Allergologie Select最新文献

Food allergy represents a significant health issue characterized by a sizeable epidemiological burden, involving up to 5% of adults and up to 8% of children in the Western world. The elimination diet of the trigger food is the cornerstone of food allergy management. However, novel treatment options are most wanted to provide alternative strategies for this potentially fatal medical condition. Allergen immunotherapy for food allergy (FA-AIT) is considered an immunomodulatory intervention where regular exposure to increasing doses of food is performed in the context of an allergist's supervised protocol. The main objective is to decrease reactivity, attenuate life-threatening allergic episodes and reduce frequent access to the emergency department. Achieving food tolerance off-treatment is, however, the ultimate aim. In this review, we aim to summarize FA-AIT evidence and outlook.

The prevalence of non-immunoglobulin E (IgE) mediated food allergy is poorly established outside of cow's milk allergy, with a challenge-proven adjusted incidence ranging between 0.13 and 0.72%. The presence and presentation of non-IgE mediated allergy in exclusively breastfed infants is highly debated. The dilemma this poses for healthcare professionals and parents, is on the one hand the unwarranted elimination and therefore health risk to the breastfeeding mother and on the other hand under-recognition of a food allergen being a culprit in the non-IgE mediated symptoms of breastfed infants. Current international guidelines recommend exclusive breastfeeding ideally until ~ 6 months of age and the German guidelines 4 - 6 months. It is also acknowledged that breastfeeding should be promoted also within the population of food-allergic infants. This review paper aims to assess non-IgE mediated food allergies in breastfed infants using an evidence-based approach and provides clinicians working with these patients with practical guidance.

Food protein-induced enterocolitis syndrome (FPIES) is a rare, non-IgE-mediated food allergy. The triggering foods differ significantly from the typical triggers of an IgE-mediated food allergy. Until recently, there were no data on triggers of FPIES in Germany. In order to create an advisory basis for the care of German patients, a large multicenter study was initiated and published at the end of 2021. This revealed clear differences in international comparisons. The most frequent triggers for FPIES in Germany are cow's milk, fish, vegetables, and meat. Most children (84%) react to only one food. The prognosis is usually good, depending on the trigger. Regional data should be used for counseling patients with FPIES. Specific recommendations for this are given in this article.

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Background: The epithelial immune regulation is an essential and protective feature of the barrier function of the mucous membranes of the airways. Damage to the epithelial barrier can result in chronic inflammatory diseases, such as chronic rhinosinusitis (CRS) or bronchial asthma. Thymic stromal lymphopoietin (TSLP) is a central regulator in the epithelial barrier function and is associated with type 2 (T2) and non-T2 inflammation.

Materials and methods: The immunology of chronic rhinosinusitis with polyposis nasi (CRSwNP) was analyzed in a literature search, and the existing evidence was determined through searches in Medline, Pubmed as well as the national and international study and guideline registers and the Cochrane Library. Human studies or studies on human cells that were published between 2010 and 2020 and in which the immune mechanisms of TSLP in T2 and non-T2 inflammation were examined were considered.

Results: TSLP is an epithelial cytokine (alarmin) and a central regulator of the immune reaction, especially in the case of chronic airway inflammation. Induction of TSLP is implicated in the pathogenesis of many diseases like CRS and triggers a cascade of subsequent inflammatory reactions.

Conclusion: Treatment with TSLP-blocking monoclonal antibodies could therefore open up interesting therapeutic options. The long-term safety and effectiveness of TSLP blockade has yet to be investigated.

β-lactam antibiotics (BLA) are commonly reported to induce hypersensitivity reactions. However, β-lactam antibiotic-stratified analyses are rare. In the presented study, β-lactam antibiotic associated hypersensitivity reactions were analyzed in the European adverse drug reaction (ADR) database. 923, 38, 222, and 99 hypersensitivity reports for penicillins and first-, second- and third-generation cephalosporins were reported. Differences with regard to demographical parameters, seriousness and types of hypersensitivity reactions, as well as in the number of hypersensitivity reports per outpatient prescriptions were observed between the different β-lactam antibiotics. The number of ADR reports classified as serious was higher for all generations of cephalosporins compared to penicillins. Additionally, anaphylactic reactions were more often reported for first- and second-generation cephalosporins compared to third-generation cephalosporins and penicillins, while bullous reactions were more often reported for first- and third-generation cephalosporins as opposed to second-generation cephalosporins and penicillins. The observed differences may be caused by differences between β-lactam antibiotics and their routes of administration (oral, intravenous), the patient populations, or the reporting of ADRs. Due to the methodological limitations of ADR database analysis, no conclusions can be drawn whether and to what extent the aforementioned factors influenced our results.

Background: In Europe, North America, and Australia, 5% to 10% of the population are now classified as penicillin (β-lactam) allergic. Only ~ 10% of these questionable diagnoses, mostly made in childhood, can be confirmed by allergy diagnostics.

Materials and methods: The aim of this review is to show causes and consequences as well as recommendations for dealing with the often questionable diagnosis of penicillin (β-lactam) allergy (BLA).

Results: An incorrect BLA diagnosis may negatively impact antibiotic treatment needed in the future, by using a less effective antibiotic or using a broad-spectrum antibiotic, for example, further exacerbating the problem of increasing antibiotic resistance. Accordingly, there is growing pressure from antibiotic stewardship programs to critically challenge the BLA diagnosis. Conservatively, a suspected BLA is reviewed by an allergist using medical history, skin testing, laboratory testing, and provocation. This clarification is costly and is not remunerated in the German health care system; that is the reason why this testing is only offered in a few specialized clinics and practically not at all in general practice. In view of thousands of affected patients, additional strategies are needed to treat patients with a low risk of hypersensitivity reaction despite suspected allergy with a β-lactam antibiotic. In recent years, various methods have been proposed to eliminate suspected allergy as promptly as possible and directly before necessary treatment with a β-lactam antibiotic, including standardized history (also in the form of an algorithm), skin test with immediate reading after 15 minutes, or administration of a small test dose. Investigations of small case series and also multi-center studies to date have yielded promising results in terms of feasibility and safety.

Conclusion: Of the large number of patients with (questionable) BLA, most have never been tested and - if antibiotic treatment becomes necessary - simply receive an alternative antibiotic. The diagnosis of BLA therefore requires new approaches besides classical allergy testing to critically question BLA.

Despite limited evidence on clinical efficacy and increasing resistance problems, topical antibiotics are still used in everyday clinical practice. However, topical antiseptic agents such, as octenidine and polyhexanide, often have a broader efficacy spectrum. They also have a broader target tropism because of their non-specific cellular mechanisms of action. Repeated use of topical antibiotics also carries the risk of contact sensitization, which could limit potential subsequent use as systemic antibiotics. Contact allergy is a clinically relevant problem, particularly in patients with barrier-damaged skin, pre-existing dermatosis, or occupational exposure. It can be concluded that with the use of modern antiseptics, topical antibiotic therapy is rarely indicated and should be avoided, not only because of the risk of contact sensitization but also because of the unfavorable and potentially consequential resistance problem.

The administration of alternative broad-spectrum antibiotics because of a suspected allergy to beta-lactam antibiotics (BLA) is one reason for the increase in bacterial resistance to antibiotics and results in further problems, such as reduced efficiency against the causative bacteria, longer hospital stays, higher prices, and more adverse events. Patients with documented BLA allergy experience Clostridium difficile infections and postoperative surgical-site infections more frequently than patients without this label. Yet, in cases of documented and even proven IgE-mediated allergy to a BLA, such as penicillin or cephalosporin, the careful application of a different BLA with dissimilar core and side chains is possible. Cefazolin, e.g., would often be a candidate for skin and soft-tissue infections (e.g., cellulitis) or for perioperative prophylaxis, because it does not share a common side chain with any other BLA and tackles most causative bacteria. In case of severe cellulitis, a carbapenem would be a candidate. After type IV-reactions (benign maculopapular rash), an infectiologist's choice would be to apply another narrow-spectrum BLA. In cases where a long-lasting therapy with penicillin is indicated (e.g., for late syphilis or prophylaxis of erysipelas) in presence of a proven IgE-mediated allergy, desensitization would be the infectiologist's choice.

Most allergic reactions to antibiotics are caused by β-lactam antibiotics; however non-β-lactam antibiotics are also capable of causing both immediate allergic reactions as well as late-type reactions to these drugs. This is especially true for fluoroquinolones and sulfonamides. Of these, the combination of sulfamethoxazole with trimethoprim (Cotrimoxazol, e.g., Bactrim) is most important. However, there are certain types of reactions to non-β-lactam antibiotics that are not associated with β-lactam antibiotics. These include photosensitivity to sulfonamides, tetracyclines, and fluoroquinolones as well as different patterns of drug metabolism and associations with HLA alleles that may influence their prevalence. This review is focused on recent findings regarding the pathogenesis of allergic reactions to non-β-lactam antibiotics.