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Abstract

Allergologie, Jahrgang 18, Nr. 12/1995, S. 572-574

Allergenspezifische T-Zellantwort bei latexsensibilisierten Patienten

Monika Raulf-Heimsoth, Z. Chen, A. Urbanski und X. Baur

Berufsgenossenschaftliches Forschungsinstitut für Arbeitsmedizin (BGFA), Institut an der Ruhr-Universität, Bochum
Soforttyp-Allergien gegen Latex sind in den letzten Jahren sprunghaft angestiegen. Dies gilt insbesondere für Krankenhäuser und Arztpraxen, wo sehr häufig Schutzhandschuhe aus Naturlatex benutzt werden. Sensibilisierte Personen entwickeln neben Kontakturtikaria, Rhinitis und Konjunktivitis auch respiratorische Beschwerden, zum Teil sogar Schockreaktionen. Wir untersuchten die allergenspezifische T-Zellantwort von 16 latexsensibilisierten Patienten. Periphere Blutlymphozyten (PBMCs) von fünf gesunden, nicht latexexponierten Probanden dienten als Kontrollen. PBMCs von 50% der untersuchten Patienten zeigten gegenüber den Kontrollen erhöhte allergenspezifische Stimulationen, wobei die Zellen etwa vergleichbar auf Handschuhextrakt, Latexmilchextrakt und auf ein gereinigtes Latexallergen, das Hev b 1, reagierten. Die Höhe des Stimulationsindex korrelierte nicht mit der Höhe der allergenspezifischen IgE-Werte. So konnten die höchsten Proliferationsantworten bei Patienten mit spezifischem IgE im Bereich von 3,5 – 17,5 kU/l und Gesamt-IgE < 150 kU/l beobachtet werden.Correspondence to:
Dr. rer. nat. Monika Raulf-Heimsoth, Bürkle-de-la-Camp-Platz 1, D–44789 Bochum

Abstract

Unusual allergen in a butcher with respiratory symptoms

Ingrid Sander¹, Claus Keller², Christina Czibor¹, Ursula Meurer¹, Rolf Merget¹ and Monika Raulf¹

¹Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, and ²Medical Practice for Pulmonary and Bronchial Medicine, Allergology and Environmental Medicine, Frankfurt am Main, Germany
A 37-year-old butcher developed respiratory symptoms during sausage and chicken production in a large company. In addition to various spices, the enzyme transglutaminase was a possible cause. The lung function test showed mild partial reversible airway obstruction and severe bronchial hyperresponsiveness. The IgE test showed sensitizations to various spice mixtures, coriander (0.74 kU/L), and to the ImmunoCAPbound transglutaminase preparation from the workplace (7.12 kU/L). The skin prick tests with this transglutaminase were also positive. In the immunoblot of this preparation, a 40-kD protein reacted with the patient’s IgE and was identified as transglutaminase from Streptomyces mobaraensis by inhibition experiments. This is the first case of a butcher with an allergy to transglutaminase. After moving to a small enterprise without enzyme use, his symptoms improved. Sensitization and the course of the symptoms indicate a dominant role of transglutaminase in the patient’s allergic asthma.Correspondence to:
Dr. Ingrid Sander, Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum, Center of Allergology/Immunology, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
Email: [email protected]

Abstract

Allergologie select, Volume 4/2020 (110-117)

Microbial contamination in water-based metalworking fluid as trigger for occupational hypersensitivity pneumonitis – development of specific IgG tools for a suspected clinical case

Sabine Kespohl¹, Isabell Warfolomeow², Gerd Schneider³, Silke Maryska¹, Ursula Meurer¹, and Monika Raulf¹

¹Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, ²German Social Accident Insurance Institution for the Woodworking and Metalworking Industries, BGHM, Mainz, and ³Institute for Occupational Safety and Health of the German Social Accident Insurance (IFA), St. Augustin, Germany
Microbially contaminated metal-working fluid (MWF) can cause respiratory symptoms in exposed workers in the form of exogenous allergic alveolitis/hypersensitivity pneumonitis (HP). The diagnosis of HP is based, among others, on the identification of the culprit and the detection of corresponding specific IgG antibodies (sIgG) in the patient’s serum. Commercial antigen tools for the detection of these HP triggers are rarely available; therefore, antigens from contaminated MWF workplace samples were isolated exemplarily for diagnosis of a suspected HP case. Various MWF-specific bacteria were identified in the workplace samples, including Pseudomonas oleovorans, Pseudomonas alcaliphila, Pseudomonas spec., Paenibacillus glucanolyticus, and Corynebacterium amycolatum. The sIgG antigen binding, detected by ImmunoCAP system against MWF antigens from workplace samples and against the identified bacterial antigens, was much stronger in the patient serum compared to selected reference sera. The highest sIgG concentrations in the patient’s serum could be determined against Pseudomonas antigens. Inhibition tests showed cross-reactions of MWF and Pseudomonas antigens, whereby the Pseudomonas antigens cross-reacted less with each other. For in-vitro diagnosis in case of suspected HP caused by contaminated MWF, workplacerelated antigens are now available.Correspondence to:
Dr. Sabine Kespohl, 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
Email: [email protected]

Abstract

Allergologie select, Vol. 4/2020 (124-128)

Occupational diisocyanate asthma of a female professional driver – the importance of allergological diagnostics

Christian Eisenhawer, Monika Raulf, and Rolf Merget

Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Ruhr University Bochum, Bochum, Germany
Diisocyanates continue to be one of the most frequent causes of occupational asthma worldwide. They are still indispensable in industrial use as components of coatings, glues, and polyurethane foams. In Germany, respiratory diseases due to diisocyanates can be compensated by the statutory accident insurance (according to BK-Nr. 1315). The present case report shows a rare case of sensitization against diisocyanates verified by skin prick test and serological testing. Due to these findings, a modified inhalation test with an extremely low initial diisocyanate concentration in the laboratory was performed, and a positive reaction could be detected already after an extremely low diisocyanate concentration. In addition, increases of fractional exhaled nitric oxide (FeNO) and eosinophils in induced sputum after inhalation testing were seen. The present case constellation underlines the particular importance of allergological tests for diagnostic clarification of the diagnosis of diisocyanate asthma.Correspondence to:
Dr. med. Christian Eisenhawer, Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Ruhr University Bochum, Competence Center Medicine, Bürkle-de-la Camp-Platz 1, 44789 Bochum, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 5/2021 (77-81)

Occupational immediate type allergy to soapnut and quillaja bark

Rolf Merget, Monika Raulf, and Ingrid Sander

Institute for Prevention und Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Germany
A 58-year-old non-atopic chemical worker complained about work-related asthma and rhinoconjunctivitis about 4 years after exposure to quillaja bark and soapnut. Bronchial hyperresponsiveness was demonstrated after withdrawal of medication for 12 hours. Skin prick tests with extracts from quillaja bark and soapnut from the workplace were positive, but ImmunoCAP was positive only with quillaja bark, probably due to the low protein content of the extract from soapnut. Sensitizations to quillaja bark and soapnut, but not to saponin were demonstrated by immunoblot. An inhalation test with a dosimeter was positive with the soapnut extract. A link between disease and exposure was documented by serial measurements of exhaled nitric oxide at and off work, despite preventive measures. A diagnosis of occupational allergy due to quillaja bark and soapnut was made. Further exposure reduction was recommended.Correspondence to:
Prof. Dr. med. Rolf Merget, Institut für Prävention und Arbeitsmedizin der Deutschen Gesetzlichen Unfallversicherung, Institut der Ruhr-Universität Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 5/2021 (315-334)

Workplace-related inhalation test (AIT) – Specific inhalation challenge (SIC) – S2k Guideline of the German Society for Occupational and Environmental Medicine e.V. (DGAUM), the German Society for Pneumology and Respiratory Medicine e.V. (DGP)

Alexandra M. Preisser¹, Dirk Koschel², Rolf Merget³, Dennis Nowak⁴, Monika Raulf³, and Jan Heidrich¹

¹Institute for Occupational and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, ²Department of Internal Medicine and Pneumology, Fachkrankenhaus Coswig, Lung Center, Coswig, Division of Pneumology, Medical Department I, University Hospital Carl Gustav Carus, Dresden, ³Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, and ⁴Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, CPC Comprehensive Pneumology Center Munich, DZL, Deutsches Zentrum für Lungenforschung Munich, Germany
Correspondence to:
PD Dr. med. Alexandra M. Preisser, Arbeitsgruppe Klinische Arbeitsmedizin, Zentralinstitut für Arbeitsmedizin und Maritime Medizin (ZfAM), Universitätsklinikum Hamburg-Eppendorf (UKE), Seewartenstraße 10, Haus 1, 20459 Hamburg, Germany
Email: [email protected]

Abstract

Allergologie, Jahrgang 45, 3/2022, S. 211-217

Allergie im Fokus: Umwelt, Klimawandel, Exposition – Einfluss auf allergische Erkrankungen – 13./14. Mai 2022, Berlin

Tagungsleitung: Monika Raulf, Bochum, Jeroen Buters, München, und Thomas Lob-Corzilius, Osnabrück

Abstract

Allergologie select, Vol. 6/2022 (118-132)

What should be tested in patients with suspected mold exposure? Usefulness of serological markers for the diagnosis

Sabine Kespohl, Verena Liebers, Silke Maryska, Ursula Meurer, Claudia Litzenberger, Rolf Merget, and Monika Raulf

Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
The associations of mold exposure, IgE-mediated sensitization, inflammatory markers, and respiratory symptoms were analyzed in 46 exposed and 23 nonexposed individuals. Both exposure and clinical symptoms were assessed by questionnaire. Specific (s)IgE to mold mixture (mx1) was significantly higher and found more frequently in exposed (41%) than non-exposed individuals (17%), which was not observed for sIgG to mold mix (Gmx6). Notably, exposed asthmatics were more frequently sensitized to molds (55%) compared to exposed non-asthmatics (18%). In addition, the serum concentrations of club cell protein (CC16) were significantly lower in exposed subjects, especially in asthmatics. Positive associations were observed among mold sensitization, asthma, and mold exposure, but not in subjects with predominantly environmental sensitizations without mold sensitization. Thus, sIgE to mx1 but not sIgG to Gmx6 is a useful diagnostic marker to verify mold-associated respiratory symptoms.Correspondence to:
Dr. rer. nat. Sabine Kespohl, Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Deutsche Gesetzliche Unfallversicherung e.V. (DGUV), Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 6/2022 (133-141)

Is in vitro cytokine release a suitable marker to improve the diagnosis of suspected mold-related respiratory symptoms? A proof-of-concept study

Verena Liebers, Sabine Kespohl, Gerda Borowitzki, Heike Stubel, and Monika Raulf

Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Germany
Indoor mold infestation can lead to a variety of adverse health effects, including allergic and non-allergic respiratory complaints. Especially if no evidence of an allergic reaction can be found for the complaints, diagnostic tools that might explain mold-associated health problems are missing. As a proof-of-concept, in the present study whole blood assay (WBA) was used to determine cellular response by measuring cytokine release (IL-1β and IL-8) after in vitro stimulation. Blood was available from a total of 48 subjects. By questionnaire, complaints and possible mold exposure were documented. Specific in vitro blood stimulation was tested with Escherichia coli endotoxin and extracts of different molds (Aspergillus fumigatus, Penicillium chrysogenum, Aspergillus versicolor, and Cladosporium herbarum). To characterize the relevance of WBA in describing the mold-induced immune response, we compared the following groups: asthmatics vs. non-asthmatics, mx1-sensitized vs. non-mx1-sensitized, mold-exposed vs. non-mold-exposed. In response to endotoxin stimulation, a significantly higher IL-1β release was found in mx1-sensitized than in non-mx1-sensitized subjects. Furthermore, the blood of asthmatics showed significantly higher IL-8 and IL-1β release after stimulation with Penicillium chrysogenum and endotoxin, respectively, compared to non-asthmatics. However, no significant difference in the level of cytokine release was observed between the mold-exposed and non-exposed group, neither after endotoxin nor mold stimulation. In conclusion, the WBA used in this study is not a suitable tool for clinical routine diagnostic workup. Our data suggests that WBA reflects cellular differences that are disease-related but not directly attributable to mold exposure. However, in combination with further data, WBA will be a helpful und interesting tool in research, e.g., in description of the complex immune response to molds.Correspondence to:
Dr. rer. nat. Verena Liebers, Institut für Prävention und Arbeitsmedizin, der Deutschen Gesetzlichen Unfallversicherung, Institut der Ruhr-Universität Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
Email: [email protected]

Abstract

Allergologie, Jahrgang 46, Nr. 7/2023, S. 476-477

Authors’ response to comment to “What should be tested in patients with suspected mold exposure? Usefulness of serological markers for the diagnosis” Allergol Select. 2022; 6: 118-132

Sabine Kespohl und Monika Raulf

Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA)
Correspondence to:
Dr. rer. nat. Sabine Kespohl
Institute for Prevention and Occupational Medicine
of the German Social Accident Insurance
Institute of the Ruhr University Bochum (IPA), 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 (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 (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 (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 (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. 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]

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]

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