Allergologie select最新文献

Background: Hymenoptera venom allergy represents a potentially life-threatening condition. Venom immunotherapy (VIT) is the treatment of choice in patients with systemic reactions.

Case presentation: We report the case of a 65-year-old male, who experienced systemic reactions following hymenoptera stings. In vitro and in vivo allergy tests revealed sensitization predominantly to Polistes dominula and specific VIT was initiated. During VIT, the patient experienced two subsequent stings with only local reactions. After 5 years of VIT, repeated serological evaluation and skin tests turned negative, leading to the decision to discontinue therapy.

Conclusion: This case underlines the efficacy and safety of VIT in patients with severe hymenoptera venom allergy in preventing systemic reactions. A comprehensive diagnostic work-up, including laboratory and skin tests, is crucial in the management and subsequent evaluation of therapeutic efficacy.

The Therapy Allergen Ordinance (TAO) aims to migrate allergen immunotherapy (AIT) products for the treatment of common allergies, which were previously marketed in Germany as named patient products (NPPs), into authorized products provided their quality, efficacy, and safety are adequately shown. The TAO applies to all NPPs containing active ingredients based on the following allergen sources: house dust mites, bee venom, wasp venom, pollen from sweet grasses (excluding maize), birch, alder, or hazel. The last product-specific deadlines granted under the TAO for the submission of clinical data relevant to the marketing authorization process will expire in 2026. The subsequent final assessment of the updated marketing authorization application (MAA) is carried out by the competent authority, the Paul-Ehrlich-Institut. During this period of processing by the competent authority, the products remain marketable until a decision regarding the MAA has been reached. Currently (as of August 08, 2025), 40 AIT products are still marketable under the transitional provisions of the TAO (10 preparations for the treatment of allergies to house dust mites, 10 against tree pollen allergies, 16 against grass pollen allergies, and 4 mixed preparations containing non-homologous allergen groups). For 8 of these products, pharmaceutical companies have initiated the withdrawal of MAA as of October 01, 2025 or January 31, 2026, respectively. Prior to the final assessment of the updated MAAs, the competent authority is unable to make any public statements as to whether the individual applications for the remaining 32 products under the transitional provision will be concluded positively with the granting of the marketing authorization or its rejection. With the rejection of a marketing authorization, the product-specific marketability ends immediately, i.e., there is no additional sell-off period for the TAO products concerned. If a marketing authorization is granted, the marketability of the specific product is perpetuated.

Background: Artificial intelligence (AI) offers a wide range of applications in allergology, including diagnostics and disease course prediction, consultations, real-time monitoring of allergic reactions, and support for decentralized clinical studies.

Materials and methods: This review aims to highlight not only the potential applications but also the ethical aspects of using AI in allergology.

Results: Initial studies demonstrate potential applications of AI in predicting provocation tests and antibiotic delabeling. However, these models from research and development have not yet been established in clinical practice, partly because ethical considerations, alongside technical challenges, and data quality issues, must be addressed. Key ethical dilemmas include bias and fairness, the principle of non-maleficence, data protection and autonomy, transparency of AI models, and questions of accountability. AI applications must be robust and reliable to prevent harm caused by erroneous recommendations.

Conclusion: The use of AI in allergology requires clear guidelines based on principles such as autonomy, justice, and non-maleficence. General bioethical principles must be complemented by specific regulations for AI.

Adrenaline is the drug of choice for the treatment of anaphylaxis. Up to now, intramuscular administration using an autoinjector has been recommended in national and international guidelines as the first-line treatment for anaphylaxis. Various adrenaline autoinjectors are available on the German market as emergency medication for immediate treatment by medical laypersons and specialists. Recently, a nasally administered adrenaline preparation was introduced for the first time and is available on the market. There are mainly data on healthy control subjects, which show a good adrenaline level and an expected effect on blood pressure and heart rate. To date, there is little clinical experience in the world literature for patients with anaphylaxis in children/adolescents and none in adults or from Germany. Therefore, we would like to discuss theoretically the use of adrenaline via the nasal route of administration in the care of anaphylaxis patients and compare it with the intramuscular administration of adrenaline autoinjectors.

The use of artificial intelligence (AI) in medicine requires a careful selection of suitable models, as there is no universal "one size fits all" method. While linear regression is convincing due to its simplicity and interpretability, it is limited due to the assumption of linearity and susceptibility to multicollinearity and outliers. More complex approaches such as neural networks show their strengths in the detection of non-linear patterns and automatic feature extraction but require large amounts of data, high computing capacity, and suffer from limited explainability. Principal component analysis (PCA) offers an efficient reduction of dimensionality. Ultimately, the choice of model depends on the balance between accuracy, interpretability, and data availability. A selection of machine learning models is presented in this article.

This occupational case report describes a 28-year-old woman, employed since November 2020 as a research assistant working with mealworms (Tenebrio molitor), who developed symptoms of mild shortness of breath and severe redness and swelling of the eyes in early 2022, leading to the diagnosis of occupational allergic asthma due to respiratory sensitization to mealworm. Subsequent tests confirmed mono-sensitization to T. molitor and additional cross-sensitization to flour beetle (Tribolium confusum). Further studies aimed to determine the antigenic and allergenic potency of different protein fractions and rearing material isolated from T. molitor regarding protein pattern and immunological activity by T. molitor-specific polyclonal rabbit IgG and human IgE. The highest antigen content of T. molitor was measured in the rearing material, followed by mealworm flour and aqueous extraction. Allergenic proteins are particularly detected in mealworm flour and aqueous fraction at molecular weights of 24 and 11 kDa, which appear to be specific for primary airway sensitization. In addition, the airborne T. molitor antigen levels in the workplace were monitored using electrostatic dust collectors to identify hotspots of exposure. The disposal of dry insect material was shown to be responsible for the unintentional release of potential allergens. Therefore, awareness of the potential risk of a type I allergy due to the release of airborne insect allergens in the workplace should be raised.

New protein-rich flour blends from legumes are increasingly being processed for gluten-free bakery products, which may increase the risk of IgE-mediated sensitization through inhalation exposure. In the described case of a 29-year-old baker, work incapacity occurred due to respiratory complaints following exposure to various gluten-free baking ingredients. Occupation-related sensitization to "chestnut pea flour" (flour from lightly roasted and ground yellow peas) was identified, while the patient showed no IgE sensitization to five other ingredients. Significant allergic respiratory reactions occurred during bronchial challenge test with "chestnut pea" extract. Based on the test results and typical workplace-related symptoms, recognition of occupational disease was recommended. Further identification of potential causal allergens using IgE blot and allergen component-resolved diagnostics revealed IgE bindings to typical storage proteins, 2S albumin and vicilin, as well as to Bet v 1 homologous of "chestnut pea" and non-specific lipid transfer proteins. This case illustrates that the processing of protein-rich legume flours can pose new sensitization risks for workers, which should be considered in the future.

From a radiological point of view, the statement of irreversibility can only be made with certainty for the signs of irregular reticulation in conjunction with traction bronchiectasis and for honeycomb cysts in the HR-CT morphologically fibrotic phenotype. The HR-CT signs of the inflammatory phenotype can behave differently. Ground-glass nodules always have a reversible potential. In contrast, the underlying pathology of ground-glass opacity can only be assessed over time, as it does not necessarily correlate with inflammation but can also correspond to fine fibrosis. Similarly, air trapping on HR-CT is an important sign of hypersensitivity pneumonitis in both the radiologically inflammatory and fibrotic form. The persistence of air trapping in the inflammatory type over years suggests the possibility of irreversibility of the bronchiolitis in these cases. Whether a higher resolution in HR-CT, such as through photon-counting CT, can lead to clearer differentiation and prediction of reversibility and irreversibility in the future remains to be seen.

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Background: Buckwheat allergy is common in East Asian countries with high buckwheat consumption. However, with increasing popularity of buckwheat as a gluten-free food, it is also expected to become more widespread in Europe.

Case report: A health food store employee experienced anaphylaxis with urticaria, angioedema, and dyspnea after eating a slice of buckwheat bread. Prior to this reaction, the patient had repeatedly noticed rhinoconjunctival itching and sneezing when handling buckwheat. A positive skin prick test with buckwheat flour and elevated specific IgE levels to buckwheat confirmed the suspected diagnosis.

Conclusion: Food industry employees may develop sensitization to buckwheat through inhalation of buckwheat flour. This sensitization can lead to rhinoconjunctival symptoms upon airborne exposure and to anaphylaxis after ingestion.