Allergologie Select最新文献

The great milestones in medicine almost always have their precursors, which help the great event to break through. So it was with allergen-specific immunotherapy (AIT) and the great work of Noon and Freeman and their world-renowned publication in 1911. In this article, we want to outline AIT's long journey, from early attempts to achieve tolerance to allergens in the environment. Many very different methods were used; from homeopathy to the use of recombinant allergens. Initially, the allergen extracts were given only subcutaneously, but then also through other routes, such as nasal, rectal, intradermal, epicutaneous, in lymph nodes, or oral. It was the great merit of Bill Franklin, whom many of us still experienced as active participants in congresses, to point out that the effect of AIT must be documented not only by clinical observation but in a controlled form including placebo injections. AIT was thus transferred to evidence-based medicine, which we successfully apply today. We would like to express our gratitude to Bill Franklin himself and all others involved in the development of AIT with this summary of 111 years of immunotherapy.

α-gal syndrome (AGS) is caused by the intake of products containing α-gal (galactose-α-1,3-galactose) like mammalian meat. Over the last decade, scientific literature about AGS has been increasing, but the true burden of cases is still unknown [1, 2]. In the USA (University of Virginia Allergy Clinic), the number of confirmed cases of AGS was 24 in 2009 [3] and increased to 34,000 in the entire USA by 2019 [4]. As shown in surveys, in Italy AGS is present throughout the country [5]. The literature suggests that a previous tick bite can cause AGS, but in our case it was not possible to demonstrate this association as the patient did not recall any tick bite, even in childhood. After eating red meat, a 56-year-old male patient had developed symptoms such as a generalized urticaria, diarrhea, and faintness, requiring admission to the Emergency Department. The diagnosis was verified using blood CAP-FEIA test and prick-to-prick test. After completing the diagnostic process, we provided the patient with emergency therapy, and auto-injectable adrenaline was prescribed. Despite the diagnosis, the patient ate red meat once again which resulted in severe urticaria 2 hours after the meal, requiring a second visit to the Emergency Room. Now the patient is under follow-up at our Department of Allergy and Clinical Immunology.

In the recent past, digital healthcare technologies are experiencing a significant leap in development, with an additional unforeseen acceleration in implementation due to the SARS-CoV-2 pandemic. The increased use of mobile applications as well as communication technologies to search for services and support hold particular advantages for the management of chronic diseases requiring medium- to long-term treatments and regular follow-up visits. Allergen immunotherapy (AIT), requiring regular application of treatment, represents an optimal scenario for feasible digital support. From patient stratification and care pathways, over personalized decision support for complex clinical scenarios, towards a close and flexible patient-doctor communication in blended care settings: the current article summarizes the latest knowledge on the use and potential of digital health technologies in the area of AIT .

Mastocytoses are characterized by clonal proliferation of mast cells in various tissues. In childhood, cutaneous mastocytosis (CM) occurs almost exclusively. It is confined to the skin, and has a good prognosis. The most common form is the maculopapular cutaneous mastocytosis (MPCM), formerly called urticaria pigmentosa. A distinction is made between a monomorphic variant of MPCM with multiple small, roundish maculopapular skin lesions and the - more common - polymorphic variant with larger lesions of variable size. One quarter of CM diagnosed in childhood are mastocytomas, which often occur solitary or at multiple sites. The diffuse variant of CM (DCM), which affects 5% of children with CM, should be distinguished from these forms. Systemic mastocytoses (SM) with mast cell infiltrates in the bone marrow or other extracutaneous tissues, such as the gastrointestinal tract, occur predominantly in adults. The diagnosis of CM is usually made clinically: Manifestation in infancy, typical morphology and distribution, pathognomonic Darier sign. Basal serum tryptase is determined if DCM or systemic mastocytosis are to be diagnosed. Children with mastocytosis should be managed in a specialized outpatient clinic. For affected families, detailed information about the clinical picture including prognosis assessment is essential. Mast cell mediated symptoms are controlled by oral non-sedating antihistamines if needed.

Allergic rhinoconjunctivitis (hay fever) is the most common chronic disease in all industrialized nations. Therapy consists essentially in the use of anti-allergic and anti-inflammatory drugs, which mostly show a good and quick effect. With allergen-specific immunotherapy, there is also a causal possibility of tolerance induction. There is currently a considerable undersupply, as those affected trivialize the symptoms and often have concerns about long-term drug therapy. There is also great interest in using non-medicinal measures to prevent and/or relieve allergic symptoms on the assumption that these are free from side effects. In this publication, we present non-drug methods for which clinical studies are available in the literature. The methods have varying degrees of effectiveness. An evidence-based comparative assessment between the methods is not possible. There are also hardly any studies in comparison to standard drug therapy. A large number of the interventions consist of allergen reduction, e.g., with air filters, or cleaning of the mucous membranes with nasal irrigation, etc., none of which should be seen as a substitute but as a supplement to drug therapy.

A multitude of consequences from global warming and environmental pollution can already be seen for nature and humans. The continuous burning of fossil fuels leads to rising temperatures and rising water levels causing extreme weather phenomena like heat waves and flooding. Increasing levels of air pollution also cause adverse health effects. This is especially important for pollen allergy sufferers because air pollution plays a central role in the interactions between pollen and humans. Today, pollen allergy sufferers are confronted with longer pollen seasons and pollen with potentially increased allergenicity. The effects for pollen allergy sufferers are an increased duration and severity of symptoms. New research results from the Medical University of Vienna prove that out of the most important air pollution parameters (particulate matter, nitrogen dioxide, sulfur dioxide, and ozone) especially ozone causes increased symptom severity in pollen allergy sufferers during the birch, grass, and ragweed pollen seasons.

Protective gloves are an elementary component of personal protective equipment in many occupations and are intended to protect the hands from various hazards (e.g., wetness, chemicals, mechanical forces, or thermal stress). This is particularly important when other occupational safety measures (e.g., technical-organizational measures) cannot be implemented or are insufficient. However, it is not uncommon for protective gloves themselves to become a problem, as some of their ingredients (e.g., rubber accelerators) can cause allergic reactions. Accelerators in rubber gloves include thiurams, dithiocarbamates, thiazoles, guanidines, and thioureas. If no alternative means of protection are available, this may even result in abandoning the profession. This article is about rubber accelerators, which are often contained in protective gloves made of different rubber materials (e.g., natural rubber (latex) and nitrile rubber) and may cause delayed-type allergies, as well as related challenges, problems, and solutions for occupational skin protection.

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Adverse reactions to food or food ingredients are more often perceived than objectively verifiable. However, reliable laboratory tests are often lacking. As a result, people with perceived adverse reactions to food often follow extensive elimination diets for years and unnecessarily restrict their diet, as in the case of the frequently suspected histamine intolerance. In this condition, laboratory parameters such as the determination of diamine oxidase in serum have been shown to be inconclusive. The lack of symptom reproducibility calls into question the clinical picture of adverse reactions to ingested histamine. In order to approach persons with perceived histamine intolerance and to support them in moving from blanket restrictions, which are often unnecessarily strict, to effective personalized therapeutic strategies, the present guideline of the Working Group on Food Allergy of the German Society of Allergology and Clinical Immunology (DGAKI) in cooperation with the Medical Association of German Allergists (AeDA), the Pediatric Allergology and Environmental Medicine (GPA) as well as the Swiss Society of Allergology and Immunology (SGAI) and the Austrian Society of Allergology and Immunology (ÖGAI) recommends a practicable diagnostic and therapeutic approach.

The JAK-STAT pathway is involved in the signaling of multiple cytokines driving cutaneous inflammation in atopic dermatitis (AD). Janus kinase (JAK) inhibitors target individual receptor-associated kinases, thereby preventing the mediation of inflammatory signals. Several JAK inhibitors with varying mechanism of action, potency, and safety represent potential therapeutic options for AD in both topical and systemic application. The JAK1/2 selective JAK inhibitor baricitinib was the first substance from this class of drugs approved by the EMA for the systemic oral treatment of AD. The clinical development program of the JAK1 selective inhibitors upadacitinib and abrocitinib is finalized with positive results for AD. The PAN-JAK inhibitor delgocitinib was the first substance being approved for the treatment of AD (in Japan). This review article covers the rising data on investigational and approved JAK inhibitors in the context of the treatment of AD.