Original
Guideline on diagnostic procedures for suspected hypersensitivity to beta-lactam antibiotics
Gerda Wurpts, Werner Aberer, Heinrich Dickel, Randolf Brehler, Thilo Jakob, Burkhard Kreft, Vera Mahler, Hans F. Merk, Norbert Mülleneisen, Hagen Ott, Wolfgang Pfützner, Stefani Röseler, Franziska Ruëff, Helmut Sitter, Cord Sunderkötter, Axel Trautmann, Regina Treudler, Bettina Wedi, Margitta Worm, und Knut Brockow
Volume 4 (2020) p. 11 - 43
Abstract
Allergologie select, Vol. 4/2020 (11-43)
Guideline on diagnostic procedures for suspected hypersensitivity to beta-lactam antibiotics
Gerda Wurpts1, Werner Aberer2, Heinrich Dickel3, Randolf Brehler4, Thilo Jakob5, Burkhard Kreft6, Vera Mahler7,8, Hans F. Merk1, Norbert Mülleneisen9, Hagen Ott10, Wolfgang Pfützner11, Stefani Röseler1, Franziska Ruëff12, Helmut Sitter13, Cord Sunderkötter6, Axel Trautmann14, Regina Treudler15, Bettina Wedi16, Margitta Worm17, und Knut Brockow18
1Clinic for Dermatology and Allergology, Aachen Comprehensive Allergy Center (ACAC), Uniklinik RWTH Aachen, Germany 2Department of Dermatology, Graz Medical University, Graz, Austria, 3Department of Dermatology, Venereology and Allergology, St. Josef Hospital, University Hospital of the Ruhr University Bochum, Bochum, 4Department of Dermatology, University Hospital Münster, Münster, 5Department of Dermatology and Allergology, University Hospital Gießen und Marburg, Gießen Site, Gießen, 6Department of Dermatology and Venereology, University, Hospital Halle (Saale), Halle (Saale), 7Paul-Ehrlich Institute, Langen, 8Department of Dermatology, University Hospital Erlangen, Erlangen, 9Asthma and Allergy Centre, Leverkusen, 10Division of Pediatric Dermatology and Allergology, Auf der Bult Children’s Hospital, Hannover, 11Department of Dermatology and Allergology, University Hospital Gießen und Marburg, Marburg Site, Marburg, 12Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, 13Institute of Surgical Research, Philipps University Marburg, Marburg, 14Department of Dermatology and Allergy, Allergy Center Mainfranken, University Hospital Würzburg, Würzburg, 15Department of Dermatology, Venereology, and Allergology and Leipzig Interdisciplinary Center for Allergology – LICA-CAC, University of Leipzig, Leipzig, 16Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover, 17Department of Dermatology, Venereology, and Allergology, Charité University Hospital Berlin, Allergy Center Charité (ACC), Berlin, and 18Department of Dermatology and Allergology am Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
This guideline on diagnostic procedures for suspected beta-lactam antibiotic (BLA) hypersensitivity was written by the German and Austrian professional associations for allergology, and the Paul-Ehrlich Society for Chemotherapy in a consensus procedure according to the criteria of the German Association of Scientific Medical Societies. BLA such as penicillins and cephalosporins represent the drug group that most frequently triggers drug allergies. However, the frequency of reports of suspected allergy in patient histories clearly exceeds the number of confirmed cases. The large number of suspected BLA allergies has a significant impact on, e.g., the quality of treatment received by the individual patient and the costs to society as a whole. Allergies to BLA are based on different immunological mechanisms and often manifest as maculopapular exanthema, as well as anaphylaxis; and there are also a number of less frequent special clinical manifestations of drug allergic reactions. All BLA have a beta-lactam ring. BLA are categorized into different classes: penicillins, cephalosporins, carbapenems, monobactams, and beta-lactamase inhibitors with different chemical structures. Knowledge of possible cross-reactivity is of considerable clinical significance. Whereas allergy to the common beta-lactam ring occurs in only a small percentage of all BLA allergic patients, cross-reactivity due to side chain similarities, such as aminopenicillins and aminocephalosporins, and even methoxyimino cephalosporins, are more common. However, the overall picture is complex and its elucidation may require further research. Diagnostic procedures used in BLA allergy are usually made up of four components: patient history, laboratory diagnostics, skin testing (which is particularly important), and drug provocation testing. The diagnostic approach – even in cases where the need to administer a BLA is acute – is guided by patient history and risk – benefit ratio in the individual case. Here again, further studies are required to extend the present state of knowledge. Performing allergy testing for suspected BLA hypersensitivity is urgently recommended not only in the interests of providing the patient with good medical care, but also due to the immense impact of putative BLA allergies on society as a whole.Correspondence to:
Dr. med. Gerda Wurpts, Clinic for Dermatology and Allergology, Aachen Comprehensive Allergy Center (ACAC), Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
Email: [email protected]
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
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 Wedi, Werner Aberer, Knut Brockow, Heinrich Dickel, Randolf Brehler, Thilo Jakob, Burkhard Kreft, Vera Mahler, Hans F. Merk, Norbert Mülleneisen, Hagen Ott, Wolfgang Pfützner, Stefani Röseler, Franziska Ruëff, Cord Sunderkötter, Axel Trautmann, Regina Treudler, Margitta Worm, and Gerda Wurpts
Volume 5 (2021) p. 67 - 71
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]
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]
Guideline
Guideline for allergological diagnosis of drug hypersensitivity reactions
Knut Brockow, Gerda Wurpts, Axel Trautmann, Wolfgang Pfützner, Regina Treudler, Andreas J. Bircher, Randolf Brehler, Timo Buhl, Heinrich Dickel, Thomas Fuchs, Thilo Jakob, Julia Kurz, Burkhard Kreft, Lars Lange, Hans F. Merk, Maja Mockenhaupt, Norbert Mülleneisen, Hagen Ott, Johannes Ring, Franziska Ruëff, Bernhardt Sachs, Helmut Sitter, Bettina Wedi, Stefan Wöhrl, Margitta Worm, and Torsten Zuberbier
Volume 7 (2023) p. 122 - 139
Abstract
Allergologie select, Vol. 7/2023 (122-139)
Guideline for allergological diagnosis of drug hypersensitivity reactions
Knut Brockow1, Gerda Wurpts2, Axel Trautmann3, Wolfgang Pfützner4, Regina Treudler5, Andreas J. Bircher6, Randolf Brehler7, Timo Buhl8, Heinrich Dickel9, Thomas Fuchs8, Thilo Jakob10, Julia Kurz4, Burkhard Kreft11, Lars Lange12, Hans F. Merk2, Maja Mockenhaupt13, Norbert Mülleneisen14, Hagen Ott15, Johannes Ring1, Franziska Ruëff16, Bernhardt Sachs2, Helmut Sitter17, Bettina Wedi18, Stefan Wöhrl19, Margitta Worm20, and Torsten Zuberbier20
1Department of Dermatology and Allergology Biederstein, Faculty of Medicine, Technical University of Munich, Munich, 2Department of Dermatology and Allergology, Germany, Aachen Comprehensive Allergy Center (ACAC), University Hospital of RWTH Aachen University, Aachen, 3Department of Dermatology and Allergology, Allergy Center Mainfranken, University Hospital Würzburg, Würzburg, 4Department of Dermatology and Allergology, University Hospital Giessen and Marburg, Marburg, 5Department of Dermatology, Venerology and Allergology, University of Leipzig, Leipzig, Germany, 6Facoltà di Scienze biomediche, Università della Svizzera italiana, Lugano, and Department of Dermatology and Allergology, University Hospital Basel, Switzerland, 7Department of Dermatology, Münster University Hospital, Münster, 8Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, 9Department of Dermatology, Venerology and Allergology, St. Josef Hospital, University Hospital of the Ruhr University Bochum, Bochum, 10Department of Dermatology and Allergology, University Hospital, Justus-Liebig University, Gießen, 11Department of Dermatology and Venereology, University Hospital Halle, Halle (Saale), 12Pediatric Clinic, Marienhospital Bonn, Bonn, 13Documentation Center for Severe Skin Reactions, Department of Dermatology and Venereology, University Medical Center Freiburg, Freiburg, 14Asthma Allergy Center Leverkusen, Leverkusen, 15Children’s and Youth Hospital Auf der Bult, Hanover, 16Department of Dermatology and Allergology, Allergy Center, Ludwig Maximilian University of Munich, 17Institute for Theoretical Surgery, Philipps University of Marburg, Marburg, 18Hanover Medical School, Department of Dermatology, Allergology and Venereology, Hanover, Germany, 19Floridsdorf Allergy Center (FAZ), Vienna, Austria, and 20Allergology and Immunology, Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
Correspondence to:
Prof. Dr. med. Knut Brockow, Department of Dermatology and Allergology at Biederstein, Faculty of Medicine, Technical University of Munich, Biedersteiner Straße 29, 80802 Munich, Germany
Email: [email protected]
Consensus paper
“Delabeling” by direct provocation testing in children and adolescents with a suspected history of a delayed reaction to β-lactam antibiotics. Consensus paper of Gesellschaft für pädiatrische Allergologie und Umweltmedizin (GPAU
Irena Neustädter, Sophie Blatt, Gerda Wurpts, Heinrich Dickel, Christian Walter, Werner Aberer, Sebastian Bode, Timo Buhl, Sunhild Gernert, Susanne Harner, Guido Heine, Sebastian Kerzel, Meike Köhler, Lars Lange, Joachim List, Hans F. Merk, Thomas Nüßlein, Hagen Ott, Franziska Sattler, Antje Schuster, Helen Straube, Bettina Wedi, Torsten Zuberbier, and Knut Brockow
Volume 8 (2024) p. 206 - 211
Abstract
Allergologie select, Vol. 8/2024 (206-211)
“Delabeling” by direct provocation testing in children and adolescents with a suspected history of a delayed reaction to β-lactam antibiotics. Consensus paper of Gesellschaft für pädiatrische Allergologie und Umweltmedizin (GPAU
Irena Neustädter1, Sophie Blatt1, Gerda Wurpts3, Heinrich Dickel4, Christian Walter5, Werner Aberer6, Sebastian Bode7, Timo Buhl8, Sunhild Gernert9, Susanne Harner10, Guido Heine11, Sebastian Kerzel10, Meike Köhler12, Lars Lange9, Joachim List13, Hans F. Merk2, Thomas Nüßlein14, Hagen Ott15, Franziska Sattler12, Antje Schuster16, Helen Straube17, Bettina Wedi18, Torsten Zuberbier19, and Knut Brockow2
1Pediatric and Adolescent Medicine, Diakoneo Klinik Hallerwiese-Cnopfsche Kinderklinik, Nuremberg, 2Clinic and Polyclinic for Dermatology and Allergology at Biederstein, Technical University of Munich, Munich, 3Clinic for Dermatology and Allergology, Aachen Comprehensive Allergy Center (ACAC), University Hospital of RWTH Aachen University, Aachen, 4Clinic for Dermatology, Venereology and Allergology, St. Josef Hospital, University Hospital of the Ruhr University Bochum, Bochum, 5Practice for Pediatric and Adolescent Medicine, Allergology, Bad Homburg, Germany, 6Department of Dermatology and Venereology, Medical University of Graz, Austria, 7University Clinic for Children and Adolescents, Ulm, 8Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, 9Department of Pediatrics, St. Marien Hospital, GFO Clinics, Bonn, 10Clinic and Polyclinic for Pediatrics and Adolescent Medicine, University of Regensburg, Regensburg, 11Department of Dermatology, Venereology and Allergology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, 12Asthma and Allergy Outpatient Clinic, Dr. von Hauner Children’s Hospital, LMU University Hospital, Munich, 13University of Freiburg, Center for Pediatric and Adolescent Medicine, Freiburg, 14Clinic for Pediatrics and Adolescent Medicine, Gemeinschaftsklinikum Mittelrhein, Koblenz, 15Children’s and Youth Hospital Auf der Bult, Hanover, 16Clinic for General Pediatrics, Neonatology and Pediatric Cardiology, University Hospital Düsseldorf, Düsseldorf, 17Princess Margaret Children’s Hospital, Darmstadt, 18Hannover Medical School, Clinic for Dermatology, Allergology and Venereology, Hanover, and 19Allergology and Immunology, Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
Background: Approximately 10% of European children are classified as allergic to drugs. In the majority of these children, no allergy to β-lactam antibiotics (BLA) can be found. In most cases, the exanthema is caused by the infection. Materials and methods: The objective of this paper is to describe the causes and consequences of a misdiagnosis of drug allergy. We propose a method for establishing a correct diagnosis in the case of a history of a delayed reaction during treatment with a BLA. For this purpose, a proposal was discussed via e-mail communication, and consensus was reached among the members of the drug allergy working groups of the participating medical societies. Results: The suspicion of a BLA allergy based on the medical history alone can have a negative impact on future antibiotic treatment. Exanthema associated with febrile infections not related to drug administration is a frequent finding in children. This makes it all the more important to be able to recommend a standardized procedure for clarification in children and adolescents with suspected hypersensitivity reactions. The medical history should be the basis on which to diagnose either a drug allergy or another possible differential diagnosis. A mild maculopapular exanthema (MPE) can be an expression of a drug allergy or a nonspecific viral exanthema. Uncomplicated MPE is not associated with significant systemic involvement, and there is no involvement of the mucous membranes or cutaneous blistering. Only a small number of children with uncomplicated MPE show positive skin tests and only ~ 7 – 16% of suspected BLA diagnoses can be confirmed by provocation tests. Thus, in children with uncomplicated MPE, drug provocation can be performed in an outpatient setting even without prior skin testing. This paper presents a 3-day outpatient direct provocation scheme for BLA delabeling in children with uncomplicated MPE. Conclusion: Many children and adolescents are unnecessarily denied treatment with BLA after an uncomplicated MPE while being treated with a BLA.Correspondence to:
Dr. med. Irena Neustädter, Pediatric and Adolescent Medicine, Diakoneo Klinik Hallerwiese-Cnopfsche Kinderklinik, St.-Johannis-Mühlgasse 19, 90419 Nuremberg, Germany
Email: [email protected]
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]
Case Report
Contact allergy to a titanium port catheter: Diagnostic challenges and clinical resolution
Silas Fugger, Alexander Kauffmann, and Heinrich Dickel
Volume 10 (2026) p. 145 - 150
Abstract
Allergologie select, Vol. 10/2026 (145-150)
Contact allergy to a titanium port catheter: Diagnostic challenges and clinical resolution
Silas Fugger1, Alexander Kauffmann2, and Heinrich Dickel1
1Department of Dermatology, Venereology and Allergology, St. Josef Hospital, University Medical Center, Bochum, and 2Chair for Materials Science and Engineering, Institute for Materials, Faculty of Mechanical Engineering, Ruhr University Bochum, Bochum, Germany
Background: Titanium and its alloys are widely used in modern medical devices because of their favorable biocompatibility and mechanical properties. Allergic reactions to titanium-based implants are considered rare, and their diagnosis is hampered by the poor dermal penetration of metallic allergens. Case report: A 29-year-old female patient with seronegative myasthenia gravis requiring parenteral nutrition presented with persistent inflammatory dermatitis overlying a titanium port catheter (X-Port BARD Titan low-profile) 4 weeks after implantation in July 2023. Despite initial diagnostic uncertainty and sequential management modifications, her condition continued to deteriorate. Similar eruptions developed after re-implantation of the same titanium port model on the contralateral thorax. Rigorous patch testing incorporating standardized tape-stripping and extended reading intervals revealed positive sensitization to the titanium port body, while all other port components and an alternative plastic port system (BARD SlimPort M.R.I. Ultra Low-Profile) tested negative. Energy-dispersive X-ray spectroscopy confirmed the titanium body composition as a Ti-Al6-V4 alloy. Substitution with the plastic port catheter in February 2025 resulted in complete symptom resolution, with sustained clinical remission through July 2025. Conclusion: Although very uncommon, contact sensitization to titanium medical devices can occur and may present significant diagnostic and therapeutic challenges. Rigorous patch testing methodology, incorporating standardized tape-stripping and extended 168-hour readings, appears essential for detecting delayed-type hypersensitivity to metallic implants. Clinical resolution following biocompatible device substitution supports an allergic etiology in this case.Correspondence to:
Silas Fugger, Department of Dermatology, Venereology and Allergology, Ruhr University Bochum, Gudrunstraße 56, 44791 Bochum, Germany
Email: [email protected]
