Review
SARS-CoV-2 and allergy – what have we learned after two and a half years?
Knut Brockow, Rosi Wang, Sonja Mathes, Rebekka Bent, Valentina Faihs, Bernadette Eberlein, Ulf Darsow, and Tilo Biedermann
Volume 7 (2023) p. 101 - 112
Abstract
Allergologie select, Vol. 7/2023 (101-112)
SARS-CoV-2 and allergy – what have we learned after two and a half years?
Knut Brockow, Rosi Wang, Sonja Mathes, Rebekka Bent, Valentina Faihs, Bernadette Eberlein, Ulf Darsow, and Tilo Biedermann
Department of Dermatology and Allergy Biederstein, Technical University of Munich, Faculty of Medicine, Munich, Germany
Background: Coronavirus disease-2019 (COVID-19) has significantly hampered the regular workflow for allergists and allergy departments. Materials and methods: The purpose of this review is to highlight our own experiences on SARS-CoV-2 and allergy as well as to discuss findings from the literature. Results: Vaccination against SARS-CoV-2 is needed for protection against severe infection. Skin reactions may arise with SARS-CoV-2 infections. Short-term general immune reactions and skin reactions are also possible upon SARS-CoV-2 vaccination; however, they recur in only a proportion of patients during follow-up vaccinations. Initial reports of anaphylaxis after vaccination fueled public fear. On the other hand, more recent epidemiologic data do not show a substantially increased anaphylaxis risk compared with other vaccines. Fear-related reactions may be essential for many “anaphylaxis” reports. In Germany, the flow chart developed by Paul-Ehrlich-Institut (PEI) and Robert-Koch-Institut (RKI) together with the allergological societies helps to care for patients with suspected “allergy history” safely and effectively. Through this, patients with increased risk of anaphylaxis to SARS-CoV-2 vaccines and their ingredients (e.g., polyethylene glycol (PEG), polysorbate 80) are identified. However, since only small amounts of these excipients are contained in mRNA vaccines, even some PEG-allergic patients can tolerate the vaccination. In Germany, an allergy test-guided procedure is recommended for high-risk patients, including an allergy history, prick tests, intradermal and basophil activation tests, and, if necessary, provocation tests. This also appears effective for anxiety reduction in patients with vaccination skepticism. To date, all of our patients have been able to be vaccinated with SARS-CoV-2 vaccines without the occurrence of significant reactions. Conclusion: Many initial concerns about unexpected side effects of SARS-CoV-2 vaccination have not been confirmed. The flowchart and, in the case of suspicion of hypersensitivity, an allergy test-guided risk assessment helps to reduce patients’ fear of vaccination and enables safe vaccination.Correspondence to:
Knut Brockow, Department of Dermatology and Allergy Biederstein, Technical University of Munich, Faculty of Medicine, Biedersteiner Straße 29, 80802 Munich, Germany
Email: [email protected]
Review
Biologics in allergology and clinical immunology: Update on therapies for atopic diseases, urticaria, and angioedema and on safety aspects focusing on hypersensitivity reactions
Uta Jappe, Karl-Christian Bergmann, Folke Brinkmann, Valentina Faihs, Askin Gülsen, Ludger Klimek, Harald Renz, Sebastian Seurig, Christian Taube, Stephan Traidl, Regina Treudler, Martin Wagenmann, Thomas Werfel, Margitta Worm, and Torsten Zuberbier
Volume 8 (2024) p. 365 - 406
Abstract
Allergologie select, Vol. 8/2024 (365-406)
Biologics in allergology and clinical immunology: Update on therapies for atopic diseases, urticaria, and angioedema and on safety aspects focusing on hypersensitivity reactions
Uta Jappe1#2, Karl-Christian Bergmann3, Folke Brinkmann4, Valentina Faihs5, Askin Gülsen6, Ludger Klimek7, Harald Renz8, Sebastian Seurig9, Christian Taube10, Stephan Traidl11, Regina Treudler12, Martin Wagenmann13, Thomas Werfel11, Margitta Worm14, and Torsten Zuberbier3
1Division Clinical and Molecular Allergology, Research Center Borstel, Leibniz Lung Center, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Borstel, 2Interdisciplinary Allergy Outpatient Clinic, Department of Pneumology, University Medical Center Schleswig-Holstein, Campus Lübeck, University of Lübeck, 3Institute of Allergology, Charité Universitätsmedizin Berlin und Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, 4Division of Pediatric Pulmonology and Allergology, University Children’s Hospital, German Center for Lung Research (ARCN, DZL), Lübeck, 5Department of Dermatology and Allergy Biederstein, Klinikum rechts der Isar, Technical University of Munich, 6Division of Cardiology, Pulmonary Diseases, Vascular Medicine, University Hospital Duesseldorf, 7Center for Rhinology and Allergology, Wiesbaden, 8Institute of Laboratory Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Philipps Universität Marburg, Member of the German Center for Lung Research (DZL) Marburg, 9Interdisciplinary Allergy Center Nuremberg (NIZA), Department of Internal Medicine 3, Pneumology, Nuremberg Hospital, Nuremberg, 10Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Essen, 11Department of Dermatology and Allergy, Hannover Medical School, Hannover, 12Institute of Allergology IFA, Charité Universitätsmedizin corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Berlin, 13Department of Otorhinolaryngology, Düsseldorf University Hospital, Heinrich Heine University, Düsseldorf, 14Division of Allergy and Immunology, Department of Dermatology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
The development of targeted therapies for atopic diseases, urticaria, and angioedema with biologics is progressing rapidly: New “targets” of clinical-therapeutic relevance have been identified, the corresponding targeted antibodies developed, tested in clinical trials, and approved for therapy. These include the anti-IgE antibody omalizumab (also effective and approved for the treatment of urticaria), the anti-IL-4/13 receptor-specific antibody dupilumab, the two anti-IL-13 antibodies lebrikizumab and tralokinumab, the anti-TSLP antibody tezepelumab, the two anti-IL-5 antibodies mepolizumab and reslizumab, and the anti-IL5 receptor-specific antibody benralizumab for the treatment of atopic diseases. For the treatment of hereditary angioedema, C1 inhibitor and the antibody lanadelumab (directed against kallikrein) have also long been approved as biologics in addition to low-molecular substances. Other therapeutic antibodies are in various stages of development. Furthermore, the range of indications for some very effective biologics has been successfully expanded to include additional diseases. In this context, the first results on biologic therapy of food allergy and eosinophilic esophagitis are interesting. Biologics that address different target structures are also increasingly being administered in combination, either simultaneously or sequentially, in order to achieve optimal efficacy. A developing area is the use of biologics in children and the observation of immunological and non-immunological side effects. In some cases, new unexpected side effects and hypersensitivity reactions have emerged, which in turn raise pathomechanistic questions, such as conjunctivitis with dupilumab therapy, which only appears to occur in the treatment of atopic dermatitis but not in the treatment of other atopic diseases. In dermatology, paradoxical reactions have been described under therapy with some biologics. And immune reactions of type alpha to epsilon to biologics (hypersensitivity reactions) continue to be a clinically relevant problem, whereby the selection of an alternative therapeutic agent is a challenge and the diagnostics that support this have not yet been sufficiently incorporated into routine work.Correspondence to:
Prof. Dr. med. Uta Jappe, Division Clinical and Molecular Allergology, Research Center Borstel, Leibniz Lung Center, Parkallee 35, 23845 Borstel, Germany
Email: [email protected]
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
Volume 9 (2025) p. 47 - 49
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]
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
Volume 9 (2025) p. 86 - 92
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]
Case Report
Resolution of childhood wheat allergy through evolution into WALDA? A case report
Charlotte J. Kiani, Valentina Faihs, Claudia Kugler, Julia F. Pilz, Tilo Biedermann, and Knut Brockow
Volume 10 (2026) p. 114 - 119
Abstract
Allergologie select, Vol. 10/2026 (114-119)
Resolution of childhood wheat allergy through evolution into WALDA? A case report
Charlotte J. Kiani1, Valentina Faihs1, Claudia Kugler1, Julia F. Pilz1, Tilo Biedermann1, and Knut Brockow1,2
1Department of Dermatology and Allergy, Technical University of Munich, TUM School of Medicine and Health, Munich, Germany, and 2Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
Background: Wheat allergy may present with different phenotypes. Childhood-onset wheat allergy is characterized by immediate-type IgE-mediated reactions to wheat ingestion alone. It typically affects atopic individuals and often resolves spontaneously. The predominant adult-onset phenotype is WALDA (wheat allergy dependent on augmentation factors), triggered only when wheat is consumed in combination with augmentation factors. Phenotypic transition between these forms is rarely described. Case report: We present the case of a 30-year-old atopic female patient with a history of wheat-induced anaphylaxis, who presented with three distinct stages, compatible with a phenotypic transition. In infancy, the patient was diagnosed with classical IgE-mediated wheat allergy. In early adulthood, she developed augmentation factor-dependent reactions compatible with WALDA. At the age of 30, comprehensive oral food challenge testing and serological analysis revealed full clinical tolerance and loss of sensitization. Conclusion: This case illustrates a possible transient clinical course of wheat allergy with WALDA as an intermediate stage prior to resolution. Such cases may be underreported, as patients with declining wheat allergy may not be identified as having WALDA reactions, but rather as having inconstant reactivity. Allergy reassessment in adult patients with food allergy in childhood is essential to detect phenotypic shifts or to confirm resolution.Correspondence to:
Dr. med. Valentina Faihs, Department of Dermatology and Allergy, Technical University of Munich, TUM School of Medicine and Health, Biedersteiner Str. 29, 80802 Munich, Germany
Email: [email protected]
