Review
Assessment of the effects of a work-related allergy to seafood on the reduction of earning capacity in the context of BK No. 5101
Heinrich Dickel, Annette Kuehn, Beate Dickel, Andrea Bauer, Detlef Becker, Manigé Fartasch, Michael Haeberle, Swen Malte John, Vera Mahler, Christoph Skudlik, Elke Weisshaar, Thomas Werfel, Johannes Geier, and Thomas Ludwig Diepgen† for the working group “Evaluation of Allergens with regard to BK No. 5101” of the ABD and the DKG in the DDG
Volume 5 (2021) p. 33 - 44
Abstract
Allergologie select, Vol. 5/2021 (33-44)
Assessment of the effects of a work-related allergy to seafood on the reduction of earning capacity in the context of BK No. 5101
Heinrich Dickel1, Annette Kuehn2, Beate Dickel3, Andrea Bauer4, Detlef Becker5, Manigé Fartasch6, Michael Haeberle7, Swen Malte John8, Vera Mahler9, Christoph Skudlik8, Elke Weisshaar10, Thomas Werfel11, Johannes Geier12, and Thomas Ludwig Diepgen13† for the working group “Evaluation of Allergens with regard to BK No. 5101” of the ABD and the DKG in the DDG
1Department of Dermatology, Venerology and Allergology, St. Josef-Hospital, University Hospital of the Ruhr University Bochum (UK RUB), Bochum, Germany, 2Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg, 3Dermatological Practice Dr. med. Peter Wenzel, Hattingen, Germany, 4Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University, Dresden, Germany, 5Department of Dermatology, University Medical Center, Mainz, Germany, 6Institute for Prevention and Occupational Medicine (IPA) of the German Social Accident Insurance, Department of Clinical and Experimental Occupational Dermatology, Ruhr University Bochum, Bochum, Germany, 7Dermatological Practice, Künzelsau, Germany, 8Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück and Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany, 9Paul-Ehrlich-Institut (PEI), Langen, Germany, 10Division of Occupational Dermatology, Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany, 11Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany, 12Information Network of Departments of Dermatology (IVDK), Institute at the University Medical Center Göttingen, Göttingen, Germany, 13University of Heidelberg, Heidelberg, Germany
Fish, crustaceans, and mollusks are among the most potent allergenic foods of animal origin and are thus important triggers of work-related immediate-food allergies. In Germany, work-related seafood allergies are of great importance in the fishing and processing industries as well as in the areas of food preparation, food control, and food sales. There is no causal therapy of seafood allergy, only the strict and lifelong avoidance of allergens remains. The following recommendations serve to assess the impact of a seafood allergy with regard to the work opportunities ended by it for the assessment of the reduction of earning capacity (MdE (German for Minderung der Erwerbsfähigkeit)) in the context of the occupational disease number 5101 of the Annex to the German regulation for occupational diseases. As a special feature of work-related seafood allergy with regard to insurance law aspects, it must be taken into account that there is a potential risk of systemic reaction with subsequent multi-organ involvement. For the estimation of MdE in the general labor market, the impact of a seafood allergy can therefore be assessed, depending on its clinical severity, as generally “mild” to “severe” in justified individual cases.Correspondence to:
Priv.-Doz. Dr. med. Heinrich Dickel, Department of Dermatology, Venerology and Allergology, St. Josef-Hospital, University Hospital of the Ruhr University Bochum (UK RUB), Gudrunstraße 56, 44791 Bochum, Germany
Email: [email protected]
Original
Nickel and cobalt: Underestimated contact allergens in hairdressers?
Cara Symanzik, Christoph Skudlik, and Swen Malte John
Volume 6 (2022) p. 98 - 103
Abstract
Allergologie select, Vol. 6/2022 (98-103)
Nickel and cobalt: Underestimated contact allergens in hairdressers?
Cara Symanzik1,2, Christoph Skudlik1,2, and Swen Malte John1,2
1Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany 2Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany
Introduction: Nickel and cobalt were not regarded as pertinent contact allergens in the hairdressing trade for the last decades. It was even stated that the relevance of nickel allergy in the hairdressing trade has been overestimated for several years. Recently, nickel and cobalt release from a multitude of metal tools in the German hairdressing trade was documented in two field studies. Methods: Review of two field studies. Results: In 2019, nickel release from 9.2% of 229 tested metallic hairdressing tools was evidenced, and in 2021, nickel release from 27.6% as well as cobalt release from 2.1% of 475 tested tools was detected in overall 30 North German hairdressing salons. Tweezers, sectioning clips, hair clips, and straight razors were identified as nickel as well as cobalt releasing tools. Crochet hooks and tail combs were identified as only nickel releasing tools. Discussion: A variety of metallic tools – which are used daily by hairdressers – release nickel and/or cobalt in allergologically relevant amounts. This circumstance has to be considered problematic with regard to the development of work-related allergic contact dermatitis. Thus, nickel and cobalt should possibly receive greater attention as potential contact allergens in the hairdressing trade. Conclusion: The proven nickel and cobalt release from metallic hairdressing tools might entail legal ramifications in terms of insurance law. In case of nickel and cobalt allergies within the occupational group of hairdressers, metal tools might be considered as feasible sources for nickel and cobalt exposure.Correspondence to:
Dr. rer. nat. Cara Symanzik, B.Sc., M.Ed., Institut für interdisziplinäre, Dermatologische Prävention und Rehabilitation (iDerm) und Abteilung Dermatologie, Umweltmedizin und Gesundheitstheorie an der Universität Osnabrück, Am Finkenhügel 7a, 49076 Osnabrück
Email: [email protected]
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17. Tagung der Arbeitsgemeinschaft für Berufs- und Umweltdermatologie (ABD): Allergologie, Berufs- und Umweltdermatologie; 21. – 23. September 2023, Dresden
Wissenschaftliche Leitung: Prof. Dr. med. Andrea Bauer, Dresden, Prof. Dr. med. Christoph Skudlik, Osnabrück/Hamburg
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Jahrgang 71 (2023) p. 102 - 134
Abstract
Dermatologie in Beruf und Umwelt, Jahrgang 71, Nr. 3/2023 S. 102-134
17. Tagung der Arbeitsgemeinschaft für Berufs- und Umweltdermatologie (ABD): Allergologie, Berufs- und Umweltdermatologie; 21. – 23. September 2023, Dresden
Wissenschaftliche Leitung: Prof. Dr. med. Andrea Bauer, Dresden, Prof. Dr. med. Christoph Skudlik, Osnabrück/Hamburg
Guideline
Diagnosis and treatment of Hymenoptera venom allergy
Franziska Ruëff, Andrea Bauer, Sven Becker, Randolf Brehler, Knut Brockow, Adam M. Chaker, Ulf Darsow, Jörg Fischer, Thomas Fuchs, Michael Gerstlauer, Sunhild Gernert, Eckard Hamelmann, Wolfram Hötzenecker, Ludger Klimek, Lars Lange, Hans Merk, Norbert K. Mülleneisen, Irena Neustädter, Wolfgang Pfützner, Wolfgang Sieber, Helmut Sitter, Christoph Skudlik, Regina Treudler, Bettina Wedi, Stefan Wöhrl, Margitta Worm and Thilo Jakob
Volume 7 (2023) p. 154 - 190
Abstract
Allergologie select, Vol. 7/2023 (154-190)
Diagnosis and treatment of Hymenoptera venom allergy
Franziska Ruëff1, Andrea Bauer2, Sven Becker3, Randolf Brehler4, Knut Brockow5, Adam M. Chaker6, Ulf Darsow5, Jörg Fischer7, Thomas Fuchs8, Michael Gerstlauer9, Sunhild Gernert10, Eckard Hamelmann11, Wolfram Hötzenecker12, Ludger Klimek13, Lars Lange10, Hans Merk14, Norbert K. Mülleneisen15, Irena Neustädter16, Wolfgang Pfützner17, Wolfgang Sieber18, Helmut Sitter19, Christoph Skudlik20, Regina Treudler21, Bettina Wedi22, Stefan Wöhrl23, Margitta Worm24 and Thilo Jakob25
1Department of Dermatology and Allergy, LMU University Hospital, Munich, 2Department of Dermatology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, 3Department of Otorhinolaryngology, Head and Neck Surgery, University of Tuebingen, Tübingen, 4Department of Dermatology, Münster University Hospital, Münster, 5Department of Dermatology and Allergology Biederstein, Faculty of Medicine, Technical University of Munich, Munich, 6Department of Otorhinolaryngology Klinikum rechts der Isar, Faculty of Medicine, Technical University of Munich, Munich, 7University Hospital for Dermatology and Allergology, Clinic Oldenburg, Oldenburg, 8Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, 9Clinic for Children and Adolescents, University Hospital Augsburg, Augsburg, 10Pediatric Clinic, Marienhospital Bonn, GFO Kliniken, Bonn, 11Children’s Center Bethel, University Hospital OWL, Bielefeld University, Bielefeld, Germany, 12Department of Dermatology, Kepler University Hospital, Medical Faculty of University Linz, Linz, Austria, 13Center for Rhinology and Allergology, Wiesbaden, 14Department of Dermatology and Allergology, University Hospital of RWTH Aachen University, Aachen, 15Center for Asthma and Allergy, Leverkusen, 16Cnopfsche Paediatric Clinic, Nuremberg, 17Department of Dermatology and Allergology, University Hospital Marburg, Philipps-Universität Marburg, Marburg, 18Hospital Wörth an der Donau, Wörth an der Donau, 19Institute for Theoretical Surgery, Philipps-University Marburg, Marburg, 20Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrueck, Osnabrueck, and BG Clinic Hamburg, Hamburg, 21University Leipzig Medical Faculty, Leipzig, 22Comprehensive Allergy, Department of Dermatology and Allergy, Hannover Medical School, Hanover, Germany, 23Floridsdorf Allergy Center (FAZ), Vienna, Austria, 24Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, and 25Department of Dermatology and Allergology, University Hospital Giessen, Justus Liebig University Gießen, Gießen, Germany
Hymenoptera venom (HV) is injected into the skin during a sting by Hymenoptera such as bees or wasps. Some components of HV are potential allergens and can cause large local and/or systemic allergic reactions (SAR) in sensitized individuals. During their lifetime, ~ 3% of the general population will develop SAR following a Hymenoptera sting. This guideline presents the diagnostic and therapeutic approach to SAR following Hymenoptera stings. Symptomatic therapy is usually required after a severe local reaction, but specific diagnosis or allergen immunotherapy (AIT) with HV (VIT) is not necessary. When taking a patient’s medical history after SAR, clinicians should discuss possible risk factors for more frequent stings and more severe anaphylactic reactions. The most important risk factors for more severe SAR are mast cell disease and, especially in children, uncontrolled asthma. Therefore, if the SAR extends beyond the skin (according to the Ring and Messmer classification: grade > I), the baseline serum tryptase concentration shall be measured and the skin shall be examined for possible mastocytosis. The medical history should also include questions specific to asthma symptoms. To demonstrate sensitization to HV, allergists shall determine concentrations of specific IgE antibodies (sIgE) to bee and/or vespid venoms, their constituents and other venoms as appropriate. If the results are negative less than 2 weeks after the sting, the tests shall be repeated (at least 4 – 6 weeks after the sting). If only sIgE to the total venom extracts have been determined, if there is double sensitization, or if the results are implausible, allergists shall determine sIgE to the different venom components. Skin testing may be omitted if in-vitro methods have provided a definitive diagnosis. If neither laboratory diagnosis nor skin testing has led to conclusive results, additional cellular testing can be performed. Therapy for HV allergy includes prophylaxis of reexposure, patient self treatment measures (including use of rescue medication) in the event of re-stings, and VIT. Following a grade I SAR and in the absence of other risk factors for repeated sting exposure or more severe anaphylaxis, it is not necessary to prescribe an adrenaline auto-injector (AAI) or to administer VIT. Under certain conditions, VIT can be administered even in the presence of previous grade I anaphylaxis, e.g., if there are additional risk factors or if quality of life would be reduced without VIT. Physicians should be aware of the contraindications to VIT, although they can be overridden in justified individual cases after weighing benefits and risks. The use of β-blockers and ACE inhibitors is not a contraindication to VIT. Patients should be informed about possible interactions. For VIT, the venom extract shall be used that, according to the patient’s history and the results of the allergy diagnostics, was the trigger of the disease. If, in the case of double sensitization and an unclear history regarding the trigger, it is not possible to determine the culprit venom even with additional diagnostic procedures, VIT shall be performed with both venom extracts. The standard maintenance dose of VIT is 100 µg HV. In adult patients with bee venom allergy and an increased risk of sting exposure or particularly severe anaphylaxis, a maintenance dose of 200 µg can be considered from the start of VIT. Administration of a non-sedating H1-blocking antihistamine can be considered to reduce side effects. The maintenance dose should be given at 4-weekly intervals during the first year and, following the manufacturer’s instructions, every 5 – 6 weeks from the second year, depending on the preparation used; if a depot preparation is used, the interval can be extended to 8 weeks from the third year onwards. If significant recurrent systemic reactions occur during VIT, clinicians shall identify and as possible eliminate co-factors that promote these reactions. If this is not possible or if there are no such co-factors, if prophylactic administration of an H1-blocking antihistamine is not effective, and if a higher dose of VIT has not led to tolerability of VIT, physicians should should consider additional treatment with an anti IgE antibody such as omalizumab as off lable use. For practical reasons, only a small number of patients are able to undergo sting challenge tests to check the success of the therapy, which requires in-hospital monitoring and emergency standby. To perform such a provocation test, patients must have tolerated VIT at the planned maintenance dose. In the event of treatment failure while on treatment with an ACE inhibitor, physicians should consider discontinuing the ACE inhibitor. In the absence of tolerance induction, physicians shall increase the maintenance dose (200 µg to a maximum of 400 µg in adults, maximum of 200 µg HV in children). If increasing the maintenance dose does not provide adequate protection and there are risk factors for a severe anaphylactic reaction, physicians should consider a co-medication based on an anti-IgE antibody (omalizumab; off-label use) during the insect flight season. In patients without specific risk factors, VIT can be discontinued after 3 – 5 years if maintenance therapy has been tolerated without recurrent anaphylactic events. Prolonged or permanent VIT can be considered in patients with mastocytosis, a history of cardiovascular or respiratory arrest due to Hymenoptera sting (severity grade IV), or other specific constellations associated with an increased individual risk of recurrent and/or severe SAR (e.g., hereditary α-tryptasemia). In cases of strongly increased, unavoidable insect exposure, adults may receive VIT until the end of intense contact. The prescription of an AAI can be omitted in patients with a history of SAR grade I and II when the maintenance dose of VIT has been reached and tolerated, provided that there are no additional risk factors. The same holds true once the VIT has been terminated after the regular treatment period. Patients with a history of SAR grade ≥ III reaction, or grade II reaction combined with additional factors that increase the risk of non response or repeated severe sting reactions, should carry an emergency kit, including an AAI, during VIT and after regular termination of the VIT.Correspondence to:
Prof. Dr. med. Franziska Ruëff, Klinik und Poliklinik für Dermatologie, und Allergologie, Klinikum der Universität München, Frauenlobstraße 9-11, 80337 Munich, Germany,
Email: [email protected]
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15. Dermatologisches Alpenseminar: Allergologie, Berufs- und Umweltdermatologie; 9. – 11. Mai 2024, Murnau am Staffelsee
Wissenschaftliche Leitung: Prof. Dr. med. Andrea Bauer, Dresden, und Prof. Dr. med. Christoph Skudlik, Osnabrück/Hamburg
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Jahrgang 72 (2024) p. 79 - 100
Abstract
Dermatologie in Beruf und Umwelt, Jahrgang 72, Nr. 2/2024 S. 79-100
15. Dermatologisches Alpenseminar: Allergologie, Berufs- und Umweltdermatologie; 9. – 11. Mai 2024, Murnau am Staffelsee
Wissenschaftliche Leitung: Prof. Dr. med. Andrea Bauer, Dresden, und Prof. Dr. med. Christoph Skudlik, Osnabrück/Hamburg
Review
Patch testing in occupational dermatology: Practical aspects in relation to the conditions in Germany
Richard Brans and Christoph Skudlik
Volume 8 (2024) p. 82 - 89
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]
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16. Dermatologisches Alpenseminar: Allergologie, Berufs- und Umweltdermatologie; 14. – 16. Mai 2026, Murnau am Staffelsee
Wissenschaftliche Leitung: Prof. Dr. med. Andrea Bauer, Dresden, Prof. Dr. med. Christoph Skudlik, Osnabrück/Hamburg
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Jahrgang 74 (2026) p. 73 - 92
Abstract
Wissenschaftliche Leitung: Prof. Dr. med. Andrea Bauer, Dresden, Prof. Dr. med. Christoph Skudlik, Osnabrück/Hamburg
16. Dermatologisches Alpenseminar: Allergologie, Berufs- und Umweltdermatologie; 14. – 16. Mai 2026, Murnau am Staffelsee
Wissenschaftliche Leitung: Prof. Dr. med. Andrea Bauer, Dresden, Prof. Dr. med. Christoph Skudlik, Osnabrück/Hamburg
