Extended Abstracts
Allergologie im Kloster 2013
Ludger Klimek
Jahrgang 36 p. 170 - 184
Abstract
Allergologie im Kloster 2013
Ludger Klimek
Wissenschaftliche Leitung: Prof. Dr. med. Ludger Klimek, Wiesbaden
Erweiterte Abstracts
Allergologie im Kloster 2014 – Kloster Eberbach, Eltville, Rheingau, 24. Mai 2014
Wissenschaftliche Leitung: Prof. Dr. med. Ludger Klimek, Wiesbaden
Jahrgang 37 p. 125 - 141
Abstract
Allergologie, Jahrgang 37, Nr. 4/2014, S. 125-141
Allergologie im Kloster 2014 – Kloster Eberbach, Eltville, Rheingau, 24. Mai 2014
Wissenschaftliche Leitung: Prof. Dr. med. Ludger Klimek, Wiesbaden
Guideline
ARIA guideline 2019: treatment of allergic rhinitis in the German health system
L. Klimek, C. Bachert, O. Pfaar, S. Becker, T. Bieber, R. Brehler, R. Buhl, I. Casper, A. Chaker, W. Czech, J. Fischer, T. Fuchs, M. Gerstlauer, K. Hörmann, T. Jakob, K. Jung, M.V. Kopp, V. Mahler, H. Merk, N. Mülleneisen, K. Nemat, U. Rabe, J. Ring, J. Saloga, W. Schlenter, C. Schmidt-Weber, H. Seyfarth, A. Sperl, T. Spindler, P. Staubach, S. Strieth, R. Treudler, C. Vogelberg, A. Wallrafen, W. Wehrmann, H. Wrede, T. Zuberbier, A. Bedbrook, G.W. Canonica, V. Cardona, T.B. Casale, W. Czarlewski, W.J. Fokkens, E. Hamelmann, P.W. Hellings, M. Jutel, D. Larenas-Linnemann, J. Mullol, N.G. Papadopoulos, S. Toppila- Salmi, T. Werfel and J. Bousquet
Volume 3 (2019) p. 22 - 50
Abstract
Allergologie select, Volume 3/2019 (22-50)
ARIA guideline 2019: treatment of allergic rhinitis in the German health system
Ludger Klimek1, Claus Bachert2, Oliver Pfaar3, Sven Becker4, Thomas Bieber5, Randolf Brehler6, Roland Buhl7, Ingrid Casper1, Adam Chaker8, Wolfgang Czech9, Jörg Fischer10, Thomas Fuchs11, Michael Gerstlauer12, Karl Hörmann13, Thilo Jakob14, Kirsten Jung15, Matthias V. Kopp16, Vera Mahler17, Hans Merk18, Norbert Mülleneisen19, Katja Nemat20, Uta Rabe21, Johannes Ring22, Joachim Saloga23, Wolfgang Schlenter24, Carsten Schmidt-Weber25, Holger Seyfarth26, Annette Sperl1, Thomas Spindler27, Petra Staubach23, Sebastian Strieth28, Regina Treudler29, Christian Vogelberg30, Andrea Wallrafen31, Wolfgang Wehrmann32, Holger Wrede33, Torsten Zuberbier34, Anna Bedbrook35, Giorgio W. Canonica36, Victoria Cardona37, Thomas B. Casale38, Wienczylawa Czarlewski39, Wytske J. Fokkens40, Eckard Hamelmann41, Marek Jutel42, Désirée Larenas-Linnemann43, Joaquim Mullol44, Nikolaos G. Papadopoulos45, Sanna Toppila-Salmi46, Thomas Werfel47, and Jean Bousquet34#35#48#49
1Center of Rhinology and Allergology, Wiesbaden, Germany, 2Upper Airways Research Laboratory and Department of Oto-Rhino-Laryngology, Ghent University and Ghent, University Hospital, Ghent, Belgium, Division of ENT Diseases, CLINTEC, Karolinska Institute, University of Stockholm, Stockholm, Sweden, 3Department of Otorhinolaryngology, Head and Neck, Surgery, Section of Rhinology and Allergy, University, Hospital Marburg, Philipps-Universität Marburg,Marburg, Germany, 4Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Tübingen, Germany, 5Department of Dermatology and Allergy, University of Bonn, Bonn, Germany, Christine Kühne-Center for Allergy Research and Education (CK-CARE) Davos-Augsburg-Bonn-St Gallen-Zürich, St. Gallen, Switzerland, 6Department of Allergy, Occupational Dermatology and Environmental Medicine, Universitätsklinikum Münster, Münster, Germany, 7Pulmonary Department,Mainz University Hospital,Mainz, Germany, 8Department of Otolaryngology and Center for Allergy and Environment (ZAUM), Klinikum rechts der Isar, Technical University of Munich and Helmholtz Center Munich, Munich, Germany, 9Department of Dermatology, University of Freiburg, Freiburg, Germany, 10Department of Dermatology, Eberhard Karls University, Tübingen, Tübingen, Germany, 11Department of Dermatology, Venereology, and Allergology, University Medical Center, Georg August University, Göttingen, Germany, 12Pediatric Pneumology and Allergology Unit, Medical University of Augsburg, Augsburg, Germany, 13Department of Otorhinolaryngology, Mannheim University Hospital, Mannheim, Germany, 14Department of Dermatology and Allergology, University Medical Center Gießen and Marburg, Campus Gießen, Justus-Liebig-University, Gießen, Germany, 15Group Practice for Dermatology, Erfurt, Germany, 16Clinic of Pediatric and Adolescent Medicine, Airway Research Center North (ARCN), Member of the German Lung Center (DZL), Lübeck University, Lübeck, Germany, 17Medical Faculty, Friedrich- Alexander-University (FAU) Erlangen-Nürnberg, Germany, 18Department of Dermatology and Allergology, University Hospital, RWTH Aachen University, Aachen, Germany, 19Asthma and Allergy Centre, Leverkusen, Germany, 20Department of Pediatrics, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany, 21Department of Allergology, Johanniter-Krankenhaus im Fläming Treuenbrietzen GmbH, Treuenbrietzen, Germany, 22Department and Outpatient Clinic for Dermatology and Allergology am Biederstein, Technical University of Munich, Munich, Germany and Christine Kühne Center for Allergy Research and Education (CK-Care), Davos, Switzerland, 23Department of Dermatology, University Medical Center Mainz,Mainz, Germany, 24Former Head ENT - Department, Katharina- Kasper-Kliniken, Marienkrankenhaus, c/o University Hospital, Frankfurt, Germany, 25Center for Allergy and Environment (ZAUM), Member of the German Center of Lung Research (DZL) and the Inflammation and Immunology Helmholtz Initiative, Technical University of Munich and Helmholtz Center Munich, Munich, Germany, 26Pharmacy Association in Hesse, Offenbach, Germany, 27Allergy Campus Davos, Hochgebirgsklinik Davos dpt. Pediatrics, Davos, Switzerland, 28Department of Otolaryngology, University Medical Center Mainz, Mainz, Germany, 29Department of Dermatology, Venereology and Allergology, LICA – Leipzig Comprehensive Allergy Center, University of Leipzig, Leipzig, Germany, 30Department of Pediatric Pneumology and Allergology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany, 31German Allergy and Asthma Association, Mönchengladbach, Germany, 32Dermatology Group Practice,Münster, Germany, 33Herford, North Rhine-Westphalia, Germany, 34Department of Dermatology and Allergy, Allergie-Centrum – Charité, Charité – Universitätsmedizin, Berlin, Berlin, Germany, 35MACVIA-France, Montpellier, France, 36Allergy Section, Allergy and Respiratory Diseases, DIMI, University of Genoa, Genoa, Italy, 37Department of Internal Medicine, Hospital Universitari Vall d’Hebron, Barcelona, Spain, 38Division of Allergy and Immunology, University of South Florida, Tampa, FL, USA, 39Medical Consulting Czarlewski, Levallois, France, 40Department Otorhinolaryngologie, Academic Medical Centers, Amsterdam, The Netherlands, 41Children’s Center, Protestant Hospital Bethel, University Bielefeld, Bielefeld Germany, 42Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland and ALL-MED Medical Research Institute, Wroclaw, Poland, 43HospitalMédica Sur, México City, Mexico, 44Unitat de Rinologia i Clínica de l’Olfacte, Servei d’ORL, Hospital Clínic, Clinical and Experimental Respiratory Immunoallergy, IDIBAPS, University of Barcelona, Barcelona, Spain, 45Department of Allergy, 2nd Pediatric Clinic, University of Athens, Athens, Greece, 46Haartman Institute, University of Helsinki, Helsinki, Finland, 47Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany, 48University Hospital, Montpellier, 49 INSERM, Unit 1168, Paris, France
Background: The number of patients affected by allergies is increasing worldwide. The resulting allergic diseases are leading to significant costs for health care and social systems. Integrated care pathways are needed to enable comprehensive care within the national health systems. The ARIA (Allergic Rhinitis and its Impact on Asthma) initiative develops internationally applicable guidelines for allergic respiratory diseases.
Methods: ARIA serves to improve the care of patients with allergies and chronic respiratory diseases. In collaboration with other international initiatives, national associations and patient organizations in the field of allergies and respiratory diseases, real-life integrated care pathways have been developed for a digitally assisted, integrative, individualized treatment of allergic rhinitis (AR) with comorbid asthma. In the present work, these integrated care pathways have been adapted to the German situation and health system.
Results: The present ICP (integrated care pathway) guideline covers key areas of the care of AR patients with and without asthma. It includes the views of patients and other healthcare providers.
Discussion: A comprehensive ICP guideline can reflect real-life care better than traditional guideline models.Correspondence to:
Prof. Dr. Jean Bousquet
Centre Hospitalier
Régional Universitaire´de Montpellier (CHU)
371 Avenue du Doyen Gaston Giraud
34295 Montpellier Cedex 5, France
Email: [email protected]
Position Paper
Allergen immunotherapy in the current COVID-19 pandemic: A position paper of AeDA, ARIA, EAACI, DGAKI and GPA
Ludger Klimek, Oliver Pfaar, Margitta Worm, Karl-Christian Bergmann, Thomas Bieber, Roland Buhl, Jeroen Buters, Ulf Darsow, Thomas Keil, Jörg Kleine-Tebbe, Susanne Lau, Marcus Maurer, Hans Merk, Ralph Mösges, Joachim Saloga, Petra Staubach, Petra Stute, Klaus Rabe, Uta Rabe, Claus Vogelmeier, Tilo Biedermann, Kirsten Jung, Wolfgang Schlenter, Johannes Ring, Adam Chaker, Wolfgang Wehrmann, Sven Becker, Norbert Mülleneisen, Katja Nemat, Wofgang Czech, Holger Wrede, Randolf Brehler, Thomas Fuchs, Peter-Valentin Tomazic, Werner Aberer, Antje Fink-Wagner, Friedrich Horak, Stefan Wöhrl, Verena Niederberger-Leppin, Isabella Pali-Schöll, Wolfgang Pohl, Regina Roller-Wirnsberger, Otto Spranger, Rudolf Valenta, Mübecell Akdis, Cezmi Akdis, Karin Hoffmann-Sommergruber, Marek Jutel, Paolo Matricardi, FranÇois Spertini, Nikolai Khaltaev, Jean-Pierre Michel, Laurent Nicod, Peter Schmid-Grendelmeier, Eckard Hamelmann, Thilo Jakob, Thomas Werfel, Martin Wagenmann, Christian Taube, Michael Gerstlauer, Christian Vogelberg, Jean Bousquet, and Torsten Zuberbier
Volume 4 (2020) p. 44 - 52
Abstract
Allergologie select, Volume 4/2020 (44-52)
Allergen immunotherapy in the current COVID-19 pandemic: A position paper of AeDA, ARIA, EAACI, DGAKI and GPA
Ludger Klimek1, Oliver Pfaar2, Margitta Worm3, Karl-Christian Bergmann3, Thomas Bieber4, Roland Buhl5, Jeroen Buters6, Ulf Darsow7, Thomas Keil8, Jörg Kleine-Tebbe9, Susanne Lau10, Marcus Maurer69, Hans Merk11, Ralph Mösges12,13,14, Joachim Saloga15, Petra Staubach15, Petra Stute16, Klaus Rabe17, Uta Rabe18, Claus Vogelmeier19, Tilo Biedermann7,20, Kirsten Jung21, Wolfgang Schlenter22, Johannes Ring23,24, Adam Chaker25,26, Wolfgang Wehrmann27, Sven Becker28, Norbert Mülleneisen29, Katja Nemat30,31, Wofgang Czech32, Holger Wrede33, Randolf Brehler34, Thomas Fuchs35, Peter-Valentin Tomazic36, Werner Aberer37, Antje Fink-Wagner38, Friedrich Horak39, Stefan Wöhrl40, Verena Niederberger-Leppin41, Isabella Pali-Schöll42,43, Wolfgang Pohl44, Regina Roller-Wirnsberger45, Otto Spranger38, Rudolf Valenta46, Mübecell Akdis47, Cezmi Akdis47, Karin Hoffmann-Sommergruber43, Marek Jutel48, Paolo Matricardi49, FranÇois Spertini50, Nikolai Khaltaev51, Jean-Pierre Michel52, Laurent Nicod53,54, Peter Schmid-Grendelmeier55, Eckard Hamelmann56, Thilo Jakob57, Thomas Werfel58, Martin Wagenmann59, Christian Taube60, Michael Gerstlauer67, Christian Vogelberg68, Jean Bousquet61,62,63,64,65,66, and Torsten Zuberbier3
1Zentrum für Rhinologie und Allergologie, Wiesbaden, 2Sektion Rhinologie und Allergologie, Klinik für Hals-, Nasen-und Ohrenheilkunde, Universitätsklinikum Gießen und Marburg, Philipps-Universität Marburg, 3Comprehensive Allergy Centre Charité, Klinik für Dermatologie, Venerologie und Allergologie, Charité – Universitätsmedizin Berlin, 4Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum Bonn, 5III. Medizinische Klinik und Poliklinik Hämatologie, Internistische Onkologie und Pneumologie, Universitätsmedizin Mainz, 6Zentrum Allergie und Umwelt (ZAUM) Technische Universität und Helmholtz Zentrum München, 7Klinik und Poliklinik für Dermatologie und Allergologie der Technischen Universität München, 8Institut für klinische Epidemiologie und Biometrie, Julius-Maximilian-Universität, Würzburg, 9Allergie- und Asthma-Zentrum Westend, Berlin, 10Klinik für Pädiatrie m.S. Pneumologie, Immunologie und Intensivmedizin, Charité – Universitätsmedizin Berlin, 11Abteilung Dermatologie & Allergologie, RWTH Aachen Universität, 12Medizinische Fakultät der Universität zu Köln, 13CRI – Clinical Research International Ltd., Hamburg, 14ClinCompetence Cologne GmbH, Köln, 15Hautklinik, Universitätsmedizin, Johannes Gutenberg-Universität, Mainz, 16Europäische Vereinigung für Vitalität und Aktives Altern, Leipzig, 17Abteilung für Pneumologie, LungenClinic Grosshansdorf, 18Klinik für Allergologie, Johanniter-Krankenhaus im Fläming Treuenbrietzen GmbH, Treuenbrietzen, 19Klinik für Innere Medizin Schwerpunkt Pneumologie, Philipps-Universität Marburg, 20Einheit für Klinische Allergologie (EKA), Helmholtz Zentrum München, Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH), Neuherberg, 21Praxis für Dermatologie, Immunologie und Allergologie, Erfurt, 22Ärzteverband Deutscher Allergologen, Dreieich, 23Haut- und Laserzentrum an der Oper, München, 24Academia: München, 25HNO-Klinik des Klinikums rechts der Isar, Technische Universität München, 26Zentrum Allergie und Umwelt München (ZAUM); Helmholtz Zentrum München, 27Praxis für Dermatologie und Allergologie, Münster, 28Klinik für Hals-, Nasen- und Ohrenheilkunde, Universität Tübingen, 29Asthma und Allergiezentrum Leverkusen, 30Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, Dresden, 31Praxis für Kinderpenumologie/Allergologie am Kinderzentrum Dresden (Kid), Dresden, 32Klinik für Dermatologie, Universität Freiburg, 33Hals-, Nasenund Ohrenarzt, Nordrhein-Westfalen, 34Klinik für Allergologie, Berufsdermatologie und Umweltmedizin, Universitätsklinikum Münster, 35Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum, Georg-August-Universität, Göttingen, 36Klinische Abteilung für Allgemeine HNO, Medizinische Universität Graz, Österreich, 37Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, Österreich, 38Global Allergy and Airways Patient Platform GAAPP, Wien, Österreich, 39Praxis für Hals-, Nasen- und Ohrenkrankheiten, Wien, Österreich, 40Floridsdorfer Allergiezentrum, Wien, Österreich, 41Universitätsklinik für Hals-, Nasen- und Ohrenkrankheiten, Medizinische Universität Wien, Österreich, 42Institut für Komparative Medizin, Interdisziplinäres Messerli Forschungsinstitut, Veterinärmedizinische Universität Wien und Medizinische Universität Wien, Österreich, 43Institut für Pathophysiologie und Allergieforschung, Medizinische Universität Wien, Österreich, 44Abteilung für Atmungs- und Lungenkrankheiten, Krankenhaus Hietzing, Wien, Österreich, 45Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Österreich, 46Institut für Pathophysiologie, Medizinische Universität Wien, Österreich, 47Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Schweiz, 48Department of Clinical Immunology, Medizinische Universität Breslau, Polen, 49Charité – Universitätsmedizin Berlin, 50Division of Allergy and Immunology, Centre Hospitalier Universitaire Vaudois, Lausanne, Schweiz, 51GARD Chairman, Genf, Schweiz, 52Department of Rehabilitation and Geriatrics, University of Geneva, Genf, Schweiz, 53Clinique Cecil, Hirslanden Gruppe, Lausanne, Schweiz, 54Abteilung Pneumologie, Centre hospitalier universitaire vaudois, Lausanne, Schweiz, 55Allergiestation, Dermatologische Klinik, Universitätsspital Zürich, Schweiz, 56Kinderzentrum Bethel, Evangelisches Klinikum Bethel, Universitätsmedizin OWL der Universität Bielefeld, 57Klinik für Dermatologie, Allergologie, Universitätsklinikum Gießen, UKGM, Justus-Liebig-Universität Gießen, 58Klinik fürDermatologie, Allergologie und Venerologie Medizinische Hochschule Hannover, 59HNO-Klinik, Universitätsklinikum Düsseldorf, 60Klinik für Pneumologie, Ruhrlandklinik, Universitätsmedizin Essen, 61MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, Frankreich, 62INSERM U 1168, VIMA: Ageing and Chronic Diseases Epidemiological and Public Health Approaches, Villejuif, 63Université Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, Frankreich, 64Euforea, Brussels, Belgien, 65Charité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, 66Berlin Institute of Health, Comprehensive Allergy Center, Department of Dermatology and Allergy, Berlin, 67Abteilung für Kinderpneumologie und Allergologie, Medizinische Universität Augsburg, 68Klinik für Kinderpneumologie und Allergologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, 69Dermatologische Allergologie, Allergie-Centrum-Charité, Klinik für Dermatologie, Venerologie und Allergologie, Charité – Universitätsmedizin Berlin
Correspondence to:
Prof. Dr. Ludger Klimek, Zentrum für Rhinologie und Allergologie, An den Quellen 10, 65183 Wiesbaden
Email: [email protected]
Position Paper
Use of biologicals in allergic and type-2 inflammatory diseases during the current COVID-19 pandemic
Ludger Klimek, Oliver Pfaar, Margitta Worm, Thomas Eiwegger, Jan Hagemann, Markus Ollert, Eva Untersmayr, Karin Hoffmann-Sommergruber, Alessandra Vultaggio, Ioana Agache, Sevim Bavbek, Apostolos Bossios, Ingrid Casper, Susan Chan, Alexia Chatzipetrou, Christian Vogelberg, Davide Firinu, Paula Kauppi, Antonios Kolios, Akash Kothari, Andrea Matucci, Oscar Palomares, Zsolt Szépfalusi, Wolfgang Pohl, Wolfram Hötzenecker, Alexander R. Rosenkranz, Karl-Christian Bergmann, Thomas Bieber, Roland Buhl, Jeroen Buters, Ulf Darsow, Thomas Keil, Jörg Kleine-Tebbe, Susanne Lau, Marcus Maurer, Hans Merk, Ralph Mösges, Joachim Saloga, Petra Staubach, Uta Jappe, Klaus F. Rabe, Uta Rabe, Claus Vogelmeier, Tilo Biedermann, Kirsten Jung, Wolfgang Schlenter, Johannes Ring, Adam Chaker, Wolfgang Wehrmann, Sven Becker, Laura Freudelsperger, Norbert Mülleneisen, Katja Nemat, Wolfgang Czech, Holger Wrede, Randolf Brehler, Thomas Fuchs, Peter-Valentin Tomazic, Werner Aberer, Antje-Henriette Fink-Wagner, Fritz Horak, Stefan Wöhrl, Verena Niederberger-Leppin, Isabella Pali-Schöll, Wolfgang Pohl, Regina Roller-Wirnsberger, Otto Spranger, Rudolf Valenta, Mübecell Akdis, Paolo M. Matricardi, François Spertini, Nicolai Khaltaev, Jean-Pierre Michel, Larent Nicod, Peter Schmid-Grendelmeier, Marco Idzko, Eckard Hamelmann, Thilo Jakob, Thomas Werfel, Martin Wagenmann, Christian Taube, Erika Jensen-Jarolim, Stephanie Korn, Francois Hentges, Jürgen Schwarze, Liam O´Mahony, Edward F. Knol, Stefano del Giacco, Tomás Chivato Pérez, Jean Bousquet, Anna Bedbrook, Torsten Zuberbier, Cezmi Akdis, and Marek Jutel
Volume 4 (2020) p. 53 - 68
Abstract
Allergologie select, Volume 4/2020 (53-68)
Use of biologicals in allergic and type-2 inflammatory diseases during the current COVID-19 pandemic
Ludger Klimek1, Oliver Pfaar2, Margitta Worm3, Thomas Eiwegger4,5,6, Jan Hagemann7, Markus Ollert8,9, Eva Untersmayr10, Karin Hoffmann-Sommergruber10, Alessandra Vultaggio11, Ioana Agache12, Sevim Bavbek13, Apostolos Bossios14,15, Ingrid Casper1,16,17, Susan Chan18, Alexia Chatzipetrou19, Christian Vogelberg20, Davide Firinu21, Paula Kauppi22, Antonios Kolios16,23, Akash Kothari4, Andrea Matucci11, Oscar Palomares24, Zsolt Szépfalusi25, Wolfgang Pohl26, Wolfram Hötzenecker27, Alexander R. Rosenkranz28, Karl-Christian Bergmann3, Thomas Bieber29, Roland Buhl30, Jeroen Buters31, Ulf Darsow32, Thomas Keil33, Jörg Kleine-Tebbe34, Susanne Lau35, Marcus Maurer98, Hans Merk36, Ralph Mösges37,38,39, Joachim Saloga40, Petra Staubach40, Uta Jappe41, Klaus F. Rabe42, Uta Rabe42, Claus Vogelmeier44, Tilo Biedermann32,45, Kirsten Jung46, Wolfgang Schlenter47, Johannes Ring48,49, Adam Chaker50,51, Wolfgang Wehrmann52, Sven Becker53, Laura Freudelsperger7, Norbert Mülleneisen54, Katja Nemat55, Wolfgang Czech56, Holger Wrede57, Randolf Brehler58, Thomas Fuchs59, Peter-Valentin Tomazic60, Werner Aberer61, Antje-Henriette Fink-Wagner62, Fritz Horak63, Stefan Wöhrl64, Verena Niederberger-Leppin65, Isabella Pali-Schöll10,66,67, Wolfgang Pohl68, Regina Roller-Wirnsberger69, Otto Spranger70, Rudolf Valenta71,94,95,96, Mübecell Akdis72, Paolo M. Matricardi73, François Spertini74, Nicolai Khaltaev75, Jean-Pierre Michel76, Larent Nicod77, Peter Schmid-Grendelmeier78, Marco Idzko79, Eckard Hamelmann80, Thilo Jakob81, Thomas Werfel82, Martin Wagenmann83, Christian Taube84, Erika Jensen-Jarolim10,66, Stephanie Korn30, Francois Hentges85, Jürgen Schwarze86, Liam O´Mahony87, Edward F. Knol88, Stefano del Giacco89, Tomás Chivato Pérez90, Jean Bousquet91,92,93,94,95, Anna Bedbrook91, Torsten Zuberbier3, Cezmi Akdis72, and Marek Jutel96,97
1Zentrum für Rhinologie und Allergologie, Wiesbaden, 2HNO-Universitätsklinik Marburg, Sektion Rhinologie und Allergologie, Medizinische Fakultät Marburg, Philipps-Universität Marburg, 3Comprehensive Allergy Centre Charité, Klinik für Dermatologie, Venerologie und Allergologie, Charité – Universitätsmedizin Berlin, Germany, 4Translational Medicine Program, Peter Gilgan Centre for Research and Learning, Hospital for Sick Children, Toronto, Ontario, Canada, 5Division of Immunology and Allergy, Food Allergy and Anaphylaxis Program, The Hospital for Sick Children, Toronto, Ontario, Canada, 6Department of Immunology, University of Toronto, Toronto, Ontario, Canada, 7Hals-, Nasen-, Ohrenklinik und Poliklinik, Universitätsmedizin Mainz, Germany 8Department of Infection and Immunity, Luxembourg Institute of Health (LIH), Esch-sur-Alzette, Luxemburg, 9Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis, University of Southern Denmark, Odense, Denmark, 10Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medizinische Fakultät der Universität Wien, Vienna, Austria, 11Immunoallergology Unit, Careggi University Hospital, Florence, Italy, 12Transylvania University, Brasov, Romania, 13Ankara University, School of Medicine, Department of Chest Disease, Division of, Immunology and Allergy, Ankara, Turkey, 14Abteilung für Atemwegsmedizin und Allergie, Karolinska University Hospital, Huddinge und Abteilung für Medizin, Huddinge, Karolinska Institutet, Stockholm, Sweden, 15Zentrum für Allergieforschung, Karolinska Institutet, Stockholm, Sweden, 16Department of Immunology, University Hospital Zürich, Zürich, Switzerland, 17Faculty of Medicine, University of Zürich, Zürich, Switzerland, 18Guy’s and St. Thomas’ NHS Foundation Trust, Westminster Bridge Road, London, United Kingdom, King’s College London School of Life Course Sciences & School of Immunology & Microbial Sciences, King’s Health Partners, United Kingdom, 19Allergy Unit 2nd Department of Dermatology and Venereology, National University of Athens, Medical School, University General Hospital „ATTIKON“, Athen, Greece, 20Universitätsklinikum Carl Gustav Carus, Klinik und Poliklinik für Kinder- und Jugendmedizin, Fachbereich Kinderpneumologie/Allergologie, Dresden, Germany 21Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy, 22Abteilung für Allergie, Entzündungszentrum, Universitätsklinikum Helsinki, Helsinki, Finland, 23Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA, 24Department of Biochemistry and Molecular Biology, Chemistry School, Complutense University of Madrid, Spain, 25Abteilung für Pädiatrische Pulmologie, Allergologie und Endokrinologie, Universitätsklinik für Kinder- und Jugendheilkunde, Comprehensive Center for Pediatrics, Medizinische Universität Wien, Vienna, Austria, 26Abteilung für Atmungs- und Lungenerkrankungen, Krankenhaus Hietzing, Vienna, Austria, 27Abteilung für Dermatologie und Venerologie, Kepler Universitätsklinikum, Linz, Austria, 28Klinische Abteilung für Nephrologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Austria, 29Klinik für Dermatologie und Allergologie, Universität Bonn, Bonn, 30Schwerpunkt Pneumologie, III. Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz, Mainz, 31Zentrum Allergie und Umwelt (ZAUM) Technische Universität und Helmholtz Zentrum München, 32Klinik und Poliklinik für Dermatologie und Allergologie der Technischen Universität München, 33Institut für Klinische Epidemiologie und Biometrie, Universität Würzburg, 34Allergie- und Asthma-Zentrum Westend, Berlin, 35Klinik für Pädiatrie m.S. Pneumologie, Immunologie und Intensivmedizin, Charité – Universitätsmedizin Berlin, 36Abteilung Dermatologie und Allergologie, RWTH Universität, Aachen, 37Medizinische Fakultät der Universität zu Köln, Cologne 38CRI – Clinical Research International Ltd., Hamburg, 39ClinCompetence Cologne GmbH, Köln, Cologne 40Hautklinik und Poliklinik, Universitätsmedizin Mainz, 41Forschungsgruppe Klinische und Molekulare Allergologie des Forschungszentrums Borstel, Airway Research Center North (ARCN), Mitglied des Deutschen Zentrums für Lungenforschung (DZL); Interdisziplinäre Allergie-Ambulanz, Medizinische Klinik III, Universität zu Lübeck, 42LungenClinic Grosshansdorf, Großhansdorf, 43Klinik für Allergologie, Johanniter-Krankenhaus im Fläming Treuenbrietzen GmbH, Treuenbrietzen, 44Klinik für Innere Medizin Schwerpunkt Pneumologie, Philipps-Universität Marburg, 45Einheit für Klinische Allergologie (EKA), Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Neuherberg, 46Praxis für Dermatologie, Immunologie und Allergologie, Erfurt, 47Ärzteverband Deutscher Allergologen, Dreieich, 48Haut- und Laserzentrum an der Oper, München, Munich, 49Academia München, 50HNO-Klinik, Universitätsklinik TUM, München, 51ZAUM, Helmholtz Zentrum München, Munich 52Praxis für Dermatologie und Allergologie, Münster, 53Klinik für Hals-, Nasen- und Ohrenheilkunde, Universität Tübingen, 54Asthma und Allergiezentrum Leverkusen, 55Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, Dresden; Praxis für Kinderpenumologie/Allergologie am Kinderzentrum Dresden (Kid), Dresden, 56Praxis und Klinik für Dermatologie/Allergologie am Schwarzwald-Baar Klinikum, Villingen-Schwenningen, 57Hals-, Nasen- und Ohrenarzt, Nordrhein-Westfalen, 58Universitätsklinikum Münster, Klinik für Hautkrankheiten, Ambulanz für Allergologie, Berufsdermatologie und Umweltmedizin, Münster, 59Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum, Georg-August-Universität, Göttingen, Germany 60Klinische Abteilung für allgemeine HNO, Medizinische Universität Graz, Austria, 61Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, Austria, 62Global Allergy and Airways Patient Platform GAAPP, Vienna, Austria, 63Allergiezentrum Wien West, Vienna, Austria, 64Floridsdorfer Allergiezentrum, Vienna, Austria, 65Universitätsklinik für Hals-, Nasen- und Ohrenkrankheiten, Medizinische Universität Vienna, Austria, 66Komperative Medizin, Interdisziplinäres Messerli Forschungsinstitut, Veterinärmedizinische Universität Wien, Medizinische Universität Wien, 67Institut für Pathophysiologie und Allergieforschung, Medizinische Universität Wien, 68Abteilung für Atmungs- und Lungenerkrankungen, Krankenhaus Hietzing, Vienna, Austria, 69Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Austria, 70Österreichische Lungenunion, Vienna, Austria, 71Immunopathologie, Abteilung für Pathophysiologie und Allergieforschung, Zentrum für Pathophysiologie, Infektiologie und Immunologie, Medizinische Universität Wien, Austria, 72Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland, 73Charité – Universitätsmedizin Berlin, 74Division of Allergy and Immunology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland, 75GARD Chairman, Genf, Switzerland, 76Department of Rehabilitation and Geriatrics, University of Geneva, Genf, Switzerland, 77Clinic Cecil of Hirslanden Group of Lausanne; Centre Hôpitalier Universitaire du canton de Vaud Lausanne, Switzerland, 78Allergiestation, Dermatologische Klinik, Universitätsspital Zürich, Switzerland, 79Klinische Abteilung für Pneumologie, Universitätsklinik für Innere Medizin II, Medizinische Universität Wien, Austria, 80Kinderzentrum Bethel, Evangelisches Klinikum Bethel, Universitätsmedizin OWL der Universität Bielefeld, 81Klinik für Dermatologie und Allergologie, Universitätsklinikum Gießen, UKGM, Justus-Liebig-Universität, Gießen, 82Klinik für Dermatologie, Allergologie und Venerologie Medizinische Hochschule Hannover, 83HNO-Klinik, Universitätsklinikum Düsseldorf, 84Universitätsklinikum Essen (AöR), Germany 85Service Immunologie-Allergologie Centre Hospitalier de Luxembourg, Luxemburg, 86Kinderleben und Gesundheit, Universität von Edinburgh, United Kingdom, 87Medicine and Microbiology, APC Microbiome Ireland, National University of Ireland, Cork, Irland, 88Departments of Immunology, Dermatology and Allergology, University Medical Center Utrecht, the Netherlands, 89Università degli Studi di Cagliari, Cagliari, Italy, 90University Foundation San Pablo CEU, Madrid, Spain, 91MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, France, 92INSERM U 1168, VIMA: Ageing and chronic diseases Epidemiological and public health approaches, Villejuif, France, 93Université Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France, 94Euforea, Brussels, Belgium, 95Berlin Institute of Health, Comprehensive Allergy Center, Department of Dermatology and Allergy, Charité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Germany 96Department of Clinical Immunology, Wrocław Medical University, Wrocław, Poland, 97ALL-MED Medical Research Institute, Wrocław, Poland, and 98Dermatologische Allergologie, Allergie-Centrum-Charité, Klinik für Dermatologie, Venerologie und Allergologie, Charité – Universitätsmedizin Berlin, Germany
Background: Since the beginning of the COVID-19 pandemic, the treatment of patients with allergic and atopy-associated diseases has faced major challenges. Recommendations for “social distancing” and the fear of patients becoming infected during a visit to a medical facility have led to a drastic decrease in personal doctor-patient contacts. This affects both acute care and treatment of the chronically ill. The immune response after SARS-CoV-2 infection is so far only insufficiently understood and could be altered in a favorable or unfavorable way by therapy with monoclonal antibodies. There is currently no evidence for an increased risk of a severe COVID-19 course in allergic patients. Many patients are under ongoing therapy with biologicals that inhibit type 2 immune responses via various mechanisms. There is uncertainty about possible immunological interactions and potential risks of these biologicals in the case of an infection with SARS-CoV-2. Materials and methods: A selective literature search was carried out in PubMed, Livivo, and the internet to cover the past 10 years (May 2010 – April 2020). Additionally, the current German-language publications were analyzed. Based on these data, the present position paper provides recommendations for the biological treatment of patients with allergic and atopy-associated diseases during the COVID-19 pandemic. Results: In order to maintain in-office consultation services, a safe treatment environment must be created that is adapted to the pandemic situation. To date, there is a lack of reliable study data on the care for patients with complex respiratory, atopic, and allergic diseases in times of an imminent infection risk from SARS-CoV-2. Type-2-dominant immune reactions, as they are frequently seen in allergic patients, could influence various phases of COVID-19, e.g., by slowing down the immune reactions. Theoretically, this could have an unfavorable effect in the early phase of a SARS-Cov-2 infection, but also a positive effect during a cytokine storm in the later phase of severe courses. However, since there is currently no evidence for this, all data from patients treated with a biological directed against type 2 immune reactions who develop COVID-19 should be collected in registries, and their disease courses documented in order to be able to provide experience-based instructions in the future. Conclusion: The use of biologicals for the treatment of bronchial asthma, atopic dermatitis, chronic rhinosinusitis with nasal polyps, and spontaneous urticaria should be continued as usual in patients without suspected infection or proven SARS-CoV-2 infection. If available, it is recommended to prefer a formulation for self-application and to offer telemedical monitoring. Treatment should aim at the best possible control of difficult-to-control allergic and atopic diseases using adequate rescue and add-on therapy and should avoid the need for systemic glucocorticosteroids. If SARS-CoV-2 infection is proven or reasonably suspected, the therapy should be determined by weighing the benefits and risks individually for the patient in question, and the patient should be involved in the decision-making. It should be kept in mind that the potential effects of biologicals on the immune response in COVID-19 are currently not known. Telemedical offers are particularly desirable for the acute consultation needs of suitable patients.Correspondence to:
Prof. Dr. Ludger Klimek, Zentrum für Rhinologie und Allergologie, An den Quellen 10, 65183 Wiesbaden
Email: [email protected]
Review
Biologics for atopic diseases: Indication, side effect management, and new developments
Uta Jappe, Hendrik Beckert, Karl-Christian Bergmann, Askin Gülsen, Ludger Klimek, Sandra Philipp, Julia Pickert, Michèle M. Rauber-Ellinghaus, Harald Renz, Christian Taube, Regina Treudler, Martin Wagenmann, Thomas Werfel, Margita Worm, and Torsten Zuberbier
Volume 5 (2021) p. 1 - 25
Abstract
Allergologie select, Vol. 5/2021 (1-25)
Biologics for atopic diseases: Indication, side effect management, and new developments
Uta Jappe1,2, Hendrik Beckert3, Karl-Christian Bergmann4, Askin Gülsen2, Ludger Klimek5, Sandra Philipp6, Julia Pickert7, Michèle M. Rauber-Ellinghaus8, Harald Renz9, Christian Taube3, Regina Treudler10, Martin Wagenmann11, Thomas Werfel12, Margita Worm13, and Torsten Zuberbier14
1Research Group Clinical and Molecular Allergology of the Research Center Borstel, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), 2Interdisciplinary Allergy Outpatient Clinic, Medical Clinic III, University of Lübeck, 3Department of Pulmonary Medicine, University Hospital Essen – Ruhrlandklinik, Essen, 4Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 5Center for Rhinology and Allergology, Wiesbaden, 6Dermatology practice Dr. Markus Friedrich/Dr. Sandra Philipp, Oranienburg, 7Department of Dermatology and Allergology, University Hospital Gießen and Marburg, Marburg site, 8Experimental Dermatology and Allergology, Justus Liebig University Giessen, 9Department of Medicine, Institute of Laboratory Medicine and Pathobiochemistry – Molecular Diagnostics, Member of the German Centre for Lung Research (DZL), Philipps-University, Marburg, 10Leipzig Comprehensive Allergy Center LICA-CAC, Department of Dermatology, Venereology and Allergology, University of Leipzig, 11Department of Otorhinolaryngology, HNO-Klinik, Universitätsklinikum Düsseldorf, Düsseldorf, 12Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, 13Dermatology, Venerology and Allergology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, 14Department of Dermatology and Allergy, Charité Universitätsmedizin, Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Comprehensive Allergy Center, Berlin, Germany
With the advent of biologicals, more and more therapeutics are available that specifically address specific switch points in the pathomechanism of immunologically dominated diseases. Thus, the focus of diagnostics and therapy (precision medicine) is more on the individual disease characteristics of the individual patient. Regarding the different phenotypes of atopic diseases, severe asthma was the first entity for which biologicals were approved, followed by urticaria, and finally atopic dermatitis and chronic rhinosinusitis with nasal polyps. Experience in the treatment of severe bronchial asthma has shown that the intensity of the response to biological therapy depends on the quality of clinical and immunological phenotyping of the patients. This also applies to different diseases of the atopic form, as patients can suffer from several atopic diseases at the same time, each with different characteristics. Biologics are already emerging that may represent a suitable therapy for allergic bronchial asthma, which often occurs together with severe neurodermatitis, and chronic rhinosinusitis with nasal polyps. In practice, however, the question of possible combinations of biologicals for the therapy of complex clinical pictures of individual patients is increasingly arising. In doing so, the side effect profile must be taken into account, including hypersensitivity reactions, whose diagnostic and logistical management must aim at a safe and efficient therapy of the underlying disease. Increased attention must also be paid to biological therapy in pregnancy and planned (predictable) vaccinations as well as existing infections, such as SARS-CoV-2 infection. Before starting a biological therapy, the immune status should be checked with regard to chronic viral and bacterial infections and, if necessary, the vaccination status should be refreshed or missing vaccinations should be made up for before starting therapy. Currently, reliable data on the effect of biologicals on the immunological situation of SARS-CoV-2 infection and COVID-19 are not available. Therefore, research and development of suitable diagnostic methods for detection of immunologically caused side effects as well as detection of potential therapy responders and non-responders is of great importance.Correspondence to:
Prof. Dr. med. Uta Jappe, Research Center Borstel, Leibniz Lung Center, Parkallee 35, 23845 Borstel
Email: [email protected]
Statement
Severe allergic reactions to the COVID-19 vaccine – statement and practical consequences
Jörg Kleine-Tebbe, Ludger Klimek, Eckard Hamelmann, Oliver Pfaar, Christian Taube, Martin Wagenmann, Thomas Werfel, and Margitta Worm
Volume 5 (2021) p. 26 - 28
Abstract
Allergologie select, Vol. 5/2021 (26-28)
Severe allergic reactions to the COVID-19 vaccine – statement and practical consequences
Jörg Kleine-Tebbe1, Ludger Klimek2, Eckard Hamelmann3, Oliver Pfaar4, Christian Taube5, Martin Wagenmann6, Thomas Werfel7, and Margitta Worm8
1Allergy and Asthma Center Westend, Berlin, 2Center for Rhinology and Allergology of the ENT University Clinic Mannheim, Wiesbaden, 3University Clinic for Pediatrics and Adolescent Medicine, Bethel Children’s Center, Evangelical Hospital Bielefeld gGmbH, Bielefeld, 4Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, 5Ruhrlandklinik gGmbH, West German Lung Center at the University Hospital Essen – University Hospital, 6Clinic of Otorhinolaryngology, University Hospital Düsseldorf, 7Clinic of Dermatology, Allergology, and Venerology, Hannover Medical School,and 8Allergy Center-Charité, Clinic for Dermatology, Venerology, and Allergology, Campus Charité Mitte, University Medicine Berlin, Germany
Correspondence to:
Prof. Dr. Jörg Kleine-Tebbe, Allergy and Asthma Center Westend, Spandauer Damm 130, Haus 9, 14050 Berlin, Germany
Email: [email protected]
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]
Position paper
COVID-19 vaccination of patients with allergies and type-2 inflammation with concurrent antibody therapy (biologicals) – A Position Paper of the German Society of Allergology and Clinical Immunology (DGAKI) and the German Society for Applied Allergo
Oliver Pfaar, Ludger Klimek, Eckard Hamelmann, Jörg Kleine-Tebbe, Christian Taube, Martin Wagenmann, Thomas Werfel, Randolf Brehler, Natalija Novak, Norbert Mülleneisen, Sven Becker, and Margitta Worm
Volume 5 (2021) p. 140 - 147
Abstract
Allergologie select, Vol. 5/2021 (140-147)
COVID-19 vaccination of patients with allergies and type-2 inflammation with concurrent antibody therapy (biologicals) – A Position Paper of the German Society of Allergology and Clinical Immunology (DGAKI) and the German Society for Applied Allergo
Oliver Pfaar1, Ludger Klimek2, Eckard Hamelmann3, Jörg Kleine-Tebbe4, Christian Taube5, Martin Wagenmann6, Thomas Werfel7, Randolf Brehler8, Natalija Novak9, Norbert Mülleneisen10, Sven Becker11, and Margitta Worm12
1Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, 2Center for Rhinology and Allergology, Wiesbaden, 3University Hospital for Pediatrics and Adolescent Medicine, Children’s Center Bethel, University of Bielefeld, 4Allergy Center Westend, Berlin, 5Clinic of Pneumology University Hospital Essen – Ruhrlandklinik, Essen, 6Clinic of Otolaryngology, University Hospital Düsseldorf, Düsseldorf, 7Department of Dermatology, Allergology and Venerology, Hannover Medical School, Hannover, 8Department of Dermatology, Wilhelm University of Münster, Münster, 9Department of Dermatology and Allergology, Bonn, 10Allergy and Asthma Center, Leverkusen, 11Department of Otorhinolaryngology, University Hospital, Tübingen, and 12Allergology and Immunology, Department of Dermatotology, Venereology and Allergology, Charité Universitätsmedizin Berlin, Germany
Background: After the beginning and during the worldwide pandemic caused by the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), patients with allergic and atopic diseases have felt and still feel insecure. Currently, four vaccines against SARS-CoV-2 have been approved by the Paul Ehrlich Institute in Germany, and vaccination campaigns have been started nationwide. In this respect, it is of utmost importance to give recommendations on possible immunological interactions and potential risks of immunomodulatory substances (monoclonal antibodies, biologicals) during concurrent vaccination with the approved vaccines. Materials and methods: This position paper provides specific recommendations on the use of immunomodulatory drugs in the context of concurrent SARS-CoV-2 vaccinations based on current literature. Results: The recommendations are covering the following conditions in which biologicals are indicated and approved: 1) chronic inflammatory skin diseases (atopic dermatitis, chronic spontaneous urticaria), 2) bronchial asthma, and 3) chronic rhinosinusitis with nasal polyps (CRSwNP). Patients with atopic dermatitis or chronic spontaneous urticaria are not at increased risk for allergic reactions after COVID-19 vaccination. Nevertheless, vaccination may result in transient eczema exacerbation due to general immune stimulation. Vaccination in patients receiving systemic therapy with biologicals can be performed. Patients with severe asthma and concomitant treatment with biologicals also do not have an increased risk of allergic reaction following COVID-19 vaccination which is recommended in these patients. Patients with CRSwNP are also not known to be at increased risk for allergic vaccine reactions, and continuation or initiation of a treatment with biologicals is also recommended with concurrent COVID-19 vaccination. In general, COVID-19 vaccination should be given within the interval between two applications of the respective biological, that is, with a time-lag of at least 1 week after the previous or at least 1 week before the next biological treatment planned. Conclusion: Biologicals for the treatment of atopic dermatitis, chronic spontaneous urticaria, bronchial asthma, and CRSwNP should be continued during the current COVID-19 vaccination campaigns. However, the intervals of biological treatment may need to be slightly adjusted (DGAKI/AeDA recommendations as of March 22, 2021).Correspondence to:
Prof. Dr. med. Oliver Pfaar, Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstraße, 35043 Marburg, Germany
Email: [email protected]
Guideline
Update of the S2k guideline on the management of IgE-mediated food allergies
Margitta Worm, Imke Reese, Barbara Ballmer-Weber, Kirsten Beyer, Stephan C. Bischoff, Barbara Bohle, Knut Brockow, Martin Claßen, Peter J. Fischer, Eckard Hamelmann, Uta Jappe, Jörg Kleine-Tebbe, Ludger Klimek, Berthold Koletzko, Lars Lange, Susanne Lau, Ute Lepp, Vera Mahler, Katja Nemat, Martin Raithel, Joachim Saloga, Christiane Schäfer, Sabine Schnadt, Jens Schreiber, Zsolt Szépfalusi, Regina Treudler, Martin Wagenmann, Thomas Werfel, and Torsten Zuberbier
Volume 5 (2021) p. 195 - 243
Abstract
Allergologie select, Vol. 5/2021 (195-243)
Update of the S2k guideline on the management of IgE-mediated food allergies
Margitta Worm1, Imke Reese2, Barbara Ballmer-Weber3, Kirsten Beyer4, Stephan C. Bischoff5, Barbara Bohle6, Knut Brockow7, Martin Claßen8, Peter J. Fischer9, Eckard Hamelmann10, Uta Jappe11#12, Jörg Kleine-Tebbe13, Ludger Klimek14, Berthold Koletzko15, Lars Lange16, Susanne Lau4, Ute Lepp17, Vera Mahler18, Katja Nemat19, Martin Raithel20, Joachim Saloga21, Christiane Schäfer22, Sabine Schnadt23, Jens Schreiber24, Zsolt Szépfalusi25, Regina Treudler26, Martin Wagenmann27, Thomas Werfel28, and Torsten Zuberbier29
1Allergology and Immunology, Department of Dermatology, Venereology, and Allergology, Charité – Universitätsmedizin Berlin, Germany, 2Nutritional Counseling and Therapy, Focus on Allergology, Munich, Germany, 3University Hospital Zurich, Department of Dermatology, Zurich, Switzerland, and Cantonal Hospital St. Gallen, Department of Dermatology and Allergology, St. Gallen, Switzerland, 4Clinic of Pediatrics m. S. Pneumology, Immunology and Intensive Care Medicine, Charité – Universitätsmedizin Berlin, Germany, 5Institute of Nutritional Medicine and Prevention, University of Hohenheim, Stuttgart, Germany, 6Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Austria, 7Department of Dermatology and Allergology, Biederstein, Klinikum rechts der Isar, Technical University of Munich, Germany, 8Klinik für Kinder und Jugendmedizin/Päd. Intensivmedizin, Eltern-Kind-Zentrum Prof. Hess Klinikum Bremen-Mitte, 9Practice for Pediatric and Adolescent Medicine m. S. Allergology and Pediatric Pneumology, Schwäbisch Gmünd, 10University Clinic for Pediatric and Adolescent Medicine, Evangelisches Klinikum Bethel gGmbH, Bielefeld, 11Research Group Clinical and Molecular Allergology, Research Center Borstel, Airway Research Center North (ARCN), member of the German Center for Lung Research (DZL), Borstel, 12Interdisciplinary Allergy Outpatient Clinic, Medical Clinic III, University Hospital Schleswig-Holstein, Lübeck, 13Allergy and Asthma Center Westend, Berlin, 14Center for Rhinology and Allergology, Wiesbaden, 15Pediatric Clinic and Pediatric Polyclinic, Dr. von Haunersches Kinderspital, Department of Metabolic and Nutritional Medicine, Ludwig-Maximilians-University, Munich, 16Pediatric and Adolescent Medicine, St.- Marien-Hospital, Bonn, 17Practice for Pulmonary Medicine and Allergology, Buxtehude, 18Paul-Ehrlich-Institut, Langen, 19Practice for Pediatric Pneumology/Allergology at the Children’s Center Dresden (Kid), Dresen, 20Medical Clinic II, Malteser Waldkrankenhaus, Erlangen, 21Department of Dermatology, University Medical Center, Johannes Gutenberg-University Mainz, 22Nutritional Therapy, Focus on Allergology and Gastroenterology, Schwarzenbek, Germany, 23German Allergy and Asthma Association, Mönchengladbach, Germany, 24Pneumology, University Hospital of Otto von Guericke University, Magdeburg, Germany, 25University Hospital for Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria, 26Clinic of Dermatology, Venereology and Allergology, University Medical Center Leipzig, Germany, 27Nose and Throat Clinic, University Hospital Düsseldorf, Germany, 28Clinic of Dermatology, Allergology and Venerology, Hannover Medical School, Germany, and 29Department of Dermatology, Venerology and Allergology, Charité – Universitätsmedizin Berlin
Correspondence to:
Univ.-Prof. Dr. med. Margitta Worm, Allergologie und Immunologie, Klinik für Dermatologie, Venerologie, und Allergologie, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin
Email: [email protected]
Extended Abstracts
Allergologie im Kloster 2021, Kloster Eberbach, 10. – 11. September 2021
Wissenschaftliche Leitung: Ludger Klimek, Wiesbaden
Jahrgang 44 (2021) p. 640 - 662
Abstract
Allergologie im Kloster 2021, Kloster Eberbach, 10. – 11. September 2021
Wissenschaftliche Leitung: Ludger Klimek, Wiesbaden
Position paper
COVID-19 vaccination and allergen immunotherapy (AIT) - A position paper of the German Society for Applied Allergology (AeDA) and the German Society for Allergology and Clinical Immunology (DGAKI)
Ludger Klimek, Oliver Pfaar, Eckard Hamelmann, Jörg Kleine-Tebbe, Christian Taube, Martin Wagenmann, Thomas Werfel, Randolf Brehler, Natalija Novak, Norbert Mülleneisen, Sven Becker, and Margitta Worm
Volume 5 (2021) p. 251 - 259
Abstract
Allergologie select, Vol. 5/2021 (251-259)
COVID-19 vaccination and allergen immunotherapy (AIT) - A position paper of the German Society for Applied Allergology (AeDA) and the German Society for Allergology and Clinical Immunology (DGAKI)
Ludger Klimek1, Oliver Pfaar2, Eckard Hamelmann3, Jörg Kleine-Tebbe4, Christian Taube5, Martin Wagenmann6, Thomas Werfel7, Randolf Brehler8, Natalija Novak9, Norbert Mülleneisen10, Sven Becker11, and Margitta Worm12
1Center for Rhinology and Allergology, Wiesbaden, 2Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, 3University Hospital for Pediatrics and Adolescent Medicine, Children’s Center Bethel, University of Bielefeld, 4Allergy Center Westend, Berlin, 5Department of Pneumology, University Hospital Essen – Ruhrlandklinik, Essen, 6Department of Otorhinolaryngology, University Hospital Düsseldorf, Düsseldorf, 7Department of Dermatology, Allergology and Venerology, Hanover Medical School, 8Department of Dermatology, University Hospital Münster, Division of Allergology, Occupational Dermatology and Environmental Medicine, Münster, 9Department of Dermatology and Allergy, Polyclinic for Dermatology and Allergology, Bonn, 10Asthma and Allergy Center, Leverkusen, 11Clinic for Otorhinolaryngology, University Hospital, Tübingen, and 12Allergology and Immunology, Clinic for Dermatotology, Venerology and Allergology, Charité Universitätsmedizin Berlin, Germany
Background: Vaccinations against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) are intended to induce an immune response to protect against infection/disease. Allergen immunotherapy (AIT) is thought to induce a (different) immune response, e.g., to induce tolerance to allergens. In this position paper we clarify how to use AIT in temporal relation to COVID-19 vaccination. Four SARSCoV-2 vaccines are currently approved in the EU, and their possible immunological interactions with AIT are described together with practical recommendations for use. Materials and methods: Based on the internationally published literature, this position paper provides specific recommendations for the use of AIT in temporal relation to a SARSCoV-2 vaccination. Results: AIT is used in 1) allergic rhinitis, 2) allergic bronchial asthma, 3) insect venom allergy, 4) food allergy (peanut). Conclusion: For the continuation of an ongoing AIT, we recommend an interval of 1 week before and after vaccination for subcutaneous immunotherapy (SCIT). For sublingual immunotherapy (SLIT) and oral immunotherapy (OIT), we recommend taking Position paper them up to the day before vaccination and a break of 2 – 7 days after vaccination. Initiation of a new SCIT, SLIT, or OIT should be delayed until 1 week after the day of the second vaccination. For SCIT, we generally recommend an interval of ~ 1 week to COVID-19 vaccination.Correspondence to:
Prof. Dr. med. Ludger Klimek, Zentrum für Rhinologie und Allergologie, An den Quellen 10, 65183 Wiesbaden, Germany
Email: [email protected]
Guideline
Guideline on management of suspected adverse reactions to ingested histamine - Guideline of the German Society for Allergology and Clinical Immunology (DGAKI), the Society for Pediatric Allergology and Environmental Medicine (GPA), the Medical Association
Imke Reese, Barbara Ballmer-Weber, Kirsten Beyer, Sabine Dölle-Bierke, Jörg Kleine-Tebbe, Ludger Klimek, Sonja Lämmel, Ute Lepp, Joachim Saloga, Christiane Schäfer, Zsolt Szepfalusi, Regina Treudler, Thomas Werfel, Torsten Zuberbier, and Margitta Worm
Volume 5 (2021) p. 305 - 314
Abstract
Allergologie select, Vol. 5/2021 (305-314)
Guideline on management of suspected adverse reactions to ingested histamine - Guideline of the German Society for Allergology and Clinical Immunology (DGAKI), the Society for Pediatric Allergology and Environmental Medicine (GPA), the Medical Association
Imke Reese1, Barbara Ballmer-Weber2, Kirsten Beyer3, Sabine Dölle-Bierke4, Jörg Kleine-Tebbe5, Ludger Klimek6, Sonja Lämmel7, Ute Lepp8, Joachim Saloga9, Christiane Schäfer10, Zsolt Szepfalusi11, Regina Treudler12, Thomas Werfel13, Torsten Zuberbier14, and Margitta Worm4
1Nutrition Therapy, Munich, Germany, 2Clinic for Dermatology and Allergology, Cantonal Hospital St. Gallen and Department of Dermatology, University Hospital Zurich, Switzerland, 3Clinic for Pediatrics with focus on Pneumology and Immunology, Charité-Universitätsmedizin – Campus Virchow-Klinikum, Berlin, 4Allergology and Immunology, Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, 5Allergy and Asthma Center Westend, Berlin, 6Center for Rhinology and Allergology, Wiesbaden, 7German Allergy and Asthma Association (DAAB), Mönchengladbach, 8Practice for Pulmonary Medicine and Allergology, Stade, 9Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, 10Nutrition Therapy, Schwarzenbek, 11Department of Pediatrics, Division of Pediatric Pulmonology, Allergology and Endocrinology, Comprehensive Center Pediatrics, Medical University of Vienna, Vienna, Austria, 12Department of Dermatology, Venereology and Allergology, Leipzig University Medical Center, 13Department of Dermatology and Allergy, Hannover Medical School, and 14Comprehensive Allergy Centre Charité, Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Germany
Adverse reactions to food or food ingredients are more often perceived than objectively verifiable. However, reliable laboratory tests are often lacking. As a result, people with perceived adverse reactions to food often follow extensive elimination diets for years and unnecessarily restrict their diet, as in the case of the frequently suspected histamine intolerance. In this condition, laboratory parameters such as the determination of diamine oxidase in serum have been shown to be inconclusive. The lack of symptom reproducibility calls into question the clinical picture of adverse reactions to ingested histamine. In order to approach persons with perceived histamine intolerance and to support them in moving from blanket restrictions, which are often unnecessarily strict, to effective personalized therapeutic strategies, the present guideline of the Working Group on Food Allergy of the German Society of Allergology and Clinical Immunology (DGAKI) in cooperation with the Medical Association of German Allergists (AeDA), the Pediatric Allergology and Environmental Medicine (GPA) as well as the Swiss Society of Allergology and Immunology (SGAI) and the Austrian Society of Allergology and Immunology (ÖGAI) recommends a practicable diagnostic and therapeutic approach.Correspondence to:
Dr. Imke Reese, Ernährungsberatung und -therapie, Schwerpunkt Allergologie, Ansprengerstr. 19, 80803 München
Email: [email protected]
Review
Nonpharmacological measures to prevent allergic symptoms in pollen allergy: A critical review
Karl-Christian Bergmann, Markus Berger, Ludger Klimek, Oliver Pfaar, Barbora Werchan, Matthias Werchan, and Torsten Zuberbier
Volume 5 (2021) p. 349 - 360
Abstract
Allergologie select, Vol. 5/2021 (349-360)
Nonpharmacological measures to prevent allergic symptoms in pollen allergy: A critical review
Karl-Christian Bergmann1, Markus Berger2, Ludger Klimek3, Oliver Pfaar4, Barbora Werchan5, Matthias Werchan5, and Torsten Zuberbier1
1Charité, Universitätsmedizin Berlin, Clinic for Dermatology, Venereology and Allergy, Berlin, Germany, 2Institut für Pathophysiologie und Allergieforschung, Zentrum für Pathophysiologie, Infektiologie und Immunologie, Medizinische Universität Wien, Vienna, Austria, 3Center for Rhinology and Allergology, Wiesbaden, 4Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, 5German Pollen Information Service Foundation (PID), Berlin, Germany
Allergic rhinoconjunctivitis (hay fever) is the most common chronic disease in all industrialized nations. Therapy consists essentially in the use of anti-allergic and anti-inflammatory drugs, which mostly show a good and quick effect. With allergenspecific immunotherapy, there is also a causal possibility of tolerance induction. There is currently a considerable undersupply, as those affected trivialize the symptoms and often have concerns about long-term drug therapy. There is also great interest in using non-medicinal measures to prevent and/or relieve allergic symptoms on the assumption that these are free from side effects. In this publication, we present non-drug methods for which clinical studies are available in the literature. The methods have varying degrees of effectiveness. An evidence-based comparative assessment between the methods is not possible. There are also hardly any studies in comparison to standard drug therapy. A large number of the interventions consist of allergen reduction, e.g., with air filters, or cleaning of the mucous membranes with nasal irrigation, etc., none of which should be seen as a substitute but as a supplement to drug therapy.Correspondence to:
Prof. Dr. Karl-Christian Bergmann, Charité, Universitätsmedizin Berlin, Klinik für Dermatologie, Venerologie und Allergie, Luisenstraße 2, 10117 Berlin, Germany
Email: [email protected]
Guideline
S3 Guideline Allergy Prevention
Matthias V. Kopp, Cathleen Muche-Borowski, Michael Abou-Dakn, Birgit Ahrens, Kirsten Beyer, Katharina Blümchen, Petra Bubel, Adam Chaker, Monika Cremer, Regina Ensenauer, Michael Gerstlauer, Uwe Gieler, Inga-Marie Hübner, Fritz Horak, Ludger Klimek, Berthold V. Koletzko, Sybille Koletzko, Susanne Lau, Thomas Lob-Corzilius, Katja Nemat, Eva M.J. Peters, Antonio Pizzulli†, Imke Reese, Claudia Rolinck-Werninghaus, Elien Rouw, Bianca Schaub, Sebastian Schmidt, Jens-Oliver Steiß, Anne Kathrin Striegel, Zsolt Szépfalusi, Dietmar Schlembach, Thomas Spindler, Christian Taube, Valérie Trendelenburg, Regina Treudler, Ulrich Umpfenbach, Christian Vogelberg, Martin Wagenmann, Anke Weißenborn, Thomas Werfel, Margitta Worm, Helmut Sitter, and Eckard Hamelmann
Volume 6 (2022) p. 61 - 97
Abstract
Allergologie select, Vol. 6/2022 (61-97)
S3 Guideline Allergy Prevention
Matthias V. Kopp1, Cathleen Muche-Borowski2, Michael Abou-Dakn3, Birgit Ahrens4, Kirsten Beyer5, Katharina Blümchen4, Petra Bubel6, Adam Chaker7, Monika Cremer8, Regina Ensenauer9, Michael Gerstlauer10, Uwe Gieler11, Inga-Marie Hübner12, Fritz Horak13, Ludger Klimek14, Berthold V. Koletzko15, Sybille Koletzko16, Susanne Lau5, Thomas Lob-Corzilius17, Katja Nemat18, Eva M.J. Peters11, Antonio Pizzulli†19, Imke Reese20, Claudia Rolinck-Werninghaus21, Elien Rouw22, Bianca Schaub23, Sebastian Schmidt24, Jens-Oliver Steiß25, Anne Kathrin Striegel26, Zsolt Szépfalusi27, Dietmar Schlembach28, Thomas Spindler29, Christian Taube30, Valérie Trendelenburg5, Regina Treudler31, Ulrich Umpfenbach32, Christian Vogelberg33, Martin Wagenmann34, Anke Weißenborn35, Thomas Werfel36, Margitta Worm37, Helmut Sitter38, and Eckard Hamelmann39
1Airway Research Center North, University of Lübeck, Member of Deutsches Zentrum für Lungenforschung, Universitätsklinik für Kinderheilkunde, Inselspital, Bern, Schweiz, 2Institut für Allgemeinmedizin, University Medical Center Hamburg-Eppendorf, Hamburg, Deutschland, 3Clinic for Gynecology and Obstetrics, St. Joseph-Krankenhaus Berlin-Tempelhof, Deutschland, 4Children’s Hospital, University Hospital Frankfurt, Deutschland, 5Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Deutschland, 6HNO-Facharztpraxis, Eisleben, Deutschland, 7HNO-Klinik, Klinikum rechts der Isar, Technical University of Munich, Munich, Deutschland, 8Ökotrophologin, Journalistin, Idstein/Taunus, Deutschland, 9Institut für Kinderernährung, Max Rubner-Institut, Karlsruhe, Deutschland, 10Kinderklinik, Universitätsklinikum Augsburg, Deutschland, 11Klinik für Psychosomatik und Psychotherapie des UKGM, Universitätsklinik, Giessen, Deutschland, 12Arbeitsgemeinschaft Dermatologiche Prävention e.V., Hamburg, Deutschland, 13Allergiezentrum Wien West, Wien, Österreich, 14Zentrum für Rhinologie und Allergologie, Wiesbaden, Deutschland, 15Integriertes Sozialpädiatrisches Zentrum, Dr. von Haunerschen Kinderspital, LMU Klinikum der Universität München, München, Deutschland, 16Abteilung für Stoffwechsel und Ernährung, Dr. von Haunersches Kinderspital, LMU Klinikum der Universität München, München, Deutschland, 17Kinder- und Jugendmedizin, Christliches Kinderhospital Osnabrück, Deutschland, 18Kinderzentrum Dresden-Friedrichstadt, Dresden, Deutschland, 19Schwerpunktpraxis für Allergologie und Lungenheilkunde im Kinder- und Jugendalter, Berlin, Deutschland, 20Ernährungsberatung und -therapie mit Schwerpunkt Allergologie, München, Deutschland, 21Praxis für Kinder- und Jugendmedizin, Teltow, Deutschland, 22Kinderarztpraxis, Bühl, Deutschland, 23Asthma- und Allergieambulanz, Dr. von Haunersches Kinderspital, LMU Klinikum der Universität, München, Deutschland, 24Allgemeine Pädiatrie, Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsmedizin Greifswald, Greifswald, Deutschland, 25Facharztpraxis für Kinder- und Jugendmedizin, Fulda, Deutschland, 26Kinder- und Jugendmedizin, Universitätsklinikum, Köln, Deutschland, 27Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich, 28Klinik für Geburtsmedizin, Vivantes Klinikum Neukölln, Berlin, 29Hochgebirgsklinik Davos, Schweiz, 30Klinik für Pneumologie, Ruhrlandklinik, Westdeutsches Lungenzentrum am Universitätsklinikum, Essen, Deutschland, 31Klinik für Dermatologie, Venerologie und Allergologie, Leipziger Allergie-Centrum LICA – CAC, Universitätsmedizin, Leipzig, Deutschland, 32Praxis für Kinder- und Jugendmedizin, Dülken, Deutschland, 33Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus an der Technischen Universität, Dresden, Deutschland, 34HNO-Klinik, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland, 35German Federal Institute for Risk Assessment, Berlin, Deutschland, 36Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover, Hannover, Deutschland, 37Klinik für Dermatologie, Allergologie und Venerologie, Campus Charité Mitte, Universitätsmedizin Berlin, Berlin, Deutschland, 38Institut für Chirurgische Forschung, Philipps-Universität, Marburg, Deutschland, and 39Kinder-Zentrum Bethel, Evangelisches Klinikum Bethel, Universitätsklinik für Kinder- und Jugendmedizin, Universitätsklinikum OWL, Universität Bielefeld, Bielefeld, Deutschland
Background: The persistently high prevalence of allergic diseases in Western industrial nations and the limited possibilities of causal therapy make evidence-based recommendations for primary prevention necessary. Methods: The recommendations of the S3 Guideline Allergy Prevention, published in its last version in 2014, were revised and consented on the basis of a current systematic literature search. The evidence search was conducted for the period 06/2013 – 11/2020 in the electronic databases Cochrane and MEDLINE, as well as in the reference lists of current reviews and through references from experts. The literature found was screened in two filtering processes, first by title and abstract, and the remaining papers were screened in the full text for relevance. The studies included were sorted by level of evidence, and the study quality was indicated in terms of potential bias (low/high). The revised recommendations were formally agreed and consented upon with the participation of representatives of the relevant professional societies and (self-help) organizations (nominal group process). Of 5,681 hits, 286 studies were included and assessed. Results: Recommendations on maternal nutrition during pregnancy and breastfeeding as well as on infant nutrition in the first months of life again play an important role in the updated guideline: Many of the previous recommendations were confirmed by the current data. It was specified that breastfeeding should be exclusive for the first 4 – 6 months after birth, if possible, and that breastfeeding should continue with the introduction of complementary foods. A new recommendation is that supplementary feeding of cow’s milk-based infant formula should be avoided in the first days of life if the mother wishes to breastfeed. Furthermore, it was found that the evidence for a clear recommendation for hydrolyzed infant formula in nonbreastfed infants at risk of atopic diseases is currently insufficient. It is therefore recommended to check whether an infant formula with proven efficacy, demonstrated in allergy prevention studies, is available until the introduction of complementary feeding. Finally, based on the EAACI guideline, recommendations were made for the prevention of hen’s egg allergy by introducing and regularly giving thoroughly heated (e.g., baked or hard-boiled) but not “raw” hen’s egg (also no scrambled egg) with the complementary food. The recommendation to introduce peanut in complementary feeding was formulated cautiously for the German-speaking countries: In families with regular peanut consumption, the regular administration of peanut-containing foods in ageappropriate form (e.g., peanut butter) with the complementary diet can be considered for the primary prevention of peanut allergy in infants with atopic dermatitis (AD). Before introduction, a clinically relevant peanut allergy must be ruled out, especially in infants with moderate to severe AD. There is still insufficient evidence for an allergy-preventive efficacy of prebiotics or probiotics, vitamin D, or other vitamins in the form of supplements so that recommendations against their supplementation were adopted for the first time in the current guideline. Biodiversity plays an important role in the development of immunological tolerance to environmental and food allergens: there is clear evidence that growing up on a farm is associated with a lower risk of developing asthma and allergic diseases. This is associated with early non-specific immune stimulation due to, among other things, the greater microbial biodiversity of house dust in this habitat. This aspect is also reflected in the recommendations on animal husbandry, on which a differentiated statement was made: In families without a recognizable increased allergy risk, pet keeping with cats or dogs should not generally be restricted. Families with an increased allergy risk or with children with already existing AD should not acquire a new cat – in contrast, however, dog ownership should not be discouraged. Interventions to reduce exposure to dust mite allergens in the home, such as the use of mite allergen-proof mattress covers (“encasings”), should be restricted to patients with already proven specific sensitization against house dust mite allergen. Children born by caesarean section have a slightly increased risk of asthma – this should be taken into account when advising on mode of delivery outside of emergency situations. Recent work also supports the recommendations on air pollutants: Active and passive exposure to tobacco smoke increase the risk of allergies, especially asthma, and should therefore be avoided. Exposure to nitrogen oxides, ozone, and small particles (PM 2.5) is associated with an increased risk, especially for asthma. Therefore, exposure to emissions of nitrogen oxides, ozone, and small particles (PM 2.5) should be kept low. The authors of this guideline are unanimously in favor of enacting appropriate regulations to minimize these air pollutants. There is no evidence that vaccinations increase the risk of allergies, but conversely there is evidence that vaccinations can reduce the risk of allergies. All children, including children at risk, should be vaccinated according to the current recommendations of the national public health institutes, also for allergy prevention. Conclusion: The consensus of recommendations in this guideline is based on an extensive evidence base. The update of the guideline enables evidence-based and up-to-date recommendations for the prevention of allergic diseases including asthma and atopic dermatitis.Correspondence to:
Prof. Dr. med. Matthias Kopp, Medizinbereich Kinder und Jugendliche, Insel Gruppe AG, Inselspital, Universität Bern, Freiburgstraße 15, 3010 Bern,
or
Prof. Dr. med. Eckard Hamelmann, Kinder-Zentrum Bethel, Evangelisches Klinikum Bethel, Universität Bielefeld, Burgsteig 13, 33617 Bielefeld
Email: [email protected]
Erweiterte Autorenreferate
Allergologie im Kloster 2022 – Kloster Eberbach, Eltville/Rheingau, 13. und 14. Mai 2022
Wissenschaftliche Leitung: Prof. Dr. med. Ludger Klimek, Wiesbaden
Jahrgang 45 (2022) p. 288 - 318
Abstract
Allergologie im Kloster 2022 – Kloster Eberbach, Eltville/Rheingau, 13. und 14. Mai 2022
Wissenschaftliche Leitung: Prof. Dr. med. Ludger Klimek, Wiesbaden
Review
Epithelial immune regulation of inflammatory airway diseases: Chronic rhinosinusitis with nasal polyps (CRSwNP)
Ludger Klimek, Jan Hagemann, Hans-Jürgen Welkoborsky, Mandy Cuevas, Ingrid Casper, Ulrike Förster-Ruhrmann, Felix Klimek, Constantin A. Hintschich, Tilman Huppertz, Christoph Bergmann, Peter-Valentin Tomazic, and Sven Becker
Volume 6 (2022) p. 148 - 166
Abstract
Allergologie select, Vol. 6/2022 (148-166)
Epithelial immune regulation of inflammatory airway diseases: Chronic rhinosinusitis with nasal polyps (CRSwNP)
Ludger Klimek1,2, Jan Hagemann2, Hans-Jürgen Welkoborsky3, Mandy Cuevas4, Ingrid Casper1, Ulrike Förster-Ruhrmann5, Felix Klimek1, Constantin A. Hintschich6, Tilman Huppertz2, Christoph Bergmann7, Peter-Valentin Tomazic8, and Sven Becker9
1Center for Rhinology and Allergology, Wiesbaden, 2Clinic and Polyclinic for Otolaryngology, University Medical Center Mainz, Mainz, 3Clinic for Ear, Nose and Throat Medicine, Head and Neck Surgery, Nordstadt Clinic of the KRH, Hannover, 4Clinic and Polyclinic for Otolaryngology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, 5HNO-University Clinic Charité, Berlin, 6Clinic and Polyclinic for Ear, Nose and Throat Medicine, University Hospital Regensburg, Regensburg, 7HNO RKM740 Interdisciplinary Specialist Clinic, Düsseldorf, Germany, 8HNO-University Clinic Graz, Medical University Graz, Austria, and 9HNO-University Clinic Tübingen, Germany
Background: The epithelial immune regulation is an essential and protective feature of the barrier function of the mucous membranes of the airways. Damage to the epithelial barrier can result in chronic inflammatory diseases, such as chronic rhinosinusitis (CRS) or bronchial asthma. Thymic stromal lymphopoietin (TSLP) is a central regulator in the epithelial barrier function and is associated with type 2 (T2) and non-T2 inflammation. Materials and methods: The immunology of chronic rhinosinusitis with polyposis nasi (CRSwNP) was analyzed in a literature search, and the existing evidence was determined through searches in Medline, Pubmed as well as the national and international study and guideline registers and the Cochrane Library. Human studies or studies on human cells that were published between 2010 and 2020 and in which the immune mechanisms of TSLP in T2 and non-T2 inflammation were examined were considered. Results: TSLP is an epithelial cytokine (alarmin) and a central regulator of the immune reaction, especially in the case of chronic airway inflammation. Induction of TSLP is implicated in the pathogenesis of many diseases like CRS and triggers a cascade of subsequent inflammatory reactions. Conclusion: Treatment with TSLP-blocking monoclonal antibodies could therefore open up interesting therapeutic options. The long-term safety and effectiveness of TSLP blockade has yet to be investigated.Correspondence to:
Prof. Dr. med. L. Klimek, Zentrum für Rhinologie und Allergologie Wiesbaden, An den Quellen 10, 65183 Wiesbaden, Germany
Email: [email protected]
Review
Digital health for allergen immunotherapy
Stephanie Dramburg, Paolo Maria Matricardi, Oliver Pfaar, and Ludger Klimek
Volume 6 (2022) p. 293 - 298
Abstract
Allergologie select, Vol. 6/2022 (293-298)
Digital health for allergen immunotherapy
Stephanie Dramburg1, Paolo Maria Matricardi1, Oliver Pfaar2, and Ludger Klimek3
1Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité – Universitätsmedizin Berlin, Berlin, 2Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, and 3Center for Rhinology and Allergology Wiesbaden, Wiesbaden, Germany
In the recent past, digital healthcare technologies are experiencing a significant leap in development, with an additional unforeseen acceleration in implementation due to the SARS-CoV-2 pandemic. The increased use of mobile applications as well as communication technologies to search for services and support hold particular advantages for the management of chronic diseases requiring medium- to longterm treatments and regular follow-up visits. Allergen immunotherapy (AIT), requiring regular application of treatment, represents an optimal scenario for feasible digital support. From patient stratification and care pathways, over personalized decision support for complex clinical scenarios, towards a close and flexible patient-doctor communication in blended care settings: the current article summarizes the latest knowledge on the use and potential of digital health technologies in the area of AIT.Correspondence to:
Stephanie Dramburg, MD, Department of Pediatric Respiratory Care, Immunology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
Email: [email protected]
Review
Clinical endpoints in allergen immunotherapy: State of the art 2022
Roy Gerth van Wijk, Ludger Klimek, and Oliver Pfaar
Volume 7 (2023) p. 39 - 46
Abstract
Allergologie select, Vol. 7/2023 (39-46)
Clinical endpoints in allergen immunotherapy: State of the art 2022
Roy Gerth van Wijk1, Ludger Klimek2, and Oliver Pfaar3
1Section of Allergology and Clinical Immunology, Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands, 2Center for Rhinology and Allergology, Wiesbaden, and 3Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
110 years after the classical study by Noon, numerous studies have confirmed the efficacy of allergen immunotherapy. A variety of clinical endpoints have been used in these trials. This review gives an overview of clinical endpoints for randomized clinical trials on allergen immunotherapy (AIT) in rhinitis and asthma. In addition, real-life studies have been carried out with the same kind of endpoints. In general, AIT studies are characterized by a lack of standardized and validated outcome measures. For allergic rhinoconjunctivitis, digital tools have been developed to monitor patients. Such tools are particularly useful to obtain real-world evidence for AIT. Finally, well-accepted outcome measures are available for cost-effectiveness studies.Correspondence to:
Roy Gerth van Wijk, MD, PhD, Professor of Allergy, Section of Allergology and Clinical Immunology, Department of Internal Medicine, Erasmus MC, Rotterdam the Netherlands
Email: [email protected]
Erweiterte Autorenreferate
Allergologie im Kloster 2023 – Kloster Eberbach, Eltville/Rheingau, 12. und 13. Mai 2023
Wissenschaftliche Leitung: Prof. Dr. med. Ludger Klimek, Wiesbaden
Jahrgang 46 (2023) p. 267 - 294
Abstract
Allergologie, Jahrgang 46, Nr. 4/2023, S. 267-294
Allergologie im Kloster 2023 – Kloster Eberbach, Eltville/Rheingau, 12. und 13. Mai 2023
Wissenschaftliche Leitung: Prof. Dr. med. Ludger Klimek, Wiesbaden
