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]
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
Recommendations on how to proceed in case of suspected allergy to penicillin/β-lactam antibiotics. Position paper of the German Society for Allergology and Clinical Immunology (DGAKI) in cooperation with the German Society for Pediatric Allergology (
Knut Brockow, Wolfgang Pfützner, Bettina Wedi, Gerda Wurpts, Axel Trautmann, Burkhard Kreft, Timo Buhl, Mathias Sulk, Andreas Recke, Kathrin Scherer, Stefan Wöhrl, Irena Neustädter, Regina Treudler, Christiane Querbach, and Margitta Worm
Volume 9 (2025) p. 28 - 39
Abstract
Allergologie select, Vol. 9/2025 (28-39)
Recommendations on how to proceed in case of suspected allergy to penicillin/β-lactam antibiotics. Position paper of the German Society for Allergology and Clinical Immunology (DGAKI) in cooperation with the German Society for Pediatric Allergology (
Knut Brockow1, Wolfgang Pfützner2, Bettina Wedi3, Gerda Wurpts4, Axel Trautmann5, Burkhard Kreft6, Timo Buhl7, Mathias Sulk8, Andreas Recke9, Kathrin Scherer10, Stefan Wöhrl11, Irena Neustädter12, Regina Treudler13, Christiane Querbach14, and Margitta Worm15
1Department of Dermatology and Allergology Biederstein, Faculty of Medicine and Health, Technical University of Munich, Munich, 2Department of Dermatology and Allergology, University Hospital Giessen and Marburg, Marburg, 3Hanover Medical School, Department of Dermatology, Allergology and Venereology, Hanover, 4Department of Dermatology and Allergology, Germany, Aachen Comprehensive Allergy Center (ACAC), University Hospital of RWTH Aachen University, Aachen, 5Department of Dermatology and Allergology, Allergy Center Mainfranken, University Hospital Würzburg, Würzburg, 6Department of Dermatology and Venereology, University Hospital Halle, Halle (Saale), 7Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, 8Department of Dermatology, Münster University Hospital, Münster, 9Department of Dermatology, Allergology and Venereology, University Hospital Schleswig-Holstein, Holstein Campus Lübeck, Lübeck, Germany, 10Department of Dermatology, Cantonal Hospital Aarau, Aarau, and Department of Dermatology and Allergology, University Hospital Basel, Switzerland, 11Floridsdorf Allergy Center (FAZ), Vienna, Austria, 12Pediatric Clinic, Diakoneo Klinik Hallerwiese-Cnopfsche Kinderklinik, Nuremberg, 13Institute for Allergy Research, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, 14Hospital Pharmacy, Klinikum rechts der Isar, Technical University of Munich, Munich, and 15Allergology and Immunology, Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
β-lactam antibiotics (BLAs) are still the antibiotics of first choice for the treatment of many bacterial infections. Treatment with a BLA is often hindered by a suspected allergy, up to 10% of the population report an allergy to penicillin. After Position Paper allergological evaluation of the suspected allergic reaction to a BLA, most patients show a low probability of a BLA allergy; only in a minority of cases an allergic reaction to the repeated administration of a BLA appear likely in view of the previous history. In > 90% of cases, the suspected BLA allergy can be ruled out by allergy diagnostics. We recommend a risk-stratified approach in the context of an urgent need for BLA, which should enable most patients to receive a BLA therapy. After acute therapy, allergy diagnostics have to be done to clearly prove or reliably rule out a BLA allergy.Correspondence to:
Prof. Dr. med. Knut Brockow, Department of Dermatology and Allergology Biederstein, Faculty of Medicine and Health, Technical University of Munich, Biedersteiner Strasse 29, 80802 Munich, Germany
Email: [email protected]
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]
