Volume 9 (2025)
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Original
Significant handling errors and education gaps regarding the use of the emergency kit among adult patients with Hymenoptera venom allergy
Julia Zarnowski, Louise Wilkens, and Regina Treudler
Page No. 1
Abstract
Allergologie select, Vol. 9/2025 (1-7)
Significant handling errors and education gaps regarding the use of the emergency kit among adult patients with Hymenoptera venom allergy
Julia Zarnowski1, Louise Wilkens1, and Regina Treudler1,2
1Department of Dermatology, Venereology and Allergology, University Hospital Leipzig, Leipzig, and 2Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
Aim: In case of systemic anaphylactic reactions after Hymenoptera stings, patients should be provided with an adrenaline autoinjector (AAI). We aimed to evaluate the education and handling competence of patients in a real-world setting. Materials and methods: Patients with Hymenoptera venom allergy presenting for the first time in our clinic with a previously prescribed emergency kit including an AAI were interviewed using a standardized questionnaire and were asked to demonstrate the AAI use with a dummy. Results: 82 patients (62.2% female, mean age 52.0 ± 17.3 years) with allergy to wasp venom (85.3%), bee venom (9.8%), or hornet venom (4.9%) were included. 37.8% reported to have received a practical training on the AAI upon prescription. 59.8% of all patients showed significant handling errors which would have led to misinjections in 30.6%. Conclusion: Our data demonstrate a considerable lack of education, significant handling errors of the emergency kit, and a high risk of misinjections of the AAI. As the emergency kit is potentially lifesaving, the awareness for a sufficient education and training needs to be risen.Correspondence to:
Dr. med. Julia Zarnowski, Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig, Philipp-Rosenthal-Straße 69, 04103 Leipzig, Germany
Email: [email protected]
Original
Substantial psychosocial impairments in patients with chronic urticaria are associated with delayed referral to urticaria centers, non-academic treatments, and dietary changes
Julia Zarnowski, Paula Kage, and Regina Treudler
Page No. 8
Abstract
Allergologie select, Vol. 9/2025 (8-15)
Substantial psychosocial impairments in patients with chronic urticaria are associated with delayed referral to urticaria centers, non-academic treatments, and dietary changes
Julia Zarnowski1, Paula Kage1,2, and Regina Treudler1,3
1Department of Dermatology, Venereology and Allergology, University Hospital Leipzig, Leipzig, 2Dermatological practice, Dr. med. Paula Kage, Freiberg, and 3Institute for Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
Background: Chronic idiopathic urticaria (CIU) is common in allergological practice. Although therapeutic options have improved in the past decade, patients still suffer from a significant burden of disease and are often treated insufficiently. Objective: We aimed at analyzing the psychiatric comorbidities, social impairments, and treatment gap in a real-world setting. Materials and methods: Adult patients with CIU were investigated for demographical data, medical history, and psychosocial burden. Validated questionnaires were used to assess urticaria activity, control of disease, quality-of-life impairment, and psychiatric comorbidities. Results: 82 patients (78% female; 47.5 ± 14.8 years) were included. 65.9% had insufficient disease control, 11% reported on prior self-medication with drugs, 19.5% were seeking help from non-academic medicine, and 54.9% tried a change of diet. The use of non-academic treatment was significantly associated with higher disease activity. Self-initiated dietary changes were significantly associated with less control of disease. Delayed referrals to a urticaria-specialized center were significantly linked to self-reported psychiatric diseases, self-medication with drugs and self-initiated dietary changes. Conclusion: Our data show an unsatisfactory control of CIU in many patients and substantial psychosocial impairments which are also associated with a delayed referral to urticaria centers, self-initiated non-academic treatments, and dietary changes.Correspondence to:
Dr. med. Julia Zarnowski, Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig, Philipp-Rosenthal-Straße 69, 04103 Leipzig, Germany
Email: [email protected]
Letter
Comment on Reese et al. 2023 “Vegan Diets from an Allergy Point of View – Position Paper of the DGAKI Working Group on Food Allergy”. Allergologie Select. 2023; 7: 57-83.
Christian Koeder
Page No. 16
Abstract
Allergologie select, Vol. 9/2025 (16-17)
Comment on Reese et al. 2023 “Vegan Diets from an Allergy Point of View – Position Paper of the DGAKI Working Group on Food Allergy”. Allergologie Select. 2023; 7: 57-83.
Christian Koeder
Institute for Prevention and Cancer Epidemiology (IPE), Faculty of Medicine, University of Freiburg, Freiburg, Germany
Correspondence to:
Dr. med. Christian Koeder, Institute for Prevention and Cancer Epidemiology (IPE), Faculty of Medicine, University of Freiburg, Elsässerstraße 2, 79110 Freiburg, Germany
Email: [email protected]
Response
Response to Letter to the Editor from Christian Koeder
Imke Reese, Christiane Schäfer, Barbara Ballmer-Weber, Kirsten Beyer, Sabine Dölle-Bierke, Suzanne van Dullemen, Uta Jappe, Sabine Schnadt, and Regina Treudler
Page No. 18
Abstract
Allergologie select, Vol. 9/2025 (18-20)
Response to Letter to the Editor from Christian Koeder
Imke Reese1, Christiane Schäfer2, Barbara Ballmer-Weber3,4, Kirsten Beyer5, Sabine Dölle-Bierke6, Suzanne van Dullemen7, Uta Jappe8,9, Sabine Schnadt10, and Regina Treudler11
1Nutrition Therapy, Munich, 2NutritionTherapy, Schwarzenbek, Germany, 3Clinic for Dermatology and Allergology, Cantonal Hospital St. Gallen, St. Gallen, 4Department of Dermatology, University Hospital Zürich, Switzerland, 5Clinic for Pediatrics with focus on Pneumology and Immunology, Charité-Universitätsmedizin – Campus, Virchow-Klinikum, 6Allergology and Immunology, Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, 7University Clinic Frankfurt, Clinic for Pediatrics, Frankfurt/Main, 8Division of Clinical and Molecular Allergology, Research, Center Borstel, German Center for Lung Research (DZL) Airway Research Center North (ARCN), Borstel, 9Interdisciplinary Allergy Outpatient Clinic, Department of Pneumology, University of Lübeck, Lübeck, 10German Allergy and Asthma Association (DAAB), Mönchengladbach, and 11Department of Dermatology, Venereology and Allergology, Leipzig University Medical Center, Leipzig, Germany
Correspondence to:
Dr. Imke Reese, Ernährungsberatung und -therapie, Schwerpunkt Allergologie, Ansprengerstr. 19, 80803 Munich, Germany
Email: [email protected]
Original
Recent findings from the anaphylaxis registry: Where are we, where do we want to go?
Margitta Worm, Sabine Dölle-Bierke, Lea Faust, and Veronika Höfer
Page No. 21
Abstract
Allergologie select, Vol. 9/2025 (21-27)
Recent findings from the anaphylaxis registry: Where are we, where do we want to go?
Margitta Worm, Sabine Dölle-Bierke, Lea Faust, and Veronika Höfer
Allergology and Immunology, Clinic for Dermatology, Venereology and Allergology, Campus Charité Mitte, Universitätsmedizin Berlin, Berlin, Germany
The anaphylaxis registry collects structured data across Europe regarding elicitors, accompanying circumstances and other diseases as well as the treatment of severe allergic reactions. By March 2024, 16,988 cases had been registered, of which ~ 1/3 were children and 2/3 were adults. Among children, boys are most frequent affected, while among adults, women are most frequently affected. The most common elicitors depend on age and continue to be dominated by the food allergens in children and by insect venom in adults. The occurrence of anaphylaxis without skin symptoms is not uncommon and occurs in children in the range of 5%, regardless of the trigger, while in adults the frequency is generally higher (up to 15%) and there are triggerdependent differences. The analysis of the rare food allergens that trigger anaphylaxis shows, for example, spices such as saffron and sumac and vegetables such as chicory or spring onions. One case was elicited by a mealworm. Food shows an increase in triggering anaphylaxis in children. The trigger spectrum of foods is large and relevant due to the increasing plant-based diets. Rare allergens can cause anaphylaxis and should be further considered and monitored in the coming years to determine their frequency as triggers of severe reactions.Correspondence to:
Prof. Dr. med. Margitta Worm, Klinik für Dermatologie, Venerologie und Allergologie, Allergologie und Immunologie, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
Email: [email protected]
Position Paper
Recommendations on how to proceed in case of suspected allergy to penicillin/β-lactam antibiotics. Position paper of the German Society for Allergology and Clinical Immunology (DGAKI) in cooperation with the German Society for Pediatric Allergology (
Knut Brockow, Wolfgang Pfützner, Bettina Wedi, Gerda Wurpts, Axel Trautmann, Burkhard Kreft, Timo Buhl, Mathias Sulk, Andreas Recke, Kathrin Scherer, Stefan Wöhrl, Irena Neustädter, Regina Treudler, Christiane Querbach, and Margitta Worm
Page No. 28
Abstract
Allergologie select, Vol. 9/2025 (28-39)
Recommendations on how to proceed in case of suspected allergy to penicillin/β-lactam antibiotics. Position paper of the German Society for Allergology and Clinical Immunology (DGAKI) in cooperation with the German Society for Pediatric Allergology (
Knut Brockow1, Wolfgang Pfützner2, Bettina Wedi3, Gerda Wurpts4, Axel Trautmann5, Burkhard Kreft6, Timo Buhl7, Mathias Sulk8, Andreas Recke9, Kathrin Scherer10, Stefan Wöhrl11, Irena Neustädter12, Regina Treudler13, Christiane Querbach14, and Margitta Worm15
1Department of Dermatology and Allergology Biederstein, Faculty of Medicine and Health, Technical University of Munich, Munich, 2Department of Dermatology and Allergology, University Hospital Giessen and Marburg, Marburg, 3Hanover Medical School, Department of Dermatology, Allergology and Venereology, Hanover, 4Department of Dermatology and Allergology, Germany, Aachen Comprehensive Allergy Center (ACAC), University Hospital of RWTH Aachen University, Aachen, 5Department of Dermatology and Allergology, Allergy Center Mainfranken, University Hospital Würzburg, Würzburg, 6Department of Dermatology and Venereology, University Hospital Halle, Halle (Saale), 7Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, 8Department of Dermatology, Münster University Hospital, Münster, 9Department of Dermatology, Allergology and Venereology, University Hospital Schleswig-Holstein, Holstein Campus Lübeck, Lübeck, Germany, 10Department of Dermatology, Cantonal Hospital Aarau, Aarau, and Department of Dermatology and Allergology, University Hospital Basel, Switzerland, 11Floridsdorf Allergy Center (FAZ), Vienna, Austria, 12Pediatric Clinic, Diakoneo Klinik Hallerwiese-Cnopfsche Kinderklinik, Nuremberg, 13Institute for Allergy Research, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, 14Hospital Pharmacy, Klinikum rechts der Isar, Technical University of Munich, Munich, and 15Allergology and Immunology, Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
β-lactam antibiotics (BLAs) are still the antibiotics of first choice for the treatment of many bacterial infections. Treatment with a BLA is often hindered by a suspected allergy, up to 10% of the population report an allergy to penicillin. After Position Paper allergological evaluation of the suspected allergic reaction to a BLA, most patients show a low probability of a BLA allergy; only in a minority of cases an allergic reaction to the repeated administration of a BLA appear likely in view of the previous history. In > 90% of cases, the suspected BLA allergy can be ruled out by allergy diagnostics. We recommend a risk-stratified approach in the context of an urgent need for BLA, which should enable most patients to receive a BLA therapy. After acute therapy, allergy diagnostics have to be done to clearly prove or reliably rule out a BLA allergy.Correspondence to:
Prof. Dr. med. Knut Brockow, Department of Dermatology and Allergology Biederstein, Faculty of Medicine and Health, Technical University of Munich, Biedersteiner Strasse 29, 80802 Munich, Germany
Email: [email protected]
Original
The importance of registries in clinical practice: Insights from the national atopic dermatitis registry TREATgermany
Tatjana Honstein, Barbara Kind, Dora Stölzl, Inken Harder, Sigrid Müller, Thomas Birkner, Luise Heinrich, Sascha Fischer, Nicole Sander, Annice Heratizadeh, Jochen Schmitt, Stephan Weidinger, and Thomas Werfel
Page No. 40
Abstract
Allergologie select, Vol. 9/2025 (40-46)
The importance of registries in clinical practice: Insights from the national atopic dermatitis registry TREATgermany
Tatjana Honstein1, Barbara Kind2, Dora Stölzl3, Inken Harder3, Sigrid Müller2, Thomas Birkner2, Luise Heinrich2, Sascha Fischer1, Nicole Sander3, Annice Heratizadeh1, Jochen Schmitt2, Stephan Weidinger3, and Thomas Werfel1
1Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover,, 2Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, and 3Department of Dermatology, Venereology and Allergology, Schleswig-Holstein University Hospital, Kiel Campus, Kiel, Germany
Atopic dermatitis (AD) is an inflammatory, multifactorial skin disease characterized by eczematous skin lesions, severe itching, and serious limitations in quality of life. Since 2016, TREATgermany has been a national clinical registry for patients with moderate to severe AD with around 2,550 participating patients, enabling the collection of physical, patient-reported social and psychological data as well as the collection of biosamples in routine care. TREATgermany is one of the largest academically managed AD registries in the world. This current review summarizes a selection of published analyses from registry data from TREATgermany, which retrospectively identified important correlations with regard to treatment response and safety, and investigated quality of life, performance, and mental health under everyday conditions. In addition, initial molecular signatures were identified from the blood and skin samples obtained from the patients included in the registry, which may be useful as prognostic markers.Correspondence to:
Tatjana Honstein, Hannover Medical School, OE6600, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
Email: [email protected]
Case Report
Occupational buckwheat allergy in a health food store employee: From inhalative exposure to anaphylaxis
Julia Felicitas Pilz, Valentina Faihs, Claudia Kugler, Ulf Darsow, Tilo Biedermann, and Knut Brockow
Page No. 47
Abstract
Allergologie select, Vol. 9/2025 (47-49)
Occupational buckwheat allergy in a health food store employee: From inhalative exposure to anaphylaxis
Julia Felicitas Pilz, Valentina Faihs, Claudia Kugler, Ulf Darsow, Tilo Biedermann, and Knut Brockow
Department of Dermatology and Allergy Biederstein, School of Medicine and Health, Technical University of Munich (TUM), Munich, Germany
Background: Buckwheat allergy is common in East Asian countries with high buckwheat consumption. However, with increasing popularity of buckwheat as a gluten-free food, it is also expected to become more widespread in Europe. Case report: A health food store employee experienced anaphylaxis with urticaria, angioedema, and dyspnea after eating a slice of buckwheat bread. Prior to this reaction, the patient had repeatedly noticed rhinoconjunctival itching and sneezing when handling buckwheat. A positive skin prick test with buckwheat flour and elevated specific IgE levels to buckwheat confirmed the suspected diagnosis. Conclusion: Food industry employees may develop sensitization to buckwheat through inhalation of buckwheat flour. This sensitization can lead to rhinoconjunctival symptoms upon airborne exposure and to anaphylaxis after ingestion.Correspondence to:
Dr. med. Julia Felicitas Pilz, Department of Dermatology and Allergy Biederstein, Klinikum rechts der Isar, Technical University of Munich, Biedersteiner Str. 29, 80802 Munich, Germany
Email: [email protected]
Letter
Nasal eosinophil count and visual analog scale in patients with allergic rhinitis
Giorgio Ciprandi and Irene Schiavetti
Page No. 50
Abstract
Allergologie select, Vol. 9/2025 (50-52)
Nasal eosinophil count and visual analog scale in patients with allergic rhinitis
Giorgio Ciprandi1 and Irene Schiavetti2
1Allergy Clinic, Department of Outpatients, Casa di Cura Villa Montallegro, and 2Health Science Department, University of Genoa, Genoa, Italy
Correspondence to:
Giorgio Ciprandi, MD, Allergy Clinic, Department of Outpatients, Casa di Cura Villa Montallegro, Via Paolo Boselli 5, 16146 Genoa, Italy
Email: [email protected]
Review
Characteristics of irreversibility in high-resolution computed tomography in chronic hypersensitivity pneumonitis
Beate Rehbock, Andreas Gschwendtner, and Okka W. Hamer
Page No. 53
Abstract
Allergologie select, Vol. 9/2025 (53-57)
Characteristics of irreversibility in high-resolution computed tomography in chronic hypersensitivity pneumonitis
Beate Rehbock1, Andreas Gschwendtner2, and Okka W. Hamer3
1Institute for Lung Imaging and Image Assessment, Potsdam, 2Institute of Pathology, Kulmbach Hospital, Kulmbach, and 3Department of Radiology, University Medical Center Regensburg and Caritas St. Maria Lung Clinic, Donaustauf, Germany
From a radiological point of view, the statement of irreversibility can only be made with certainty for the signs of irregular reticulation in conjunction with traction bronchiectasis and for honeycomb cysts in the HR-CT morphologically fibrotic phenotype. The HR-CT signs of the inflammatory phenotype can behave differently. Ground-glass nodules always have a reversible potential. In contrast, the underlying pathology of ground-glass opacity can only be assessed over time, as it does not necessarily correlate with inflammation but can also correspond to fine fibrosis. Similarly, air trapping on HR-CT is an important sign of hypersensitivity pneumonitis in both the radiologically inflammatory and fibrotic form. The persistence of air trapping in the inflammatory type over years suggests the possibility of irreversibility of the bronchiolitis in these cases. Whether a higher resolution in HR-CT, such as through photon-counting CT, can lead to clearer differentiation and prediction of reversibility and irreversibility in the future remains to be seen.Correspondence to:
Dr. med. Beate Rehbock, Institute for Lung Imaging and Image Assessment, Große Weinmeisterstrasse 36a, 14469 Potsdam, Germany
Email: [email protected]
Case Report
Legumes in bread baking: A hidden risk for an IgE-mediated inhalant allergy
Sabine Kespohl, Christian Eisenhawer, Silke Maryska, Ingrid Sander, Irene Mittermann, Martina Aumayr, and Monika Raulf
Page No. 58
Abstract
Allergologie select, Vol. 9/2025 (58-65)
Legumes in bread baking: A hidden risk for an IgE-mediated inhalant allergy
Sabine Kespohl1, Christian Eisenhawer1, Silke Maryska1, Ingrid Sander1, Irene Mittermann2, Martina Aumayr2, and Monika Raulf1
1Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany, and 2MacroAssay Diagnostics, Vienna, Austria
New protein-rich flour blends from legumes are increasingly being processed for gluten-free bakery products, which may increase the risk of IgE-mediated sensitization through inhalation exposure. In the described case of a 29-year-old baker, work incapacity occurred due to respiratory complaints following exposure to various gluten-free baking ingredients. Occupationrelated sensitization to “chestnut pea flour” (flour from lightly roasted and ground yellow peas) was identified, while the patient showed no IgE sensitization to five other ingredients. Significant allergic respiratory reactions occurred during bronchial challenge test with “chestnut pea” extract. Based on the test results and typical workplace-related symptoms, recognition of occupational disease was recommended. Further identification of potential causal allergens using IgE blot and allergen component-resolved diagnostics revealed IgE bindings to typical storage proteins, 2S albumin and vicilin, as well as to Bet v 1 homologous of “chestnut pea” and non-specific lipid transfer proteins. This case illustrates that the processing of protein-rich legume flours can pose new sensitization risks for workers, which should be considered in the future.Correspondence to:
Dr. Sabine Kespohl, Department Competence Centre for Allergology/Immunology, 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]
Case Report
Airborne exposure-induced occupational type I allergy to Tenebrio molitor: Case report and studies on immunological reactivity
Laura Weißenborn, Sabine Kespohl, Silke Maryska, Ingrid Sander, Jakob Bickhardt, Thomas Henle, and Monika Raulf
Page No. 66
Abstract
Allergologie select, Vol. 9/2025 (66-74)
Airborne exposure-induced occupational type I allergy to Tenebrio molitor: Case report and studies on immunological reactivity
Laura Weißenborn1, Sabine Kespohl2, Silke Maryska2, Ingrid Sander2, Jakob Bickhardt3, Thomas Henle1, and Monika Raulf2
1Chair of Food Chemistry, Technische Universität Dresden, Dresden, 2Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, and 3Pulmonary Specialist Practice and Training Center, Dresden, Germany
This occupational case report describes a 28-year-old woman, employed since November 2020 as a research assistant working with mealworms (Tenebrio molitor), who developed symptoms of mild shortness of breath and severe redness and swelling of the eyes in early 2022, leading to the diagnosis of occupational allergic asthma due to respiratory sensitization to mealworm. Subsequent tests confirmed mono-sensitization to T. molitor and additional cross-sensitization to flour beetle (Tribolium confusum). Further studies aimed to determine the antigenic and allergenic potency of different protein fractions and rearing material isolated from T. molitor regarding protein pattern and immunological activity by T. molitor-specific polyclonal rabbit IgG and human IgE. The highest antigen content of T. molitor was measured in the rearing material, followed by mealworm flour and aqueous extraction. Allergenic proteins are particularly detected in mealworm flour and aqueous fraction at molecular weights of 24 and 11 kDa, which appear to be specific for primary airway sensitization. In addition, the airborne T. molitor antigen levels in the workplace were monitored using electrostatic dust collectors to identify hotspots of exposure. The disposal of dry insect material was shown to be responsible for the unintentional release of potential allergens. Therefore, awareness of the potential risk of a type I allergy due to the release of airborne insect allergens in the workplace should be raised.Correspondence to:
Laura Weißenborn, Technische Universität Dresden, Professur für Lebensmittelchemie, Bergstraße 66, 01062 Dresden, Germany
Email: [email protected]
Review
AI – one size fits all?
Stephan Traidl, Sonja Mathes, and Sebastian Seurig
Page No. 75
Abstract
Allergologie select, Vol. 9/2025 (75-79)
AI – one size fits all?
Stephan Traidl1, Sonja Mathes2, and Sebastian Seurig3
1Department of Dermatology and Allergy, Hannover Medical School, Hanover, 2Department of Dermatology and Allergy, School of Medicine and Health, Technical University of Munich, Munich, and 3Department of Respiratory Medicine, Allergology and Sleep Medicine, General Hospital Nuremberg, Campus North, Paracelsus Medical University, Nuremberg, Germany
The use of artificial intelligence (AI) in medicine requires a careful selection of suitable models, as there is no universal “one size fits all” method. While linear regression is convincing due to its simplicity and interpretability, it is limited due to the assumption of linearity and susceptibility to multicollinearity and outliers. More complex approaches such as neural networks show their strengths in the detection of non-linear patterns and automatic feature extraction but require large amounts of data, high computing capacity, and suffer from limited explainability. Principal component analysis (PCA) offers an efficient reduction of dimensionality. Ultimately, the choice of model depends on the balance between accuracy, interpretability, and data availability. A selection of machine learning models is presented in this article.Correspondence to:
PD Dr. med. Stephan Traidl, MSc, Department of Dermatology and Allergy, Hannover Medical School, Carl-Neuberg-Str.1, 30625 Hanover, Germany
Email: [email protected]
Review
Adrenaline nasal spray in emergency management: An initial expert opinion
Regina Treudler, Knut Brockow, Kirsten Beyer, Ludger Klimek, Lars Lange, Sabine Schnadt, Johannes Ring, and Margitta Worm
Page No. 80
Abstract
Allergologie select, Vol. 9/2025 (80-85)
Adrenaline nasal spray in emergency management: An initial expert opinion
Regina Treudler1, Knut Brockow2, Kirsten Beyer3,4, Ludger Klimek5, Lars Lange6, Sabine Schnadt7, Johannes Ring2, and Margitta Worm8
1Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, 2Department of Dermatology and Allergology am Biederstein, Faculty of Medicine and Health, Technical University of Munich, Munich, 3Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, 4German Center for Child and Adolescent Health (DZKJ), Berlin, 5Center for Rhinology and Allergology, Wiesbaden, 6Department of Pediatrics and Adolescent Medicine, St. Marien-Hospital, Bonn, 7German Allergy and Asthma Association (DAAB). (DAAB), Mönchengladbach, and 8Department of Dermatology, Venerology and Allergology, Charité – Universitätsmedizin Berlin, Berlin, Germany
Adrenaline is the drug of choice for the treatment of anaphylaxis. Up to now, intramuscular administration using an autoinjector has been recommended in national and international guidelines as the first-line treatment for anaphylaxis. Various adrenaline autoinjectors are available on the German market as emergency medication for immediate treatment by medical laypersons and specialists. Recently, a nasally administered adrenaline preparation was introduced for the first time and is available on the market. There are mainly data on healthy control subjects, which show a good adrenaline level and an expected effect on blood pressure and heart rate. To date, there is little clinical experience in the world literature for patients with anaphylaxis in children/adolescents and none in adults or from Germany. Therefore, we would like to discuss theoretically the use of adrenaline via the nasal route of administration in the care of anaphylaxis patients and compare it with the intramuscular administration of adrenaline autoinjectors.Correspondence to:
Prof. Dr. med. Regina Treudler, Institute of Allergology, Charité – Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
Email: [email protected]
Review
Ethical aspects of the application of artificial intelligence in allergology
Sonja Mathes, Sebastian Seurig, Stephan Traidl, Valentina Faihs, Marta Dechant, Knut Brockow, and Ulf Darsow
Page No. 86
Abstract
Allergologie select, Vol. 9/2025 (86-92)
Ethical aspects of the application of artificial intelligence in allergology
Sonja Mathes1, Sebastian Seurig2, Stephan Traidl3, Valentina Faihs1, Marta Dechant1, Knut Brockow1, and Ulf Darsow1
1Department of Dermatology and Allergy, School of Medicine and Health, Technische Universität München, Munich, 2Department of Respiratory Medicine, Allergology and Sleep Medicine, General Hospital Nuremberg, Campus North, Paracelsus Medical University, Nuremberg, and 3Department of Dermatology and Allergy, Hannover Medical School, Hanover, Germany
Background: Artificial intelligence (AI) offers a wide range of applications in allergology, including diagnostics and disease course prediction, consultations, real-time monitoring of allergic reactions, and support for decentralized clinical studies. Materials and methods: This review aims to highlight not only the potential applications but also the ethical aspects of using AI in allergology. Results: Initial studies demonstrate potential applications of AI in predicting provocation tests and antibiotic delabeling. However, these models from research and development have not yet been established in clinical practice, partly because ethical considerations, alongside technical challenges, and data quality issues, must be addressed. Key ethical dilemmas include bias and fairness, the principle of nonmaleficence, data protection and autonomy, transparency of AI models, and questions of accountability. AI applications must be robust and reliable to prevent harm caused by erroneous recommendations. Conclusion: The use of AI in allergology requires clear guidelines based on principles such as autonomy, justice, and non-maleficence. General bioethical principles must be complemented by specific regulations for AI.Correspondence to:
Dr. med. Sonja Mathes, Klinik und Poliklinik für Dermatologie und Allergologie, Biedersteiner Straße 29, 80802 Munich, Germany
Email: [email protected]
Original
Therapy Allergen Ordinance (TAO): The final stretch
Vera Mahler, Diana Hartenstein, Iris Lauer, Stefan Vieths, Claudia Ruoff, Julia Zimmer, and Susanne Kaul
Page No. 93
Abstract
Allergologie select, Vol. 9/2025 (93-99)
Therapy Allergen Ordinance (TAO): The final stretch
Vera Mahler1, Diana Hartenstein1, Iris Lauer1, Stefan Vieths2, Claudia Ruoff3, Julia Zimmer1, and Susanne Kaul1
1Allergology Division, 2President of the Paul-Ehrlich-Institut; Molecular Allergology Research Group, and 3Legal Affairs Section, Safety of Biomedicines and Diagnostics Division, Paul-Ehrlich-Institut, Langen, Germany
The Therapy Allergen Ordinance (TAO) aims to migrate allergen immunotherapy (AIT) products for the treatment of common allergies, which were previously marketed in Germany as named patient products (NPPs), into authorized products provided their quality, efficacy, and safety are adequately shown. The TAO applies to all NPPs containing active ingredients based on the following allergen sources: house dust mites, bee venom, wasp venom, pollen from sweet grasses (excluding maize), birch, alder, or hazel. The last product-specific deadlines granted under the TAO for the submission of clinical data relevant to the marketing authorization process will expire in 2026. The subsequent final assessment of the updated marketing authorization application (MAA) is carried out by the competent authority, the Paul-Ehrlich-Institut. During this period of processing by the competent authority, the products remain marketable until a decision regarding the MAA has been reached. Currently (as of August 08, 2025), 40 AIT products are still marketable under the transitional provisions of the TAO (10 preparations for the treatment of allergies to house dust mites, 10 against tree pollen allergies, 16 against grass pollen allergies, and 4 mixed preparations containing non-homologous allergen groups). For 8 of these products, pharmaceutical companies have initiated the withdrawal of MAA as of October 01, 2025 or January 31, 2026, respectively. Prior to the final assessment of the updated MAAs, the competent authority is unable to make any public statements as to whether the individual applications for the remaining 32 products under the transitional provision will be concluded positively with the granting of the marketing authorization or its rejection. With the rejection of a marketing authorization, the product-specific marketability ends immediately, i.e., there is no additional sell-off period for the TAO products concerned. If a marketing authorization is granted, the marketability of the specific product is perpetuated.Correspondence to:
Prof. Vera Mahler, MD, Abteilung Allergologie, Paul-Ehrlich-Institut, Paul-Ehrlich-Str. 51-59, 63225 Langen, Germany
Email: [email protected]
Case Report
Hymenoptera venom allergy: How negative testing after five years of immunotherapy informs treatment discontinuation
Matteo Cavara, Alice Botta, Alessandra Chiei Gallo, Eleonora Bono, Christian P. Ratti, Enrico Iemoli, and Valeria G.R. Ortolani
Page No. 100
Abstract
Allergologie select, Vol. 9/2025 (100-104)
Hymenoptera venom allergy: How negative testing after five years of immunotherapy informs treatment discontinuation
Matteo Cavara, Alice Botta, Alessandra Chiei Gallo, Eleonora Bono, Christian P. Ratti, Enrico Iemoli, and Valeria G.R. Ortolani
Allergy and Clinical Immunology Unit, ASST Fatebenefratelli Sacco, Sacco Hospital, Milan, Italy
Background: Hymenoptera venom allergy represents a potentially life‐threatening condition. Venom immunotherapy (VIT) is the treatment of choice in patients with systemic reactions. Case presentation: We report the case of a 65‐year‐old male, who experienced systemic reactions following hymenoptera stings. In vitro and in vivo allergy tests revealed sensitization predominantly to Polistes dominula and specific VIT was initiated. During VIT, the patient experienced two subsequent stings with only local reactions. After 5 years of VIT, repeated serological evaluation and skin tests turned negative, leading to the decision to discontinue therapy. Conclusion: This case underlines the efficacy and safety of VIT in patients with severe hymenoptera venom allergy in preventing systemic reactions. A comprehensive diagnostic work-up, including laboratory and skin tests, is crucial in the management and subsequent evaluation of therapeutic efficacy.Correspondence to:
Dr. Matteo Cavara, Allergy and Clinical Immunology Unit, ASST Fatebenefratelli Sacco, Sacco Hospital, Via Giovanni Battista Grassi, 74, 20157, Milan, Italy
Email: [email protected]
