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]
Abstract
Allergologie select, Vol. 10/2026 (120-144)
Update of the evidence- and consensus-based S3 guideline on atopic dermatitis: Systemic therapy with biologics or Janus kinase inhibitors and specific aspects of systemic therapy in pregnancy and lactation
Thomas Werfel1, Annice Heratizadeh1, Matthias Augustin2, Christine Bangert3, Andrea Bauer4, Tilo Biedermann5, Richard Brans6, Nadine Domröse1, Uwe Gieler7, Oliver Gießler-Fichtner8, Eckard Hamelmann9, Selina Hampe10, Ruben Heuer11, Julia Kahle10, Maria Kinberger11, Markus Koch12, Meike Köhler13, Franz Legat14, Katja Nemat15,16, Irena Neustädter17, Eva M. J. Peters18, Susanne Radonjic-Hoesli19, Imke Reese20, Peter Schmid-Grendelmeier21, Uta-Katharina Schmidt-Göhrich22, Jochen Schmitt23, Christina Schnopp5, Thomas Schwennesen24, Dagmar Simon19, Kristina Stamos16, Christian Termeer25,26, Regina Treudler27, Ralph von Kiedrowski28, Iris Wagner24, Anja Waßmann-Otto29, Gesine Weckmann30, Ricardo Niklas Werner11, Andreas Wollenberg31,32, Margitta Worm33, and Hagen Ott13,34
1Department of Dermatology and Allergy, Hannover Medical School, Hannover, 2Competence Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany, 3Department of Dermatology, Medical University of Vienna, Vienna, Austria, 4Department of Dermatology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, 5TUM University Hospital, Department of Dermatology and Allergy, Munich, 6Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the Osnabrück University, Osnabrück, 7Department of Psychosomatic Medicine and Psychotherapy, University Hospital Gießen, Gießen, 8Gaißach Specialist Clinic of DRV Bayern Süd, Gaißach, 9Children’s Center, Evangelical Hospital Bethel, University Hospital OWL, University of Bielefeld, Bielefeld, 10German Allergy and Asthma Association (DAAB), Mönchengladbach, 11Department of Dermatology, Venereology and Allergology, Division of Evidence Based Medicine in Dermatology (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, 12Alpenklinik Santa Maria, Bad Hindelang, 13Section for Integrated Pediatric Dermatology (iKinD), Munich Center for Children with Medical and Developmental Complexity, LMU University Hospital, Munich, Germany, 14Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria, 15Practice for pediatric pneumology and allergology, Children’s Center Dresden-Friedrichstadt (Kid), 16Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, 17Hospital Hallerwiese, Cnopfsche Kinderklinik, Nuremberg, 18Psychoneuroimmunology Laboratory, Department of Psychosomatic Medicine and Psychotherapy, Justus-Liebig University Gießen, Gießen, Germany, 19Department of Dermatology, Inselspital Bern, Bern, Switzerland, 20Private Practice for Dietary Advice and Nutrition Therapy with Special Interest in Adverse Reactions to Food, Munich, Germany, 21Allergy Unit, Department of Dermatology, University Hospital Zurich and Christine Kuehne Center for Allergy Research and Education CK-CARE Davos, Switzerland, 22 Carus Family Practice at Dresden University Hospital, 23Center for Evidence-Based Healthcare (ZEGV), University Hospital Dresden and Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, 24German Eczema Association (DNB), Hamburg, 25Dermatology Practice at Löwenmarkt, Stuttgart-Weilimdorf, 26Department of Dermatology, University-Hospital Freiburg, Freiburg, 27Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, 28Selters Dermatology Practice, Selters, 29Mensing Derma MVZ, Hamburg, 30Weckmann Institute of Medical and Healthcare Education, Rostock, 31Department of Dermatology and Allergology, University Hospital Augsburg, Augsburg, 32Clinic and Polyclinic for Dermatology and Allergology, Ludwig Maximilian University, Munich, 33Department of Dermatology, Venereology, and Allergology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, and 34Department of Pediatric Surgery, Dr. Von Hauner Children’s Hospital, LMU University Hospital, Munich, Germany
This guideline is a partial update of the S3 guideline on atopic dermatitis (AWMF register no. 013-027) published in 2023. The chapters on systemic therapy with biologics and Janus kinase inhibitors as well as the chapter on pregnancy, breastfeeding and family planning in the context of systemic therapies for atopic dermatitis have been updated. This was prompted by new approvals (lebrikizumab, nemolizumab), approval extensions (abrocitinib from 12 years of age, baricitinib from 2 years of age) and new evidence on the use of biologics before and during pregnancy. In addition, a new chapter on treatment goals, treatment expectations and criteria for treatment adjustment (“treat-to-target”) in systemic therapies has been added to the guideline. This article only presents the updated and newly added chapters. The complete guideline is available on the AWMF website.Correspondence to:
PD Dr. Annice Heratizadeh, Department of Dermatology and Allergy, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
Email: [email protected]
