüller⁴,⁵,³³,a,b

¹Section for Hygiene in Healthcare Facilities, Division of Infection Control and Environmental Hygiene, Cologne Health Department, Cologne, ²Formerly: State Agency for Social Services (LAsD) Schleswig-Holstein, Kiel, ³Bavarian Health and Food Safety Authority, Munich, ⁴Laboratory Dr. Wisplinghoff, ⁵ZfMK – Center for Environment, Hygiene and Mycology Cologne, Cologne, ⁶Department for Otorhinolaryngology, Head and Neck Surgery, University Medical Center Tübingen, Tübingen, Germany, ⁷Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria, ⁸Institute of Allergology Charité, Charité – University Medicine Berlin, Berlin, ⁹Institute for Translational Research, CECAD Cluster of Excellence, University of Cologne, Cologne, Germany and Department I for Internal Medicine, Cologne University Hospital, Cologne, ¹⁰Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, ¹¹Baden-Württemberg State Health Office in the Stuttgart Regional Council, Stuttgart, ¹²Formerly: Baden-Württemberg State Health Office in the Stuttgart Regional Council, Stuttgart, ¹³Environmental Health and Prevention, Institute and Polyclinic for Occupational, Social and Environmental Medicine, University of Munich Hospital Ludwig-Maximilians-University, Munich, ¹⁴Allergological-Immunological Laboratory, Helios Lung and Allergy Center Bonn, Bonn, ¹⁵Faculty of Health, Professorship for Extracorporeal Lung Replacement Procedures, University of Witten/Herdecke, Witten/Herdecke, ¹⁶Lung Clinic Cologne Merheim, Clinics of the City of Cologne, Cologne, ¹⁷Center for Rhinology and Allergology, Wiesbaden, ¹⁸Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, ¹⁹Institute for Occupational Safety and Health (IFA) of the German Social Accident Insurance (DGUV), Unit Biological Agents, Sankt Augustin, ²⁰Medical Institute for Environmental and Occupational Medicine MIU GmbH Erkrath, Erkrath, ²¹Scientific working group of environmental medicine of the German Society of Pediatric Allergology (GPAU), ²²Asthma and Allergy Center Leverkusen, Leverkusen, ²³Institute and Polyclinic for Occupational, Social and Environmental Medicine, member of the German Center for Lung Research, Hospital of the University of Munich, Munich, ²⁴Center for Allergology and Asthma, Johanniter Hospital Treuenbrietzen, Treuenbrietzen, ²⁵Institute for Prevention and Occupational Medicine of the German Statutory Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, ²⁶Center for Pediatrics and Adolescent Medicine, University Hospital Giessen and Marburg GmbH, Giessen, ²⁷Specialized Practice in Allergology and Pediatric Pulmonology in Fulda, Fulda, ²⁸Institute for Clinical Hygiene, Medical Microbiology and Clinical Infectiology, Paracelsus Private Medical University Nuremberg Clinic, Nuremberg, ²⁹Doctor for Pediatrics and Adolescent Medicine, Pediatric Pulmonology, Environmental Medicine, Classical Homeopathy, Asthma Trainer, Neurodermatitis Trainer, Viersen, ³⁰FG II ¹.⁴ Microbiological Risks, German Environment Agency, Berlin, ³¹German Pollen Information Service Foundation (PID), Berlin, Germany, ³²Department of Laboratory Medicine, Division of Clinical Microbiology – Medical University of Vienna, Vienna, Austria, and ³³Institute for Occupational, Social and Environmental Medicine, Uniclinic RWTH Aachen, Aachen, Germany, aCo-author, bMember of a scientific medical society, a society or a medical association with voting rights
Correspondence to:
Dr. rer. nat. Julia Hurraß, Hygiene in Health Care Facilities, Department of Infection and Environmental Hygiene, Cologne City Health Department, Neumarkt 15 – 21, 50667 Cologne, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 8/2024 (199-205)

“Climate-friendly” diets from an allergy point of view

Imke Reese

Private Practice for Dietary Advice and Nutrition Therapy with Special Interest in Adverse Reactions to Food, Munich, Germany
Since the EAT-Lancet Commission’s call for a change in diet towards more plant-based foods, especially protein sources, this so called “Planetary Health Diet (PHD)” has been widely discussed. While for some the reduction in animal foods is not enough and vegan diets are advocated to save the climate, others are sounding the alarm that the reduction is too drastic and that the PHD makes it impossible to provide a diet that meets our needs (of essential nutrients). In addition to climate aspects, health benefits often cited to justify the PHD do not take into account that vegetarians/vegans differ from the general population by far more factors than the reduction or elimination of animal foods. Also not sufficiently discussed is the fact that a diet which excludes or severely restricts animal foods is also associated with health risks if critical nutrients are not adequately covered. Moreover, the challenge of meeting protein requirements is underestimated by many. The food industry has responded to the trend towards more plant-based foods by massively expanding the range of highly processed or ultra-processed vegan foods. These – vegan or not vegan – are suspected of being partly responsible for the development of non-communicable diseases. In addition to general criticism regarding the usefulness of advertising the PHD, the replacement of animal protein sources with plant-based sources notably harbors a number of additional relevant risks for allergy sufferers so that the latter should be classified as an unfavorable target group for the implementation of the PHD recommendations.Correspondence to:
Dr. Imke Reese, Ernährungsberatung und -therapie, Schwerpunkt Allergologie, Ansprengerstr. 19, 80803 Munich, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 8/2024 (206-211)

“Delabeling” by direct provocation testing in children and adolescents with a suspected history of a delayed reaction to β-lactam antibiotics. Consensus paper of Gesellschaft für pädiatrische Allergologie und Umweltmedizin (GPAU

Irena Neustädter¹, Sophie Blatt¹, Gerda Wurpts³, Heinrich Dickel⁴, Christian Walter⁵, Werner Aberer⁶, Sebastian Bode⁷, Timo Buhl⁸, Sunhild Gernert⁹, Susanne Harner¹⁰, Guido Heine¹¹, Sebastian Kerzel¹⁰, Meike Köhler¹², Lars Lange⁹, Joachim List¹³, Hans F. Merk², Thomas Nüßlein¹⁴, Hagen Ott¹⁵, Franziska Sattler¹², Antje Schuster¹⁶, Helen Straube¹⁷, Bettina Wedi¹⁸, Torsten Zuberbier¹⁹, and Knut Brockow²

¹Pediatric and Adolescent Medicine, Diakoneo Klinik Hallerwiese-Cnopfsche Kinderklinik, Nuremberg, ²Clinic and Polyclinic for Dermatology and Allergology at Biederstein, Technical University of Munich, Munich, ³Clinic for Dermatology and Allergology, Aachen Comprehensive Allergy Center (ACAC), University Hospital of RWTH Aachen University, Aachen, ⁴Clinic for Dermatology, Venereology and Allergology, St. Josef Hospital, University Hospital of the Ruhr University Bochum, Bochum, ⁵Practice for Pediatric and Adolescent Medicine, Allergology, Bad Homburg, Germany, ⁶Department of Dermatology and Venereology, Medical University of Graz, Austria, ⁷University Clinic for Children and Adolescents, Ulm, ⁸Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, ⁹Department of Pediatrics, St. Marien Hospital, GFO Clinics, Bonn, ¹⁰Clinic and Polyclinic for Pediatrics and Adolescent Medicine, University of Regensburg, Regensburg, ¹¹Department of Dermatology, Venereology and Allergology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, ¹²Asthma and Allergy Outpatient Clinic, Dr. von Hauner Children’s Hospital, LMU University Hospital, Munich, ¹³University of Freiburg, Center for Pediatric and Adolescent Medicine, Freiburg, ¹⁴Clinic for Pediatrics and Adolescent Medicine, Gemeinschaftsklinikum Mittelrhein, Koblenz, ¹⁵Children’s and Youth Hospital Auf der Bult, Hanover, ¹⁶Clinic for General Pediatrics, Neonatology and Pediatric Cardiology, University Hospital Düsseldorf, Düsseldorf, ¹⁷Princess Margaret Children’s Hospital, Darmstadt, ¹⁸Hannover Medical School, Clinic for Dermatology, Allergology and Venereology, Hanover, and ¹⁹Allergology and Immunology, Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
Background: Approximately 10% of European children are classified as allergic to drugs. In the majority of these children, no allergy to β-lactam antibiotics (BLA) can be found. In most cases, the exanthema is caused by the infection. Materials and methods: The objective of this paper is to describe the causes and consequences of a misdiagnosis of drug allergy. We propose a method for establishing a correct diagnosis in the case of a history of a delayed reaction during treatment with a BLA. For this purpose, a proposal was discussed via e-mail communication, and consensus was reached among the members of the drug allergy working groups of the participating medical societies. Results: The suspicion of a BLA allergy based on the medical history alone can have a negative impact on future antibiotic treatment. Exanthema associated with febrile infections not related to drug administration is a frequent finding in children. This makes it all the more important to be able to recommend a standardized procedure for clarification in children and adolescents with suspected hypersensitivity reactions. The medical history should be the basis on which to diagnose either a drug allergy or another possible differential diagnosis. A mild maculopapular exanthema (MPE) can be an expression of a drug allergy or a nonspecific viral exanthema. Uncomplicated MPE is not associated with significant systemic involvement, and there is no involvement of the mucous membranes or cutaneous blistering. Only a small number of children with uncomplicated MPE show positive skin tests and only ~ 7 – 16% of suspected BLA diagnoses can be confirmed by provocation tests. Thus, in children with uncomplicated MPE, drug provocation can be performed in an outpatient setting even without prior skin testing. This paper presents a 3-day outpatient direct provocation scheme for BLA delabeling in children with uncomplicated MPE. Conclusion: Many children and adolescents are unnecessarily denied treatment with BLA after an uncomplicated MPE while being treated with a BLA.Correspondence to:
Dr. med. Irena Neustädter, Pediatric and Adolescent Medicine, Diakoneo Klinik Hallerwiese-Cnopfsche Kinderklinik, St.-Johannis-Mühlgasse 19, 90419 Nuremberg, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 8/2024 (212-219)

Regulatory framework for development and marketing authorization of allergen products for diagnosis of rare type I and type IV allergies: The current status

Julia Zimmer and Vera Mahler

Paul-Ehrlich-Institut, Division of Allergology, Langen, Germany
Development, production, and marketing authorization of allergen products is generally challenging due to several specific characteristics, including the natural source as well as the multitude of allergenic materials. Also, depending on the frequency of sensitization in the population, the number of patients available for inclusion in clinical trials can be a limiting factor for product development. In the development of allergen products for diagnosis of type I and type IV allergies these challenges are particularly demanding because, in contrast to certain products for allergen-specific immunotherapy, no exemptions from marketing authorization are foreseen for this product group in Directive 2001/83/EC. Thus, the regulatory framework is constantly adapted within the legal scope in order to balance necessary regulatory requirements ensuring quality, safety, and efficacy with the clinical need for a comprehensive range of diagnostic allergen products. In this article, we give an overview on the current regulatory framework for development and marketing authorization of allergen products for diagnosis of rare type I and type IV allergies.Correspondence to:
Prof. Dr. med. Vera Mahler, Paul-Ehrlich-Institut, Paul-Ehrlich-Straße 51 – 59, 63325 Langen, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 8/2024 (220-227)

Diagnostics of IgE-mediated occupational allergies: Between reality, requirements, and opportunities

Monika Raulf and Sabine Kespohl

Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany
Occupational skin and respiratory allergies are among the most common occupational diseases in Germany. The identification of the allergy trigger is essential for the recognition of an occupational allergy as well as for effective individual prevention. However, occupational type I allergens are among the “rare” allergens and the possibilities of guideline-compliant diagnosis using quality-tested skin test solutions is becoming increasingly difficult due to the reduction in commercially available test allergens. In order to guarantee meaningful diagnostic workup for all affected insured persons with suspected occupational type I allergies and to ensure this in the future, a durable optimization, standardization, and availability of allergy tests for occupational allergic diseases is urgently required. The need for action has been recognized by the German Social Accident Insurance (DGUV), and steps to eliminate the diagnostic gaps have been initiated by a joint research project at the Institute for Prevention and Occupational Medicine of the DGUV (IPA) and the Paul Ehrlich Institut (PEI). The evaluation of alternative methods for the production of standardized test allergen solutions can also be used for newly emerging allergens in the workplace. New allergen sources at workplaces and thus also sensitization and allergies among employees can be expected as a result of changes in work processes and the introduction of new technologies and/or working materials, which are also introduced in connection with climate change and the concept of sustainability.Correspondence to:
Prof. Dr. Monika Raulf, Institute for Prevention and Occupational Medicine of the German
Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Germany and Department Competence Center Allergology/Immunology, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 8/2024 (228)

Corrigendum to Article Vegan diets from an allergy point of view – Position paper of the DGAKI working group on food allergy. Allergol Select. 2023; 7: 57-83

Imke Reese on behalf of the DGAKI working group on food allergy

Regarding the article by Reese I, Schäfer C, Ballmer-Weber B, Beyer K, Dölle-Bierke S, van Dullemen S, Jappe U, Müller S, Schnadt S, Treudler R, Worm M. Vegan diets from an allergy point of view – Position paper of the DGAKI working group on food allergy. Allergol Select. 2023; 7: 57-83, the authors would like to apologize for an unfortunate error that occurred during translation of the German position paper into English: not vitamin B12 but vitamin B2 was only met to a limited extent by the vegan group of the VeChi Diet Study (page 60, left column, 3rd paragraph). Please find the correct version of the sentence below:
The results of the VeChi Diet Study (Vegetarian and Vegan Children Study), a German cross-sectional study of young children aged between 1 and 3 years with different diets (vegan, vegetarian, omnivorous) show that the requirements of critical micronutrients such as calcium and iodine as well as the long-chain omega-3 fatty acids are not met in vegans and those of vitamin B2 and iron (due to poorer availability from plant sources) are only met to a limited extent [17].

The error has been corrected in the HTML and PDF versions of the article -> response page of the article

Imke Reese on behalf of the DGAKI working group on food allergy

Abstract

Allergologie select, Vol. 8/2024 (229-232)

Scorpion sting and allergic reaction to scorpion venom: A case-based review

Jozélio Freire de Carvalho

Núcleo de Pesquisa em Doenças Crônicas não Transmissíveis (NUPEN), School of Nutrition from the Federal University of Bahia, Salvador, Bahia, Brazile
Objective: To describe a young patient with scorpion sting (SS) with typical lesions of urticaria besides the local SS clinical picture. Materials and methods: A systematic screening of articles dating from 1966 to 2021 was conducted in the main databases. All articles included the association between SS and urticaria. A new case report is added to the published list. Results: The literature search found 5 articles with 29 patients with SS and urticaria/allergic reactions. We performed our analysis by adding our present case, resulting in a total of 30 cases. Most were male, and their ages varied from 29 to 48 years. Regarding SS severity, most were mild or moderate. In two articles, patients had more than one sting. The allergic reaction varied from urticaria, pruritus, flushing, angioedema, wheezing, rhinorrhea, sneezing, consciousness alterations, and gastrointestinal and cardiovascular alterations. In 5/6 (83%) articles, the patients were alive at the study time. One subject died from anaphylactic shock. Conclusion: The present article systematically reviewed all published cases of SS and allergic reactions to scorpion venom. It is an infrequent association; most patients are male and in the productive age, and reaction may vary from mild to severe, including death.Correspondence to:
Dr. Jozélio Freire de Carvalho, Rua das Violetas, 42, ap. 502, Pituba, Salvador, Bahia, Brazil
Email: [email protected]

Abstract

Allergologie select, Vol. 8/2024 (233-237)

A case of paradoxical vocal cord movement misdiagnosed as anaphylaxis

Mustafa Ilker Inan, Yasemin Akgul Balaban, Sait Yesillik, and Ozgur Kartal

Ankara Gulhane Training and Research Hospital, Division of Immunology and Allergic Diseases, Ankara, Turkiye
Introduction: Anaphylaxis is a severe and life-threatening systemic hypersensitivity reaction. The most frequently encountered causes are foods, drugs, and bee venom, but anaphylaxis may also occur idiopathically. Paradoxical vocal cord movement (PVCM), is a cause of upper airway obstruction due to abnormal adduction of vocal cords during inspiration and, to some degree on expiration. It may be misdiagnosed as asthma or anaphylaxis, and there may be delays in diagnosis. Case report: We present a 20-year-old male patient with coexistence of urticaria and stridor findings who was evaluated and treated as having idiopathic anaphylaxis but then was diagnosed with PVCM after recurrence of stridor attacks. Conclusion: It is useful to bear the diagnosis of PVCM in mind in patients with recurrent and unexplained stridor or in patients with stridor that does not improve despite treatment for another diagnosis such as anaphylaxis. This way, administration of epinephrine, high-dose corticosteroids and interventions such as intubation or tracheostomy can be avoided.Correspondence to:
Dr. Mustafa Ilker Inan, Division of Immunology and Allergic Diseases, Ankara Gulhane Training And Research Hospital, General Dr. Tevfik Sağlam cd. No:1 Etlik, Ankara, Postal Code: 06010 Turkiye
Email: [email protected]

Abstract

Allergologie select, Vol. 8/2024 (238-250)

Procedure for a standardized preparation of skin prick test solutions for the diagnosis of occupational type I allergies in the absence of commercial extracts

Sabine Kespohl¹, Robin Jost², Silke Maryska¹, Lena-Maria Altin³, Ingrid Sander¹, Stefan Schülke², Kathrin E. Paulus-Tremel², Andreas Bonertz², Thomas Klose³, Vera Mahler², and Monika Raulf¹

¹Institute for Prevention and Occupational Medicine of the DGUV, Ruhr-University Bochum (IPA), Bochum, ²Division Allergology, Paul-Ehrlich-Institut, Langen, and ³Sonnenschein Apotheke, Koblenz, Germany
In order to ensure valid diagnostics for occupational test allergen solutions despite the ongoing reduction in the availability of commercial test extracts, a plan B was initiated for the possible production of skin prick test (SPT) solutions in public pharmacies. For important occupational allergen sources (wheat and rye, storage mites, animal epithelia, mold material) laboratory extraction methods were analyzed in comparison to pharmacy compatible extraction methods regarding protein quantity and quality in SDS-PAGE combined with silver staining. Subsequently, using the example of bovine epithelia, adapted extraction procedures as well as in-process and final product controls were transferred to a public pharmacy. Allergen sources with a high protein content, such as wheat and rye grains as well as storage mites, showed good comparability of the extractable protein quantity and protein pattern, regardless of the applied extraction method. In contrast, allergen source materials with a low total protein content, such as animal epithelia and molds, can benefit from laboratory extraction conditions such as mechanical disruption and specific buffer additives. In the qualitative protein silver staining, characteristic protein patterns were identified for each allergen source. Depending on the extraction method, only minor differences in total protein patterns were observed in animal epithelia and molds. Using source materials from two suppliers, the resulting allergen extracts displayed clear differences in protein content in storage mites and quantitative and qualitative differences in molds. A practical preparation attempt of SPT solutions in a public pharmacy was successful. SPT solutions prepared with adapted pharmacy extraction methods showed a comparable protein and Bos d 2 allergen content and equivalent qualities in the protein pattern compared to a previously available commercial SPT solution. Accordingly, it can be assumed that standardized SPT solutions with sufficient allergen quality for occupational allergen sources can be prepared in public pharmacies if certified allergen sources with appropriate protein content are available.Correspondence to:
Dr. Sabine Kespohl, Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Department Competence Center Allergology/Immunology, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 8/2024 (251-264)

Possible manufacture of test allergens in public pharmacies for the diagnosis of type I allergies: Legal aspects

Robin Jost¹,², Sabine Kespohl³, Kathrin E. Paulus-Tremel¹, Julia Zimmer¹, Andreas Bonertz¹, Ingrid Sander³, Thomas Klose⁴, Lena-Maria Altin⁴, Simone Heller⁴, Ralph Heimke-Brinck⁵, Frank Dörje⁵, Susanne Philippus⁶, Matthias Meyer⁷, Sabrina Segebrecht⁸, Torsten Wessel⁹, Dieter Starke¹⁰, Stefan Schülke¹, Monika Raulf³, and Vera Mahler¹,²

¹Allergology Division, Paul-Ehrlich-Institut (PEI), Langen (Hesse), ²Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, ³Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (DGUV), Institute of the Ruhr-Universität Bochum (IPA), Bochum, ⁴Sonnenschein Apotheke, Koblenz, ⁵Pharmacy Department, Erlangen University Hospital, Erlangen, ⁶Thuringian State Authority for Consumer Protection, Department Pharmacy, Bad Langensalza, ⁷Bundeswehr Commissioner for the Surveillance of Medicinal Products, Supervisory Agency for Public Law Tasks of the Bundeswehr Medical Service South, Munich, ⁸Drug Supervision, State Social Services Agency of Land Schleswig-Holstein, Neumünster, ⁹Pharmacy Inspector, Local inspectorate for pharmacies, District of Wesel, Moers, and ¹⁰ State Agency for Social Affairs, Youth and Care, Rhineland-Palatinate, Koblenz, Germany
The availability of high-quality skin test allergens is a prerequisite for the reliable diagnosis of occupational type I allergies. Due to the withdrawal of existing marketing authorizations (MAs) by pharmaceutical companies and the lack of new MAs for commercial test allergens, there is an increasing diagnostic gap in Germany and other EU member states, which makes it necessary to investigate alternative ways of providing in vivo diagnostics. The German Medicinal Products Act (Arzneimittelgesetz = AMG) allows for the possibility of preparing medicinal products in pharmacies without the need for an MA or a manufacturing authorization pursuant to Section 13 (2) No. 1 in conjunction with Section 13 (2a) Sentence 2 No. 3 AMG. This also includes test allergens. In addition to the AMG, the requirements of the German Ordinance on the Operation of Pharmacies (Apothekenbetriebsordnung – ApBetrO) and the European Pharmacopoeia apply in particular. Medicolegal and practical challenges, as well as potentials of manufacturing skin prick test solutions in public pharmacies are presented based on examples of different allergen source materials.Correspondence to:
Prof. Dr. Vera Mahler, Paul-Ehrlich-Institut, Paul-Ehrlich-Straße 51-59, 63225 Langen, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 8/2024 (265-269)

Maculopapular rash with multiple drug hypersensitivity to cotrimoxazole, amikacin, piperacillin/tazobactam, and meropenem in a patient with hairy cell leukemia

Katie Townsend¹,³,⁴, Claire Leck¹, Thippeswamy Billahalli¹, Elizabeth Barachina¹, and Timothy J. Watts¹,²

¹Department of Respiratory Medicine & Allergy, Homerton Healthcare NHS Foundation Trust, ²National Heart & Lung Institute, Imperial College London, ³Department of Immunology, Royal Free London Hospital NHS Foundation Trust, and ⁴University College London Institute of Immunity and Transplantation, Pears building, Rowland Street, London, United Kingdom
We describe a rare case of a 54-year-old female with hairy cell leukemia, who following treatment for neutropenic sepsis, developed an extensive severe maculopapular exanthema with perifollicular hemorrhage. Cladribine, cotrimoxazole, allopurinol, domperidone, amikacin, piperacillin/tazobactam, and meropenem had all been given in the 9 days prior to eruption onset. Three months later, drug patch testing/delayed intradermal testing was positive to cotrimoxazole, trimethoprim, amikacin, piperacillin/tazobactam, and meropenem, with additional evidence of penicillin crossreactivity. Drug challenge tests were negative to allopurinol and domperidone. She was diagnosed with multiple drug hypersensitivity to cotrimoxazole, amikacin, piperacillin/tazobactam, and meropenem. Multiple drug hypersensitivity is a novel syndrome mainly seen with severe delayed type IV drug eruptions, involving long-lasting strong T-cell reactivity to two or more structurally unrelated drugs.Correspondence to:
Dr. Katie Townsend, BM BCh, MRCP, UCL Pears Building, Rowland Hill Street, London, NW3 2QG, UK
Email: [email protected]

Abstract

Allergologie select, Vol. 8/2024 (270-277)

Protocol for the systematic reviews on the desirable and undesirable effects of pharmacological treatments of allergic rhinitis informing the ARIA 2024 guidelines

Rafael José Vieira¹,², Maria Inês Torres¹,², Antonio Bognanni³,⁴, Sara Gil-Mata¹,², Renato Ferreira-da-Silva¹,², Nuno Lourenço-Silva¹,², António Cardoso-Fernandes¹,², André Ferreira²,⁵,⁶, Henrique Ferreira-Cardoso¹,², João Teles¹,², Miguel Campos-Lopes¹,², João A. Fonseca¹,², Juan José Yepes-Nuñez³,⁷, Ludger Klimek⁸,⁹, Torsten Zuberbier¹⁰,¹¹, Holger Schünemann³, Jean Bousquet¹⁰,¹¹,¹², and Bernardo Sousa-Pinto¹,²

¹MEDCIDS – Department of Community Medicine, Information and Health Decision Sciences, ²CINTESIS@RISE – Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal, ³Department of Health Research Methods, Evidence and Impact, ⁴Department of Medicine, Evidence in Allergy Group, McMaster University, Hamilton, ON, Canada, ⁵Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, ⁶Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal, ⁷School of Medicine, Universidad de los Andes, Bogotá, Colombia, ⁸Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, ⁹Center for Rhinology and Allergology, Wiesbaden, ¹⁰Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ¹¹Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany, and ¹²ARIA, Montpellier, France
There is insufficient evidence regarding the comparative efficacy and safety of pharmacological treatments of allergic rhinitis (AR). In the context of informing the 2024 revision of the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines, we plan to perform three systematic reviews of randomized controlled trials (RCTs) comparing the desirable and undesirable effects (i) between intranasal and oral medications for AR; (ii) between combinations of intranasal and oral medications versus nasal or oral medications alone; and (iii) among different intranasal specific medications. We will search four electronic bibliographic databases and three clinical trials databases for RCTs examining patients ≥ 12 years old with seasonal or perennial AR. Assessed outcomes will include the Total Nasal Symptom Score, the Total Ocular Symptom Score, and the Rhinoconjunctivitis Quality-of-Life Questionnaire. We will assess the methodological quality of included primary studies by using the Cochrane risk-of-bias tool. If appropriate, we will perform a pairwise random-effects meta-analysis for each pair of assessed medication classes and outcomes, as well as a network meta-analysis to assess the comparative efficacy of intranasal medications among each other. Heterogeneity will be explored by sensitivity and subgroup analyses. This set of systematic reviews will allow for a comprehensive assessment of the effectiveness and safety of pharmacological interventions for AR and inform recommendations in the context of the ARIA guidelines.Correspondence to:
Professor Jean Bousquet, Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 8/2024 (278-282)

Successful case of deferasirox slow desensitization in adults

Buket Basa Akdogan¹, Ilkay Koca Kalkan¹, Gozde Koycu Buhari¹, Ozlem Ozdedeoğlu¹, Hale Ates¹, Kurtulus Aksu¹, and Ferda Oner Erkekol²

¹University of Health Sciences Ataturk Chest Diseases and Chest Surgery Education and Research Hospital, and ²Yıldırım Beyazıt University, Division of Immunology and Allergy, Department of Chest Diseases, Ankara, Türkiye
Introduction: When deferasirox is used in iron chelation therapy, maculopapular rash occurs in 10% of patients, but there is no accepted and implemented protocol for the management of these drug reactions in adults. Case report: A 23-year-old woman diagnosed with thalassemia major is presented. She had taken 1,500 mg oral deferasirox for 1 week. Five hours after the last dose, a pruritic maculopapular rash developed on the body, face, and hands. The rash spread to the whole body within 3 days. The absolute necessity for the patient to take the drug was clarified by the hematology department. The patient’s history was evaluated. A delayed-type hypersensitivity reaction due to deferasirox was considered. Management: The slow desensitization protocol described in the literature and applied on a case-by-case basis in pediatric patients was modified to shorten the duration by determining appropriate doses for the current preparation. The desensitization process was started with 1/100,000 of the total dose and the therapeutic dose was reached with a 2- to 2.5-fold increase in dose. No pre-medication was applied. During the procedure, at a low dose of 0.1 mg, local flushing and erythema was observed around the auricle on the face. The reaction did not progress. Conclusion: Slow desensitization protocol for oral deferasirox was successfully applied in an adult patient.Correspondence to:
Buket Basa Akdogan, MD, Incirli st. No:57 Floor:3, 34147 Bakirkoy/Istanbul, Türkiye
Email: [email protected]

Abstract

Allergologie select, Vol. 8/2024 (283-292)

Hypersensitivity pneumonitis to phthalic anhydride: Case description and review of the literature

Vera van Kampen¹, Anja Theile², Andrea Tannapfel², Christian Eisenhawer¹, Thomas Brüning¹, and Rolf Merget¹

¹Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), and ²Institute of Pathology, Ruhr University Bochum, Bochum, Germany
Hypersensitivity pneumonitis (HP) is a rare, mostly occupational allergic disease of the lungs. There are many inhalable antigens that can cause HP. Most are organic dusts, rarely chemicals. A clinical case of HP is presented in a cable production worker with exposure to plasticizers who was initially diagnosed with idiopathic pulmonary fibrosis. The presence of specific IgG antibodies (sIgG) to phthalic anhydride in the patient’s serum, together with reduced carbon monoxide diffusion capacity, hypoxemia at rest and on exertion, and the findings on computed tomography and histology, seemed to confirm the diagnosis of chronic HP due to phthalates, particularly as exposure to phthalate compounds at work was reported by the Technical Inspection Service. A review of the literature revealed that there is evidence of plasticizer alveolitis. While in four previous case reports phthalic anhydride was suspected as the cause of occupational HP because of workrelated symptoms, we were able to detect sIgG to phthalic anhydride for the first time. This case illustrates that phthalates, which have rarely been described as triggers of HP, should be considered in cases of suspected occupational HP.Correspondence to:
Dr. Vera van Kampen, Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp Platz 1, 44789 Bochum, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 8/2024 (293-298)

Basophil activation test in Hymenoptera venom allergy

Bernadette Eberlein¹, Knut Brockow¹, Ulf Darsow¹, Tilo Biedermann¹, and Simon Blank²

¹Department of Dermatology and Allergy Biederstein, School of Medicine and Health, Technical University of Munich, and ²Center of Allergy and Environment (ZAUM), Technical University of Munich, School of Medicine and Helmholtz Center Munich, German Research Center for Environmental Health, Munich, Germany
Before starting venom-specific immunotherapy (VIT), systemic sting reactions to Hymenoptera venoms require allergological workup in order to prove an IgEmediated reaction and to identify the culprit insect venom. In addition to skin tests and the determination of specific IgE antibodies, the basophil activation test (BAT) using flow cytometry has emerged as a powerful tool and sensitive marker for this purpose in recent years. BAT seems to have a better informative value in terms of clinical relevance compared to the other tests. In Hymenoptera venom allergies, BAT is particularly useful for the diagnosis of cases with unclear or contradictory history and sensitization profile. Its results are associated with adverse reactions during VIT and efficacy of VIT and therefore have a certain predictive value for side effects and treatment failure of VIT. In research, it is mainly used to characterize the allergenic components of Hymenoptera venoms. This review article focuses on these topics.Correspondence to:
Prof. Dr. Bernadette Eberlein, Department of Dermatology and Allergy Biederstein, School of Medicine and Health, Technical University of Munich, Biedersteiner Str. 29, 80802 Munich, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 8/2024 (299-303)

Diagnostic measures in patients with severe insect sting reactions and elevated baseline serum tryptase levels

Silvan Lange, Eva Oppel, Marius Winkler, and Franziska Ruëff

Department of Dermatology and Allergy, LMU University Hospital, Munich, Germany
Mastocytosis or an elevated basal serum tryptase (bST) level are known risk factors for patients with insect venom allergy. We report on 3 patients with a history of severe anaphylactic insect sting reactions who underwent a detailed workup for insect venom allergy before starting venom immunotherapy. In addition to insect venom sensitization, an elevated concentration of bST (15.5, 20.8, and 23.2 μg/L) was found in all cases. There was no evidence of mastocytosis in the skin (MIS). Further testing revealed hereditary α-hypertryptasemia (HαT) in 2 patients and a D816V mutation by liquid biopsy in 1 patient, which is a minor diagnostic criterion for indolent systemic mastocytosis. Even without iliac crest puncture, causes of elevated bST can be narrowed down with minimally invasive diagnostic measures. As this has practical implications, patients with elevated bST should always undergo further work-up to determine the cause of this abnormal finding.Correspondence to:
Prof. Dr. med. Franziska Ruëff, Klinik und Poliklinik für Dermatologie und Allergologie, Allergiezentrum, LMU Klinikum, Frauenlobstr. 9 – 11, 80337 Munich, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 8/2024 (304-323)

Rapid identification of primary atopic disorders (PAD) by a clinical landmarkguided, upfront use of genomic sequencing

Tim Niehues¹, Sandra von Hardenberg², and Eunike Velleuer¹,³

¹Center for Child and Adolescent Health, Helios Hospital Krefeld, Academic Hospital of RWTH Aachen, Krefeld, ²Department of Human Genetics, Hannover Medical School, Hannover, and ³Department of Cytopathology, Institute of Pathology, Heinrich Heine University Düsseldorf, Germany
Primary atopic disorders (PAD) are monogenic disorders caused by pathogenic gene variants encoding proteins that are key for the maintenance of a healthy skin barrier and a well-functioning immune system. Physicians face the challenge to find single, extremely rare PAD patients/families among the millions of individuals with common allergic diseases. We describe case scenarios with signature PAD. We review the literature and deduct specific clinical red flags for PAD detection. They include a positive family history and/or signs of pathological susceptibility to infections, immunodysregulation, or syndromic disease. Results of conventional laboratory and most immunological lab studies are not sufficient to make a definitive diagnosis of PAD. In the past, multistep narrowing of differential diagnoses by various immunological and other laboratory tests led to testing of single genes or gene panel analyses, which was a time-consuming and often unsuccessful approach. The implementation of whole-genomic analyses in the routine diagnostics has led to a paradigm shift. Upfront genome-wide analysis by whole genome sequencing (WGS) will shorten the time to diagnosis, save patients from unnecessary investigations, and reduce morbidity and mortality. We propose a rational, clinical landmark-based approach for deciding which cases pass the filter for carrying out early WGS. WGS result interpretation requires a great deal of caution regarding the causal relationship of variants in PAD phenotypes and absence of proof by adequate functional tests. In case of negative WGS results, a re-iteration attitude with re-analyses of the data (using the latest data base annotation)) may eventually lead to PAD diagnosis. PAD, like many other rare genetic diseases, will only be successfully managed, if physicians from different clinical specialties and geneticists interact regularly in multidisciplinary conferences.Correspondence to:
Tim Niehues, Center for Child and Adolescent Health, Helios Hospital Krefeld, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 8/2024 (324-331)

Hen’s egg ladder: Therapy option for the gradual introduction of hen’s eggs in cases of hen’s egg allergy

Amely Brückner¹, Petra Funk-Wentzel², and Stephanie Hompes³

¹Elbe Klinikum Buxtehude, Clinic for Dermatology, Competence Center for Chronic Skin Diseases, Buxtehude, ²Practice for Nutrition Therapy, Stuttgart, and ³Altona Children’s Hospital, Hamburg, Germany
More than 10 years ago, the British Society for Allergy and Clinical Immunology (BSACI) published guidelines for the management of egg allergy [1]. For the first time, these included a stepwise plan for the reintroduction of egg for egg-allergic children who could already tolerate well-cooked egg, such as cakes and cookies. Since then, various egg ladders have been developed [2, 3, 4, 5, 6, 7, 8, 9]. In the past 3 years, several studies have been published suggesting that a gradual introduction of highly processed to less processed egg containing foods contribute to the acceleration of tolerance development [2, 3, 4, 5]. However, depending on the study and egg ladder, the egg products vary in their level of processing (wheat matrix, degree, and location of heating (e.g., oven, pan, pot), egg quantity, and egg protein). In the UK, the introduction of the egg ladder is recommended at the age of 12 months or if the last reaction occurred 6 months before. The benefits of introducing egg at home include an early increase in the variety of foods, reduction of food fears, improved nutrient intake, and the avoidance of hospitalization fears in children [10]. Children with mild reactions in the past can start with small amounts of baked goods at home. Food challenges in an inpatient setting to exclude or reconfirm the allergy should be conducted if the patients have previously had severe allergic reactions, i.e., anaphylaxis, or if the smallest amounts triggered an allergic reaction or if existing asthma is poorly controlled [10, 11]. The present work includes, in addition to the evaluation of study results, a presentation of the recent studies regarding egg ladders. From these, a new egg ladder as therapeutic option for the German-speaking region has been developed. As already done for the milk ladder a detailed step-by-step plan, selection criteria, a recipe collection, and also ideas for commercial prepackaged food items can be found in the appendices [11].Correspondence to:
Dipl. oec. troph. Amely Brückner, Elbe Kliniken Stade Buxtehude – Dermatologisches Zentrum Buxtehude, Kompetenzzentrum für chronische Hauterkrankungen, Am Krankenhaus 1, 21614 Buxtehude
Email: [email protected]

Abstract

Allergologie select, Vol. 8/2024 (332-335)

Long-term tolerance and efficacy of venom immunotherapy after an episode of Crohn’s disease and ankylosing spondylitis after up-dosing

Marius Winkler, Franziska Ruëff, Silvan Lange, Annett Walker, and Eva Oppel

Department of Dermatology and Allergy, LMU Munich, University Hospital, Munich, Germany
Hymenoptera stings can cause severe anaphylactic reactions in patients with an underlying Hymenoptera venom allergy (HVA). In such cases, venom immunotherapy (VIT) is a highly effective measure to prevent future anaphylaxis. The management of patients with a clear allergological indication for VIT and contraindications to VIT (e.g., autoimmune diseases) remains a clinical challenge. We report the case of a 54-year-old male gardener who experienced life-threatening anaphylaxis after being stung by wasps in the head and neck region. After confirmation of a Vespula venom allergy (VVA) by intradermal test and VV-specific serum IgE antibodies, VIT was started using a rush protocol. One month after reaching the maintenance dose, the patient experienced a worsening of his pre-existing Crohn’s disease and ankylosing spondylitis. VIT was stopped, and the autoimmune diseases were treated with systemic steroids and sulfasalazine. As the patient wished to remain in his profession, and in view of the previous severe anaphylaxis, we restarted VIT after the autoimmune diseases had resolved, using a slower up-dosing protocol. This approach was tolerated without side effects, and the patient tolerated a sting challenge and several field stings without anaphylactic symptoms.Correspondence to:
Marius Winkler, Klinik und Poliklinik für Dermatologie und Allergologie, Allergiezentrum, LMU Klinikum, Frauenlobstr. 9 – 11, 80337 München, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 8/2024 (336-345)

Hereditary angioedema (HAE) in children and adolescents: New treatment options

Maria Fasshauer¹ and Bettina Wedi²

¹Klinikum St. Georg Leipzig, Clinic for Pediatrics and Adolescent Medicine, ImmunDefektCentrum Leipzig (IDCL), Leipzig, and ²Hannover Medical School (MHH), Department of Dermatology, Allergology and Venereology, Interdisciplinary Allergy Center of the MHH, Treatment Center for Hereditary Angioedema of the MHH, Hannover, Germany
Modern management of hereditary angioedema (HAE) due to reduced C1 inhibitor (C1-INH) function or concentration (HAE-C1-INH) focuses on individualized therapeutic strategies to address the specific needs of children and adolescents as well as the severity of the disease. Psychosocial factors such as the burden of disease and therapy on quality of life and participation play an important role. New medications have already significantly improved the prognosis and health related quality of life in HAE patients, but not all of these therapies have yet been approved for children. Further treatment options that inhibit bradykinin effects are currently being investigated. They target factor XIIa, prekallikrein, plasma kallikrein, or the bradykinin B2 receptor. Modern research focuses on oral options or long-acting parenteral therapy approaches to further optimize care and, in particular, the needs of children. There are also initial developments in the field of gene therapy, which could represent a causal treatment option for HAE in the future.Correspondence to:
Dr. med. Maria Fasshauer, Klinikum St. Georg Leipzig, Clinic for Pediatrics and Adolescent Medicine, ImmunDefektCentrum Leipzig (IDCL), Delitzscher Str. 141, 04129 Leipzig, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 8/2024 (346-357)

The international HAE guideline under real-life conditions: From possibilities to limits in daily life – current real-world data of 8 German angioedema centers

Jens Greve¹, Robin Lochbaum¹, Susanne Trainotti², Eva-Vanessa Ebert², Thomas Buttgereit³, Antonia Scherer⁴, Lisa Knipps⁴,⁵, Anna Smola⁶, Sebastian Volc⁷, Andreas Recke⁸, Katharina Marlies Duda⁹, Mathias Sulk¹⁰, and Janina Hahn¹

Jens Greve¹, Robin Lochbaum¹, Susanne Trainotti², Eva-Vanessa Ebert², Thomas Buttgereit³, Antonia Scherer⁴, Lisa Knipps⁴,⁵, Anna Smola⁶, Sebastian Volc⁷, Andreas Recke⁸, Katharina Marlies Duda⁹, Mathias Sulk¹⁰, and Janina Hahn¹
Background and objectives: Patients with rare diseases like hereditary angioedema (HAE) are usually referred to an angioedema center to ensure guideline-compliant and experience-based therapy. Even though there are established guidelines and several approved therapeutics, there are still open questions and situations in the daily care of HAE patients, where an exchange between centers is needed. Materials and methods: A survey was conducted among physicians from German angioedema centers regarding challenges and issues in everyday HAE treatment. The main focus was on the topic of long-term prophylaxis (LTP). For rarer subcategories of angioedema, the centers conducted a literature review to discuss open questions. Results: The responses of 12 physicians from 8 angioedema centers were analyzed in the survey. The attack frequency was the most important criterion for deciding to initiate LTP in HAE patients (100%). Two centers no longer generally recommend the initiation of pre-interventional prophylaxis in HAE patients under LTP. The therapeutic concepts of acquired angioedema due to C1 inhibitor deficiency and HAE in children were two associated specialized areas that were discussed in more detail. Conclusion: The current guideline serves as the foundation for daily practice in treating HAE at specialized centers. Thus, for rare conditions like HAE, an exchange among the treating centers is essential to adequately address specific issues and rare subgroups.Correspondence to:
Prof. Dr. Jens Greve, Department of Oto-Rhino-Laryngology. Head and Neck Surgery, Ulm University Medical Center, Frauensteige 12, 89075 Ulm, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 8/2024 (358-364)

Dietary and physical trigger factors in hereditary angioedema: Self-conducted investigation and literature overview

Julia Zarnowski¹ and Regina Treudler¹,²

¹Department of Dermatology, Venereology and Allergology, University Hospital Leipzig, Leipzig, and ²Institute of Allergology, Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany
Background: In hereditary angioedema (HAE), numerous factors are known to trigger an attack. The possible influence of diet or recreational sports has been given little consideration in studies. The aim of our work was to investigate the influence of nutrition and physical activity in patients with HAE at the Leipzig ACARE Center. Materials and methods: Patients with HAE were given a self-designed questionnaire inquiring for family history, disease progression, and encountered burden due to HAE, current therapy, and disease control (angioedema control test (AECT)) as well as the influence of diet and/or recreational sports on HAE attacks. Results: Inclusion of 30 patients (23 female, 77%) with a mean age of 49.5 ± 16.9 years and mean body mass index of 25.1 ± 6.4 kg/m2. 60% received prophylactic treatment, and 37% received exclusively on-demand therapy. The mean AECT score was 10.9 ± 5.1 and patients reported 15.5 ± 26.9 days of absence due to HAE attacks in the last 12 months. 33% reported an association with food intake, in particular worsening of abdominal symptoms (n = 7), swelling of the extremities (n = 3), face, larynx, or genital area (n = 1 each). 70% reported regular exercise, most commonly cycling (n = 11), running or walking (n = 10), or strength training (n = 10). 62% reported a worsening of HAE due to recreational exercise. Conclusion: Dietary factors and physical activity frequently led to an aggravation of HAE in our cohort and should be taken into consideration when counseling patients with regard to trigger avoidance.Correspondence to:
Dr. med. Julia Zarnowski, Department of Dermatology, Venereology and Allergology, University Hospital Leipzig, Philipp-Rosenthal-Straße 69, 04103 Leipzig, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 8/2024 (365-406)

Biologics in allergology and clinical immunology: Update on therapies for atopic diseases, urticaria, and angioedema and on safety aspects focusing on hypersensitivity reactions

Uta Jappe¹#², Karl-Christian Bergmann³, Folke Brinkmann⁴, Valentina Faihs⁵, Askin Gülsen⁶, Ludger Klimek⁷, Harald Renz⁸, Sebastian Seurig⁹, Christian Taube¹⁰, Stephan Traidl¹¹, Regina Treudler¹², Martin Wagenmann¹³, Thomas Werfel¹¹, Margitta Worm¹⁴, and Torsten Zuberbier³

¹Division Clinical and Molecular Allergology, Research Center Borstel, Leibniz Lung Center, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Borstel, ²Interdisciplinary Allergy Outpatient Clinic, Department of Pneumology, University Medical Center Schleswig-Holstein, Campus Lübeck, University of Lübeck, ³Institute of Allergology, Charité Universitätsmedizin Berlin und Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, ⁴Division of Pediatric Pulmonology and Allergology, University Children’s Hospital, German Center for Lung Research (ARCN, DZL), Lübeck, ⁵Department of Dermatology and Allergy Biederstein, Klinikum rechts der Isar, Technical University of Munich, ⁶Division of Cardiology, Pulmonary Diseases, Vascular Medicine, University Hospital Duesseldorf, ⁷Center for Rhinology and Allergology, Wiesbaden, ⁸Institute of Laboratory Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Philipps Universität Marburg, Member of the German Center for Lung Research (DZL) Marburg, ⁹Interdisciplinary Allergy Center Nuremberg (NIZA), Department of Internal Medicine ³, Pneumology, Nuremberg Hospital, Nuremberg, ¹⁰Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Essen, ¹¹Department of Dermatology and Allergy, Hannover Medical School, Hannover, ¹²Institute of Allergology IFA, Charité Universitätsmedizin corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Berlin, ¹³Department of Otorhinolaryngology, Düsseldorf University Hospital, Heinrich Heine University, Düsseldorf, ¹⁴Division of Allergy and Immunology, Department of Dermatology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
The development of targeted therapies for atopic diseases, urticaria, and angioedema with biologics is progressing rapidly: New “targets” of clinical-therapeutic relevance have been identified, the corresponding targeted antibodies developed, tested in clinical trials, and approved for therapy. These include the anti-IgE antibody omalizumab (also effective and approved for the treatment of urticaria), the anti-IL-4/13 receptor-specific antibody dupilumab, the two anti-IL-13 antibodies lebrikizumab and tralokinumab, the anti-TSLP antibody tezepelumab, the two anti-IL-5 antibodies mepolizumab and reslizumab, and the anti-IL5 receptor-specific antibody benralizumab for the treatment of atopic diseases. For the treatment of hereditary angioedema, C1 inhibitor and the antibody lanadelumab (directed against kallikrein) have also long been approved as biologics in addition to low-molecular substances. Other therapeutic antibodies are in various stages of development. Furthermore, the range of indications for some very effective biologics has been successfully expanded to include additional diseases. In this context, the first results on biologic therapy of food allergy and eosinophilic esophagitis are interesting. Biologics that address different target structures are also increasingly being administered in combination, either simultaneously or sequentially, in order to achieve optimal efficacy. A developing area is the use of biologics in children and the observation of immunological and non-immunological side effects. In some cases, new unexpected side effects and hypersensitivity reactions have emerged, which in turn raise pathomechanistic questions, such as conjunctivitis with dupilumab therapy, which only appears to occur in the treatment of atopic dermatitis but not in the treatment of other atopic diseases. In dermatology, paradoxical reactions have been described under therapy with some biologics. And immune reactions of type alpha to epsilon to biologics (hypersensitivity reactions) continue to be a clinically relevant problem, whereby the selection of an alternative therapeutic agent is a challenge and the diagnostics that support this have not yet been sufficiently incorporated into routine work.Correspondence to:
Prof. Dr. med. Uta Jappe, Division Clinical and Molecular Allergology, Research Center Borstel, Leibniz Lung Center, Parkallee 35, 23845 Borstel, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 8/2024 (407-424)

Occupational anaphylaxis: A Position Paper of the German Society of Allergology and Clinical Immunology (DGAKI)

Regina Treudler¹, Margitta Worm², Andrea Bauer³, Heinrich Dickel⁴, Guido Heine⁵, Uta Jappe⁶, Ludger Klimek⁷, Monika Raulf⁸, Bettina Wedi⁹, Dorothea Wieczorek⁹, Wojciech Francuzik², Thilo Jakob¹⁰, Oliver Pfaar¹¹, Johannes Ring¹², Franziska Rueff¹³, Sabine Schnadt¹⁴, Thomas Werfel⁹, Gerda Wurpts¹⁵, Julia Zarnowski¹⁶, Torsten Zuberbier¹,¹⁷, and Knut Brockow¹²

¹Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, ²Department of Dermatology, Venereology and Allergology, Charité – Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, ³Department of Dermatology, University AllergyCenter, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, ⁴Department of Dermatology, Venereology and Allergology, St. Josef Hospital, University Medical Center, Ruhr University Bochum, Bochum, ⁵Department of Dermatology, Venereology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, ⁶Division of Clinical and Molecular Allergology, Research Center Borstel, Airway Research, Center North (ARCN), Member of the German Center for Lung Research, Borstel, Interdisciplinary Allergy Outpatient Clinic, Department of Pneumology, University of Luebeck, ⁷Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz and Center for Rhinology and Allergology, Wiesbaden, ⁸Department of Allergology/Immunology; Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bochum, Germany, ⁹Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover, ¹⁰Department of Dermatology and Allergology, University Medical Center Giessen (UKGM), Justus-Liebig-University Giessen, Giessen, ¹¹Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, ¹²Department of Dermatology and Allergy Biederstein, School of Medicine and Health, Technical University of Munich TUM), ¹³Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, ¹⁴German Allergy and Asthma Association (DAAB), Mönchengladbach, ¹⁵Clinic for Dermatology and Allergology, Aachen Comprehensive Allergy Center (ACAC), University Hospital of RWTH Aachen University, Aachen, ¹⁶Department of Dermatology, Venerology and Allergology, University of Leipzig Medical Center, Leipzig, and ¹⁷Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
Background: Anaphylaxis is a systemic allergic reaction that is potentially life-threatening. Occupational anaphylaxis is an anaphylaxis that occurs in an occupational context. In this position paper, we propose diagnostic criteria for occupational anaphylaxis and provide an overview of the current state of knowledge in terms of prevalence, triggers, prevention, and management. Results: The most common triggers of occupational anaphylaxis include Hymenoptera venoms, followed by food and drugs. Chemicals, bites or contact with animals (mammals/snakes/insects) and natural rubber latex are far less common. Occupations at risk for occupational anaphylaxis are therefore beekeepers, outdoor workers, or those who handle food as well as healthcare workers. The route of contact, intensity, and frequency of exposure, type of allergen, and the simultaneous occurrence of co-factors determine the clinical manifestation. A detailed medical history is required to confirm the diagnosis of anaphylaxis and to identify the trigger. Both skin tests and the determination of specific IgE are recommended, but only very few commercially available and quality-tested allergens are available that can be examined using both test methods. Preventive measures are based on avoiding further exposure or, if necessary, replacing a working substance. A written emergency plan and the prescription of an adrenaline autoinjector as well as instructions for its use are mandatory. Allergen immunotherapy is recommended for systemic Hymenoptera venom allergy. Depending on the national healthcare systems, patients with occupational anaphylaxis must be reported to the accident insurance. Conclusion: Occupational anaphylaxis is very rare. We recommend educational measures and generally standardized recording of occupational anaphylaxis for occupations with an increased risk of anaphylaxis.Correspondence to:
Prof. Dr. Regina Treudler, Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Institute of Allergology, Hindenburgdamm 30, 12203 Berlin, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 8/2024 (425-433)

Registries in allergy: Structure, target groups, and key findings of allergyfocused registries in Germany

Marie Farkic, Philipp Globig, Aikaterina Alexiou, and Margitta Worm

Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergology, Charité – Universitätsmedizin Berlin, Berlin, Germany
In allergology, clinical registries fill knowledge gaps of epidemiology, mechanisms of allergic diseases, and real-world treatment outcomes. Considering the continuous rise of allergic diseases worldwide, registries become increasingly important for the optimization and harmonization of patient care. In the current review, we present four ongoing allergy-focused registries initiated in Germany. We conducted a focused literature search and discussed their structure, main purposes, and findings. Registries included are the “Information Network of Departments of Dermatology”, the “European Anaphylaxis Registry”, the “GAN Severe Asthma Registry”, and “TREATgermany”. Despite differences in scope and operation, all registries gather harmonized real-world data that is indispensable for evidence-based decision making in clinical practice and ultimately improves patient care in allergology.Correspondence to:
Marie Farkic, Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergology, Charité – Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 8/2024 (434-441)

Sensitization to food allergens is associated with more severe wheezing in children

Ozge Yılmaz¹, Cecilia M. Patino², Fatma Taneli³, Esra Toprak Kanik¹, Ahmet Turkeli¹, Ceyhun Gozukara³, Sezen Irmak³, and Hasan Yuksel¹

¹Manisa Celal Bayar University, School of Medicine, Department of Pediatric Allergy and Pulmonology, Manisa, Turkey, ²University of Southern California, Keck School of Medicine, Department of Preventive Medicine, Los Angeles, CA, USA, and ³Manisa Celal Bayar University, School of Medicine, Department of Biochemistry, Manisa, Turkey
Aims: We investigated sensitization to food allergens as a prognostic factor for wheezing in children with recurrent wheezing and compared serum club cell 16 (CC16) and surfactant protein D (SP-D) among these children with and without sensitization to food allergens. Materials and methods: Children with recurrent wheezing were enrolled in this prospective cohort study. Specific IgE to five common food allergens (Fx5) was assessed at baseline, and children were followed-up for 1 year for new-onset wheezing episodes. Baseline wheezing severity score, CC16, and SP-D levels were measured. Results: We enrolled 295 children (44 Fx5(+)). Poisson regression analysis revealed that Fx5 positivity changed the yearly frequency of wheeze by a factor of 1.66 (p = 0.05, 95% CI: (0.99 – 2.75)). Levels of CC16 and SP-D were not significantly different between the groups (p = 0.679 and p = 0.988). Conclusion: Sensitization to food allergens irrespective of food associated clinical allergy findings is associated with worse prognosis of wheezing in children.Correspondence to:
Prof. Ozge Yilmaz, MD, Manisa Celal Bayar University School of Medicine, Department of Pediatric Allergy and Pulmonology, Manisa, Turkey
Email: [email protected]

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