Allergo Journal International最新文献

Purpose

In 2015, an interdisciplinary project was started to fill the gap of knowledge on the toxicokinetics of aluminium (Al) after exposure from adjuvanted products for subcutaneous immunotherapy (SCIT).

Methods

Two complementary initiatives of the project are explained. The results of two studies are reviewed and put in connection with the overarching goal. An estimate is given which steps have been reached and which are still needed.

Results

Recent in vivo data provided evidence of systemically available Al from SCIT products in rats (Weisser et al. 2020 [1]). The data are highly valuable for further development of the physiology-based toxicokinetic (PBTK) model for Al exposure which has been established in parallel (Hethey et al. 2021 [2]).

Conclusion

The Hethey model is an important step towards prediction of Al exposure in man from various sources. For use in risk assessment of Al exposure from SCIT products further extension of the model is warranted.

The prevalence of sensitization to molds is low in healthy people, but significant in asthmatics. As it has not yet been possible to establish a cause-and-effect relationship between the presence of mold allergens and the occurrence of allergic symptoms, there is a great deal of uncertainty. The update of the S2k guideline “Medical–clinical diagnostics for indoor mold exposure” should help to objectify the topic. Based on the recommendations listed there for the diagnosis of suspected IgE-mediated mold allergy, this article presents the possibilities of skin tests, IgE determinations, and other in vitro test options, but also their limitations in clarifying the cause. Potential possibilities include component-resolved allergy diagnostics, while the limitations include the difficult standardization of test allergen extracts due to the complex allergen source and the insufficient commercial availability of the test extracts. A diagnostic algorithm is presented as a tool for a systematic approach to patients with suspected mold-associated respiratory allergy.

Aspergillus-associated diseases are rare and pose challenges for practitioners. Diagnosis is complex and requires rational, targeted, and multidisciplinary collaboration, as well as a high degree of expertise and an individualized approach. For the infectious diseases physician, the focus is on the question of infection or colonization. In severely immunocompromised patients, invasive aspergillosis occurs, which most frequently affects the lungs (IPA) and is characterized by invasive, destructive growth. This acute clinical picture is associated with a high mortality rate. Chronic pulmonary aspergillosis (CPA) develops on the basis of pre-existing changes in lung structure caused by other pulmonary diseases and often requires surgical treatment. Another chronic form is allergic bronchopulmonary aspergillosis (ABPA). It is often associated with bronchiectasis in patients with bronchial asthma or cystic fibrosis. Sinus mycoses are divided into non-invasive and invasive forms, which can occur in immunocompromised patients and most commonly affect the maxillary sinus. Here, local surgical measures are an obligatory part of treatment, whereas the non-invasive form usually has an allergic component. In addition, drug-based antifungal and/or anti-inflammatory therapy is used for all entities.

Introduction

Pharmacotherapy is the main pillar in the treatment of allergic rhinitis. While antihistamines (AH) and intranasal glucocorticosteroids (INCS) have long been part of the therapeutic standard, a pharmacological combination of both active substances in a nasal spray has so far only been implemented and made available in two preparations in Germany. Recently, an intranasal olopatadine hydrochloride-mometasone furoate (Olo-Mom) combination was introduced as a nasal spray for the treatment of seasonal and perennial allergic rhinitis.

Methods

In a literature search, treatment options for allergic rhinitis were analyzed and the available evidence was determined by searching Medline, PubMed, and the national and international study (ClinicalTrials.gov) and guideline registers and the Cochrane Library. Human studies published on the topic in the period up to and including August 2023 were taken into account.

Results

Based on the international literature and previous experience, the results are summarized and recommendations are given. The drugs used in the pharmacotherapy of AR primarily include INCS, intranasal and oral AH, leukotriene antagonists, intranasal cromoglicic acid preparations, intranasal and oral vasoconstrictors, and nasal rinses. For patients with intermittent and persistent allergic rhinitis, INCS are the first-line therapy, but in many patients they do not work sufficiently or quickly enough. The fixed combination Olo-Mom nasal spray showed significant improvements in the Reflective Total Nasal Symptom Score (rTNSS) in two phase II clinical trials with twice-daily and once-daily administration. In phase III studies, Olo-Mom nasal spray administered twice daily showed significant improvements in rTNSS compared to placebo, olopatadine monotherapy, and mometasone monotherapy.

Conclusion

In summary, AH and INCS will remain the main groups of active ingredients in the treatment of allergic rhinitis in the future. In combination preparations such as the new combination nasal spray olopatadine hydrochloride-mometasone furoate, they are highly effective and safe, thus opening up new perspectives, especially for patients with moderate and severe allergic rhinitis from the age of 12 years.

Background

Decorative tattoos and permanent make-up have been gaining popularity for years. Increasingly, intolerance reactions occur.

Methods

Literature search of PubMed and reference books on diagnostic and treatment options for tattoo complications.

Results

At least one third of persistent intolerance reactions to tattoos are allergic reactions. The diagnostic work-up should include the tattoo ink used and, particularly in cases of scattered eczema, other products applied. Pigments penetrate very poorly into the epidermis and are not available as commercial test preparations. Consequently, patch tests very often show (false) negative results in affected individuals. Allergological individual diagnosis and assessment of clinical relevance are rarely possible as the chemical composition of the culprit tattoo ink is usually unknown.

Discussion

Diagnosis of tattoo allergy is challenging. The IVDK Tattoo Study 2.0 enables the identification of metals and pigments in skin samples, the preparation of individual patch test preparations with pigments, and the investigation of specific T lymphocytes in blood samples. In addition, assessment of the clinical relevance can be improved by exposure data and results of laboratory diagnostics.