Allergologie select最新文献

Background: Chronic idiopathic urticaria (CIU) is common in allergological practice. Although therapeutic options have improved in the past decade, patients still suffer from a significant burden of disease and are often treated insufficiently.

Objective: We aimed at analyzing the psychiatric comorbidities, social impairments, and treatment gap in a real-world setting.

Materials and methods: Adult patients with CIU were investigated for demographical data, medical history, and psychosocial burden. Validated questionnaires were used to assess urticaria activity, control of disease, quality-of-life impairment, and psychiatric comorbidities.

Results: 82 patients (78% female; 47.5 ± 14.8 years) were included. 65.9% had insufficient disease control, 11% reported on prior self-medication with drugs, 19.5% were seeking help from non-academic medicine, and 54.9% tried a change of diet. The use of non-academic treatment was significantly associated with higher disease activity. Self-initiated dietary changes were significantly associated with less control of disease. Delayed referrals to a urticaria-specialized center were significantly linked to self-reported psychiatric diseases, self-medication with drugs and self-initiated dietary changes.

Conclusion: Our data show an unsatisfactory control of CIU in many patients and substantial psychosocial impairments which are also associated with a delayed referral to urticaria centers, self-initiated non-academic treatments, and dietary changes.

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.

Aims: We investigated sensitization to food allergens as a prognostic factor for wheezing in children with recurrent wheezing and compared serum club cell 16 (CC16) and surfactant protein D (SP-D) among these children with and without sensitization to food allergens.

Materials and methods: Children with recurrent wheezing were enrolled in this prospective cohort study. Specific IgE to five common food allergens (Fx5) was assessed at baseline, and children were followed-up for 1 year for new-onset wheezing episodes. Baseline wheezing severity score, CC16, and SP-D levels were measured.

Results: We enrolled 295 children (44 Fx5(+)). Poisson regression analysis revealed that Fx5 positivity changed the yearly frequency of wheeze by a factor of 1.66 (p = 0.05, 95% CI: (0.99 - 2.75)). Levels of CC16 and SP-D were not significantly different between the groups (p = 0.679 and p = 0.988).

Conclusion: Sensitization to food allergens irrespective of food associated clinical allergy findings is associated with worse prognosis of wheezing in children.

In allergology, clinical registries fill knowledge gaps of epidemiology, mechanisms of allergic diseases, and real-world treatment outcomes. Considering the continuous rise of allergic diseases worldwide, registries become increasingly important for the optimization and harmonization of patient care. In the current review, we present four ongoing allergy-focused registries initiated in Germany. We conducted a focused literature search and discussed their structure, main purposes, and findings. Registries included are the "Information Network of Departments of Dermatology", the "European Anaphylaxis Registry", the "GAN Severe Asthma Registry", and "TREATgermany". Despite differences in scope and operation, all registries gather harmonized real-world data that is indispensable for evidence-based decision making in clinical practice and ultimately improves patient care in allergology.

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.

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.

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.

Background and objectives: Patients with rare diseases like hereditary angioedema (HAE) are usually referred to an angioedema center to ensure guideline-compliant and experience-based therapy. Even though there are established guidelines and several approved therapeutics, there are still open questions and situations in the daily care of HAE patients, where an exchange between centers is needed.

Materials and methods: A survey was conducted among physicians from German angioedema centers regarding challenges and issues in everyday HAE treatment. The main focus was on the topic of long-term prophylaxis (LTP). For rarer subcategories of angioedema, the centers conducted a literature review to discuss open questions.

Results: The responses of 12 physicians from 8 angioedema centers were analyzed in the survey. The attack frequency was the most important criterion for deciding to initiate LTP in HAE patients (100%). Two centers no longer generally recommend the initiation of pre-interventional prophylaxis in HAE patients under LTP. The therapeutic concepts of acquired angioedema due to C1 inhibitor deficiency and HAE in children were two associated specialized areas that were discussed in more detail.

Conclusion: The current guideline serves as the foundation for daily practice in treating HAE at specialized centers. Thus, for rare conditions like HAE, an exchange among the treating centers is essential to adequately address specific issues and rare subgroups.

Modern management of hereditary angioedema (HAE) due to reduced C1 inhibitor (C1-INH) function or concentration (HAE-C1-INH) focuses on individualized therapeutic strategies to address the specific needs of children and adolescents as well as the severity of the disease. Psychosocial factors such as the burden of disease and therapy on quality of life and participation play an important role. New medications have already significantly improved the prognosis and health related quality of life in HAE patients, but not all of these therapies have yet been approved for children. Further treatment options that inhibit bradykinin effects are currently being investigated. They target factor XIIa, prekallikrein, plasma kallikrein, or the bradykinin B2 receptor. Modern research focuses on oral options or long-acting parenteral therapy approaches to further optimize care and, in particular, the needs of children. There are also initial developments in the field of gene therapy, which could represent a causal treatment option for HAE in the future. This article focuses on the presentation and treatment of HAE type I (reduced C1-INH concentration) and HAE type II (impaired C1-INH function) in children and adolescents. Acquired AE and HAE with normal C1-INH are rare in the pediatric age group and are not discussed in detail here.

Hymenoptera stings can cause severe anaphylactic reactions in patients with an underlying Hymenoptera venom allergy (HVA). In such cases, venom immunotherapy (VIT) is a highly effective measure to prevent future anaphylaxis. The management of patients with a clear allergological indication for VIT and contraindications to VIT (e.g., autoimmune diseases) remains a clinical challenge. We report the case of a 54-year-old male gardener who experienced life-threatening anaphylaxis after being stung by wasps in the head and neck region. After confirmation of a Vespula venom allergy (VVA) by intradermal test and VV-specific serum IgE antibodies, VIT was started using a rush protocol. One month after reaching the maintenance dose, the patient experienced a worsening of his pre-existing Crohn's disease and ankylosing spondylitis. VIT was stopped, and the autoimmune diseases were treated with systemic steroids and sulfasalazine. As the patient wished to remain in his profession, and in view of the previous severe anaphylaxis, we restarted VIT after the autoimmune diseases had resolved, using a slower up-dosing protocol. This approach was tolerated without side effects, and the patient tolerated a sting challenge and several field stings without anaphylactic symptoms.