Allergo Journal International最新文献

Currently, allergen-specific immunotherapy (AIT) with active ingredients derived from the causative allergen source is the only disease-modifying treatment for allergic patients. However, compared to, e.g., live-attenuated vaccines for the prevention of infectious diseases, purified allergens for AIT in many cases display only a low immunogenicity. This reduces treatment efficacy and prolongs treatment duration. Here, adjuvants may be a promising tool, allowing for dose reduction of the respective allergen while increasing immunogenicity of co-applied allergens and/or modulating allergen-specific immune responses toward T helper 1 (Th1) or regulatory phenotypes or the production of blocking antibody isotypes. Currently available adjuvants can be distinguished into first-generation adjuvants (promoting immune responses via aggregation and controlled release of co-applied allergens from a depot) and second-generation adjuvants (triggering immune responses via the activation of pattern recognition receptors expressed by immune cells). This review summarizes the mechanisms and effects of adjuvants currently or previously used for AIT (aluminum hydroxide, calcium phosphate, microcrystalline tyrosine, and monophosphoryl lipid A [MPLA]) and focuses on novel developments using mannan-, virus-like particle (VLP)-, and flagellin-based adjuvants and therapeutics for the treatment of allergic diseases.

Background

When coronavirus disease 2019 (COVID-19) vaccines were introduced, they were suspected of triggering severe allergic reactions disproportionately often. This contributed to the fear of vaccination, particularly among allergy patients.

Methods

In an allergy center in eastern Bavaria, we used a skin prick test to investigate how often sensitization to COVID-19 vaccines can be detected and whether appropriate testing could significantly reduce the fear of vaccination.

Results

Comirnaty® (n = 245 tested/6.93% clearly positive reaction; Biontec/Pfizer, Mainz, Germany/New York City, NY, USA), Spikevax® (56/14.28%; Moderna, Cambridge, MA, USA), Vaxzevria® (208/4.32%; Astra Zeneca, Cambridge, England) and Jcovden® (48/4.16%; Johnson & Johnson, New Brunswick, NJ, USA) were tested by skin prick test. Most participants tested were female (83.6%) and had a history of allergies (94.8%). Depending on the result of the skin prick test, the test subjects were advised on vaccination. In a questionnaire survey approximately 1 year after testing, 75.7% of the N = 70 respondents stated that their fear of vaccination had been greatly or very greatly reduced as a result of the testing and counseling. In the follow-up survey, 88.5% of all respondents had been vaccinated at least once. No notable allergic problems occurred during the COVID-19 vaccination in study participants.

Conclusion

The study shows that simple skin prick testing could reduce fears and concerns about allergic reactions to COVID-19 vaccines, and thus significantly increase the willingness to vaccinate in the population, especially among allergy patients.

The term “molds” is defined and relevant sources of molds are given. The conditions and growth of mold fungi are explained. The determination of mould spores and colony-forming units (CFU) in the air is briefly explained and it is made clear that the total spore count is relevant for assessing the sensitizing and allergenic effect of moulds. Outdoor air-associated moulds such as Alternaria alternata, Aspergillus fumigatus, Cladosporium herbarum and Penicillium chrysogenum (mx1 mould mixture) are of particular importance due to their high degree of sensitization. Their concentration in the air is determined by the vegetation and is therefore dependent on the season. In people who were tested for mx1, sensitization to Alternaria alternata (m6) was predominantly observed for the individual allergens. For many indoor-associated moulds, no (valid) commercially available test extracts for the detection of sensitization, so-called allergy tests, are available. Allergy test results of mold mixtures, such as mx1, cannot be used to determine an indoor mold allergy, nor can the results of mold measurements in the rooms used by the respective persons be used for a risk assessment in the event of an existing mold infestation in the interior. The classification of mold fungi is explained.

The AWMF S2k guideline “Medical clinical diagnostics for indoor mold exposure” was introduced in 2016. The guideline is based on a standardized procedure of the AWMF including a systematic literature search involving several medical disciplines. The expert group has updated this guideline in accordance with AWMF specifications. For this purpose, a new Medline search was carried out for the current version of the guideline up to June 2022 with additional search terms. The search results were evaluated and further narrowed down by means of abstract screening and, where applicable, evidence-based evaluation of the full texts. Medical guidelines on related topics were also taken into account. The updated guideline is available since October 2023. This is intended to close the existing knowledge gap for rational and efficient medical diagnostics for indoor mold contamination and provides 26 core statements and recommendations, which are presented in detail.

The AWMF (Association of the Scientific Medical Societies) mold guideline “Medical clinical diagnostics for indoor mold exposure”—Update 2023 [44] concludes that there is limited or presumed evidence of a link between indoor dampness/mold exposure and health problems. However, there is inadequate or insufficient evidence for an association between indoor dampness/mold exposure and the environmental medical syndromes sick building syndrome (SBS), multiple chemical sensitivity (MCS) and chronic fatigue syndrome (CFS). Newly coined terms, such as biotoxicosis and mold and vapor hypersensitivity syndrome (MDHS) or volatoxins, suggest a nosological specificity of a pathophysiological connection for which, however, there is no evidence to date. The background to this assessment is presented in this paper.

Molds are ubiquitous in our environment and are considered by the population to be the most important indoor pollutant problem [1]. The current 2023 update to the AWMF mold guideline [1] is intended to allay or channel fears and provide assistance for a sensible diagnosis and treatment decision.

The detection of an IgE-mediated allergy implies for allergists Allergen immunotherapy (AIT) as an established treatment option. However, compared to the well-validated AIT with pollen and house dust mites, the decision to use AIT with mold extracts must be weighed more heavily between the benefits and risks.

Spores of Alternaria alternata are found in high concentrations in the outdoor air. Due to the high allergenic potential and the small size of the spores, an Alternaria allergy often leads to bronchial asthma, especially in children. The effectiveness of AIT with Alternaria extracts has been tested in several studies; for other molds, especially those from the indoor environment, the efficacy and applicability is very limited.

In terms of differential diagnosis, it must be borne in mind that molds can not only cause common allergic reactions but can also be responsible for allergic bronchopulmonary mycoses/aspergillosis (ABPA), Aspergillus bronchitis, exogenous allergic alveolitis (EAA), invasive aspergillosis, mycoses and rhinosinusitis. Very high concentrations, which can occur particularly in workplaces, can also result in toxic effects (“organic dust toxic syndrome”); molds are also held responsible for mucous membrane irritation, odor effects and mood disorders [1].