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]
Original
Guideline on diagnostic procedures for suspected hypersensitivity to beta-lactam antibiotics
Gerda Wurpts, Werner Aberer, Heinrich Dickel, Randolf Brehler, Thilo Jakob, Burkhard Kreft, Vera Mahler, Hans F. Merk, Norbert Mülleneisen, Hagen Ott, Wolfgang Pfützner, Stefani Röseler, Franziska Ruëff, Helmut Sitter, Cord Sunderkötter, Axel Trautmann, Regina Treudler, Bettina Wedi, Margitta Worm, und Knut Brockow
Volume 4 (2020) p. 11 - 43
Abstract
Allergologie select, Vol. 4/2020 (11-43)
Guideline on diagnostic procedures for suspected hypersensitivity to beta-lactam antibiotics
Gerda Wurpts1, Werner Aberer2, Heinrich Dickel3, Randolf Brehler4, Thilo Jakob5, Burkhard Kreft6, Vera Mahler7,8, Hans F. Merk1, Norbert Mülleneisen9, Hagen Ott10, Wolfgang Pfützner11, Stefani Röseler1, Franziska Ruëff12, Helmut Sitter13, Cord Sunderkötter6, Axel Trautmann14, Regina Treudler15, Bettina Wedi16, Margitta Worm17, und Knut Brockow18
1Clinic for Dermatology and Allergology, Aachen Comprehensive Allergy Center (ACAC), Uniklinik RWTH Aachen, Germany 2Department of Dermatology, Graz Medical University, Graz, Austria, 3Department of Dermatology, Venereology and Allergology, St. Josef Hospital, University Hospital of the Ruhr University Bochum, Bochum, 4Department of Dermatology, University Hospital Münster, Münster, 5Department of Dermatology and Allergology, University Hospital Gießen und Marburg, Gießen Site, Gießen, 6Department of Dermatology and Venereology, University, Hospital Halle (Saale), Halle (Saale), 7Paul-Ehrlich Institute, Langen, 8Department of Dermatology, University Hospital Erlangen, Erlangen, 9Asthma and Allergy Centre, Leverkusen, 10Division of Pediatric Dermatology and Allergology, Auf der Bult Children’s Hospital, Hannover, 11Department of Dermatology and Allergology, University Hospital Gießen und Marburg, Marburg Site, Marburg, 12Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, 13Institute of Surgical Research, Philipps University Marburg, Marburg, 14Department of Dermatology and Allergy, Allergy Center Mainfranken, University Hospital Würzburg, Würzburg, 15Department of Dermatology, Venereology, and Allergology and Leipzig Interdisciplinary Center for Allergology – LICA-CAC, University of Leipzig, Leipzig, 16Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover, 17Department of Dermatology, Venereology, and Allergology, Charité University Hospital Berlin, Allergy Center Charité (ACC), Berlin, and 18Department of Dermatology and Allergology am Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
This guideline on diagnostic procedures for suspected beta-lactam antibiotic (BLA) hypersensitivity was written by the German and Austrian professional associations for allergology, and the Paul-Ehrlich Society for Chemotherapy in a consensus procedure according to the criteria of the German Association of Scientific Medical Societies. BLA such as penicillins and cephalosporins represent the drug group that most frequently triggers drug allergies. However, the frequency of reports of suspected allergy in patient histories clearly exceeds the number of confirmed cases. The large number of suspected BLA allergies has a significant impact on, e.g., the quality of treatment received by the individual patient and the costs to society as a whole. Allergies to BLA are based on different immunological mechanisms and often manifest as maculopapular exanthema, as well as anaphylaxis; and there are also a number of less frequent special clinical manifestations of drug allergic reactions. All BLA have a beta-lactam ring. BLA are categorized into different classes: penicillins, cephalosporins, carbapenems, monobactams, and beta-lactamase inhibitors with different chemical structures. Knowledge of possible cross-reactivity is of considerable clinical significance. Whereas allergy to the common beta-lactam ring occurs in only a small percentage of all BLA allergic patients, cross-reactivity due to side chain similarities, such as aminopenicillins and aminocephalosporins, and even methoxyimino cephalosporins, are more common. However, the overall picture is complex and its elucidation may require further research. Diagnostic procedures used in BLA allergy are usually made up of four components: patient history, laboratory diagnostics, skin testing (which is particularly important), and drug provocation testing. The diagnostic approach – even in cases where the need to administer a BLA is acute – is guided by patient history and risk – benefit ratio in the individual case. Here again, further studies are required to extend the present state of knowledge. Performing allergy testing for suspected BLA hypersensitivity is urgently recommended not only in the interests of providing the patient with good medical care, but also due to the immense impact of putative BLA allergies on society as a whole.Correspondence to:
Dr. med. Gerda Wurpts, Clinic for Dermatology and Allergology, Aachen Comprehensive Allergy Center (ACAC), Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
Email: [email protected]
Original
Obesity-associated asthma in childhood
Maria Mangova1,2, Tobias Lipek1,2, Maike vom Hove1,2, Antje Körner1, Wieland Kiess1,2, Regina Treudler2,3, and Freerk Prenzel1,2
Volume 4 (2020) p. 76 - 84
Abstract
Allergologie select, Volume 4/2020 (76-84)
Obesity-associated asthma in childhood
Maria Mangova, Tobias Lipek, Maike vom Hove, Antje Körner, Wieland Kiess, Regina Treudler, and Freerk Prenzel
1University of Leipzig Medical Center, Department for Pediatrics, 2LICA – Leipzig Interdisciplinary Center for Allergy (Comprehensive Allergy Center), and 3University of Leipzig Medical Center, Department of Dermatology, Venereology and Allergy, Leipzig, Germany
Obesity and bronchial asthma are very common diseases in children and adolescents, associated with a considerable burden of disease, reduced quality of life and comorbidities. Obesity is a significant risk factor for bronchial asthma. On the one hand, obesity leads to changes in the mechanics and function of the lungs and chest. On the other hand, obesity-associated inflammatory processes with increased production of leptin and cytokines may trigger bronchial inflammation with the appearance of asthmatic symptoms. The diseases are also linked by genetic factors. Physical activity and weight reduction have a significant benefit. Pharmacotherapy must be based on the pattern of inflammation. This article summarizes the current state of the literature on the association of asthma and obesity and presents current and possible future treatment options.Correspondence to:
Dr. med. Freerk Prenzel, University of Leipzig Medical Center, Department for Pediatrics, Liebigstr. 20a, 04103, Leipzig, Germany
Email: [email protected]
Review
Atopic dermatitis and psychosocial comorbidities – What’s new?
Paula Kage, Julia Zarnowski, Jan-Christoph Simon, and Regina Treudler
Volume 4 (2020) p. 86 - 96
Abstract
Allergologie select, Volume 4/2020 (86-96)
Atopic dermatitis and psychosocial comorbidities – What’s new?
Paula Kage, Julia Zarnowski, Jan-Christoph Simon, and Regina Treudler
Department of Dermatology, Venereology and Allergology, Leipzig Interdisciplinary Center for Allergology – LICA-CAC, University of Leipzig, Germany
Atopic dermatitis (AD) is a chronic inflammatory disease. During the last years, researchers have focused on a variety of associated comorbidities, especially psychosocial disease. This article aims at giving an overview over recent data. A systematic literature research was performed in PubMed including data from the time period January 1, 2018 until March 1, 2020. Patients with AD frequently suffer from cocomitant depression, anxiety, and attention deficit hyperactivity disorder. There is less evidence about the relation between AD and schizophrenia, eating disorder, and obsessive compulsive disorder. There is still great need for research in the connection between AD and psychosocial disease, particularly about the pathogenesis and the influence of new therapies.Correspondence to:
Dr. med. Paula Kage, Department of Dermatology, Venereology and Allergology, Leipzig Interdisciplinary Center for Allergology – LICA-CAC, University of Leipzig, Philipp-Rosenthal-Straße 23, 04103 Leipzig, Germany
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
Induction of penicillin tolerance during pregnancy: Allergological opinion on the recommendation of the current AWMF Guidelines on Diagnosis and Treatment of Syphilis (AWMF Registry No. 059-002)
Bettina Wedi, Werner Aberer, Knut Brockow, Heinrich Dickel, Randolf Brehler, Thilo Jakob, Burkhard Kreft, Vera Mahler, Hans F. Merk, Norbert Mülleneisen, Hagen Ott, Wolfgang Pfützner, Stefani Röseler, Franziska Ruëff, Cord Sunderkötter, Axel Trautmann, Regina Treudler, Margitta Worm, and Gerda Wurpts
Volume 5 (2021) p. 67 - 71
Abstract
Allergologie select, Vol. 5/2021 (67-71)
Induction of penicillin tolerance during pregnancy: Allergological opinion on the recommendation of the current AWMF Guidelines on Diagnosis and Treatment of Syphilis (AWMF Registry No. 059-002)
Bettina Wedi1, Werner Aberer2, Knut Brockow3, Heinrich Dickel4, Randolf Brehler5, Thilo Jakob6, Burkhard Kreft7, Vera Mahler8,9, Hans F. Merk10, Norbert Mülleneisen11, Hagen Ott12, Wolfgang Pfützner13, Stefani Röseler14, Franziska Ruëff15, Cord Sunderkötter16, Axel Trautmann17, Regina Treudler18, Margitta Worm19, and Gerda Wurpts20
1Department of Dermatology, Allergology, and Venereology, Comprehensive Allergy Center, Hannover Medical School, Germany, 2Department of Dermatology, Medical University Graz, Austria, 3Department and Outpatient Clinic for Dermatology and Allergology am Biederstein, Technical University of Munich, 4Department of Dermatology, Venereology, and Allergology, St. Josef-Hospital, University Hospital of the Ruhr University of Bochum, 5Department of Dermatology, University Hospital Muenster, 6Department of Dermatology and Allergology, University Medical Center Gießen and Marburg, Campus Gießen, 7Department of Dermatology and Venereology, University Hospital Halle (Saale), 8Paul-Ehrlich-Institut, Langen, 9Dermatologists at the Merckhaus Dr. Herbst and Kollegen, Darmstadt, 10Department of Dermatology and Allergology, Aachen Comprehensive Allergy Center (ACAC), University Hospital RWTH Aachen, 11Lung and Allergy Center, Leverkusen, 12Pediatric Dermatology and Allergology, Children’s and Youth Hospital “Auf der Bult”, Hannover, 13Department of Dermatology and Allergology, University Medical Center Gießen and Marburg, Campus Marburg, 14Augustinians Hospital, Academic Teaching Hospital of the University of Cologne, 15Department and Outpatient Clinic of Dermatology, and Allergology, Allergy Center, Hospital of the University of Munich, 16University Hospital and Outpatient Clinic of Dermatogy and Venereology, University Hospital Halle (Saale), 17Department and Outpatient Clinic of Dermatology, Venereology, and Allergology, Allergy Center Mainfranken, University Hospital Würzburg, 18Department and Outpatient Clinic of Dermatology, Venereology, and Allergology and Leipzig Interdisciplinary Allergy Center – LICACAC, University of Leipzig, 19Department for Dermatology, Venereology, and Allergology, Charité-University Medicine Berlin, Allergy Center-Charité (ACC), Berlin, 20Department of Dermatology and Allergology, Aachen Comprehensive Allergy Center (ACAC), University Hospital RWTH Aachen, Germany
Correspondence to:
Prof. Dr. Bettina Wedi, Klinik für Dermatologie, Allergologie und Venerologie, Comprehensive Allergy Center, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
Email: [email protected]
Statement
Practical recommendations for the allergological risk assessment of the COVID-19 vaccination – a harmonized statement of allergy centers in Germany
Margitta Worm, Andrea Bauer, Bettina Wedi, Regina Treudler, Wolfgang Pfuetzner, Knut Brockow, Timo Buhl, Torsten Zuberbier, Joachim Fluhr, Gerda Wurpts, Ludger Klimek, Thilo Jakob, Hans F. Merk, Norbert Mülleneisen, Stefani Roeseler, Heinrich Dickel, Ulrike Raap, and Jörg Kleine-Tebbe
Volume 5 (2021) p. 72 - 76
Abstract
Allergologie select, Vol. 5/2021 (72-76)
Practical recommendations for the allergological risk assessment of the COVID-19 vaccination – a harmonized statement of allergy centers in Germany
Margitta Worm1, Andrea Bauer2, Bettina Wedi3, Regina Treudler4, Wolfgang Pfuetzner5, Knut Brockow6, Timo Buhl7, Torsten Zuberbier8, Joachim Fluhr8, Gerda Wurpts9, Ludger Klimek10, Thilo Jakob11, Hans F. Merk12, Norbert Mülleneisen13, Stefani Roeseler14, Heinrich Dickel15, Ulrike Raap16, and Jörg Kleine-Tebbe17
1Allergology and Immunology, Department of Dermatology, Venereology and Allergology, Campus Charité Mitte, University Medicine Berlin, 2Clinic and Polyclinic for Dermatology, University Hospital Carl Gustav Carus at the Technical University Dresden, 3Department of Dermatology, Allergology and Venereology Comprehensive Allergy Center (CAC) Treatment Center for Hereditary Angioedema in the ZSE, Hannover Medical School, 4Clinic of Dermatology, Venereology and Allergology, Leipzig University Medical Center, 5Hesse Allergy Center, Clinic for Dermatology and Allergology, Marburg University Hospital, 6Dermatology Clinic Campus Biederstein, Klinikum rechts der Isar, Technical University of Munich, 7Dermatology Venereology and Allergology Clinic, University Medical Center Göttingen Georg-August-University, 8Department of Dermatology and Allergy, Comprehensive Allergy Center Charité – Universitätsmedizin Berlin, Germany, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 9Department of Dermatology and Allergology, University Hospital Aachen, 10Center for Rhinology and Allergology of the ENT University Clinic Mannheim, Wiesbaden, 11Department of Dermatology, Venerology and Allergology, University Hospital Giessen, 12Dermatology Clinic, RWTH Aachen University, 13Asthma and Allergy Center, Leverkusen, 14Allergy, Asthma and Anaphylaxis Center, Clinic of Pneumology, Allergology, Sleep and Respiratory Medicine, Augustinians Hospital, Cologne, 15Department of Allergology, Occupational and Environmental Dermatology, Clinic for Dermatology, Venereology and Allergology, St. Josef Hospital, Ruhr University Bochum, 16Department of Experimental Allergology and Immunodermatology, Department of Human Medicine, University of Oldenburg, and 17Allergy and Asthma Center Westend, Berlin, Germany
Severe allergic reactions to vaccines are very rare. Single severe reactions have occurred worldwide after vaccination with the new mRNA-based COVID-19 vaccines. PEG2000 is discussed as a possible trigger. We provide guidance on risk assessment regarding COVID-19 vaccination in patients with allergic diseases and suggest a standardized, resource-oriented diagnostic and therapeutic procedure. Reports of severe allergic reactions in the context of COVID-19 vaccination can be made via www.anaphylaxie.net using an online questionnaire.Correspondence to:
Univ.-Prof. Dr. med. Margitta Worm, Charité – Universitätsmedizin Berlin, Allergologie und Immunologie, Klinik für Dermatologie und Allergologie, Charitéplatz 1, 10117 Berlin
Email: [email protected]
Original
Anaphylaxis in middle-aged patients
Wojciech Francuzik, Magdalena Kraft, Kathrin Scherer Hofmeier, Franziska Ruëff, Claudia Pföhler, Regina Treudler, Roland Lang, Thomas Hawranek, Nicola Wagner, und Margitta Worm
Volume 5 (2021) p. 133 - 139
Abstract
Allergologie select, Vol. 5/2021 (133-139)
Anaphylaxis in middle-aged patients
Wojciech Francuzik1, Magdalena Kraft1,2, Kathrin Scherer Hofmeier3, Franziska Ruëff4, Claudia Pföhler5, Regina Treudler6, Roland Lang7, Thomas Hawranek7, Nicola Wagner8, und Margitta Worm1
1Allergy and Immunology, Department of Dermatology, Venereology and Allergology, Charité – Universitätsmedizin Berlin, Berlin, 2Central Emergency Department, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany 3Allergology, Clinic for Dermatology, University Hospital Basel, Basel, Switzerland, 4Clinic and Polyclinic for Dermatology and Allergology, University Hospital Munich, Munich, 5Clinic for Dermatology, Venerology and Allergology, Saarland University Hospital and Medical Faculty of Saarland University, Homburg, 6Clinic and Polyclinic for Dermatology, Venerology and Allergology, Leipzig University Hospital, Leipzig, Germany, 7University Clinic for Dermatology and Allergology, Paracelsus Medical Private University Salzburg, Salzburg, Austria and 8Dermatology Clinic, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
Age is one of the most important factors influencing the course of anaphylaxis: moreover, the frequency of elicitors of anaphylaxis is age-associated. We analyzed 8,465 anaphylactic episodes in adult patients in three age groups with a focus on patients in the middle-age group (35 – 65 years old). Insect venom was the most frequent trigger in this age group (51.2%) followed by drugs (22.8%) and food (17.3%). Severe reactions were observed in 40.1% of middle-aged patients and occurred more frequently in this age group than in patients below 35 years (27.6%) and less frequently than in patients over 65 years (55.6%). The symptoms and comorbidity profile also changed with age, most significantly regarding the increase in rates of concomitant cardiologic diseases and (severe) cardiovascular symptoms.Correspondence to:
Prof. Dr. med. Margitta Worm, Allergologie und Immunologie, Klinik für Dermatologie, Venerologie, und Allergologie, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin
Email: [email protected]
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]
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]
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]
Case Report
Treatment of severe cow’s milk allergy with omalizumab in an adult
Benjamin Klein, Jan Christoph Simon, and Regina Treudler
Volume 7 (2023) p. 20 - 24
Abstract
Allergologie select, Vol. 7/2023 (20-24)
Treatment of severe cow’s milk allergy with omalizumab in an adult
Benjamin Klein, Jan Christoph Simon, and Regina Treudler
Department of Dermatology, Venereology, and Allergology, and LICA-CAC, University Hospital Leipzig, Leipzig, Leipzig, Germany
Background: The therapy of severe food allergy so far consists mainly of allergen abstinence and emergency treatment. The use of anti-IgE antibodies represents a promising therapy. Case report: We report on a 22-year-old male with severe cow’s milk allergy with multiple anaphylactic reactions, known since infancy and persisting into adulthood with sometimes severe immediate-type reactions on accidental ingestion. The prick test for native whole milk was positive, the CAP-FEIA was also positive for milk protein, mare’s milk, whey, sheep’s milk whey as well as Bos d4, Bos d5, and Bos d8 and blue cheese; total IgE was 1,265 kU/L. The patient’s history included well-controlled bronchial asthma. An off-label therapy with omalizumab (3 × 150 mg/month SC) and cetirizine 10 mg once daily was initiated. Under this therapy, we performed a double-blind oral exposure test to cow’s milk in the patient after long term. Thereby 14 mL could be tolerated. After consumption of 30 mL of cow’s milk, urticaria, dyspnea, and angioedema occurred. Conclusion: Under therapy with omalizumab, an increase of the tolerance to cow’s milk was shown in our patient. As a consequence, reactions during accidental consumption could be prevented.Correspondence to:
Dr. med. Benjamin Klein, Department of Dermatology, Venerology, and Allergology, University Hospital Leipzig, Philipp Rosenthal Strasse 23, 04103 Leipzig, Germany
Email: [email protected]
Position Paper
Vegan diets from an allergy point of view – Position paper of the DGAKI working group on food allergy
Imke Reese, Christiane Schäfer, Barbara Ballmer-Weber, Kirsten Beyer, Sabine Dölle-Bierke, Suzanne van Dullemen, Uta Jappe, Sabine Müller, Sabine Schnadt, Regina Treudler, and Margitta Worm
Volume 7 (2023) p. 57 - 83
Abstract
Allergologie select, Vol. 7/2023 (57-83)
Vegan diets from an allergy point of view – Position paper of the DGAKI working group on food allergy
Imke Reese1, Christiane Schäfer2, Barbara Ballmer-Weber3,4, Kirsten Beyer5, Sabine Dölle-Bierke6, Suzanne van Dullemen7, Uta Jappe8,9, Sabine Müller10, Sabine Schnadt11, Regina Treudler12, and Margitta Worm6
1Nutrition Therapy, Munich, 2NutritionTherapy, Schwarzenbek, Germany, 3Clinic for Dermatology and Allergology, Cantonal Hospital St. Gallen, St. Gallen, 4Department of Dermatology, University Hospital Zürich, Switzerland, 5Clinic for Pediatrics with focus on Pneumology and Immunology, Charité-Universitätsmedizin – Campus Virchow-Klinikum, 6Allergology and Immunology, Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, 7University Clinic Frankfurt, Clinic for Pediatrics, Frankfurt, 8Division of Clinical and Molecular Allergology, Research Center Borstel, German Center for Lung Research (DZL) Airway Research Center North (ARCN), Borstel, 9Interdisciplinary Allergy Outpatient Clinic, Department of Pneumology, University of Lübeck, Lübeck, 10Department of Dermatology and Venereology, University Clinic Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, 11German Allergy and Asthma Association (DAAB), Mönchengladbach, and 12Department of Dermatology, Venereology and Allergology, Leipzig University Medical Center, Leipzig, Germany
Vegan diets are currently attracting a great deal of attention. However, avoiding animal-based foods restricts the diet and is associated with risks, the extent and medical implications of which are at present not sufficiently understood. Elimination diets represent the usual therapeutic long-term management in the presence of food allergy. In order to understand the risks of vegan diets and to discuss these critically from the perspective of food allergies, the expertise of a nutritionist/dietitian with expertise in this area is indispensable. This position paper deals with the incentives behind and the benefits of a plant-based diet. The knowledge required to cover macro- and micronutrient dietary requirements is presented. Using the avoidance of cow’s milk as an example, the challenges of adequately meeting nutritional needs are identified and (so-called) milk alternatives are evaluated from an allergy and nutritional point of view. Finally, other plant-based (substitute) products are evaluated from the same perspective, as significant protein sources in vegan diets (e.g., legumes, nuts, and seeds) are at the same time potential and potent triggers of allergic reactions. However, the allergic potential of many substitute products cannot be fully assessed at present due to gaps in research. Wheat as the most important trigger for anaphylaxis in adults is also evaluated. Finally, the increase in ultra-processed products in the (vegan) food sector and their potential consequences for the immune system are discussed.
Please notice: There is an erratum to this article, which can be found at: https://www.dustri.com/nc/de/article-response-page.html?artId=191243&doi=10.5414%2FALX02400ECorr.Correspondence to:
Dr. Imke Reese, Ernährungsberatung und -therapie, Schwerpunkt Allergologie, Ansprengerstr. 19, 80803 Munich, Germany
Email: [email protected]
Guideline
Guideline for allergological diagnosis of drug hypersensitivity reactions
Knut Brockow, Gerda Wurpts, Axel Trautmann, Wolfgang Pfützner, Regina Treudler, Andreas J. Bircher, Randolf Brehler, Timo Buhl, Heinrich Dickel, Thomas Fuchs, Thilo Jakob, Julia Kurz, Burkhard Kreft, Lars Lange, Hans F. Merk, Maja Mockenhaupt, Norbert Mülleneisen, Hagen Ott, Johannes Ring, Franziska Ruëff, Bernhardt Sachs, Helmut Sitter, Bettina Wedi, Stefan Wöhrl, Margitta Worm, and Torsten Zuberbier
Volume 7 (2023) p. 122 - 139
Abstract
Allergologie select, Vol. 7/2023 (122-139)
Guideline for allergological diagnosis of drug hypersensitivity reactions
Knut Brockow1, Gerda Wurpts2, Axel Trautmann3, Wolfgang Pfützner4, Regina Treudler5, Andreas J. Bircher6, Randolf Brehler7, Timo Buhl8, Heinrich Dickel9, Thomas Fuchs8, Thilo Jakob10, Julia Kurz4, Burkhard Kreft11, Lars Lange12, Hans F. Merk2, Maja Mockenhaupt13, Norbert Mülleneisen14, Hagen Ott15, Johannes Ring1, Franziska Ruëff16, Bernhardt Sachs2, Helmut Sitter17, Bettina Wedi18, Stefan Wöhrl19, Margitta Worm20, and Torsten Zuberbier20
1Department of Dermatology and Allergology Biederstein, Faculty of Medicine, Technical University of Munich, Munich, 2Department of Dermatology and Allergology, Germany, Aachen Comprehensive Allergy Center (ACAC), University Hospital of RWTH Aachen University, Aachen, 3Department of Dermatology and Allergology, Allergy Center Mainfranken, University Hospital Würzburg, Würzburg, 4Department of Dermatology and Allergology, University Hospital Giessen and Marburg, Marburg, 5Department of Dermatology, Venerology and Allergology, University of Leipzig, Leipzig, Germany, 6Facoltà di Scienze biomediche, Università della Svizzera italiana, Lugano, and Department of Dermatology and Allergology, University Hospital Basel, Switzerland, 7Department of Dermatology, Münster University Hospital, Münster, 8Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, 9Department of Dermatology, Venerology and Allergology, St. Josef Hospital, University Hospital of the Ruhr University Bochum, Bochum, 10Department of Dermatology and Allergology, University Hospital, Justus-Liebig University, Gießen, 11Department of Dermatology and Venereology, University Hospital Halle, Halle (Saale), 12Pediatric Clinic, Marienhospital Bonn, Bonn, 13Documentation Center for Severe Skin Reactions, Department of Dermatology and Venereology, University Medical Center Freiburg, Freiburg, 14Asthma Allergy Center Leverkusen, Leverkusen, 15Children’s and Youth Hospital Auf der Bult, Hanover, 16Department of Dermatology and Allergology, Allergy Center, Ludwig Maximilian University of Munich, 17Institute for Theoretical Surgery, Philipps University of Marburg, Marburg, 18Hanover Medical School, Department of Dermatology, Allergology and Venereology, Hanover, Germany, 19Floridsdorf Allergy Center (FAZ), Vienna, Austria, and 20Allergology and Immunology, Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
Correspondence to:
Prof. Dr. med. Knut Brockow, Department of Dermatology and Allergology at Biederstein, Faculty of Medicine, Technical University of Munich, Biedersteiner Straße 29, 80802 Munich, Germany
Email: [email protected]
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]
Case Report
Rapid response to dupilumab in an adult patient with eosinophilic esophagitis and allergic asthma
Benjamin Klein and Regina Treudler
Volume 8 (2024) p. 78 - 81
Abstract
Allergologie select, Vol. 8/2024 (78-81)
Rapid response to dupilumab in an adult patient with eosinophilic esophagitis and allergic asthma
Benjamin Klein1,2 and Regina Treudler1,3
1Leipzig Comprehensive Allergy Center LICA-CAC, Department of Dermatology, Venereology and Allergology, University of Leipzig, Leipzig, Germany, 2Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA, and 3Institute of Allergology, Charité Universitätsmedizin Berlin, Berlin, Germany
Background: Eosinophilic esophagitis (EoE) is an inflammatory disease of the esophagus that belongs to the spectrum of Th2-mediated diseases. It is often associated with atopic comorbidities such as allergic asthma (AA) and poses a therapeutic challenge. Case report: We report on a 43-year-old patient with EoE and AA who did not show sufficient therapeutic control despite standard therapy. We started treatment with dupilumab, whereupon both EoE and AA rapidly improved and complete symptom resolution could be documented. The response to dupilumab was assessed by laboratory monitoring and gastroscopy, which showed a reduction of markers of type II inflammation and eosinophilic infiltrates in the esophagus. Summary: Our report emphasizes the effective and safe use of dupilumab as a treatment option for EoE with concomitant beneficial effects on AA.Correspondence to:
Prof. Dr. Regina Treudler, Institute of Allergology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
Email: [email protected]
Original
Dietary and physical trigger factors in hereditary angioedema: Self-conducted investigation and literature overview
Julia Zarnowski and Regina Treudler
Volume 8 (2024) p. 358 - 364
Abstract
Allergologie select, Vol. 8/2024 (358-364)
Dietary and physical trigger factors in hereditary angioedema: Self-conducted investigation and literature overview
Julia Zarnowski1 and Regina Treudler1,2
1Department of Dermatology, Venereology and Allergology, University Hospital Leipzig, Leipzig, and 2Institute of Allergology, Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany
Background: In hereditary angioedema (HAE), numerous factors are known to trigger an attack. The possible influence of diet or recreational sports has been given little consideration in studies. The aim of our work was to investigate the influence of nutrition and physical activity in patients with HAE at the Leipzig ACARE Center. Materials and methods: Patients with HAE were given a self-designed questionnaire inquiring for family history, disease progression, and encountered burden due to HAE, current therapy, and disease control (angioedema control test (AECT)) as well as the influence of diet and/or recreational sports on HAE attacks. Results: Inclusion of 30 patients (23 female, 77%) with a mean age of 49.5 ± 16.9 years and mean body mass index of 25.1 ± 6.4 kg/m2. 60% received prophylactic treatment, and 37% received exclusively on-demand therapy. The mean AECT score was 10.9 ± 5.1 and patients reported 15.5 ± 26.9 days of absence due to HAE attacks in the last 12 months. 33% reported an association with food intake, in particular worsening of abdominal symptoms (n = 7), swelling of the extremities (n = 3), face, larynx, or genital area (n = 1 each). 70% reported regular exercise, most commonly cycling (n = 11), running or walking (n = 10), or strength training (n = 10). 62% reported a worsening of HAE due to recreational exercise. Conclusion: Dietary factors and physical activity frequently led to an aggravation of HAE in our cohort and should be taken into consideration when counseling patients with regard to trigger avoidance.Correspondence to:
Dr. med. Julia Zarnowski, Department of Dermatology, Venereology and Allergology, University Hospital Leipzig, Philipp-Rosenthal-Straße 69, 04103 Leipzig, Germany
Email: [email protected]
Review
Biologics in allergology and clinical immunology: Update on therapies for atopic diseases, urticaria, and angioedema and on safety aspects focusing on hypersensitivity reactions
Uta Jappe, Karl-Christian Bergmann, Folke Brinkmann, Valentina Faihs, Askin Gülsen, Ludger Klimek, Harald Renz, Sebastian Seurig, Christian Taube, Stephan Traidl, Regina Treudler, Martin Wagenmann, Thomas Werfel, Margitta Worm, and Torsten Zuberbier
Volume 8 (2024) p. 365 - 406
Abstract
Allergologie select, Vol. 8/2024 (365-406)
Biologics in allergology and clinical immunology: Update on therapies for atopic diseases, urticaria, and angioedema and on safety aspects focusing on hypersensitivity reactions
Uta Jappe1#2, Karl-Christian Bergmann3, Folke Brinkmann4, Valentina Faihs5, Askin Gülsen6, Ludger Klimek7, Harald Renz8, Sebastian Seurig9, Christian Taube10, Stephan Traidl11, Regina Treudler12, Martin Wagenmann13, Thomas Werfel11, Margitta Worm14, and Torsten Zuberbier3
1Division Clinical and Molecular Allergology, Research Center Borstel, Leibniz Lung Center, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Borstel, 2Interdisciplinary Allergy Outpatient Clinic, Department of Pneumology, University Medical Center Schleswig-Holstein, Campus Lübeck, University of Lübeck, 3Institute of Allergology, Charité Universitätsmedizin Berlin und Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, 4Division of Pediatric Pulmonology and Allergology, University Children’s Hospital, German Center for Lung Research (ARCN, DZL), Lübeck, 5Department of Dermatology and Allergy Biederstein, Klinikum rechts der Isar, Technical University of Munich, 6Division of Cardiology, Pulmonary Diseases, Vascular Medicine, University Hospital Duesseldorf, 7Center for Rhinology and Allergology, Wiesbaden, 8Institute of Laboratory Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Philipps Universität Marburg, Member of the German Center for Lung Research (DZL) Marburg, 9Interdisciplinary Allergy Center Nuremberg (NIZA), Department of Internal Medicine 3, Pneumology, Nuremberg Hospital, Nuremberg, 10Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Essen, 11Department of Dermatology and Allergy, Hannover Medical School, Hannover, 12Institute of Allergology IFA, Charité Universitätsmedizin corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Berlin, 13Department of Otorhinolaryngology, Düsseldorf University Hospital, Heinrich Heine University, Düsseldorf, 14Division of Allergy and Immunology, Department of Dermatology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
The development of targeted therapies for atopic diseases, urticaria, and angioedema with biologics is progressing rapidly: New “targets” of clinical-therapeutic relevance have been identified, the corresponding targeted antibodies developed, tested in clinical trials, and approved for therapy. These include the anti-IgE antibody omalizumab (also effective and approved for the treatment of urticaria), the anti-IL-4/13 receptor-specific antibody dupilumab, the two anti-IL-13 antibodies lebrikizumab and tralokinumab, the anti-TSLP antibody tezepelumab, the two anti-IL-5 antibodies mepolizumab and reslizumab, and the anti-IL5 receptor-specific antibody benralizumab for the treatment of atopic diseases. For the treatment of hereditary angioedema, C1 inhibitor and the antibody lanadelumab (directed against kallikrein) have also long been approved as biologics in addition to low-molecular substances. Other therapeutic antibodies are in various stages of development. Furthermore, the range of indications for some very effective biologics has been successfully expanded to include additional diseases. In this context, the first results on biologic therapy of food allergy and eosinophilic esophagitis are interesting. Biologics that address different target structures are also increasingly being administered in combination, either simultaneously or sequentially, in order to achieve optimal efficacy. A developing area is the use of biologics in children and the observation of immunological and non-immunological side effects. In some cases, new unexpected side effects and hypersensitivity reactions have emerged, which in turn raise pathomechanistic questions, such as conjunctivitis with dupilumab therapy, which only appears to occur in the treatment of atopic dermatitis but not in the treatment of other atopic diseases. In dermatology, paradoxical reactions have been described under therapy with some biologics. And immune reactions of type alpha to epsilon to biologics (hypersensitivity reactions) continue to be a clinically relevant problem, whereby the selection of an alternative therapeutic agent is a challenge and the diagnostics that support this have not yet been sufficiently incorporated into routine work.Correspondence to:
Prof. Dr. med. Uta Jappe, Division Clinical and Molecular Allergology, Research Center Borstel, Leibniz Lung Center, Parkallee 35, 23845 Borstel, Germany
Email: [email protected]
Position Paper
Occupational anaphylaxis: A Position Paper of the German Society of Allergology and Clinical Immunology (DGAKI)
Regina Treudler, Margitta Worm, Andrea Bauer, Heinrich Dickel, Guido Heine, Uta Jappe, Ludger Klimek, Monika Raulf, Bettina Wedi, Dorothea Wieczorek, Wojciech Francuzik, Thilo Jakob, Oliver Pfaar, Johannes Ring, Franziska Rueff, Sabine Schnadt, Thomas Werfel, Gerda Wurpts, Julia Zarnowski, Torsten Zuberbier, and Knut Brockow
Volume 8 (2024) p. 407 - 424
Abstract
Allergologie select, Vol. 8/2024 (407-424)
Occupational anaphylaxis: A Position Paper of the German Society of Allergology and Clinical Immunology (DGAKI)
Regina Treudler1, Margitta Worm2, Andrea Bauer3, Heinrich Dickel4, Guido Heine5, Uta Jappe6, Ludger Klimek7, Monika Raulf8, Bettina Wedi9, Dorothea Wieczorek9, Wojciech Francuzik2, Thilo Jakob10, Oliver Pfaar11, Johannes Ring12, Franziska Rueff13, Sabine Schnadt14, Thomas Werfel9, Gerda Wurpts15, Julia Zarnowski16, Torsten Zuberbier1,17, and Knut Brockow12
1Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, 2Department of Dermatology, Venereology and Allergology, Charité – Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, 3Department of Dermatology, University AllergyCenter, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, 4Department of Dermatology, Venereology and Allergology, St. Josef Hospital, University Medical Center, Ruhr University Bochum, Bochum, 5Department of Dermatology, Venereology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, 6Division of Clinical and Molecular Allergology, Research Center Borstel, Airway Research, Center North (ARCN), Member of the German Center for Lung Research, Borstel, Interdisciplinary Allergy Outpatient Clinic, Department of Pneumology, University of Luebeck, 7Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz and Center for Rhinology and Allergology, Wiesbaden, 8Department of Allergology/Immunology; Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bochum, Germany, 9Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover, 10Department of Dermatology and Allergology, University Medical Center Giessen (UKGM), Justus-Liebig-University Giessen, Giessen, 11Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, 12Department of Dermatology and Allergy Biederstein, School of Medicine and Health, Technical University of Munich TUM), 13Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, 14German Allergy and Asthma Association (DAAB), Mönchengladbach, 15Clinic for Dermatology and Allergology, Aachen Comprehensive Allergy Center (ACAC), University Hospital of RWTH Aachen University, Aachen, 16Department of Dermatology, Venerology and Allergology, University of Leipzig Medical Center, Leipzig, and 17Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
Background: Anaphylaxis is a systemic allergic reaction that is potentially life-threatening. Occupational anaphylaxis is an anaphylaxis that occurs in an occupational context. In this position paper, we propose diagnostic criteria for occupational anaphylaxis and provide an overview of the current state of knowledge in terms of prevalence, triggers, prevention, and management. Results: The most common triggers of occupational anaphylaxis include Hymenoptera venoms, followed by food and drugs. Chemicals, bites or contact with animals (mammals/snakes/insects) and natural rubber latex are far less common. Occupations at risk for occupational anaphylaxis are therefore beekeepers, outdoor workers, or those who handle food as well as healthcare workers. The route of contact, intensity, and frequency of exposure, type of allergen, and the simultaneous occurrence of co-factors determine the clinical manifestation. A detailed medical history is required to confirm the diagnosis of anaphylaxis and to identify the trigger. Both skin tests and the determination of specific IgE are recommended, but only very few commercially available and quality-tested allergens are available that can be examined using both test methods. Preventive measures are based on avoiding further exposure or, if necessary, replacing a working substance. A written emergency plan and the prescription of an adrenaline autoinjector as well as instructions for its use are mandatory. Allergen immunotherapy is recommended for systemic Hymenoptera venom allergy. Depending on the national healthcare systems, patients with occupational anaphylaxis must be reported to the accident insurance. Conclusion: Occupational anaphylaxis is very rare. We recommend educational measures and generally standardized recording of occupational anaphylaxis for occupations with an increased risk of anaphylaxis.Correspondence to:
Prof. Dr. Regina Treudler, Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Institute of Allergology, Hindenburgdamm 30, 12203 Berlin, Germany
Email: [email protected]
Original
Significant handling errors and education gaps regarding the use of the emergency kit among adult patients with Hymenoptera venom allergy
Julia Zarnowski, Louise Wilkens, and Regina Treudler
Volume 9 (2025) p. 1 - 7
Abstract
Allergologie select, Vol. 9/2025 (1-7)
Significant handling errors and education gaps regarding the use of the emergency kit among adult patients with Hymenoptera venom allergy
Julia Zarnowski1, Louise Wilkens1, and Regina Treudler1,2
1Department of Dermatology, Venereology and Allergology, University Hospital Leipzig, Leipzig, and 2Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
Aim: In case of systemic anaphylactic reactions after Hymenoptera stings, patients should be provided with an adrenaline autoinjector (AAI). We aimed to evaluate the education and handling competence of patients in a real-world setting. Materials and methods: Patients with Hymenoptera venom allergy presenting for the first time in our clinic with a previously prescribed emergency kit including an AAI were interviewed using a standardized questionnaire and were asked to demonstrate the AAI use with a dummy. Results: 82 patients (62.2% female, mean age 52.0 ± 17.3 years) with allergy to wasp venom (85.3%), bee venom (9.8%), or hornet venom (4.9%) were included. 37.8% reported to have received a practical training on the AAI upon prescription. 59.8% of all patients showed significant handling errors which would have led to misinjections in 30.6%. Conclusion: Our data demonstrate a considerable lack of education, significant handling errors of the emergency kit, and a high risk of misinjections of the AAI. As the emergency kit is potentially lifesaving, the awareness for a sufficient education and training needs to be risen.Correspondence to:
Dr. med. Julia Zarnowski, Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig, Philipp-Rosenthal-Straße 69, 04103 Leipzig, Germany
Email: [email protected]
