Allergo Journal International最新文献

The extension of the approval of dupilumab for the treatment of severe atopic dermatitis in children 6 months of age and older in Germany creates a potential conflict with the administration of live attenuated vaccines. According to the product information, the administration of live attenuated vaccines is contraindicated during ongoing dupilumab therapy. This position paper, written by specialists in pediatric immunology and allergology from Germany and Switzerland, aims to support pediatricians to provide their patients with the best possible treatment with dupilumab and appropriate vaccinations based on the currently available evidence, including statements and advice for clinical situations. The practical implementation of these statements requires a differentiated approach. The position paper covers the situation in Germany, with special attention to the recommendations of the STIKO (Standing Committee on Vaccination) and the Robert Koch Institute for German-speaking countries and the legal situation here.

Allergen immunotherapy (AIT) is a proven treatment for allergic diseases such as allergic rhinoconjunctivitis (ARC), allergic asthma (AA) and insect sting allergy. Particularly in children and adolescents, who have a high prevalence of these diseases, AIT plays a crucial role in not only alleviating symptoms but also influencing the natural course of the disease. This article examines the use and importance of AIT in children and adolescents in Germany in the final phase of the Therapy Allergen Ordinance (TAV). The focus is on the efficacy and safety of the therapy, as well as the approval of the respective therapeutic allergens for the respective age group.

Dietary counselling in the field of food allergy aims primarily to empower individuals to prevent allergic reactions, but its impact on allergic reactions remains unclear. This study examined the impact of dietary counselling and other factors on allergic reactions in children with food allergies.

In a multicentre study, parents of children (0–10 years) recently diagnosed with food allergies completed online questionnaires collecting data on subsequent allergic reactions. Data were collected at baseline and at 3, 6 and 12 months postdiagnosis. We fitted a negative binominal model to the data in order to quantify effects of counselling, time period and multiple food allergies on food allergy reaction rates.

Among the 48 enrolled children, 31 encountered a total of 85 food allergic reactions. The monthly reaction rate decreased from 0.28 in the first 3 months to 0.07 between 6 and 12 months. Children receiving counselling from a dietitian demonstrated a lower ratio (incidence rate ratio [IRR] = 0.37, confidence interval [CI] 0.19–0.72, p = 0.004). Those with more than three food allergies have an increased ratio compared to those with one to two food allergies (IRR = 6.18, CI 2.75–3.89, p < 0.001).

Individual dietary counselling has the potential to prevent subsequent allergic reactions after diagnosis as it reduced the risk of allergic reactions by 63%. This impact might be most pronounced in the early months following diagnosis. Children with multiple food allergies are at a higher risk of allergic reactions and should, therefore, be prioritized to receive dietary counselling.

The prevalence of allergic diseases has risen in the 21st century, drawing attention to specific therapeutic and preventive strategies. Due to the key role of immunoglobulin E (IgE) in the development of allergic reactions, IgE represents a key target treatment. In this scenario, IgE immunoadsorption (IgE-IA) has been investigated as a procedure that selectively removes circulating IgE antibodies from the bloodstream of patients with atopy.

This narrative review aims to critically summarize the current insights regarding IgE-IA in the context of the management of allergic diseases, ranging from the rationale to the technical aspects, as well as the benefits and unmet needs.

IgE-IA might be a treatment strategy in well-selected patients with allergic diseases. IgE depletion through sessions of IgE-IA results in immediate clinical improvement and might be useful in acute situations when a rapid clinical response is required or when classic approaches are contraindicated or ineffective. Due to the reduced effectiveness over time, IgE-IA could be a valid first approach before starting another IgE depletion therapy, such as omalizumab, when its commencement would otherwise be contraindicated by too-high serum IgE levels.

Overall, IgE-IA is safe and well tolerated; however, this procedure is currently difficult to implement in routine clinical practice because of costs, time demands, need for hospitalization, and the invasiveness of the procedure, with the associated risks related to the necessity of venous catheterization.

Atopic dermatitis (AD) is often associated with allergic comorbidities, such as allergic asthma or allergic rhinoconjunctivitis (ARC). Sensitizations to pollen can directly impact AD, as patients can experience exacerbation during pollen season. This study aims to gain more insights into the pollen sensitization patterns of AD patients in Central Europe compared with sub-Saharan Africa (SSA).

We performed a case–control study involving a total of 90 participants: 20 AD patients and 10 healthy controls (HC) each from Switzerland (CH), Tanzania (TZ), and Madagascar (MD). We collected clinical data and serum samples and performed a multiplex IgE test (ALEX² Allergy Explorer, MacroArray Diagnostics, Vienna, Austria).

The prevalence of ARC and asthma in AD patients was similar in all countries (ARC: 60% TZ, 70% CH, 75% MD; asthma: 25% TZ, 30% CH, 20% MD). Total IgE levels were significantly higher in both SSA HC populations compared with the Swiss HC. The analysis of specific IgE levels revealed major differences in sensitization patterns between Africa and Europe, especially regarding grass pollen allergens. Swiss AD patients were sensitized to various grass pollen such as Bahia grass, Bermuda grass, common reed, perennial ryegrass, rye, and timothy grass. However, these allergens were irrelevant in the SSA population: no AD patient or HC subject was sensitized to the tested grass pollen.

The considerably different sensitization patterns between European and SSA AD patients warrant the development of allergy testing and desensitization therapies tailored to the African setting. Therefore, there is a need to characterize local pollen types and counts.