Allergo Journal International最新文献

Diagnosing food allergies requires a well-considered approach from the very first step. The reason for this is the frequent presence of clinically irrelevant immunoglobulin E (IgE) sensitizations in a large proportion of individuals. Equating sensitization detected by skin prick tests or the detection of specific IgE antibodies with clinical relevance can lead to the misdiagnosis of an allergy. Therefore, a thorough patient history is essential as the foundation of the diagnostic process. Another reason is the high rate of self-suspected allergies among patients due to a lack of understanding of the typical symptoms of food allergies. Patients assume that unspecific symptoms or skin changes are the result of food intolerance. However, food allergies trigger clearly defined symptoms that are often easy to ask about. The physician’s task is, therefore, to separate implausible from plausible symptoms by taking a thorough medical history and then subsequently plan a targeted diagnostic work-up. In doing so, the limitations and diagnostic potential of serological testing using allergen extracts and components, as well as those of skin testing, must be clearly understood. This article provides a concise summary of the essential steps in the diagnosis of food allergy.

There is currently no standardized evaluation system in Germany for defining and classifying the severity of IgE-mediated food allergies (FA). Following the development of the international classification system named DEFASE (Definition of Food Allergy Severity), this evaluation system is now also being introduced in Germany and its applicability in the German healthcare system is being tested.

An international consensus was reached on DEFASE through a two-stage process (systematic literature review followed by an e‑Delphi).

The DEFASE score is the first comprehensive classification of the severity of a FA that takes into account not only the severity of an individual reaction, but the entire scenario of the disease, including the clinical features alongside patient’s reported outcomes and economic burden. It is important that an international consensus has been reached on a scoring system for FA, which can now also be used in Germany as d‑DEFASE. The scoring system is currently tested in research projects to be introduced soon into clinical practice, targeting these models to various food allergenic sources, populations, and settings.

Anaphylaxis is a potentially life-threatening type 1 hypersensitivity reaction mediated by specific IgE. Culprit allergens frequently include foods, drugs, and insect venom. Sulfites are widely used as additives in food processing but also occur naturally in high concentrations in certain foods. Additionally, they are added as preservatives to aqueous cosmetic and medical solutions. Sulfites have been reported to cause a variety of allergic reactions including anaphylaxis. Here, we present a case of a patient with repetitive anaphylactic reactions to sulfites in food. An allergy workup showed a positive prick test to sodium metabisulfite and a positive oral provocation test. Our patient was successfully treated for anaphylaxis with a sulfite-containing adrenaline auto-injector, suggesting the benefits of adrenaline outweigh the theoretical risks in an acute anaphylactic setting.

Mastocytosis encompasses a spectrum of clonal mast cell disorders characterized by the proliferation and accumulation of atypical mast cells in various organs, including the skin, bone marrow, and gastrointestinal tract. Initially described in 1869 as a cutaneous manifestation, the systemic variant (SM), involving additional organs, was documented in 1949. Clinical distinctions are made between indolent SM (ISM), where mediator-related symptoms predominate, and more aggressive forms, in which organ dysfunction is the primary concern. In recent decades, there has been continuous progress in elucidating the pathogenesis, classification, and management of mastocytosis, aided by specialized networks such as the European Competence Network Mastocytosis (ECNM) and the German Competence Network on Mastocytosis (Kompetenznetzwerk Mastozytose e. V.). A significant therapeutic advancement has been the development of targeted tyrosine kinase inhibitors, including midostaurin and avapritinib, which have been utilized for several years in treating aggressive SM. Recently, avapritinib in lower dosage was also approved for ISM patients with moderate to severe symptoms. For patients with milder forms of ISM, a symptom-oriented basic therapy is recommended. The diagnosis of SM requires interdisciplinary collaboration and strict adherence to established diagnostic criteria. Moreover, innovative patient-centered approaches, such as the MASTHAVE® app, support ongoing follow-up and have the potential to enhance quality of life. Long-term research efforts are increasingly directed toward developing personalized therapies that target the molecular mechanisms underlying the disease.

Nettle pollen is a rare but regionally relevant allergen against which successful allergen immunotherapy (AIT) can be carried out. The risk of confusion with glasswort (Parietaria judaica) must be considered regionally and, if necessary, excluded through an enzyme allergosorbent test (EAST). Patients report the usual symptoms of rhinitis, but often also shortness of breath (nettle allergy as a trigger for allergic asthma). In our study, mild local side effects at the injection site were shown with AIT, but this did not lead to discontinuation of treatment in any patient. Sensitization to stinging nettle pollen is usually a comorbidity in polysensitized patients.

The diversity of allergic disorders and their associated underlying mechanisms render allergy diagnosis particularly challenging. There is a palette of available in vivo and in vitro tests, while result interpretation must always be made in conjunction with clinical history. The focus of the present article is on laboratory diagnostics, where several diagnostic tests have been developed targeting different parts of the allergic cascade. The results of these tests may indicate the presence of clinical allergy but also provide information on disease severity, treatment options, and therapy responsiveness. First-line testing involves allergen specific IgE (sIgE) antibody measurements, and several considerations are required when choosing the exact test. Among others, the allergens to be tested, the use of allergen extracts versus molecular components, cross-reactivity aspects, cost, and geographical sensitization patterns need to be considered. There are technical distinctions between main commercially available automated platforms, which is often reflected by differences in their test results. Diagnostically challenging cases can be supplemented by tests assessing the key effector cells, i.e., basophils, mast cells, and eosinophils, as well as by tests targeting several of the released mediators, including tryptase, lipids, and histamine. Overall, non-IgE-based laboratory tests need additional standardization and research to support their clinical utility.