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Abstract

Allergologie select, Vol. 5/2021 (1-25)

Biologics for atopic diseases: Indication, side effect management, and new developments

Uta Jappe¹,², Hendrik Beckert³, Karl-Christian Bergmann⁴, Askin Gülsen², Ludger Klimek⁵, Sandra Philipp⁶, Julia Pickert⁷, Michèle M. Rauber-Ellinghaus⁸, Harald Renz⁹, Christian Taube³, Regina Treudler¹⁰, Martin Wagenmann¹¹, Thomas Werfel¹², Margita Worm¹³, and Torsten Zuberbier¹⁴

¹Research Group Clinical and Molecular Allergology of the Research Center Borstel, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), ²Interdisciplinary Allergy Outpatient Clinic, Medical Clinic III, University of Lübeck, ³Department of Pulmonary Medicine, University Hospital Essen – Ruhrlandklinik, Essen, ⁴Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, ⁵Center for Rhinology and Allergology, Wiesbaden, ⁶Dermatology practice Dr. Markus Friedrich/Dr. Sandra Philipp, Oranienburg, ⁷Department of Dermatology and Allergology, University Hospital Gießen and Marburg, Marburg site, ⁸Experimental Dermatology and Allergology, Justus Liebig University Giessen, ⁹Department of Medicine, Institute of Laboratory Medicine and Pathobiochemistry – Molecular Diagnostics, Member of the German Centre for Lung Research (DZL), Philipps-University, Marburg, ¹⁰Leipzig Comprehensive Allergy Center LICA-CAC, Department of Dermatology, Venereology and Allergology, University of Leipzig, ¹¹Department of Otorhinolaryngology, HNO-Klinik, Universitätsklinikum Düsseldorf, Düsseldorf, ¹²Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, ¹³Dermatology, Venerology and Allergology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, ¹⁴Department of Dermatology and Allergy, Charité Universitätsmedizin, Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Comprehensive Allergy Center, Berlin, Germany
With the advent of biologicals, more and more therapeutics are available that specifically address specific switch points in the pathomechanism of immunologically dominated diseases. Thus, the focus of diagnostics and therapy (precision medicine) is more on the individual disease characteristics of the individual patient. Regarding the different phenotypes of atopic diseases, severe asthma was the first entity for which biologicals were approved, followed by urticaria, and finally atopic dermatitis and chronic rhinosinusitis with nasal polyps. Experience in the treatment of severe bronchial asthma has shown that the intensity of the response to biological therapy depends on the quality of clinical and immunological phenotyping of the patients. This also applies to different diseases of the atopic form, as patients can suffer from several atopic diseases at the same time, each with different characteristics. Biologics are already emerging that may represent a suitable therapy for allergic bronchial asthma, which often occurs together with severe neurodermatitis, and chronic rhinosinusitis with nasal polyps. In practice, however, the question of possible combinations of biologicals for the therapy of complex clinical pictures of individual patients is increasingly arising. In doing so, the side effect profile must be taken into account, including hypersensitivity reactions, whose diagnostic and logistical management must aim at a safe and efficient therapy of the underlying disease. Increased attention must also be paid to biological therapy in pregnancy and planned (predictable) vaccinations as well as existing infections, such as SARS-CoV-2 infection. Before starting a biological therapy, the immune status should be checked with regard to chronic viral and bacterial infections and, if necessary, the vaccination status should be refreshed or missing vaccinations should be made up for before starting therapy. Currently, reliable data on the effect of biologicals on the immunological situation of SARS-CoV-2 infection and COVID-19 are not available. Therefore, research and development of suitable diagnostic methods for detection of immunologically caused side effects as well as detection of potential therapy responders and non-responders is of great importance.Correspondence to:
Prof. Dr. med. Uta Jappe, Research Center Borstel, Leibniz Lung Center, Parkallee 35, 23845 Borstel
Email: [email protected]

Abstract

Allergologie select, Vol. 5/2021 (26-28)

Severe allergic reactions to the COVID-19 vaccine – statement and practical consequences

Jörg Kleine-Tebbe¹, Ludger Klimek², Eckard Hamelmann³, Oliver Pfaar⁴, Christian Taube⁵, Martin Wagenmann⁶, Thomas Werfel⁷, and Margitta Worm⁸

¹Allergy and Asthma Center Westend, Berlin, ²Center for Rhinology and Allergology of the ENT University Clinic Mannheim, Wiesbaden, ³University Clinic for Pediatrics and Adolescent Medicine, Bethel Children’s Center, Evangelical Hospital Bielefeld gGmbH, Bielefeld, ⁴Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, ⁵Ruhrlandklinik gGmbH, West German Lung Center at the University Hospital Essen – University Hospital, ⁶Clinic of Otorhinolaryngology, University Hospital Düsseldorf, ⁷Clinic of Dermatology, Allergology, and Venerology, Hannover Medical School,and ⁸Allergy Center-Charité, Clinic for Dermatology, Venerology, and Allergology, Campus Charité Mitte, University Medicine Berlin, Germany
Correspondence to:
Prof. Dr. Jörg Kleine-Tebbe, Allergy and Asthma Center Westend, Spandauer Damm 130, Haus 9, 14050 Berlin, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 5/2021 (29-32)

Rare food allergens

Karin Hoffmann-Sommergruber

Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
In food allergy, only a restricted number of protein families have been identified to contain allergenic proteins. These can be further grouped into major allergens, responsible for inducing allergic reactions in the majority of patients allergic to the food source, as compared to minor allergens only affecting a small number of food allergic patients. In addition, rare allergens have only been described for single cases so far. Rare allergens can derive from novel foods, including exotic varieties and foods not yet frequently consumed in certain regions. Also, new or modified processing strategies could induce a higher allergenicity in certain dietary proteins. And finally, low abundancy and/or low allergenic activity may also account for some rare allergens. For allergenic risk assessment, cross-reactivity of novel allergens with already known allergens is in place and facilitates the identification of potential new allergens, while de novo sensitization to yet undefined allergens can only be described retrospectively. This review presents some examples of recently identified rare allergens.Correspondence to:
Karin Hoffmann-Sommergruber, Department of Pathophysiology and Allergy Research, AKH-EBO3 Q, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
Email: [email protected]

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]

Abstract

Allergologie select, Vol. 5/2021 (45-50)

Benefits and limitations of sting challenge in hymenoptera venom allergy

Katharina Aßmus, Markus Meissner, Roland Kaufmann, and Eva Maria Valesky

Department of Dermatology, Venereology and Allergology, University Hospital, Goethe University, Frankfurt, Germany
The prevalence of systemic reactions to hymenoptera stings is up to 7.5%. Venom-specific immunotherapy (VIT) is an established treatment for insect venom allergy. In order to monitor the allergic status and thus the success of the therapy, controlled sting challenge under VIT continues to be the gold standard. This review deals not only with useful indications and therapeutic consequences but also with critical aspects that should be considered when performing sting challenge.Correspondence to:
Prof. Dr. Eva Maria Valesky, Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 5/2021 (51-56)

Occupational rhinitis

Sebastian Kotz¹, Lisa Pechtold¹,², Rudolf A. Jörres³, Dennis Nowak³, and Adam M. Chaker¹,²

¹Department of Otolaryngology – Head and Neck Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany, ²Center of Allergy and Environment (ZAUM) of the Technical University of Munich (TUM) and the Helmholtz Zentrum München (HMGU), and ³Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Clinical Center of the Ludwig Maximilian University Munich, Germany, Comprehensive Pneumology Center (CPC) Munich, German Center for Lung Research (DZL)
Occupational rhinitis (OR) has so far received little attention even though it shares common pathophysiological features and trigger factors and is closely associated with occupational asthma (OA). Work-related exposure to certain substances, such as animal dander, is considered to be the main factor for the development of OR. The new EAACI definition of OR stresses the causal relationship between workplace exposure and onset of rhinitis symptoms as opposed to previous definitions that mainly focused on a temporal relationship between workplace exposure and occurrence of nasal symptoms. Also, it has been suggested to use the term “work-related rhinitis” for classifying the different forms of rhinitis associated with the workplace. These forms can be subdivided into allergic or non-allergic OR, which is due to causes and conditions related to a particular work environment, as well as work-exacerbated rhinitis, which is defined as a pre-existing rhinitis exacerbated by exposure at the workplace. Even though taking a detailed patient history is especially important when it comes to diagnosing OR, the gold standard for confirming the diagnosis is nasal provocation testing. Best possible symptomatic relief and prevention of development of OA constitute the main therapeutic objectives in OR. Treatment options consist of total avoidance of trigger substances (main goal), reduction of exposure to certain substances, and pharmacotherapy. Furthermore, it is important to note that allergic OR is an occupational disease in Germany (Berufskrankheit No 4301) and needs to be reported to health authorities.Correspondence to:
Sebastian Kotz, Department of Otolaryngology – Head and Neck Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 5/2021 (57-66)

Long-term impact of hymenoptera venom immunotherapy on clinical course, immune parameters, and psychosocial aspects

Jan Adelmeyer¹, Julia Pickert¹, Wolfgang Pfützner¹,², and Christian Möbs²

¹Clinical and Experimental Allergology, Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, and ²Department of Dermatology and Allergology, Allergy Center Hessen, University Medical Center Marburg, Marburg, Germany
Background: Venom immunotherapy (VIT) is highly efficient in subjects suffering from IgE-mediated allergy to hymenoptera venom (HV), and VIT results in substantial improvement of quality of life (QoL). However, VIT-induced tolerance may be lost over time after cessation of treatment, putting patients at risk of re-sting anaphylaxis. Materials and methods: To study the effect of VIT on maintenance of HV tolerance we evaluated the natural history of 54 patients who were treated with VIT up to 29 years ago, with a special focus on re-stings and their subsequent course. Furthermore, we analyzed HV-specific IgE, IgG, and IgG4 antibody titers. Finally, we assessed the long-term impact of VIT on various psychosocial aspects like dealing with hymenoptera exposures, daily life activities, self-assurance, and personal environment. Results: 29 (53.7%) subjects experienced at least one re-sting after stopping VIT, with 23 (79%) showing no systemic reaction (SR). Eleven of these (37.9%) took emergency drugs as a safety measurement. Six individuals (21%) showed loss of tolerance experiencing an anaphylactic reaction. No difference in HV-specific IgE, IgG4, or IgG antibody concentrations was noticed among the different patients. Subjects who tolerated a re-sting without applying emergency drugs felt least affected in their social-behavioral leisure activities when hymenoptera were around or by anxiety for new stings. Conclusion: VIT leads to long-term tolerance in the majority of HV-allergic patients, however, ~ 1/5 may lose protection over time, arguing for continued follow-up on VIT-treated subjects and keeping them equipped with an emergency kit. Notably, VIT also results in a lasting, strong impact on self-assurance and sense of well-being in individuals who tolerated a re-sting without employing emergency drugs, which emphasizes the need to use them only in case of systemic symptoms after stopping successful VIT.Correspondence to:
Wolfgang Pfützner, MD, Clinical and Experimental Allergology, Department of Dermatology and Allergology, Philipps-Universität Marburg, Baldingerstraße, 35043 Marburg, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 5/2021 (67-71)

Induction of penicillin tolerance during pregnancy: Allergological opinion on the recommendation of the current AWMF Guidelines on Diagnosis and Treatment of Syphilis (AWMF Registry No. 059-002)

Bettina Wedi¹, Werner Aberer², Knut Brockow³, Heinrich Dickel⁴, Randolf Brehler⁵, Thilo Jakob⁶, Burkhard Kreft⁷, Vera Mahler⁸,⁹, Hans F. Merk¹⁰, Norbert Mülleneisen¹¹, Hagen Ott¹², Wolfgang Pfützner¹³, Stefani Röseler¹⁴, Franziska Ruëff¹⁵, Cord Sunderkötter¹⁶, Axel Trautmann¹⁷, Regina Treudler¹⁸, Margitta Worm¹⁹, and Gerda Wurpts²⁰

¹Department of Dermatology, Allergology, and Venereology, Comprehensive Allergy Center, Hannover Medical School, Germany, ²Department of Dermatology, Medical University Graz, Austria, ³Department and Outpatient Clinic for Dermatology and Allergology am Biederstein, Technical University of Munich, ⁴Department of Dermatology, Venereology, and Allergology, St. Josef-Hospital, University Hospital of the Ruhr University of Bochum, ⁵Department of Dermatology, University Hospital Muenster, ⁶Department of Dermatology and Allergology, University Medical Center Gießen and Marburg, Campus Gießen, ⁷Department of Dermatology and Venereology, University Hospital Halle (Saale), ⁸Paul-Ehrlich-Institut, Langen, ⁹Dermatologists at the Merckhaus Dr. Herbst and Kollegen, Darmstadt, ¹⁰Department of Dermatology and Allergology, Aachen Comprehensive Allergy Center (ACAC), University Hospital RWTH Aachen, ¹¹Lung and Allergy Center, Leverkusen, ¹²Pediatric Dermatology and Allergology, Children’s and Youth Hospital “Auf der Bult”, Hannover, ¹³Department of Dermatology and Allergology, University Medical Center Gießen and Marburg, Campus Marburg, ¹⁴Augustinians Hospital, Academic Teaching Hospital of the University of Cologne, ¹⁵Department and Outpatient Clinic of Dermatology, and Allergology, Allergy Center, Hospital of the University of Munich, ¹⁶University Hospital and Outpatient Clinic of Dermatogy and Venereology, University Hospital Halle (Saale), ¹⁷Department and Outpatient Clinic of Dermatology, Venereology, and Allergology, Allergy Center Mainfranken, University Hospital Würzburg, ¹⁸Department and Outpatient Clinic of Dermatology, Venereology, and Allergology and Leipzig Interdisciplinary Allergy Center – LICACAC, University of Leipzig, ¹⁹Department for Dermatology, Venereology, and Allergology, Charité-University Medicine Berlin, Allergy Center-Charité (ACC), Berlin, ²⁰Department of Dermatology and Allergology, Aachen Comprehensive Allergy Center (ACAC), University Hospital RWTH Aachen, Germany
Correspondence to:
Prof. Dr. Bettina Wedi, Klinik für Dermatologie, Allergologie und Venerologie, Comprehensive Allergy Center, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 5/2021 (72-76)

Practical recommendations for the allergological risk assessment of the COVID-19 vaccination – a harmonized statement of allergy centers in Germany

Margitta Worm¹, Andrea Bauer², Bettina Wedi³, Regina Treudler⁴, Wolfgang Pfuetzner⁵, Knut Brockow⁶, Timo Buhl⁷, Torsten Zuberbier⁸, Joachim Fluhr⁸, Gerda Wurpts⁹, Ludger Klimek¹⁰, Thilo Jakob¹¹, Hans F. Merk¹², Norbert Mülleneisen¹³, Stefani Roeseler¹⁴, Heinrich Dickel¹⁵, Ulrike Raap¹⁶, and Jörg Kleine-Tebbe¹⁷

¹Allergology and Immunology, Department of Dermatology, Venereology and Allergology, Campus Charité Mitte, University Medicine Berlin, ²Clinic and Polyclinic for Dermatology, University Hospital Carl Gustav Carus at the Technical University Dresden, ³Department of Dermatology, Allergology and Venereology Comprehensive Allergy Center (CAC) Treatment Center for Hereditary Angioedema in the ZSE, Hannover Medical School, ⁴Clinic of Dermatology, Venereology and Allergology, Leipzig University Medical Center, ⁵Hesse Allergy Center, Clinic for Dermatology and Allergology, Marburg University Hospital, ⁶Dermatology Clinic Campus Biederstein, Klinikum rechts der Isar, Technical University of Munich, ⁷Dermatology Venereology and Allergology Clinic, University Medical Center Göttingen Georg-August-University, ⁸Department of Dermatology and Allergy, Comprehensive Allergy Center Charité – Universitätsmedizin Berlin, Germany, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, ⁹Department of Dermatology and Allergology, University Hospital Aachen, ¹⁰Center for Rhinology and Allergology of the ENT University Clinic Mannheim, Wiesbaden, ¹¹Department of Dermatology, Venerology and Allergology, University Hospital Giessen, ¹²Dermatology Clinic, RWTH Aachen University, ¹³Asthma and Allergy Center, Leverkusen, ¹⁴Allergy, Asthma and Anaphylaxis Center, Clinic of Pneumology, Allergology, Sleep and Respiratory Medicine, Augustinians Hospital, Cologne, ¹⁵Department of Allergology, Occupational and Environmental Dermatology, Clinic for Dermatology, Venereology and Allergology, St. Josef Hospital, Ruhr University Bochum, ¹⁶Department of Experimental Allergology and Immunodermatology, Department of Human Medicine, University of Oldenburg, and ¹⁷Allergy and Asthma Center Westend, Berlin, Germany
Severe allergic reactions to vaccines are very rare. Single severe reactions have occurred worldwide after vaccination with the new mRNA-based COVID-19 vaccines. PEG2000 is discussed as a possible trigger. We provide guidance on risk assessment regarding COVID-19 vaccination in patients with allergic diseases and suggest a standardized, resource-oriented diagnostic and therapeutic procedure. Reports of severe allergic reactions in the context of COVID-19 vaccination can be made via www.anaphylaxie.net using an online questionnaire.Correspondence to:
Univ.-Prof. Dr. med. Margitta Worm, Charité – Universitätsmedizin Berlin, Allergologie und Immunologie, Klinik für Dermatologie und Allergologie, Charitéplatz 1, 10117 Berlin
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 (82-88)

Turning off the alarm – Targeting alarmins and other epithelial mediators of allergic inflammation with biologics

Melanie Albrecht

Molecular Allergology/Research Group of the Vice President, Paul Ehrlich Institute, Langen, Germany
Besides the major players IL-4, IL-13, IL-5, and IgE as targets for biologics, other mediators have been identified that are secreted by epithelial cells and act upstream in the cascade of allergic inflammation. Such are the alarmin IL-33 as well as TSLP and IL-5. The role of each cytokine in sensitization and effector phase of allergic inflammation and how development of biologics is ongoing in order to inhibit this pathomechanism will be described in the following article.Correspondence to:
Dr. phil. nat. Melanie Albrecht, Molekulare Allergologie/Forschungsgruppe des Vizepräsidenten, Paul-Ehrlich-Institut, Paul-Ehrlich-Str. 51-59, 63225 Langen
Email: [email protected]

Abstract

Allergologie select, Vol. 5/2021 (89-95)

Use of biologics in chronic spontaneous urticaria – beyond omalizumab therapy?

Martin Metz and Marcus Maurer

Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Dermatological Allergology, Allergy Center Charité, Department of Dermatology, Venereology and Allergology
In chronic spontaneous urticaria (CSU), itchy wheals, angioedema, or both occur regularly, often daily, and for years. An effective therapy for CSU aims at achieving complete symptom control. The current guideline for the management of CSU patients recommends non-sedative anthistamines in standard or up to 4-fold higher dosages as 1st and 2nd line treatment. For most CSU patients this treatment is not sufficient; for them, the anti-IgE antibody omalizumab is the therapy of choice. Although good to very good symptom control can be achieved in most cases, there are many patients with insufficient response. For these patients, but also as an alternative to therapy with omalizumab, numerous other biologicals are currently under development. In this review, we provide an overview of possible future biologic therapies for chronic urticaria.Correspondence to:
Prof. Dr. Martin Metz, AG Dermatologische Allergologie, Allergie-Centrum-Charité, Klinik für Dermatologie, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin
Email: [email protected]

Abstract

Allergologie select, Vol. 5/2021 (96-102)

Biologics in asthma management – Are we out of breath yet?

Nadja Struß¹ and Jens M. Hohlfeld¹,²,³

¹Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, ²Department of Respiratory Medicine, Hannover Medical School, ³Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany
The biologics authorized for the add-on therapy of severe asthma are monoclonal antibodies (mAbs). Before they are considered for therapy intensification, the patient’s asthma endotype is determined on the basis of phenotypic characteristics. So far, 5 biologics are available that target the signaling pathways of the “TH2-high” asthma endotype, in which cytokines of the inflammation cascade mediated by type 2 T-helper cells are upregulated. The corresponding phenotype of this inflammatory endotype is severe eosinophilic asthma, with elevated eosinophils, immunoglobulin E, and fractional exhaled nitric oxide (FeNO). In contrast, the heterogeneous “TH2-low” endotype is not yet sufficiently understood. Frequently described in this variant is an increase of sputum neutrophils and an increased expression of the TH17-mediated interleukin-17 signaling pathway. There are numerous biologics currently in clinical trials, the thymic stromal lymphopoietin (TSLP) mAbs in particular have shown promising results independent of the asthma phenotype.Correspondence to:
Prof. Dr. med. Jens M. Hohlfeld, Division Director, Respiratory Research, Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Feodor-Lynen-Str. 15, 30625 Hanover
Email: [email protected]

Abstract

Allergologie select, Vol. 5/2021 (103-107)

Use of biologics in food allergy management

Margitta Worm, Wojciech Francuzik, Sabine Dölle-Bierke and Aikaterina Alexiou

Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergy, Charité – Universitätsmedizin Berlin, Germany
Food allergies are a common medical problem, with children being the most affected patient group. The standard of care of food allergy consists of the acute treatment in case of a reaction and food avoidance in the long term, which influences the quality of life of patients. In this article, current developments for the causal treatment of food allergy including specific immunotherapy and biologics will be discussed. Epicutaneous and oral immunotherapy are currently in clinical development for the treatment of food allergy, and the results demonstrate good tolerability and efficacy with an increase in the oral threshold level. Biologics and, in particular, anti-IgE are currently investigated for their therapeutic use in food allergies. The results are promising, suggesting efficacy and tolerability.Correspondence to:
Univ.-Prof. Dr. med. Margitta Worm, Charité – Universitätsmedizin Berlin, Allergologie und Immunologie, Klinik für Dermatologie und Allergologie, Charitéplatz 1, 10117 Berlin, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 5/2021 (108-118)

Use of biologics in allergen immunotherapy

Wolfgang Pfützner and Mathias Schuppe

Department of Dermatology and Allergology, Clinical-Experimental Allergology, Allergy Center Hessen, University Hospital Marburg, Philipps-University Marburg
Biologics are drugs that are derived or synthesized from biological sources. A particular class are recombinant monoclonal antibodies. Their targeted application against distinct molecules of intercellular communication is of significant relevance in the treatment of tumor, inflammatory, or allergic diseases. But also in the context of allergen immunotherapy (AIT) they can be of special value. This is exemplified by the anti-IgE antibody omalizumab, which allows to achieve allergen tolerance in patients suffering from severe allergic reactions and increased risk of AIT-induced anaphylaxis. Furthermore, omalizumab administration during AIT effectively lowers the rsik of allergic side effects. This is demonstrated by a variety of studies and case reports of patients suffering either form respiratory, food, or insect venom allergy. Besides a direct blocking of IgE-mediated effects, T-cellular immune mechanisms might also be involved. Another interesting option is the applcation of recombinant IgG antibodes directed against specific epitopes of an allergen. Similar to AIT-induced IgG antibodies they can prevent the binding of allergens to IgE-antibodes as well as the hereby elicited allergic reactions.Correspondence to:
Prof. Dr. med. Wolfgang Pfützner, Klinik für Dermatologie und Allergologie, Allergie-Zentrum Hessen, Universitätsklinikum Marburg, Baldingerstraße, 35043 Marburg, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 5/2021 (119-127)

Anti-IgE: A treatment option in allergic rhinitis?

Oliver Pfaar, Francesca Gehrt, Hansen Li, Stefan A. Rudhart, Alexander Nastev, Boris A. Stuck, and Stephan Hoch

Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
Background: Allergic rhinitis (AR) is the most common IgE-mediated allergic disease. Multiple clinical trials have demonstrated promising results on the AR treatment with biologics, in particular with the use of omalizumab – an anti-IgE antibody. Omalizumab has also been established in the routine management of allergic asthma and chronic idiopathic urticaria. However, currently there is no approved license for the use of biologics in AR in Germany. Materials and methods: A systematic literature review has been completed including randomized controlled trials, meta-analyses, and reviews on the treatment of AR with omalizumab. Results: The systematic review demonstrates strong evidence supporting the use of omalizumab in the treatment of AR with regard to symptom control, safety profile, and management of comorbidities. Conclusion: Omalizumab is a good and safe option in the treatment of AR in terms of symptom control and the management of pre-existing comorbidities. Further clinical trials with other biologics in the management of AR are needed and are expected to follow soon.Correspondence to:
Prof. Dr. med. Oliver Pfaar, Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstraße, 35043 Marburg, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 5/2021 (128-132)

Omalizumab ensures compatibility to bee venom immunotherapy (VIT) after VIT-induced anaphylaxis in a patient with systemic mastocytosis

Askin Gülsen¹, Franziska Ruëff², and Uta Jappe¹,³

¹Interdisciplinary Allergy Outpatient Clinic, Department of Pneumology, University of Luebeck, ²Department of Dermatology and Allergology, Klinikum der Ludwig-Maximilians-Universität, Munich, and ³Division of Clinical and Molecular Allergology, Research Center Borstel, Leibniz Lung Center, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Borstel, Germany
Background: Systemic reactions and anaphylaxis due to Hymenoptera venoms occur in up to 7.5% of the European population. Fatal sting reactions are very rare. Serum tryptase levels should be measured in all patients with a history of severe reactions in order to detect mastocytosis and to determine the risk of severe reactions to venom immunotherapy (VIT). The risk to experience severe or even fatal anaphylaxis due to insect stings is quite high in patients with mastocytosis. Therefore, lifelong VIT is recommended in these highly threatened patients. Multicenter studies involving a large population report that up to 20% of patients undergoing VIT have intolerance and systemic reactions to immunotherapy. Some of these side effects occur repeatedly and cannot be managed by standard treatment. A pre-treatment with the anti-IgE antibody omalizumab was useful in many cases. However, omalizumab is not approved for the indication anaphylaxis. Therefore, there is still no defined protocol for omalizumab pre-treatment, and the optimal duration, dosage as well as long-time benefits are still unclear. Case report: We present a 60-year-old female patient with mastocytosis who developed a severe anaphylactic reaction during initiation of bee VIT. Serum tryptase was elevated, and a KIT mutation D816V was subsequently confirmed. Component-resolved diagnostic tests revealed specific IgE antibodies to recombinant Api m 1 only. The patient was treated with 150 mg omalizumab, administered subcutaneously 5 weeks, 3 weeks, and 1 week prior to re-start of immunotherapy and for 2 months in parallel to VIT. Updosing was done by a 7-day rush schedule. During this period, no anaphylactic reaction developed, and the bee VIT was well tolerated with up to 200 µg bee venom. The patient is currently in the 3rd year of treatment and tolerates the treatment very well. Conclusion: Omalizumab may be used as a premedication in patients with mastocytosis who do not tolerate VIT. Although there is no consensus on the treatment protocol, treatment for 2 – 6 months is considered adequate. The long-term benefits of such treatment require further research.Correspondence to:
Prof. Dr. Uta Jappe, FG Klinische und Molekulare Allergologie, Forschungszentrum Borstel, Leibniz, Lungenzentrum, Parkallee 1 – 40, 23845 Borstel
Email: [email protected]

Abstract

Allergologie select, Vol. 5/2021 (133-139)

Anaphylaxis in middle-aged patients

Wojciech Francuzik¹, Magdalena Kraft¹,², Kathrin Scherer Hofmeier³, Franziska Ruëff⁴, Claudia Pföhler⁵, Regina Treudler⁶, Roland Lang⁷, Thomas Hawranek⁷, Nicola Wagner⁸, und Margitta Worm¹

¹Allergy and Immunology, Department of Dermatology, Venereology and Allergology, Charité – Universitätsmedizin Berlin, Berlin, ²Central Emergency Department, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany ³Allergology, Clinic for Dermatology, University Hospital Basel, Basel, Switzerland, ⁴Clinic and Polyclinic for Dermatology and Allergology, University Hospital Munich, Munich, ⁵Clinic for Dermatology, Venerology and Allergology, Saarland University Hospital and Medical Faculty of Saarland University, Homburg, ⁶Clinic and Polyclinic for Dermatology, Venerology and Allergology, Leipzig University Hospital, Leipzig, Germany, ⁷University Clinic for Dermatology and Allergology, Paracelsus Medical Private University Salzburg, Salzburg, Austria and ⁸Dermatology Clinic, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
Age is one of the most important factors influencing the course of anaphylaxis: moreover, the frequency of elicitors of anaphylaxis is age-associated. We analyzed 8,465 anaphylactic episodes in adult patients in three age groups with a focus on patients in the middle-age group (35 – 65 years old). Insect venom was the most frequent trigger in this age group (51.2%) followed by drugs (22.8%) and food (17.3%). Severe reactions were observed in 40.1% of middle-aged patients and occurred more frequently in this age group than in patients below 35 years (27.6%) and less frequently than in patients over 65 years (55.6%). The symptoms and comorbidity profile also changed with age, most significantly regarding the increase in rates of concomitant cardiologic diseases and (severe) cardiovascular symptoms.Correspondence to:
Prof. Dr. med. Margitta Worm, Allergologie und Immunologie, Klinik für Dermatologie, Venerologie, und Allergologie, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin
Email: [email protected]

Abstract

Allergologie select, Vol. 5/2021 (140-147)

COVID-19 vaccination of patients with allergies and type-2 inflammation with concurrent antibody therapy (biologicals) – A Position Paper of the German Society of Allergology and Clinical Immunology (DGAKI) and the German Society for Applied Allergo

Oliver Pfaar¹, Ludger Klimek², Eckard Hamelmann³, Jörg Kleine-Tebbe⁴, Christian Taube⁵, Martin Wagenmann⁶, Thomas Werfel⁷, Randolf Brehler⁸, Natalija Novak⁹, Norbert Mülleneisen¹⁰, Sven Becker¹¹, and Margitta Worm¹²

¹Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, ²Center for Rhinology and Allergology, Wiesbaden, ³University Hospital for Pediatrics and Adolescent Medicine, Children’s Center Bethel, University of Bielefeld, ⁴Allergy Center Westend, Berlin, ⁵Clinic of Pneumology University Hospital Essen – Ruhrlandklinik, Essen, ⁶Clinic of Otolaryngology, University Hospital Düsseldorf, Düsseldorf, ⁷Department of Dermatology, Allergology and Venerology, Hannover Medical School, Hannover, ⁸Department of Dermatology, Wilhelm University of Münster, Münster, ⁹Department of Dermatology and Allergology, Bonn, ¹⁰Allergy and Asthma Center, Leverkusen, ¹¹Department of Otorhinolaryngology, University Hospital, Tübingen, and ¹²Allergology and Immunology, Department of Dermatotology, Venereology and Allergology, Charité Universitätsmedizin Berlin, Germany
Background: After the beginning and during the worldwide pandemic caused by the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), patients with allergic and atopic diseases have felt and still feel insecure. Currently, four vaccines against SARS-CoV-2 have been approved by the Paul Ehrlich Institute in Germany, and vaccination campaigns have been started nationwide. In this respect, it is of utmost importance to give recommendations on possible immunological interactions and potential risks of immunomodulatory substances (monoclonal antibodies, biologicals) during concurrent vaccination with the approved vaccines. Materials and methods: This position paper provides specific recommendations on the use of immunomodulatory drugs in the context of concurrent SARS-CoV-2 vaccinations based on current literature. Results: The recommendations are covering the following conditions in which biologicals are indicated and approved: 1) chronic inflammatory skin diseases (atopic dermatitis, chronic spontaneous urticaria), 2) bronchial asthma, and 3) chronic rhinosinusitis with nasal polyps (CRSwNP). Patients with atopic dermatitis or chronic spontaneous urticaria are not at increased risk for allergic reactions after COVID-19 vaccination. Nevertheless, vaccination may result in transient eczema exacerbation due to general immune stimulation. Vaccination in patients receiving systemic therapy with biologicals can be performed. Patients with severe asthma and concomitant treatment with biologicals also do not have an increased risk of allergic reaction following COVID-19 vaccination which is recommended in these patients. Patients with CRSwNP are also not known to be at increased risk for allergic vaccine reactions, and continuation or initiation of a treatment with biologicals is also recommended with concurrent COVID-19 vaccination. In general, COVID-19 vaccination should be given within the interval between two applications of the respective biological, that is, with a time-lag of at least 1 week after the previous or at least 1 week before the next biological treatment planned. Conclusion: Biologicals for the treatment of atopic dermatitis, chronic spontaneous urticaria, bronchial asthma, and CRSwNP should be continued during the current COVID-19 vaccination campaigns. However, the intervals of biological treatment may need to be slightly adjusted (DGAKI/AeDA recommendations as of March 22, 2021).Correspondence to:
Prof. Dr. med. Oliver Pfaar, Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstraße, 35043 Marburg, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 5/2021 (148-156)

Anti-inflammatory effect of herbal traditional medicine extract on molecular regulation in allergic asthma

Xiaopeng Sun¹, Entezar Mehrabi Nasab², Seyyede Masoume Athari³, and Seyyed Shamsadin Athari⁴

¹Department of Otolaryngology, Second Affiliated Hospital of Xi’an Medical College, Xi’an, China, ²Cardiologist, Department of Cardiology, School of Medicine, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, ³Department of Biology, Faculty of Basic Sciences, Maragheh University, Maragheh, and ⁴Department of Immunology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
Asthma is an important global health problem, and the main cause of asthma is allergic reaction and immune system dysregulation. Airway inflammation causes bronchial narrowing, and goblet cell hyperplasia leads to mucus hypersecretion that leads to airflow obstruction and difficulty breathing. The Th2 cytokines can induce allergic asthma. Camellia, Adhatoda, and Glycyrrhiza are the traditional medicines that are used in some countries. In the current study, we evaluated three herbal extracts on airway inflammatory responses in asthmatic mice. The asthma model was induced in mice that were divided into 6 groups: Phosphate-buffered saline (PBS) group, ovalbumin (OVA) group, OVA-budesonide group, OVA-Glycyrrhiza group, OVA-Camellia group, and OVA-Adhatoda group. Measurements of IL-4, IL-5, IL-13, glutamate oxaloacetate transaminase (GOT), glutamic pyruvic transaminase (GPT), IgE, histamine, percentages of eosinophils in bronchoalveolar lavage fluid (BALf), gene expression of COX-2, CCL24, CCL11, eotaxin, and histopathological study of lung were done. Adhatoda significantly attenuated the IL-4, IgE, and histamine levels. Glycyrrhiza attenuated the levels of IL-5, IL-13, GTP, GOT (on day 51), mRNA expression of eotaxin, CCL24, CCL11, and COX-2, eosinophil infiltration, mucus secretion, and goblet cell hyperplasia. Camellia decreased IL-13, GTP, COX-2 mRNA expression, mucus secretion, and goblet cell hyperplasia on day 31 and 51. We evaluated effect of three plants on allergic bio-factors. Glycyrrhiza as main anti-inflammatory treatment, Adhatoda as anti-allergic, and Camellia as anti-mucus releasing treatment can be used in attacks of allergic asthma.Correspondence to:
Dr. Seyyed Shamsadin Athari, Department of Immunology, School of Medicine, Zanjan University of Medical Sciences, Mahdavi street, 4513956111 Zanjan, Iran
Email: [email protected]

Abstract

Allergologie select, Vol. 5/2021 (157-161)

Allergic bronchopulmonary aspergillosis (ABPA) in an atopic patient with difficult-to-expectorate airway secretions

Marcus Joest

Lung and Allergy Center Bonn, Germany
In the workup of a 55-year-old atopic patient with cough and viscous secretions, we diagnosed an allergic bronchopulmonary aspergillosis (ABPA) on the basis of common diagnostic criteria for adult asthma patients (Rosenberg-Patterson and ISHAM), supported by the use of IgE antibodies against the Aspergillus components Asp f 2, f 4, and f 6. Initial treatment with prednisolone and itraconazole led to remission. In the long-term follow-up, there were few relapses until 2015, which responded well to standard treatment with oral steroids, and since 2016 the patient is in stable remission. The case highlights the valuable contribution of Aspergillus IgE measurements, including the specific IgEs against the components Asp f 1, f 2, f 4, and f 6 in the diagnosis of ABPA.Correspondence to:
Dr. Marcus Joest, Lungen- und Allergiezentrum Bonn, Weberstraße 118, 53113 Bonn
Email: [email protected]

Abstract

Allergologie select, Vol. 5/2021 (162-179)

Precision medicine reaching out to the patients in allergology – a German-Japanese workshop report

Oliver Pfaar¹, Katharina Blumchen², Eistine Boateng³, Eckard Hamelmann⁴, Tomohisa Iinuma⁵, Thilo Jakob⁶, Susanne Krauss-Etschmann³,⁷, Hiroyuki Nagase⁸, Saeko Nakajima⁹, Taiji Nakano¹⁰, Harald Renz¹¹, Sakura Sato¹², Christian Taube¹³, Martin Wagenmann¹⁴, Thomas Werfel¹⁵, Margitta Worm¹⁶, and Kenji Izuhara¹⁷

Oliver Pfaar, Katharina Blumchen, Eistine Boateng, Eckard Hamelmann, Tomohisa Iinuma, Thilo Jakob, Susanne Krauss-Etschmann, Hiroyuki Nagase, Saeko Nakajima, Taiji Nakano, Harald Renz, Sakura Sato, Christian Taube, Martin Wagenmann, Thomas Werfel, Margitta Worm, and Kenji Izuhara
An expert workshop in collaboration of the German Society of Allergy and Clinical Immunology (DGAKI) and the Japanese Society of Allergy (JSA) provided a platform for key opinion leaders of both countries aimed to join expertise and to highlight current developments and achievements in allergy research. Key domains of the meeting included the following seven main sections and related subchapters: 1) basic immunology, 2) bronchial asthma, 3) prevention of allergic diseases, 4) food allergy
and anaphylaxis, 5) atopic dermatitis, 6) venom allergy, and 7) upper airway diseases. This report provides a summary of panel discussions of all seven domains and highlights unmet needs and project possibilities of enhanced collaborations of scientific projects.Correspondence to:
Prof. Dr. Oliver Pfaar, Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstraße, 35039 Marburg, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 5/2021 (180-186)

Molecular allergy diagnosis using pollen marker allergens and pollen panallergens: Five patterns seen in multiple test reactions to pollen extracts

Jörg Kleine-Tebbe, Juliane Ackermann-Simon, and Gerald Hanf

Allergy and Asthma Center Westend, Outpatient Clinic & Research Center Hanf, Ackermann and Kleine-Tebbe, Berlin, Germany
Polysensitizations to tree, grass, and weed pollen are found in ~ 20% of pollen-allergic individuals. They are often based on broad IgE cross-reactivities to pollen panallergens belonging to highly conserved protein families: 1. profilins, 2. polcalcins (calcium-binding proteins in pollen), 3. cyclophilins. They represent highly conserved cross-reactive minor allergens present in all pollen species, but also in plant foods and other organisms. Despite being rarely clinically relevant they can hamper allergy diagnostic tests with extracts. In this situation, molecular allergy diagnosis is able to distinguish broad cross-reactivity due to allergen-specific IgE to pollen panallergens (i.e. profilins Bet v 2 or Phl p 12; polcalcins Bet v 4 or Phl p 7; and, in the future, cyclophilins Bet v 7 or Ole e 15) from primary IgE sensitizations to so-called marker allergens represented by important pollen major allergens: Bet v 1 for the birch and beech family (Fagales), Ole e 1 for olive and ash (Oleaceae), Phl p 1 for temperate climate grasses (Poaceae), Art v 1 for mugwort (Artemisia), Amb a 1 for Ambrosia species (Ambrosia). Five typical cases (A – E) with positive skin prick test results to tree, grass, and weed pollen extracts demonstrate typical patterns of IgE sensitization with a variable impact of pollen panallergens: A – profilins, B – polcalcins, C – profilins and polcalcins, D – presumably cyclophilins, E – primary polysensitization to tree, grass, and weed pollen without interference from profilins or polcalcins. Differences between pollen extract-based skin prick test diagnosis and molecular allergen-specific IgE testing are explained using the presented concept. This approach allows to reduce the number of allergen extracts – presuming they are also clinically relevant – for allergen immunotherapy (i.e., only tree and/or grass pollen extracts), particularly in pollen-polysensitized patients.Correspondence to:
Prof. Dr. Jörg Kleine-Tebbe, MD, Allergy and Asthma Center Westend, Outpatient Clinic & Research Center, Spandauer Damm 130, Haus 9, 14050 Berlin, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 5/2021 (187-194)

Relationship between allergic rhinitis and diamine oxidase activity: A preliminary report

Miguel Mayo-Yáñez¹,², Andrea Díaz-Díaz³, Juan C. Vázquez-Barro¹,⁴, Jesús Herranz González-Botas¹,⁵, Angélica Figueroa³, and Carlos S. Martín-Martín⁵,⁶

¹Otorhinolaryngology, Head and Neck Surgery Department, University Hospital Complex of A Coruña (CHUAC), A Coruña, Galicia, ²Clinical Research in Medicine, International Center for Doctorate and Advanced Studies (CIEDUS), University of Santiago de Compostela (USC), Santiago de Compostela, Galicia, ³Epithelial Plasticity and Metastasis Group, Biomedical Research Institute of A Coruña (INIBIC), University Hospital Complex of A Coruña (CHUAC), University of A Coruña (UDC), A Coruña, Galicia, ⁴School of Educational Sciences, University of A Coruña (UDC), A Coruña, Galicia, ⁵School of Medicine and Odontology, University of Santiago de Compostela (USC), Santiago de Compostela, Galicia, Spain, and ⁶Otorhinolaryngology, Head and Neck Surgery Department, University Hospital Complex of Santiago de Compostela (CHUS), Santiago de Compostela, Galicia, Spain
Aim: To analyze the diamine oxidase (DAO), the main catabolic enzyme of histamine, degradation activity and its relation with symptoms of persistent allergic rhinitis. Methods: In this descriptive and analytical observational study, we collected DAO activity levels and the nasal peak inspiratory flow. Results: Enzymatic activity deficit in 108 patients was 46.3% (95% CI, 0.44 – 0.63), 33.33% in mild and 47.92% in moderate/severe rhinitis (p = 0.376). The nasal peak inspiratory flow in patients with a deficit in DAO activity was 76.30 ± 28.40 L/min compared to 93.62 ± 37.50 L/min in patients with normal enzymatic activity (p = 0.010). Conclusions: It seems that the lower the catabolic activity of DAO, the lower the nasal peak inspiratory flow observed. Although DAO activity levels could be a severity biomarker in allergic rhinitis, a causeeffect association cannot be concluded. The enzyme could be another actor in the pathophysiology of allergic rhinitis.Correspondence to:
Miguel Mayo-Yáñez, MD, MSc, Otorhinolaryngology, Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), As Xubias 84, 15006, A Coruña, Spain
Email: [email protected]

Abstract

Allergologie select, Vol. 5/2021 (195-243)

Update of the S2k guideline on the management of IgE-mediated food allergies

Margitta Worm¹, Imke Reese², Barbara Ballmer-Weber³, Kirsten Beyer⁴, Stephan C. Bischoff⁵, Barbara Bohle⁶, Knut Brockow⁷, Martin Claßen⁸, Peter J. Fischer⁹, Eckard Hamelmann¹⁰, Uta Jappe¹¹#¹², Jörg Kleine-Tebbe¹³, Ludger Klimek¹⁴, Berthold Koletzko¹⁵, Lars Lange¹⁶, Susanne Lau⁴, Ute Lepp¹⁷, Vera Mahler¹⁸, Katja Nemat¹⁹, Martin Raithel²⁰, Joachim Saloga²¹, Christiane Schäfer²², Sabine Schnadt²³, Jens Schreiber²⁴, Zsolt Szépfalusi²⁵, Regina Treudler²⁶, Martin Wagenmann²⁷, Thomas Werfel²⁸, and Torsten Zuberbier²⁹

¹Allergology and Immunology, Department of Dermatology, Venereology, and Allergology, Charité – Universitätsmedizin Berlin, Germany, ²Nutritional Counseling and Therapy, Focus on Allergology, Munich, Germany, ³University Hospital Zurich, Department of Dermatology, Zurich, Switzerland, and Cantonal Hospital St. Gallen, Department of Dermatology and Allergology, St. Gallen, Switzerland, ⁴Clinic of Pediatrics m. S. Pneumology, Immunology and Intensive Care Medicine, Charité – Universitätsmedizin Berlin, Germany, ⁵Institute of Nutritional Medicine and Prevention, University of Hohenheim, Stuttgart, Germany, ⁶Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Austria, ⁷Department of Dermatology and Allergology, Biederstein, Klinikum rechts der Isar, Technical University of Munich, Germany, ⁸Klinik für Kinder und Jugendmedizin/Päd. Intensivmedizin, Eltern-Kind-Zentrum Prof. Hess Klinikum Bremen-Mitte, ⁹Practice for Pediatric and Adolescent Medicine m. S. Allergology and Pediatric Pneumology, Schwäbisch Gmünd, ¹⁰University Clinic for Pediatric and Adolescent Medicine, Evangelisches Klinikum Bethel gGmbH, Bielefeld, ¹¹Research Group Clinical and Molecular Allergology, Research Center Borstel, Airway Research Center North (ARCN), member of the German Center for Lung Research (DZL), Borstel, ¹²Interdisciplinary Allergy Outpatient Clinic, Medical Clinic III, University Hospital Schleswig-Holstein, Lübeck, ¹³Allergy and Asthma Center Westend, Berlin, ¹⁴Center for Rhinology and Allergology, Wiesbaden, ¹⁵Pediatric Clinic and Pediatric Polyclinic, Dr. von Haunersches Kinderspital, Department of Metabolic and Nutritional Medicine, Ludwig-Maximilians-University, Munich, ¹⁶Pediatric and Adolescent Medicine, St.- Marien-Hospital, Bonn, ¹⁷Practice for Pulmonary Medicine and Allergology, Buxtehude, ¹⁸Paul-Ehrlich-Institut, Langen, ¹⁹Practice for Pediatric Pneumology/Allergology at the Children’s Center Dresden (Kid), Dresen, ²⁰Medical Clinic II, Malteser Waldkrankenhaus, Erlangen, ²¹Department of Dermatology, University Medical Center, Johannes Gutenberg-University Mainz, ²²Nutritional Therapy, Focus on Allergology and Gastroenterology, Schwarzenbek, Germany, ²³German Allergy and Asthma Association, Mönchengladbach, Germany, ²⁴Pneumology, University Hospital of Otto von Guericke University, Magdeburg, Germany, ²⁵University Hospital for Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria, ²⁶Clinic of Dermatology, Venereology and Allergology, University Medical Center Leipzig, Germany, ²⁷Nose and Throat Clinic, University Hospital Düsseldorf, Germany, ²⁸Clinic of Dermatology, Allergology and Venerology, Hannover Medical School, Germany, and ²⁹Department of Dermatology, Venerology and Allergology, Charité – Universitätsmedizin Berlin
Correspondence to:
Univ.-Prof. Dr. med. Margitta Worm, Allergologie und Immunologie, Klinik für Dermatologie, Venerologie, und Allergologie, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin
Email: [email protected]

Abstract

Allergologie select, Vol. 5/2021 (244-250)

Atopic eczema is an environmental disease

Daria Luschkova¹, Katharina Zeiser¹,², Alika Ludwig¹, and Claudia Traidl-Hoffmann¹,³

¹Department of Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, ²Professorship of Sociology with a focus on health research, Faculty of Philosophy and Social Sciences, University of Augsburg, Augsburg, Germany and ³Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos Wolfgang, Switzerland
It is obvious that social, biogenic, and anthropogenic environmental factors, as well as nutrition contribute to the development and course of atopic eczema. Social deprivation and stress have a negative impact on atopic eczema symptoms, and social change in recent decades has led to a “westernized” lifestyle associated with high prevalence of atopic eczema in industrialized countries. Urbanization leads to an increase in air pollution and a decrease in biodiversity, which negatively affects atopic eczema. Climate change alters the allergenicity of pollen, which increases atopic eczema symptoms in some patients during the pollen season. Protective natural and social factors for the prevention of atopic eczema and for the promotion of “climate resilience” should be given greater consideration in future research.Correspondence to:
Daria Luschkova, MD, Department of Environmental Medicine, Faculty of Medicine, University of Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 5/2021 (251-259)

COVID-19 vaccination and allergen immunotherapy (AIT) - A position paper of the German Society for Applied Allergology (AeDA) and the German Society for Allergology and Clinical Immunology (DGAKI)

Ludger Klimek¹, Oliver Pfaar², Eckard Hamelmann³, Jörg Kleine-Tebbe⁴, Christian Taube⁵, Martin Wagenmann⁶, Thomas Werfel⁷, Randolf Brehler⁸, Natalija Novak⁹, Norbert Mülleneisen¹⁰, Sven Becker¹¹, and Margitta Worm¹²

¹Center for Rhinology and Allergology, Wiesbaden, ²Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, ³University Hospital for Pediatrics and Adolescent Medicine, Children’s Center Bethel, University of Bielefeld, ⁴Allergy Center Westend, Berlin, ⁵Department of Pneumology, University Hospital Essen – Ruhrlandklinik, Essen, ⁶Department of Otorhinolaryngology, University Hospital Düsseldorf, Düsseldorf, ⁷Department of Dermatology, Allergology and Venerology, Hanover Medical School, ⁸Department of Dermatology, University Hospital Münster, Division of Allergology, Occupational Dermatology and Environmental Medicine, Münster, ⁹Department of Dermatology and Allergy, Polyclinic for Dermatology and Allergology, Bonn, ¹⁰Asthma and Allergy Center, Leverkusen, ¹¹Clinic for Otorhinolaryngology, University Hospital, Tübingen, and ¹²Allergology and Immunology, Clinic for Dermatotology, Venerology and Allergology, Charité Universitätsmedizin Berlin, Germany
Background: Vaccinations against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) are intended to induce an immune response to protect against infection/disease. Allergen immunotherapy (AIT) is thought to induce a (different) immune response, e.g., to induce tolerance to allergens. In this position paper we clarify how to use AIT in temporal relation to COVID-19 vaccination. Four SARSCoV-2 vaccines are currently approved in the EU, and their possible immunological interactions with AIT are described together with practical recommendations for use. Materials and methods: Based on the internationally published literature, this position paper provides specific recommendations for the use of AIT in temporal relation to a SARSCoV-2 vaccination. Results: AIT is used in 1) allergic rhinitis, 2) allergic bronchial asthma, 3) insect venom allergy, 4) food allergy (peanut). Conclusion: For the continuation of an ongoing AIT, we recommend an interval of 1 week before and after vaccination for subcutaneous immunotherapy (SCIT). For sublingual immunotherapy (SLIT) and oral immunotherapy (OIT), we recommend taking Position paper them up to the day before vaccination and a break of 2 – 7 days after vaccination. Initiation of a new SCIT, SLIT, or OIT should be delayed until 1 week after the day of the second vaccination. For SCIT, we generally recommend an interval of ~ 1 week to COVID-19 vaccination.Correspondence to:
Prof. Dr. med. Ludger Klimek, Zentrum für Rhinologie und Allergologie, An den Quellen 10, 65183 Wiesbaden, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 5/2021 (260-264)

Anti-inflammatory topical medication – new developments in the treatment of atopic dermatitis

Johannes Wohlrab¹,², Burkhard Kreft¹, and Luisa Sophie Scholz²

¹University Hospital Halle (Saale), Clinic for Dermatology and Venereology, and ²Institute for Applied Dermatopharmacy, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
Atopic dermatitis is a chronic inflammatory disease that arises from polygenic disposition, a dysfunction of the physicochemical epithelial barrier, a cutaneous dysbiosis, and a faulty neurosensory activity and shows a highly individual acuity due to epigenetic factors. An essential component of therapeutic management is the application of anti-inflammatory topical medication. Currently, topical glucocorticoids and topical calcineurin inhibitors are routinely used in reactive and proactive therapy. In recent years, the development of molecular medicine has identified several new therapeutic targets that have enabled the development of innovative therapeutic approaches. In addition to phosphodiesterase-4 inhibitors and aryl hydrocarbon receptor modulators, it is mainly Janus kinase inhibitors with different selectivity that are emerging as new effective and safe options for topical therapy. The current data suggests that in the coming months and years representatives of the above-mentioned substance classes will be approved for topical use.Correspondence to:
Prof. Dr. Johannes Wohlrab, Klinik für Dermatologie und Venerologie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, Halle (Saale), Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 5/2021 (265-273)

A new era has begun: Treatment of atopic dermatitis with biologics

Dora Stölzl, Stephan Weidinger, and Katharina Drerup

Department of Dermatology, Venereology and Allergology, UKSH, Campus Kiel
The era of biologics for the treatment of moderate-to-severe atopic dermatitis (AD) began in 2017 with the approval of dupilumab, a monoclonal antibody that binds to the α-subunit of the interleukin IL-4 receptor. Until then, only conventional immunosuppressants were available for systemic treatment, of which only cyclosporine is approved for the treatment of severe AD. In the meantime, the therapeutic landscape of AD has been changing rapidly, and additional biologics have been developed which target IL-13, the IL-31 receptor, OX40, and OX40L, among others. Many of these substances have already shown promising results in phase 1, 2, and in some cases also phase 3 trials. In June 2021, tralokinumab, an IL-13 antibody, has been approved in Europe for the treatment of moderate-to-severe AD in adults. In addition to antibody-based therapies, “small molecules” that, e.g., inhibit Janus kinases enrich the armamentarium of systemic AD therapies. With all these agents, not only will many more targeted therapies become available, but also will the complex and heterogeneous pathophysiological processes of this disease be better understood.Correspondence to:
Dr. med. Univ. Dora Stölzl, Klinik für Dermatologie, Venerologie und Allergologie, UKSH, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 5/2021 (274-286)

Status report on the atopic dermatitis registry TREATgermany

Doreen Siegels¹, Eva Haufe¹, Luise Heinrich¹, Thomas Werfel², Stephan Weidinger³, Jochen Schmitt¹; and the TREATgermany Study Group

¹Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, ²Department of Immunodermatology and Experimental Allergology, Department of Dermatology, Allergology and Venereology, Hannover Medical School, Hannover, and ³Department of Dermatology, Venereology and Allergology, Schleswig-Holstein University Hospital, Kiel Campus, Kiel, Germany
Background: The TREATgermany registry collects data from children, adolescents, and adults with moderate-to-severe atopic dermatitis (AD) in Germany. For this purpose, clinical and patient-reported outcomes, the course of the disease, and applied therapies are observed. Methods: TREATgermany recruits patients with moderate-to-severe AD according to the diagnostic criteria of the UK Working Party, an “Objective Scoring for Atopic Dermatitis” (oSCORAD) > 20 and/or currently antiinflammatory systemic treatment for AD or previous anti-inflammatory systemic treatment for AD within past 24 months before inclusion. No study related interventions will be performed. Currently, 59 dermatological practices, clinics, and university hospitals are participating in TREATgermany (as of May 2021). Based on the interim analysis of October 13, 2020, patient characteristics were described from 4,373 documented visits of adult participants (n = 1,025). Results: The mean age at inclusion in TREATgermany was 42 years, 57.7% of patients were men (n = 591) and 42.3% were women (n = 434). According to oSCORAD, 85.8% of those included suffered from moderate-to-severe AD. At baseline visit, 744 patients had already received one or more systemic treatments for AD (glucocorticosteroids n = 600, ciclosporin A (CSA) n = 307, dupilumab n = 98). 597 patients received dupilumab during their participation in TREATgermany, 134 patients received CSA. Conclusion: With the increasing number of recruitment centers (October 2020: 38 centers; May 2021: 59 centers), TREATgermany can continue to make an important contribution to health services research for patients with moderate-to-severe AD. The registry fulfills the methodological requirements of IQWiG for the collection and processing of healthcare-related data. With the successful and expected approval of further systemic treatments, these can be compared in terms of efficacy and safety in the future. In addition, with the recruitment of children and adolescents started in 2021, this patient group can also be observed.Correspondence to:
Prof. Dr. med. Jochen Schmitt, Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden
Email: [email protected]

Abstract

Allergologie select, Vol. 5/2021 (287-292)

Barrier defect in atopic dermatitis – possibilities and limits of basic skin therapy

Lennart M. Roesner and Annice Heratizadeh

Department of Immunodermatology and Experimental Allergology, Clinic for Dermatology, Allergology and Venereology, Hannover Medical School, Hannover, Germany
The increased permeability of the skin barrier towards environmental factors such as allergens is considered a key factor in the pathogenesis of atopic dermatitis (AD). Strengthening the skin barrier through basic skin therapy represents the basis of any therapy for AD. It is well known that genetic factors as well as the skin inflammation itself contribute to the weakening of the barrier; here, recent studies have led to a deeper understanding of the complex structures of the epidermis. The possibility of counteracting the disease preventively by the use of basic skin therapy from birth on has been studied intensively in recent years. This article summarizes recent findings on the effects of basic skin therapy as a primary and secondary preventive measure.Correspondence to:
Dr. rer. nat. Lennart M. Rösner, Klinik für Dermatologie, Allergologie und Venerologie, Abteilung Immundermatologie und experimentelle Allergologie, Medizinische Hochschule Hannover (MHH) OE6610, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 5/2021 (293-304)

Janus kinase inhibitors for the therapy of atopic dermatitis

Stephan Traidl, Sina Freimooser, and Thomas Werfel

Department of Dermatology, Allergology and Venereology, Hannover Medical School, Hannover, Germany
The JAK-STAT pathway is involved in the signaling of multiple cytokines driving cutaneous inflammation in atopic dermatitis (AD). Janus kinase (JAK) inhibitors target individual receptor-associated kinases, thereby preventing the mediation of inflammatory signals. Several JAK inhibitors with varying mechanism of action, potency, and safety represent potential therapeutic options for AD in both topical and systemic application. The JAK1/2 selective JAK inhibitor baricitinib was the first substance from this class of drugs approved by the EMA for the systemic oral treatment of AD. The clinical development program of the JAK1 selective inhibitors upadacitinib and abrocitinib is finalized with positive results for AD. The PAN-JAK inhibitor delgocitinib was the first substance being approved for the treatment of AD (in Japan). This review article covers the rising data on investigational and approved JAK inhibitors in the context of the treatment of AD.Correspondence to:
Stephan Traidl, MD, Clinic for Dermatology, Allergology and Venereology, Hanover Medical School, Carl-Neuberg-Str. 1, 30625 Hanover, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 5/2021 (305-314)

Guideline on management of suspected adverse reactions to ingested histamine - Guideline of the German Society for Allergology and Clinical Immunology (DGAKI), the Society for Pediatric Allergology and Environmental Medicine (GPA), the Medical Association

Imke Reese¹, Barbara Ballmer-Weber², Kirsten Beyer³, Sabine Dölle-Bierke⁴, Jörg Kleine-Tebbe⁵, Ludger Klimek⁶, Sonja Lämmel⁷, Ute Lepp⁸, Joachim Saloga⁹, Christiane Schäfer¹⁰, Zsolt Szepfalusi¹¹, Regina Treudler¹², Thomas Werfel¹³, Torsten Zuberbier¹⁴, and Margitta Worm⁴

¹Nutrition Therapy, Munich, Germany, ²Clinic for Dermatology and Allergology, Cantonal Hospital St. Gallen and Department of Dermatology, University Hospital Zurich, Switzerland, ³Clinic for Pediatrics with focus on Pneumology and Immunology, Charité-Universitätsmedizin – Campus Virchow-Klinikum, Berlin, ⁴Allergology and Immunology, Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, ⁵Allergy and Asthma Center Westend, Berlin, ⁶Center for Rhinology and Allergology, Wiesbaden, ⁷German Allergy and Asthma Association (DAAB), Mönchengladbach, ⁸Practice for Pulmonary Medicine and Allergology, Stade, ⁹Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, ¹⁰Nutrition Therapy, Schwarzenbek, ¹¹Department of Pediatrics, Division of Pediatric Pulmonology, Allergology and Endocrinology, Comprehensive Center Pediatrics, Medical University of Vienna, Vienna, Austria, ¹²Department of Dermatology, Venereology and Allergology, Leipzig University Medical Center, ¹³Department of Dermatology and Allergy, Hannover Medical School, and ¹⁴Comprehensive Allergy Centre Charité, Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Germany
Adverse reactions to food or food ingredients are more often perceived than objectively verifiable. However, reliable laboratory tests are often lacking. As a result, people with perceived adverse reactions to food often follow extensive elimination diets for years and unnecessarily restrict their diet, as in the case of the frequently suspected histamine intolerance. In this condition, laboratory parameters such as the determination of diamine oxidase in serum have been shown to be inconclusive. The lack of symptom reproducibility calls into question the clinical picture of adverse reactions to ingested histamine. In order to approach persons with perceived histamine intolerance and to support them in moving from blanket restrictions, which are often unnecessarily strict, to effective personalized therapeutic strategies, the present guideline of the Working Group on Food Allergy of the German Society of Allergology and Clinical Immunology (DGAKI) in cooperation with the Medical Association of German Allergists (AeDA), the Pediatric Allergology and Environmental Medicine (GPA) as well as the Swiss Society of Allergology and Immunology (SGAI) and the Austrian Society of Allergology and Immunology (ÖGAI) recommends a practicable diagnostic and therapeutic approach.Correspondence to:
Dr. Imke Reese, Ernährungsberatung und -therapie, Schwerpunkt Allergologie, Ansprengerstr. 19, 80803 München
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 select, Vol. 5/2021 (335-344)

Allergic contact dermatitis to rubber accelerators in protective gloves: Problems, challenges, and solutions for occupational skin protection

Andreas Hansen¹,², Richard Brans¹,², and Flora Sonsmann¹,²

¹Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, and ²Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Germany
Protective gloves are an elementary component of personal protective equipment in many occupations and are intended to protect the hands from various hazards (e.g., wetness, chemicals, mechanical forces, or thermal stress). This is particularly important when other occupational safety measures (e.g., technical-organizational measures) cannot be implemented or are insufficient. However, it is not uncommon for protective gloves themselves to become a problem, as some of their ingredients (e.g., rubber accelerators) can cause allergic reactions. Accelerators in rubber gloves include thiurams, dithiocarbamates, thiazoles, guanidines, and thioureas. If no alternative means of protection are available, this may even result in abandoning the profession. This article is about rubber accelerators, which are often contained in protective gloves made of different rubber materials (e.g., natural rubber (latex) and nitrile rubber) and may cause delayed-type allergies, as well as related challenges, problems, and solutions for occupational skin protection.Correspondence to:
Andreas Hansen, M.A., University of Osnabrück, Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), Am Finkenhügel 7a, 49076 Osnabrück, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 5/2021 (345-348)

The influence of air pollution on pollen allergy sufferers

Markus Berger¹, Maximilian Bastl², Johannes Bouchal², Lukas Dirr², and Uwe Berger²

¹Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, and ²University Department of Otolaryngology, Medical University of Vienna, Austria
A multitude of consequences from global warming and environmental pollution can already be seen for nature and humans. The continuous burning of fossil fuels leads to rising temperatures and rising water levels causing extreme weather phenomena like heat waves and flooding. Increasing levels of air pollution also cause adverse health effects. This is especially important for pollen allergy sufferers because air pollution plays a central role in the interactions between pollen and humans. Today, pollen allergy sufferers are confronted with longer pollen seasons and pollen with potentially increased allergenicity. The effects for pollen allergy sufferers are an increased duration and severity of symptoms. New research results from the Medical University of Vienna prove that out of the most important air pollution parameters (particulate matter, nitrogen dioxide, sulfur dioxide, and ozone) especially ozone causes increased symptom severity in pollen allergy sufferers during the birch, grass, and ragweed pollen seasons.Correspondence to:
Markus Berger, Institut für Pathophysiologie und Allergieforschung, Zentrum für Pathophysiologie, Infektiologie und Immunologie, Medizinische Universität Wien, Währinger Gürtel 18 – 20, 1090 Vienna, Austria
Email: [email protected]

Abstract

Allergologie select, Vol. 5/2021 (349-360)

Nonpharmacological measures to prevent allergic symptoms in pollen allergy: A critical review

Karl-Christian Bergmann¹, Markus Berger², Ludger Klimek³, Oliver Pfaar⁴, Barbora Werchan⁵, Matthias Werchan⁵, and Torsten Zuberbier¹

¹Charité, Universitätsmedizin Berlin, Clinic for Dermatology, Venereology and Allergy, Berlin, Germany, ²Institut für Pathophysiologie und Allergieforschung, Zentrum für Pathophysiologie, Infektiologie und Immunologie, Medizinische Universität Wien, Vienna, Austria, ³Center for Rhinology and Allergology, Wiesbaden, ⁴Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, ⁵German Pollen Information Service Foundation (PID), Berlin, Germany
Allergic rhinoconjunctivitis (hay fever) is the most common chronic disease in all industrialized nations. Therapy consists essentially in the use of anti-allergic and anti-inflammatory drugs, which mostly show a good and quick effect. With allergenspecific immunotherapy, there is also a causal possibility of tolerance induction. There is currently a considerable undersupply, as those affected trivialize the symptoms and often have concerns about long-term drug therapy. There is also great interest in using non-medicinal measures to prevent and/or relieve allergic symptoms on the assumption that these are free from side effects. In this publication, we present non-drug methods for which clinical studies are available in the literature. The methods have varying degrees of effectiveness. An evidence-based comparative assessment between the methods is not possible. There are also hardly any studies in comparison to standard drug therapy. A large number of the interventions consist of allergen reduction, e.g., with air filters, or cleaning of the mucous membranes with nasal irrigation, etc., none of which should be seen as a substitute but as a supplement to drug therapy.Correspondence to:
Prof. Dr. Karl-Christian Bergmann, Charité, Universitätsmedizin Berlin, Klinik für Dermatologie, Venerologie und Allergie, Luisenstraße 2, 10117 Berlin, Germany
Email: [email protected]

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