Themenschwerpunkt: Berufsbedingte Handekzeme
Editorial:Prävention berufsbedingter Handekzeme –
Andrea Bauer, Jena
Jahrgang 26 p. 367 - 368
Abstract
Allergologie, Jahrgang 26, Nr. 9/2003, S. 367–368
Andrea Bauer, Jena
In den meisten Industrienationen führen beruflich bedingte Hauterkrankungen mit einem Anteil von ca. 30% aller gemeldeten Berufskrankheiten seit Jahren die Statistiken an oder stehen zumindest auf den vorderen Rängen.
In Deutschland war im Jahr 2001 die Berufskrankheit (BK) nach BK 5101 (Hautkrankheiten mit Ausnahme von Hautkrebs) mit 19189 gemeldeten Verdachtsanzeigen die häufigste aller BK-Anzeigen. Am häufigsten sind Arbeitnehmer in Feuchtberufen, z.B. im Friseurhandwerk, in Nahrungsmittelberufen, Metallberufen, Bauberufen, Krankenpflegeberufen usw. betroffen. Diepgen errechnete 1999 für beruflich bedingte Hauterkrankungen auf der Basis verschiedener Datenquellen eine ungefähre Inzidenzrate von 5 – 19 Fällen pro 10000 Vollzeitbeschäftigten pro Jahr [1].
Im Vordergrund stehen das irritative und das allergische Kontaktekzem. Das beruflich bedingte irritative Kontaktekzem tritt meist als Folge des ungeschützten kontinuierlichen Hautkontakts mit nicht-toxischen Konzentrationen verschiedenster Irritantien wie Wasser, Reinigungs- und Desinfektionsmitteln, Kühlschmiermitteln, Nahrungsmittelbestandteilen etc. auf. Zu Krankheitserscheinungen kommt es, wenn die regenerativen Fähigkeiten der Haut bei weiterbestehendem Kontakt zu den oben genannten Irritantien erschöpft sind. In der überwiegenden Mehrzahl der Fälle sind die Hände betroffen.
Die Charakteristika der einwirkenden Noxe, der zeitliche Verlauf der Exposition, mechanische und klimatische Zusatzfaktoren, Regenerationsmöglichkeiten und individuelle Dispositionsfaktoren bestimmen das klinische Bild. Daher ist ein weites Spektrum von akuten, subakuten und chronischen Verläufen möglich. Nicht selten treten in der Folge irritativer Handekzeme Typ-IV-Sensibilisierungen gegen Arbeitsstoffe auf. Es gibt bisher keine Möglichkeit, die individuelle Empfindlichkeit gegenüber Kontaktallergenen sicher vorherzusagen. Mögliche Ursachen der unterschiedlichen Suszeptibilität gegenüber Kontaktallergenen könnten durch genetischen Polymorphismus verschiedener Enzyme begründet sein. Die Entwicklung einer Sensibilisierung hängt von der Konzentration und der Allergenität des Kontaktallergens ab. Weiterhin spielen Ausmaß und Dauer der Exposition sowie die Lokalisation und der Hautzustand an der Expositionsstelle eine Rolle.
Das klinische Bild und die Symptomatik des allergischen Kontaktekzems zeigen große Ähnlichkeiten mit dem irritativen Kontaktekzem, was die Unterscheidung beider Entitäten insbesondere in chronischen Fällen erschwert. Auch eine histologische oder immunhistologische Unterscheidung ist schwierig. Beide Krankheitsbilder werden durch eine ausführliche Anamnese sowie durch Haut- und Provokationstests diagnostiziert.
Beruflich bedingte Handekzeme sind keine lebensbedrohlichen Erkrankungen und beeinflussen, solange sie mild ausgeprägt sind, das tägliche Leben nur in geringem Ausmaß. Schwere Fälle dagegen haben eine schlechte Prognose und beträchtliche Auswirkungen auf die Lebensqualität der Erkrankten. Darüber hinaus stellen sie nicht selten die weitere berufliche Laufbahn der betroffenen Arbeitnehmer in Frage. Die sozialen, ökonomischen und gesundheitspolitischen Auswirkungen dieser Tatsachen sind gravierend. In den letzten Jahren konnte zunehmend gezeigt werden, daß dieser Entwicklung durch effektive Präventionsmaßnahmen begegnet werden kann.
Das vorliegende Themenheft gibt einen Überblick über die Epidemiologie beruflich bedingter Handekzeme, weist die relevanten Risikofaktoren aus, skizziert Theorien und Modelle gesundheitspädagogischer Interventionen und stellt exemplarisch interdisziplinäre Studien zur Primär- und Sekundärprävention in Hautrisikoberufen vor. Wir danken allen Autoren herzlich für die gute Zusammenarbeit in der Vorbereitung des Themenhefts und wünschen den Lesern eine anregende Lektüre.
Andrea Bauer, Jena
Literatur
[1]
Diepgen T.L., P.J. Coenraads: The epidemiology of occupational contact dermatitis. Int. Arch. Occup. Environ. Health 72, 496-506 (1999).
Review
Assessment of the effects of a work-related allergy to seafood on the reduction of earning capacity in the context of BK No. 5101
Heinrich Dickel, Annette Kuehn, Beate Dickel, Andrea Bauer, Detlef Becker, Manigé Fartasch, Michael Haeberle, Swen Malte John, Vera Mahler, Christoph Skudlik, Elke Weisshaar, Thomas Werfel, Johannes Geier, and Thomas Ludwig Diepgen† for the working group “Evaluation of Allergens with regard to BK No. 5101” of the ABD and the DKG in the DDG
Volume 5 (2021) p. 33 - 44
Abstract
Allergologie select, Vol. 5/2021 (33-44)
Assessment of the effects of a work-related allergy to seafood on the reduction of earning capacity in the context of BK No. 5101
Heinrich Dickel1, Annette Kuehn2, Beate Dickel3, Andrea Bauer4, Detlef Becker5, Manigé Fartasch6, Michael Haeberle7, Swen Malte John8, Vera Mahler9, Christoph Skudlik8, Elke Weisshaar10, Thomas Werfel11, Johannes Geier12, and Thomas Ludwig Diepgen13† for the working group “Evaluation of Allergens with regard to BK No. 5101” of the ABD and the DKG in the DDG
1Department of Dermatology, Venerology and Allergology, St. Josef-Hospital, University Hospital of the Ruhr University Bochum (UK RUB), Bochum, Germany, 2Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg, 3Dermatological Practice Dr. med. Peter Wenzel, Hattingen, Germany, 4Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University, Dresden, Germany, 5Department of Dermatology, University Medical Center, Mainz, Germany, 6Institute for Prevention and Occupational Medicine (IPA) of the German Social Accident Insurance, Department of Clinical and Experimental Occupational Dermatology, Ruhr University Bochum, Bochum, Germany, 7Dermatological Practice, Künzelsau, Germany, 8Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück and Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany, 9Paul-Ehrlich-Institut (PEI), Langen, Germany, 10Division of Occupational Dermatology, Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany, 11Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany, 12Information Network of Departments of Dermatology (IVDK), Institute at the University Medical Center Göttingen, Göttingen, Germany, 13University of Heidelberg, Heidelberg, Germany
Fish, crustaceans, and mollusks are among the most potent allergenic foods of animal origin and are thus important triggers of work-related immediate-food allergies. In Germany, work-related seafood allergies are of great importance in the fishing and processing industries as well as in the areas of food preparation, food control, and food sales. There is no causal therapy of seafood allergy, only the strict and lifelong avoidance of allergens remains. The following recommendations serve to assess the impact of a seafood allergy with regard to the work opportunities ended by it for the assessment of the reduction of earning capacity (MdE (German for Minderung der Erwerbsfähigkeit)) in the context of the occupational disease number 5101 of the Annex to the German regulation for occupational diseases. As a special feature of work-related seafood allergy with regard to insurance law aspects, it must be taken into account that there is a potential risk of systemic reaction with subsequent multi-organ involvement. For the estimation of MdE in the general labor market, the impact of a seafood allergy can therefore be assessed, depending on its clinical severity, as generally “mild” to “severe” in justified individual cases.Correspondence to:
Priv.-Doz. Dr. med. Heinrich Dickel, Department of Dermatology, Venerology and Allergology, St. Josef-Hospital, University Hospital of the Ruhr University Bochum (UK RUB), Gudrunstraße 56, 44791 Bochum, Germany
Email: [email protected]
Statement
Practical recommendations for the allergological risk assessment of the COVID-19 vaccination – a harmonized statement of allergy centers in Germany
Margitta Worm, Andrea Bauer, Bettina Wedi, Regina Treudler, Wolfgang Pfuetzner, Knut Brockow, Timo Buhl, Torsten Zuberbier, Joachim Fluhr, Gerda Wurpts, Ludger Klimek, Thilo Jakob, Hans F. Merk, Norbert Mülleneisen, Stefani Roeseler, Heinrich Dickel, Ulrike Raap, and Jörg Kleine-Tebbe
Volume 5 (2021) p. 72 - 76
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]
Autorenreferate
17. Tagung der Arbeitsgemeinschaft für Berufs- und Umweltdermatologie (ABD): Allergologie, Berufs- und Umweltdermatologie; 21. – 23. September 2023, Dresden
Wissenschaftliche Leitung: Prof. Dr. med. Andrea Bauer, Dresden, Prof. Dr. med. Christoph Skudlik, Osnabrück/Hamburg
Jahrgang 71 (2023) p. 102 - 134
Abstract
Dermatologie in Beruf und Umwelt, Jahrgang 71, Nr. 3/2023 S. 102-134
17. Tagung der Arbeitsgemeinschaft für Berufs- und Umweltdermatologie (ABD): Allergologie, Berufs- und Umweltdermatologie; 21. – 23. September 2023, Dresden
Wissenschaftliche Leitung: Prof. Dr. med. Andrea Bauer, Dresden, Prof. Dr. med. Christoph Skudlik, Osnabrück/Hamburg
Guideline
Diagnosis and treatment of Hymenoptera venom allergy
Franziska Ruëff, Andrea Bauer, Sven Becker, Randolf Brehler, Knut Brockow, Adam M. Chaker, Ulf Darsow, Jörg Fischer, Thomas Fuchs, Michael Gerstlauer, Sunhild Gernert, Eckard Hamelmann, Wolfram Hötzenecker, Ludger Klimek, Lars Lange, Hans Merk, Norbert K. Mülleneisen, Irena Neustädter, Wolfgang Pfützner, Wolfgang Sieber, Helmut Sitter, Christoph Skudlik, Regina Treudler, Bettina Wedi, Stefan Wöhrl, Margitta Worm and Thilo Jakob
Volume 7 (2023) p. 154 - 190
Abstract
Allergologie select, Vol. 7/2023 (154-190)
Diagnosis and treatment of Hymenoptera venom allergy
Franziska Ruëff1, Andrea Bauer2, Sven Becker3, Randolf Brehler4, Knut Brockow5, Adam M. Chaker6, Ulf Darsow5, Jörg Fischer7, Thomas Fuchs8, Michael Gerstlauer9, Sunhild Gernert10, Eckard Hamelmann11, Wolfram Hötzenecker12, Ludger Klimek13, Lars Lange10, Hans Merk14, Norbert K. Mülleneisen15, Irena Neustädter16, Wolfgang Pfützner17, Wolfgang Sieber18, Helmut Sitter19, Christoph Skudlik20, Regina Treudler21, Bettina Wedi22, Stefan Wöhrl23, Margitta Worm24 and Thilo Jakob25
1Department of Dermatology and Allergy, LMU University Hospital, Munich, 2Department of Dermatology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, 3Department of Otorhinolaryngology, Head and Neck Surgery, University of Tuebingen, Tübingen, 4Department of Dermatology, Münster University Hospital, Münster, 5Department of Dermatology and Allergology Biederstein, Faculty of Medicine, Technical University of Munich, Munich, 6Department of Otorhinolaryngology Klinikum rechts der Isar, Faculty of Medicine, Technical University of Munich, Munich, 7University Hospital for Dermatology and Allergology, Clinic Oldenburg, Oldenburg, 8Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, 9Clinic for Children and Adolescents, University Hospital Augsburg, Augsburg, 10Pediatric Clinic, Marienhospital Bonn, GFO Kliniken, Bonn, 11Children’s Center Bethel, University Hospital OWL, Bielefeld University, Bielefeld, Germany, 12Department of Dermatology, Kepler University Hospital, Medical Faculty of University Linz, Linz, Austria, 13Center for Rhinology and Allergology, Wiesbaden, 14Department of Dermatology and Allergology, University Hospital of RWTH Aachen University, Aachen, 15Center for Asthma and Allergy, Leverkusen, 16Cnopfsche Paediatric Clinic, Nuremberg, 17Department of Dermatology and Allergology, University Hospital Marburg, Philipps-Universität Marburg, Marburg, 18Hospital Wörth an der Donau, Wörth an der Donau, 19Institute for Theoretical Surgery, Philipps-University Marburg, Marburg, 20Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrueck, Osnabrueck, and BG Clinic Hamburg, Hamburg, 21University Leipzig Medical Faculty, Leipzig, 22Comprehensive Allergy, Department of Dermatology and Allergy, Hannover Medical School, Hanover, Germany, 23Floridsdorf Allergy Center (FAZ), Vienna, Austria, 24Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, and 25Department of Dermatology and Allergology, University Hospital Giessen, Justus Liebig University Gießen, Gießen, Germany
Hymenoptera venom (HV) is injected into the skin during a sting by Hymenoptera such as bees or wasps. Some components of HV are potential allergens and can cause large local and/or systemic allergic reactions (SAR) in sensitized individuals. During their lifetime, ~ 3% of the general population will develop SAR following a Hymenoptera sting. This guideline presents the diagnostic and therapeutic approach to SAR following Hymenoptera stings. Symptomatic therapy is usually required after a severe local reaction, but specific diagnosis or allergen immunotherapy (AIT) with HV (VIT) is not necessary. When taking a patient’s medical history after SAR, clinicians should discuss possible risk factors for more frequent stings and more severe anaphylactic reactions. The most important risk factors for more severe SAR are mast cell disease and, especially in children, uncontrolled asthma. Therefore, if the SAR extends beyond the skin (according to the Ring and Messmer classification: grade > I), the baseline serum tryptase concentration shall be measured and the skin shall be examined for possible mastocytosis. The medical history should also include questions specific to asthma symptoms. To demonstrate sensitization to HV, allergists shall determine concentrations of specific IgE antibodies (sIgE) to bee and/or vespid venoms, their constituents and other venoms as appropriate. If the results are negative less than 2 weeks after the sting, the tests shall be repeated (at least 4 – 6 weeks after the sting). If only sIgE to the total venom extracts have been determined, if there is double sensitization, or if the results are implausible, allergists shall determine sIgE to the different venom components. Skin testing may be omitted if in-vitro methods have provided a definitive diagnosis. If neither laboratory diagnosis nor skin testing has led to conclusive results, additional cellular testing can be performed. Therapy for HV allergy includes prophylaxis of reexposure, patient self treatment measures (including use of rescue medication) in the event of re-stings, and VIT. Following a grade I SAR and in the absence of other risk factors for repeated sting exposure or more severe anaphylaxis, it is not necessary to prescribe an adrenaline auto-injector (AAI) or to administer VIT. Under certain conditions, VIT can be administered even in the presence of previous grade I anaphylaxis, e.g., if there are additional risk factors or if quality of life would be reduced without VIT. Physicians should be aware of the contraindications to VIT, although they can be overridden in justified individual cases after weighing benefits and risks. The use of β-blockers and ACE inhibitors is not a contraindication to VIT. Patients should be informed about possible interactions. For VIT, the venom extract shall be used that, according to the patient’s history and the results of the allergy diagnostics, was the trigger of the disease. If, in the case of double sensitization and an unclear history regarding the trigger, it is not possible to determine the culprit venom even with additional diagnostic procedures, VIT shall be performed with both venom extracts. The standard maintenance dose of VIT is 100 µg HV. In adult patients with bee venom allergy and an increased risk of sting exposure or particularly severe anaphylaxis, a maintenance dose of 200 µg can be considered from the start of VIT. Administration of a non-sedating H1-blocking antihistamine can be considered to reduce side effects. The maintenance dose should be given at 4-weekly intervals during the first year and, following the manufacturer’s instructions, every 5 – 6 weeks from the second year, depending on the preparation used; if a depot preparation is used, the interval can be extended to 8 weeks from the third year onwards. If significant recurrent systemic reactions occur during VIT, clinicians shall identify and as possible eliminate co-factors that promote these reactions. If this is not possible or if there are no such co-factors, if prophylactic administration of an H1-blocking antihistamine is not effective, and if a higher dose of VIT has not led to tolerability of VIT, physicians should should consider additional treatment with an anti IgE antibody such as omalizumab as off lable use. For practical reasons, only a small number of patients are able to undergo sting challenge tests to check the success of the therapy, which requires in-hospital monitoring and emergency standby. To perform such a provocation test, patients must have tolerated VIT at the planned maintenance dose. In the event of treatment failure while on treatment with an ACE inhibitor, physicians should consider discontinuing the ACE inhibitor. In the absence of tolerance induction, physicians shall increase the maintenance dose (200 µg to a maximum of 400 µg in adults, maximum of 200 µg HV in children). If increasing the maintenance dose does not provide adequate protection and there are risk factors for a severe anaphylactic reaction, physicians should consider a co-medication based on an anti-IgE antibody (omalizumab; off-label use) during the insect flight season. In patients without specific risk factors, VIT can be discontinued after 3 – 5 years if maintenance therapy has been tolerated without recurrent anaphylactic events. Prolonged or permanent VIT can be considered in patients with mastocytosis, a history of cardiovascular or respiratory arrest due to Hymenoptera sting (severity grade IV), or other specific constellations associated with an increased individual risk of recurrent and/or severe SAR (e.g., hereditary α-tryptasemia). In cases of strongly increased, unavoidable insect exposure, adults may receive VIT until the end of intense contact. The prescription of an AAI can be omitted in patients with a history of SAR grade I and II when the maintenance dose of VIT has been reached and tolerated, provided that there are no additional risk factors. The same holds true once the VIT has been terminated after the regular treatment period. Patients with a history of SAR grade ≥ III reaction, or grade II reaction combined with additional factors that increase the risk of non response or repeated severe sting reactions, should carry an emergency kit, including an AAI, during VIT and after regular termination of the VIT.Correspondence to:
Prof. Dr. med. Franziska Ruëff, Klinik und Poliklinik für Dermatologie, und Allergologie, Klinikum der Universität München, Frauenlobstraße 9-11, 80337 Munich, Germany,
Email: [email protected]
Autorenreferate
15. Dermatologisches Alpenseminar: Allergologie, Berufs- und Umweltdermatologie; 9. – 11. Mai 2024, Murnau am Staffelsee
Wissenschaftliche Leitung: Prof. Dr. med. Andrea Bauer, Dresden, und Prof. Dr. med. Christoph Skudlik, Osnabrück/Hamburg
Jahrgang 72 (2024) p. 79 - 100
Abstract
Dermatologie in Beruf und Umwelt, Jahrgang 72, Nr. 2/2024 S. 79-100
15. Dermatologisches Alpenseminar: Allergologie, Berufs- und Umweltdermatologie; 9. – 11. Mai 2024, Murnau am Staffelsee
Wissenschaftliche Leitung: Prof. Dr. med. Andrea Bauer, Dresden, und Prof. Dr. med. Christoph Skudlik, Osnabrück/Hamburg
Position Paper
Occupational anaphylaxis: A Position Paper of the German Society of Allergology and Clinical Immunology (DGAKI)
Regina Treudler, Margitta Worm, Andrea Bauer, Heinrich Dickel, Guido Heine, Uta Jappe, Ludger Klimek, Monika Raulf, Bettina Wedi, Dorothea Wieczorek, Wojciech Francuzik, Thilo Jakob, Oliver Pfaar, Johannes Ring, Franziska Rueff, Sabine Schnadt, Thomas Werfel, Gerda Wurpts, Julia Zarnowski, Torsten Zuberbier, and Knut Brockow
Volume 8 (2024) p. 407 - 424
Abstract
Allergologie select, Vol. 8/2024 (407-424)
Occupational anaphylaxis: A Position Paper of the German Society of Allergology and Clinical Immunology (DGAKI)
Regina Treudler1, Margitta Worm2, Andrea Bauer3, Heinrich Dickel4, Guido Heine5, Uta Jappe6, Ludger Klimek7, Monika Raulf8, Bettina Wedi9, Dorothea Wieczorek9, Wojciech Francuzik2, Thilo Jakob10, Oliver Pfaar11, Johannes Ring12, Franziska Rueff13, Sabine Schnadt14, Thomas Werfel9, Gerda Wurpts15, Julia Zarnowski16, Torsten Zuberbier1,17, and Knut Brockow12
1Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, 2Department of Dermatology, Venereology and Allergology, Charité – Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, 3Department of Dermatology, University AllergyCenter, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, 4Department of Dermatology, Venereology and Allergology, St. Josef Hospital, University Medical Center, Ruhr University Bochum, Bochum, 5Department of Dermatology, Venereology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, 6Division of Clinical and Molecular Allergology, Research Center Borstel, Airway Research, Center North (ARCN), Member of the German Center for Lung Research, Borstel, Interdisciplinary Allergy Outpatient Clinic, Department of Pneumology, University of Luebeck, 7Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz and Center for Rhinology and Allergology, Wiesbaden, 8Department of Allergology/Immunology; Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bochum, Germany, 9Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover, 10Department of Dermatology and Allergology, University Medical Center Giessen (UKGM), Justus-Liebig-University Giessen, Giessen, 11Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, 12Department of Dermatology and Allergy Biederstein, School of Medicine and Health, Technical University of Munich TUM), 13Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, 14German Allergy and Asthma Association (DAAB), Mönchengladbach, 15Clinic for Dermatology and Allergology, Aachen Comprehensive Allergy Center (ACAC), University Hospital of RWTH Aachen University, Aachen, 16Department of Dermatology, Venerology and Allergology, University of Leipzig Medical Center, Leipzig, and 17Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
Background: Anaphylaxis is a systemic allergic reaction that is potentially life-threatening. Occupational anaphylaxis is an anaphylaxis that occurs in an occupational context. In this position paper, we propose diagnostic criteria for occupational anaphylaxis and provide an overview of the current state of knowledge in terms of prevalence, triggers, prevention, and management. Results: The most common triggers of occupational anaphylaxis include Hymenoptera venoms, followed by food and drugs. Chemicals, bites or contact with animals (mammals/snakes/insects) and natural rubber latex are far less common. Occupations at risk for occupational anaphylaxis are therefore beekeepers, outdoor workers, or those who handle food as well as healthcare workers. The route of contact, intensity, and frequency of exposure, type of allergen, and the simultaneous occurrence of co-factors determine the clinical manifestation. A detailed medical history is required to confirm the diagnosis of anaphylaxis and to identify the trigger. Both skin tests and the determination of specific IgE are recommended, but only very few commercially available and quality-tested allergens are available that can be examined using both test methods. Preventive measures are based on avoiding further exposure or, if necessary, replacing a working substance. A written emergency plan and the prescription of an adrenaline autoinjector as well as instructions for its use are mandatory. Allergen immunotherapy is recommended for systemic Hymenoptera venom allergy. Depending on the national healthcare systems, patients with occupational anaphylaxis must be reported to the accident insurance. Conclusion: Occupational anaphylaxis is very rare. We recommend educational measures and generally standardized recording of occupational anaphylaxis for occupations with an increased risk of anaphylaxis.Correspondence to:
Prof. Dr. Regina Treudler, Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Institute of Allergology, Hindenburgdamm 30, 12203 Berlin, Germany
Email: [email protected]
Autorenreferate
16. Dermatologisches Alpenseminar: Allergologie, Berufs- und Umweltdermatologie; 14. – 16. Mai 2026, Murnau am Staffelsee
Wissenschaftliche Leitung: Prof. Dr. med. Andrea Bauer, Dresden, Prof. Dr. med. Christoph Skudlik, Osnabrück/Hamburg
Jahrgang 74 (2026) p. 73 - 92
Abstract
Wissenschaftliche Leitung: Prof. Dr. med. Andrea Bauer, Dresden, Prof. Dr. med. Christoph Skudlik, Osnabrück/Hamburg
16. Dermatologisches Alpenseminar: Allergologie, Berufs- und Umweltdermatologie; 14. – 16. Mai 2026, Murnau am Staffelsee
Wissenschaftliche Leitung: Prof. Dr. med. Andrea Bauer, Dresden, Prof. Dr. med. Christoph Skudlik, Osnabrück/Hamburg
Guideline
Update of the evidence- and consensus-based S3 guideline on atopic dermatitis: Systemic therapy with biologics or Janus kinase inhibitors and specific aspects of systemic therapy in pregnancy and lactation
Thomas Werfel, Annice Heratizadeh, Matthias Augustin, Christine Bangert, Andrea Bauer, Tilo Biedermann, Richard Brans, Nadine Domröse, Uwe Gieler, Oliver Gießler-Fichtner, Eckard Hamelmann, Selina Hampe, Ruben Heuer, Julia Kahle, Maria Kinberger, Markus Koch, Meike Köhler, Franz Legat, Katja Nemat, Irena Neustädter, Eva M. J. Peters, Susanne Radonjic-Hoesli, Imke Reese, Peter Schmid-Grendelmeier, Uta-Katharina Schmidt-Göhrich, Jochen Schmitt, Christina Schnopp, Thomas Schwennesen, Dagmar Simon, Kristina Stamos, Christian Termeer, Regina Treudler, Ralph von Kiedrowski, Iris Wagner, Anja Waßmann-Otto, Gesine Weckmann, Ricardo Niklas Werner, Andreas Wollenberg, Margitta Worm, and Hagen Ott
Volume 10 (2026) p. 120 - 144
Abstract
Allergologie select, Vol. 10/2026 (120-144)
Update of the evidence- and consensus-based S3 guideline on atopic dermatitis: Systemic therapy with biologics or Janus kinase inhibitors and specific aspects of systemic therapy in pregnancy and lactation
Thomas Werfel1, Annice Heratizadeh1, Matthias Augustin2, Christine Bangert3, Andrea Bauer4, Tilo Biedermann5, Richard Brans6, Nadine Domröse1, Uwe Gieler7, Oliver Gießler-Fichtner8, Eckard Hamelmann9, Selina Hampe10, Ruben Heuer11, Julia Kahle10, Maria Kinberger11, Markus Koch12, Meike Köhler13, Franz Legat14, Katja Nemat15,16, Irena Neustädter17, Eva M. J. Peters18, Susanne Radonjic-Hoesli19, Imke Reese20, Peter Schmid-Grendelmeier21, Uta-Katharina Schmidt-Göhrich22, Jochen Schmitt23, Christina Schnopp5, Thomas Schwennesen24, Dagmar Simon19, Kristina Stamos16, Christian Termeer25,26, Regina Treudler27, Ralph von Kiedrowski28, Iris Wagner24, Anja Waßmann-Otto29, Gesine Weckmann30, Ricardo Niklas Werner11, Andreas Wollenberg31,32, Margitta Worm33, and Hagen Ott13,34
1Department of Dermatology and Allergy, Hannover Medical School, Hannover, 2Competence Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany, 3Department of Dermatology, Medical University of Vienna, Vienna, Austria, 4Department of Dermatology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, 5TUM University Hospital, Department of Dermatology and Allergy, Munich, 6Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the Osnabrück University, Osnabrück, 7Department of Psychosomatic Medicine and Psychotherapy, University Hospital Gießen, Gießen, 8Gaißach Specialist Clinic of DRV Bayern Süd, Gaißach, 9Children’s Center, Evangelical Hospital Bethel, University Hospital OWL, University of Bielefeld, Bielefeld, 10German Allergy and Asthma Association (DAAB), Mönchengladbach, 11Department of Dermatology, Venereology and Allergology, Division of Evidence Based Medicine in Dermatology (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, 12Alpenklinik Santa Maria, Bad Hindelang, 13Section for Integrated Pediatric Dermatology (iKinD), Munich Center for Children with Medical and Developmental Complexity, LMU University Hospital, Munich, Germany, 14Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria, 15Practice for pediatric pneumology and allergology, Children’s Center Dresden-Friedrichstadt (Kid), 16Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, 17Hospital Hallerwiese, Cnopfsche Kinderklinik, Nuremberg, 18Psychoneuroimmunology Laboratory, Department of Psychosomatic Medicine and Psychotherapy, Justus-Liebig University Gießen, Gießen, Germany, 19Department of Dermatology, Inselspital Bern, Bern, Switzerland, 20Private Practice for Dietary Advice and Nutrition Therapy with Special Interest in Adverse Reactions to Food, Munich, Germany, 21Allergy Unit, Department of Dermatology, University Hospital Zurich and Christine Kuehne Center for Allergy Research and Education CK-CARE Davos, Switzerland, 22 Carus Family Practice at Dresden University Hospital, 23Center for Evidence-Based Healthcare (ZEGV), University Hospital Dresden and Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, 24German Eczema Association (DNB), Hamburg, 25Dermatology Practice at Löwenmarkt, Stuttgart-Weilimdorf, 26Department of Dermatology, University-Hospital Freiburg, Freiburg, 27Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, 28Selters Dermatology Practice, Selters, 29Mensing Derma MVZ, Hamburg, 30Weckmann Institute of Medical and Healthcare Education, Rostock, 31Department of Dermatology and Allergology, University Hospital Augsburg, Augsburg, 32Clinic and Polyclinic for Dermatology and Allergology, Ludwig Maximilian University, Munich, 33Department of Dermatology, Venereology, and Allergology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, and 34Department of Pediatric Surgery, Dr. Von Hauner Children’s Hospital, LMU University Hospital, Munich, Germany
This guideline is a partial update of the S3 guideline on atopic dermatitis (AWMF register no. 013-027) published in 2023. The chapters on systemic therapy with biologics and Janus kinase inhibitors as well as the chapter on pregnancy, breastfeeding and family planning in the context of systemic therapies for atopic dermatitis have been updated. This was prompted by new approvals (lebrikizumab, nemolizumab), approval extensions (abrocitinib from 12 years of age, baricitinib from 2 years of age) and new evidence on the use of biologics before and during pregnancy. In addition, a new chapter on treatment goals, treatment expectations and criteria for treatment adjustment (“treat-to-target”) in systemic therapies has been added to the guideline. This article only presents the updated and newly added chapters. The complete guideline is available on the AWMF website.Correspondence to:
PD Dr. Annice Heratizadeh, Department of Dermatology and Allergy, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
Email: [email protected]
