Allergo Journal International最新文献

House dust mite extracts for allergen-specific immunotherapy (AIT) require in Germany as other common allergens (pollen from sweet grasses [except maize], birch, alder, hazel; bee and wasp venom) marketing authorisation according to the German Therapy Allergen Ordinance (“Therapieallergene-Verordnung”, [TAV]). Mite allergen extracts that have been approved and also those which are in the approval process are subject to government batch testing. Batch test passing is a prerequisite for marketability. Appropriate quality, efficacy, and safety are prerequisites for the approval of house dust mite extracts. Five HDM allergen extracts from four manufacturers are currently approved in Germany for subcutaneous or sublingual therapy; further extracts are in the approval process. The allergen strength of different products is not comparable; manufacturers use company-specific units to describe the strength. Of the three known major allergens (Group 1 allergens: Der p 1, Der f 1, Group 2 allergens: Der p 2, Der f 2 and Group 23: Der p 23, Der f 23) only Group 1 and Group 2 allergens are usually used to standardize the extracts. Group 23 allergens are localized in the outer membrane of mite faeces, and elution requires special extraction methods. To be efficacious in a single patient an allergen extracts used for AIT must contain all allergen components against which the patient is sensitised. Based on post hoc analyses of large clinical studies, it has been proven for house dust mite tablets that Der p 23 is also contained. In Germany, the Paul Ehrlich Institute is responsible for the approval of therapeutic allergens. For the marketing authorisation information on production procedures, and quality are necessary efficacy and safety (positive benefit risk ratio) of the product must be demonstrated in clinical trials according to the current state of the art.

House dust mites and storage mites have a high allergenic potential and lead to sensitization through the formation of specific IgE antibodies. Due to their preferred residence in houses, they belong to the group of house mites, which are referred to as “domestic mites” in English. Their anatomy and biology account for their amazing adaptability to changing environmental situations (including temperature, humidity, food) and make it understandable that measures to reduce their abundance are usually difficult to implement in practice.

Domestic mites is the term used to describe dust mites and storage mites that prefer to live in houses and to which many people develop sensitization through the formation of specific IgE antibodies due to the high allergenic potency of mite allergens. As a result, mites can trigger allergic diseases of the upper and lower respiratory tract as well as cross-reactions to other allergens. Sensitization to house mites is widespread in the German population. About 11 million adults are sensitized in Germany (15.9%). Men are more frequently affected than women, and sensitizations occur more frequently in large cities and with higher socioeconomic status. Sensitizations are less frequent in old age. They can lead to diagnostic problems as clinically silent sensitizations, which is the case in about 40% of sensitizations.

The path from first symptoms to initiation of allergen-specific immunotherapy (AIT) is too long in our survey, at just under 12 years. Even from diagnosis to AIT, it still takes 8.5 years. The reasons are manifold. The complaints are mostly sneezing (75%), runny and stuffy nose (65 and 63%, respectively), itching of the eyes and nose (59%), but also breathing difficulties (40%). Most of our patients were polysensitized (78%) and had asthma (63%). AIT should be considered earlier in mite allergic patients.

House dust mites are among the most important allergy triggers worldwide. While mites of the genus Dermatophagoides occur almost worldwide, the tropical mite Blomia tropicalis and storage mites are only of importance for certain areas or groups of people. The most important allergens of Dermatophagoides pteronyssinus are Der p 1, Der p 2, and Der p 23 with immunoglobulin E (IgE)-binding frequencies of more than 70% and high allergenic activity. Also of importance are Der p 5, Der p 7, and Der p 21, which have IgE-binding frequencies of about 30%. According to the current state of knowledge, these six allergens are the allergens of clinical relevance which are also required for diagnosis and immunotherapy with individual components.

Hereditary angioedema (HAE) is a chronic, genetic condition which severely impacts those afflicted with intermittent recurrent vascular edema in mucosal and submucosal tissue or in the dermis and subcutis. These swellings adversely impact the wellbeing of patients, both physically and emotionally. Depending on the location, patients present to doctors in a range of disciplines, and not infrequently misdiagnoses occur, such as appendicitis or an allergy, with subsequent incorrect treatment. An HAE attack can also be life-threatening if larynx is affected. However, medications for treating the more common mast cell-induced angioedema are not effective in HAE. Correct diagnosis of the condition, which often first appears in childhood or adolescence, is therefore essential for effective treatment. De novo mutations where the family history is negative are particularly challenging here. However, a range of new treatment options can help HAE patients by preventing attacks and alleviating the burden of the disease. In this review, we summarize the symptoms experienced by patients with HAE as a result of their condition, but also as a result of misdiagnoses and incorrect treatments, as well as the role of preventive treatment (long-term prophylaxis) in improving the quality of life of those affected and their families. In addition, we provide specific information about how HAE can be detected at an early stage in order to be able to refer patients to experts as soon as possible. With reference to the recommendations of the updated WAO/EAACI guidelines (2022), we argue for a stronger role for long-term prophylaxis and the promotion of modern, patient-centered management of HAE using patient-reported outcome measures (PROMs) to manage quality of life and the burden of the disease.