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Background: Nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD) is often characterized by a severe course of chronic rhinosinusitis with nasal polyps (CRSwNP), comorbid asthma, and NSAID hypersensitivity. The gold standard for N-ERD diagnosis is challenge with acetylsalicylic acid (ASA). In expert recommendations, the diagnosis of N-ERD is established based on a plausible positive history of NSAID hypersensitivity and CRSwNP with asthma., Objective: The following review describes the performance of ASA challenges and their sensitivity and specificity. It also examines the extent to which a positive history of NSAID hypersensitivity correlates with ASA challenge results in clinical trials and when ASA challenges should be performed., Results and Conclusion: ASA challenges have high sensitivity and specificity. In clinical ASA challenge studies, there is a high concordance between a positive history of NSAID hypersensitivity obtained by rhinologists and the measured data of ASA challenge in patients with CRSwNP and comorbid asthma. Therefore, ASA challenge is primarily indicated in patients with an unclear history of NSAID hypersensitivity., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

The prevalence of analgesic intolerance syndrome (AIS), internationally known as NSAID-exacerbated respiratory disease (NERD), is reported to be 0.5-5.7% in the general population. The disease often begins with nasal symptoms, which are later joined by chronic rhinosinusitis with nasal polyposis (CRSwNP), asthma, and respiratory hypersensitivity reactions following use of nonsteroidal anti-inflammatory drugs (NSAIDs). In the setting of chronic respiratory disease, the type 2 inflammatory endotype is predominant in approximately 80% of patients with CRSwNP, rendering biologics directed against interleukin (IL)-4, IL‑5, IL-13, and IgE of high clinical interest, particularly in patients with severe CRSwNP and NERD. NERD is often associated with CRSwNP and asthma. Patients with CRSwNP and NERD have been treated, among other therapies, with aspirin therapy after desensitization (ATAD). With the approval of monoclonal antibodies for CRSwNP and asthma, the question arises as to what extent ATAD, which is associated with undesirable side effects, is still useful in the treatment of CRSwNP. In this manuscript, the use of ATAD in CRSwNP patients is discussed from different medical and socioeconomic points of view, both alternatively to or in combination with monoclonal antibodies. Accordingly, both ATAD and biologics continue to play a supporting role in modern treatment of CRSwNP in NERD patients, and should be used judiciously to complement each other., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

The beta-lactam antibiotics are some of the safest and best-tolerated antibiotic agents; however, many patients have reported allergies against penicillin. All beta-lactam antibiotics are only restrictively prescribed for these patients and alternative antibiotics are increasingly given, which carries the risk of negative clinical results and socioeconomic sequelae; however, over 95% of patients who reported an allergy to penicillin show a negative result in the allergy tests for penicillin and this antibiotic can safely be prescribed. The use of sensitive and specific instruments for identification of false penicillin allergies should be an important topic within the framework of antibiotic stewardship. Anesthesists can play a central role in the reduction of the enormous individual and public health burden associated with the classification of penicillin allergy by taking an appropriate medical history and a risk stratification for the identification of patients with a penicillin allergy. This overview article presents a possible delabelling algorithm within the framework of the clarification of a beta-lactam antibiotic allergy. The focus is on a structured allergy anamnesis using the penicillin allergy, five or fewer years ago, anaphylaxis/angioedema, severe cutaneous adverse reaction (SCAR) and treatment required for allergy episode (PEN-FAST) score., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Allergic reactions to antibiotics belong to hypersensitivity drug reactions and can trigger both immunoglobulin E-mediated symptoms and T cell-mediated symptoms. Skin manifestations are the most common symptoms. Although reporting a penicillin allergy results in considerable restrictions in the treatment of acute infections, which may be associated with poor treatment outcomes, in most cases the label 'penicillin allergy' is not called into question or critically reviewed. However, in 85-90% of patients, 'penicillin allergy' constitutes a mislabeling of a non-specific intolerance reaction that does not pose a risk to the patient when re-exposed to penicillins. Careful history taking, an evaluation of manifestations in the past, and easy-to-perform initial diagnostic steps are crucial in differentiating non-specific intolerance reactions from penicillin allergy sensu stricto. Thus, a penicillin de-labeling strategy allows for optimized antibiotic therapy in the event of a future infection. Although allergic cross-reactivity between different β‑lactam antibiotics can occur, the risk for a severe cross-reactivity is dependent on chemical properties of the specific β‑lactam. Published cross-reactivity tables can help in risk stratification and choice of alternative β‑lactam agents., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

The prevalence of hypersensitivity reactions to drugs is increasing. Currently, this affects more than 7% of the world population. Nonsteroidal anti-inflammatory drugs (NSAID) and beta-lactam antibiotics (BLA) are by far the most common pharmaceutical preparations involved in hypersensitivity reactions to drugs. Misdiagnoses are frequent and BLA allergies present a danger that can lead to adverse health outcomes. Therefore, delabeling (exclusion of a suspected diagnosis) is paramount for those affected. Following the occurrence of uncomplicated maculopapular exanthemas, outpatient oral drug provocation can be safely considered in children without prior skin tests. Immediate perioperative reactions are rare. The approach to studying these complex reactions requires collaboration between allergologists and anesthesiologists to provide the best possible care for these patients., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Allergic reactions to antibiotics belong to hypersensitivity drug reactions and can trigger both immunoglobulin E-mediated symptoms and T cell-mediated symptoms. Skin manifestations are the most common symptoms. Although reporting a penicillin allergy results in considerable restrictions in the treatment of acute infections, which may be associated with poor treatment outcomes, in most cases the label 'penicillin allergy' is not called into question or critically reviewed. However, in 85-90% of patients, 'penicillin allergy' constitutes a mislabeling of a non-specific intolerance reaction that does not pose a risk to the patient when re-exposed to penicillins. Careful history taking, an evaluation of manifestations in the past, and easy-to-perform initial diagnostic steps are crucial in differentiating non-specific intolerance reactions from penicillin allergy sensu stricto. Thus, a penicillin de-labeling strategy allows for optimized antibiotic therapy in the event of a future infection. Although allergic cross-reactivity between different β‑lactam antibiotics can occur, the risk for a severe cross-reactivity is dependent on chemical properties of the specific β‑lactam. Published cross-reactivity tables can help in risk stratification and choice of alternative β‑lactam agents., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

The diagnosis of drug allergy is essentially based on a detailed anamnesis, involving the doctors who first treated the patient, and skin testing (prick, intradermal and epicutaneous / patch tests). In the allergological practice / clinic, provocation tests with the presumed trigger are only carried out if the indication is very clear (see articles in this issue on drug allergy children, allergies to betalactam and other antibiotics as well as analgesic intolerance). The provocation with a probably tolerable alternative is in the foreground. Unfortunately, the skin tests of certain drug groups have a low sensitivity even under optimal conditions, but very good specificity. Accordingly, positive skin tests are mostly relevant, but negative skin tests cannot rule out an allergy. In recent years, it has therefore proved successful to carry out supplementary laboratory tests in the clarification of drug allergies. The serological tests (IgE) are of little help. In contrast, the test forms based on the analysis of leukocytes (basophil activation test, BAT, and lymphocyte transformation test, LTT) have gained in importance and complement the diagnostic repertoire. In the combination of all test methods (skin test, LTT, BAT, sometimes provocation test) the trigger of a drug allergy can be defined in a good 70 % of cases and in most cases a safe therapeutic alternative can be found. In the following, we will discuss the importance of laboratory diagnostics in drug allergy.

Drug allergy in children: more often suspected than real Abstract. Adverse drug reactions are frequent in the pediatric population. However, only a small proportion of all adverse reactions are drug allergic reactions. About 10 % of the parents report a suspected drug allergy in their children. Even though, no accurate epidemiological data are available, studies suggested that as few as 10 % of those reported an allergy really are. The most common drug allergy among children is a drug hypersensitivity to antibiotics, especially to betalactam antibiotics.In children, one of the major difficulty in the diagnosis of drug allergies, and especially to antibiotics, is the differentiation of maculopapular eruption as an allergic reaction from a viral exanthema, which is very common among children. Therefore, a high number of children are inappropriately labeled as "drug allergic". In case of suspicion of an allergy, it is recommended to perform a complete allergy workup.

Proton pump inhibitors (PPIs) belong to the most frequently taken drugs worldwide. Hypersensitivity to these medications is rare, but can lead to severe immediate type reactions. Especially cross-reactivity between the different PPIs can occur. In this case series, we describe 4 patients with immediate type reactions to pantoprazole and/or omeprazole.

The diagnostic evaluation of perioperative anaphylaxia is of great importance for the medical care of the affected persons in the context of renewed interventions in general anesthesia. The most frequent triggers include muscle relaxants, antibiotics, latex and analgesics of the type of the cyclooxygenase inhibitors, but other perioperatively administered drugs such as opioids, anesthetics, benzodiazepines, dyes, disinfectants and even corticosteroids or drug additives may also be the cause in rare cases. The most important aim is therefore the identification of the responsible drug, for which a near-time allergological diagnosis should be carried out within the first 4 weeks to 6 months after the reaction. At the end of the examinations, the patient receives a structured allergy passport, which includes information on the drug reaction, the triggers and alternative medicines, as well as possible preventive measures for future surgical procedures. It should be noted, however, that the latter are not a guarantee that, upon renewed exposure to the causative medicinal product, there will be no, possibly even heavier, anaphylactic reaction., Competing Interests: Interessenkonflikt: Die Autoren erklären, dass kein Interessenkonflikt besteht., (Georg Thieme Verlag KG Stuttgart · New York.)

Drug hypersensitivity reactions comprise approximately 25% of all adverse drug reactions and can be classified into allergic and pseudoallergic drug reactions. Immediate type anaphylactic and delayed type rash reactions of various clinical patterns can be distinguished, depending on the pathogenesis and clinical symptoms. The diagnostic work-up encompasses a thorough but also focused evaluation of the medical history, skin tests and when indicated challenge tests. Furthermore, in vitro tests, such as basophil activation tests and T cell assays not only add valuable additional information but can also yield decisive results for the diagnosis, especially in cases of severe drug reactions or reactions which cannot be further clarified by provocation tests. The aim of these measurements is not only the proof of drug intolerance and the detection of the causal drug but also the disclosure of the type of adverse reaction and the identification of potential, tolerated alternative drugs. This information is very important for the counseling of the patient and for prevention of new drug hypersensitivity reactions in the future.

In theory, all medicines can elicit allergic reactions. However, there are large differences in the frequency and clinical presentation of these reactions. Antibiotics, antiepileptic agents and NSADs trigger allergic reactions most frequently. The risk of drug allergy and of a complicated clinical course depends on the individual degree of immune activation, the dose, duration of treatment, route of administration, patient sex as well as HLA-traits, which are increasingly being identified. This article presents the commonest types of immune-mediated drug-related hypersensitivity reactions and discusses red flags which are associated with a complicated clinical course.

This article presents a case report of unilateral, periocular angioedema after intravenous application of a contrast agent with a temporary increase of intraocular pressure in an eye in which trabeculectomy had been carried out 5 weeks previously.

Admission Findings: A 41 year old patient started treatment with 300 mg/d allopurinol for asymptomatic hyperuricaemia (9,2 mg/dl)., Course: 4 weeks later he developed exfoliative skin lesions with haemorrhage, fever, eosinophilia and acute liver and renal failure, typical for an allopurinol hypersensitivity syndrome (AHS).An orthotopic liver-transplantation was performed., Conclusion: The AHS is a serious iatrogenic disease. 2 % of the treated patients develop a skin rash. 0,4 % of these patients experience suddenly and unforeseen a severe hypersensitivity with a mortality of 14-30 %. An early diagnosis is often very difficult. In the pathogenesis different causes are discussed. A hereditary component is involved. Of essential importance is the amount of the starting dose, the kidney function and concomitant drugs. In an asymptomatic hyperuricaemia the application of allopurinol is not indicated. If strong indications are present, the allopurinol therapy has to start with the lowest dose (100 mg/d). If required this dose should be increased under consequent supervision only., (© Georg Thieme Verlag KG Stuttgart · New York.)