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Background: Although allergic diseases are among the most important health disorders, allergology is not anchored as an independent subject in the clinical part of medical studies in Germany., Objective: As all universities and institutes face the same challenge, the aim of our project was to establish exemplary coordination and networking of education in allergology at one location in agreement with all involved departments and institutes. Particularly, Comprehensive Allergy Centers (CAC) offer an established infrastructure via which the revised allergology education program can be transferred to other universities., Materials and Methods: After an extensive inventory of the current allergological curriculum at the University Medical Center Göttingen, a new teaching concept was developed in interdisciplinary consensus, supplemented by first-time provision of additional digital contents ("blended learning"), and finally evaluated., Results: Initially, we observed a high level of fragmentation in the teaching of allergology in the clinical study sections of human medicine, with no coordination between the 12 clinical departments/institutes involved and no coherent framework for the specific learning content. Within the established structure of the interdisciplinary CAC, we revised, coordinated, and defined key areas for improved student education in clinical allergology. The allocation of new interactive learning elements as well as supplementary materials for self-studies was welcomed by the students and positively evaluated. A survey among students after completing the former vs. current curricula showed significant improvements in achieving the desired educational objectives., (© 2022. The Author(s).)

Background: Preservatives in cosmetics are often suspected as contact sensitizers and hence frequently patch tested in dermatitis patients. Exposure in this field has changed over the course of years., Objective: To describe the frequency of contact sensitization to various preservatives., Materials and Methods: Retrospective data analysis from the Information Network of Departments of Dermatology (IVDK) for the years 2009-2018., Results: Frequency of sensitization to methylisothiazolinone (MI) has increased from 2.0% in 2009 to 7.2% in 2013. Since 2014, the rate has been falling again. Increasing the patch test concentration of methyldibromo glutaronitrile (MDBGN) in 2016 has caused a sudden rise in positive patch test reactions from 2.0% to more than 4.5%. Allergic reactions to other preservatives occurred in less than 1% of the patients tested., Discussion: Since 2014, the worldwide "epidemic" of sensitization to MI has been subsiding in Central Europe, thanks to corresponding restrictions on use. Since 2008, there is no longer any widespread exposure to MDBGN; the new, higher test concentration elicits many false-positive test reactions and explains the sudden rise in positive patch test reactions since 2016. Despite widespread use, phenoxyethanol, benzoates, benzyl alcohol, parabens and sorbates rarely cause allergic reactions. Therefore, they can be recommended for cosmetics from the epidemiological-allergological point of view.

Background: Fragrances are regarded as the most common contact allergens after nickel. In this context, the frequency of positive patch test reactions to fragrance mix is often presented as proof. According to EU regulation No. 1223/2009, 26 fragrances that are regarded as significant allergens have to be declared on cosmetic products., Objectives: The frequency of patch test reactions to fragrances and differentiation between frequently and rarely sensitizing fragrances were evaluated., Materials and Methods: Data from the Information Network of Departments of Dermatology (IVDK), mostly of the years 2016-2018, were retrospectively analyzed., Results: Frequency of positive reactions to fragrance mix I in the departments of dermatology joining the IVDK reached a historical low of 5.4% in 2018. Since 2013, positive reactions to fragrance mix II have been declining, yielding 3.2% in 2018. Of fragrance mix I, the allergen with the most positive test reactions is no longer oakmoss absolute, but isoeugenol. In fragrance mix II, hydroxyisohexyl 3‑cyclohexene carboxaldehyde (HICC) is still leading. Only 11 of the 26 fragrances subject to mandatory declaration elicited allergic test reactions in more than 1% of the patients tested., Discussion: The decline of positive test reactions to the fragrance mixes is mainly due to the reduced use of oakmoss containing atranol and chloroatranol, and HICC. Use of these substances in cosmetic products was prohibited within the EU starting in August 2019. Therefore, a further decline of the sensitization frequencies can be expected. A differentiated consideration of the individual fragrances under allergological aspects is urgently required.

Intolerance reactions to metal implants may be caused by metal allergy. However, prior to implantation, patch testing should not be done in a prophylactic-prophetic approach. Pre-implant patch testing should only be performed to verify or exclude metal allergy in patients with a reported respective history. In the case of implant-in particular arthroplasty-related complications like, for example, pain, effusion, skin changes, reduced range of motion, or loosening, orthopedic-surgical differential diagnostics should be performed first. Allergological workup of suspected metal implant allergy should be done with the DKG baseline series which contains nickel-, cobalt- and chromium-preparations. Various studies assessing the usefulness of metal alloy discs for patch testing proved that this approach does not give reliable information about metal allergy. Positive patch test reactions to the discs cannot be assigned to a specific metal within the disc alloy components. Furthermore, availability of such metal discs might be an invitation to uncritical testing. Accordingly, due to lack of benefit in comparison to patch testing with standardized metal salt preparations, we do not recommend patch testing with metal alloy discs.

Allergic contact eczema in children is frequent. If clinically suspected, a patch test should be performed. In the present study, data obtained from 116,742 patients who had undergone a patch test from 2005-2014 were analysed. The children group (range 0-12 years) included 925 patients. If at least 700 tested individuals were considered, the most frequent sensitizations in this group were nickel sulfate (8.5 %), fragrance mix I (5.5 %), and colophony (3.4 %), whereby sensitisation in adults was higher for nickel sulfate (15.5 %) and fragrance mix 1 (8.4 %), while being similar for colophony (3.7 %). In adolescents with and without a profession, nickel sulfate (11.1 and 13.6 %, respectively) and cobalt (II) chloride (3.9 and 3.4 %, respectively) were the most frequent positively tested contact allergens. Sensitisations toward fragrance mix I was low (3.9 and 3.4 %, respectively) in comparison to the adult group (8.4 %). In both children and adolescents, toluene diamine and paraphenylenediamine sensitizations were not infrequent, but it must be considered that these allergens were only tested if suspected. The data show that the sensitisation profile among children and adolescents display patterns similar to those in adults. Sensitisations in childhood and adolescence towards dyes like paraphenylendiamine may be associated with increased use of tattooing in these groups.

Background: In Germany, occupational skin diseases rank first in the occupational skin disease statistics for many years. Especially, occupationally acquired contact allergies as well as multi-sensitization are the most important predictors for a poor prognosis and persistent eczema., Objectives: To update the spectrum and sensitization frequencies of most frequent allergens from the standard series in Germany in patients with occupationally acquired type IV sensitizations in general and within different occupational groups., Methods: Data of all employed patients (age range: 16-68 years, n = 14234) patch tested between 2003 and 2013 in the German Departments of the Information Network of Departments of Dermatology (IVDK) and diagnosed occupationally acquired contact dermatitis after patch testing were analyzed. The control group was composed of all other patients (n = 31706) within the same time frame, in which occupationally acquired allergic contact dermatitis was negated explicitly., Results: The prevalence Ratio (PR; indicating risk) was significantly increased for: Thiuram-mix (PR 5.63 95 %CI 4.97-6.4), zinkdiethyldithiocarbamate (PR 6.22 95 %CI 4.76-8.22), mercaptobenzothiazole (MBT) (PR 3.88 95 %CI 3.09-4.89), mercapto-mix without MBT (PR 3.23 95 %CI 2.59-4.03), N-isopropyl-N'-phenyl-p-phenylene diamine (IPPD) (PR 2.3195 %CI 1.87-2.86), epoxy resin (PR 2.82 95 %CI 2.45-3.25), chloromethylisothiazolinone/methylisothiazolinone (MCI/MI) (PR 2.19 95 %CI 1.97-2.42) and compositae mix II (PR 2.05 95 %CI 1.45-2.89). They were the predominant occupational allergens and were at least associated with a doubled risk (PR ≥ 2.0) for acquiring occupationally allergic contact dermatitis. The highest risk increase was identified in employees in the health services, in agriculture, metal industry, food and service industry as well as building trades, Conclusions: A limited number of occupationally relevant allergens cause the majority of sensitizations in the workforce, if standard series allergens are concerned. Data analysis of national and international contact allergy data bases provide valuable information on sensitization rates and profiles in skin risk occupations to implement targeted prevention strategies. To diagnose occupational allergic contact dermatitis in individual cases additional testing of occupation related patch test series as well as patients' own products is commonly inevitable.

In clinical practice occupational skin diseases usually present as hand dermatitis. Occupationally acquired contact allergies are of eminent relevance in many work place products e.g. skin care products, dyes and paints, epoxy resins or protective gloves. However, not infrequently, a range of other dermatoses of different etiology and localization can be occupationally induced and, at least in Germany, thus be medically treated and--if necessary--compensated for with full coverage by the statutory employers' liability insurance. Examples regarding non-eczematous skin diseases triggered by external factors are psoriatic lesions, cutaneous type-1-allergies, occupationally acquired infections, and dermatoses in other localizations which are occupationally exposed to irritant influences (e.g. feet in workers wearing occlusive safety boots). Moreover, outdoor workers deserve specific attention by the dermatologist if squamous cell carcinomas including precursor lesions like actinic keratoses or Bowen disease have occurred. In Germany, recently the scientific advisory committee to the Ministry of Labor has recommended including these skin cancers caused by occupational solar UV exposure in the national list of occupational diseases. The framework for dermatological preventive care of occupationally-induced inflammatory dermatoses has been continuously improved in the last years. The aim is to reach a similar level of care and preventive measures for patients with occupational skin cancer, including primary preventive workers' education.

A total of 56 departments of dermatology from Germany, Austria, and Switzerland collaborate to study the clinical epidemiology of contact allergies (CA). Data generated in the course of the diagnostic work-up of CA (e.g., patch test data) have been stored since 1989 in the data center in Göttingen, Germany, including data for more than 200,000 patients (March 2011). These data can be used as a register and as a surveillance system. Analysis of the register may identify and quantify risk factors of sensitization to an allergen, which is exemplified with the case of the allergen para-phenylenediamine. It turned out that-in addition to the risk factor hair dyeing-other important risk factors must be considered. In contrast, data collected every 6 months (from approximately 6,000 patients) allow for time-trend analyses of allergens, thus, identifying allergens of concern, which is of utmost importance for early preventive intervention. Here, the epidemiology of allergies to epoxy resins serves as an example. Continuous monitoring of contact allergens will also be mandatory in the future, as the CA premarketing screening systems will have imperfect predictive values with regard to human CA risk. Unfortunately, the (current) national regulatory framework severely hampers clinical surveillance/epidemiology of contact sensitization and, thus, prevention of contact allergy.

Ever-changing exposure to contact allergens, partly due to statutory directives (e.g. nickel, chromate, methyldibromo glutaronitrile) or recommendations from industrial associations (e.g. hydroxyisohexyl 3-cyclohexene carboxaldehyde), requires on-going epidemiologic surveillance of contact allergy. In this paper, the current state with special focus in fragrances and preservatives is described on the basis of data of the Information Network of Departments of Dermatology (IVDK) of the year 2010. In 2010, 12,574 patients were patch tested in the dermatology departments belonging to the IVDK. Nickel is still the most frequent contact allergen. However the continuously improved EU nickel directive already has some beneficial effect; sensitization frequency in young women is dropping. In Germany, chromate-reduced cement has been in use now for several years, leading to a decline in chromate sensitization in brick-layers. Two fragrance mixes are part of the German baseline series; they are still relevant. The most important fragrances in these mixes still are oak moss absolute and hydroxyisohexyl 3-cyclohexene carboxaldehyde. However, in relation to these leading allergens, sensitization frequency to other fragrances contained in the mixes seems to be increasing. Among the preservatives, MCI/MI has not lost its importance as contact allergen, in contrast to MDBGN. Sources of MCI/MI sensitization obviously are increasingly found in occupational context. Methylisothiazolinone is a significant allergen in occupational settings, and less frequently in body care products.

Background: Hair cosmetics, in particular hair dyes, bleaches, and permanent wave solutions, contain a number of potential contact allergens. The pattern of exposure to these in hairdressers, clients and home-users may change over time., Patients and Methods: Data on female patients who consulted centers of the Information Network of Departments of Dermatology (IVDK, http://www.ivdk.org) between 01/2003 and 12/2006 was analyzed. Patients were divided into a) hair-dressers, given they worked in this occupation and suffered from occupational skin disease (n = 480),and b) "clients",who never worked as hairdressers, but in whom hair cosmetics were considered a potential cause of contact dermatitis (n = 780)., Results: In hairdressers, the most important allergens were ammonium persulfate (21.7% positive),p-toluenediamine (PTD,19.6% positive),p-phenylenedi-amine (PPD,18.1% positive) and, with decreasing time trend, glyceryl monothioglycolate (2005/2006 still 7.5% positive). Biocides must be regarded as important allergens in hairdressers, namely,(chloro) methylisothiazolinone and methyldibromoglutaronitrile. Clients, who were considerably older on average, had possibly been tested in a more aimed fashion, yielding (strikingly) higher sensitization prevalences to a number of allergens of oxidative hair dyes such as PPD or PTD., Conclusions: The continual analysis of sensitization prevalences in patients patch tested can identify areas needing in-depth research and preventive intervention, such as avoiding the use of certain biocides in shampoo intended for professional use by hairdressers or further reducing the concentrations in oxidative hair dyes.

Patch testing is the standard procedure to detect contact sensitivity. The most frequent contact allergens are included in the standard series. We report on current trends regarding results obtained with the standard series from 2001-2004 in Germany, Austria (Graz, Vienna) and Switzerland (Basel). This analysis includes the frequency of the most common contact allergens and other aspects such as age and gender distribution and parameters of diagnostic quality such as reaction index and positivity ratio. Information on the most common contact allergens is updated.

Background: In the early 1990s, the prevalence of nickel contact allergy was high-almost 20% on a population level, and some 40% in contact dermatitis patients. Around that time, nickel exposure was starting to be regulated., Patients/methods: Descriptive and bivariate analyses of patch test results of all patients tested with nickel sulfate (5% pet.) in the departments joining the Network of Departments of Dermatology (IVDK) 1992-2001 (n=82,991, women: 52,709; men: 30,282). The annual frequency of sensitization to nickel was analyzed in women and men in four age subgroups (<31/31 to <44/44 to 58= or >58)., Results: In young women less than 31 (n=13.909) the prevalence of contact allergy to nickel decreased significantly from 36.7% in 1992 to 25.8% in 2001. In young men in the same age group (n=7087), the prevalence dropped from 8.9% in 1992 to 5.2% in 2001., Conclusions: The observed decline indicates that measures to limit the release of nickel from costume jewelry helped reduce the prevalence of nickel allergy. In general term, allergen elimination or reduction is an effective primary prevention strategy which does not depend on individual behavior modifications.

Background and Objective: The Information Network of Departments of Dermatology (IVDK) centrally collects patch tests results in cooperation with the German Contact Dermatitis Research Group (DKG). Data of patients, who underwent patch testing to evaluate otitis externa were analyzed., Patients/methods: Data of 145 patients that had been recorded between 1992 and 1997 were evaluated. The evaluation included data yielded by standardized patch testing as well as by patch testing of products that the patients had used., Results: Allergic contact dermatitis was diagnosed in one third of patients suffering from otitis externa. Topical drugs were shown to be the most important allergens. In comparison to the entire IVDK collective, the population-adjusted frequency of sensitization (PAFS) of neomycin sulfate was higher in the study population whereas that of nickel sulfate was lower. That shows that in a very specific topographic area, different allergens may be of clinical significance., Conclusions: Whereas nickel sulfate represents an important allergen in the contact dermatitis of the external ear, topical therapeutical agents, especially neomycin sulfate and, as evaluation of the patch tests of the patient's own products revealed, probably polymyxin B are the dominating allergens in otitis externa.

Patch testing as a part of the diagnostic evaluation of patients suffering from oral mucosal complaints or with symptoms where dental materials are suspected to be the cause is hampered by numerous difficulties. The ingredients of denture materials as well as their liberation in the oral cavity are often unknown. Contact with many of the potential ingredients of denture materials can occur on other occasions, as well, thus making it difficult to find out where the patient has acquired his or her sensitization. The special morphological and immunological situation in the oral mucosa may produce tolerance of substances which evoke a positive patch test reaction on the skin of the back. This paper introduces the possible spectrum of allergens in these patients and discusses the difficulties in the assessment of the relevance of positive patch test reactions. From August 1992 to July 1994, 756 patients with complaints of the oral mucosa and/or suspected contact allergy to denture materials were patch tested in the departments of dermatology joining the Information Network of Departments of Dermatology in Germany (IVDK). Among these patients, women were overrepresented, while individuals with atopic dermatitis were underrepresented. The allergen spectrum included amalgam, mercury compounds, gold salts, palladium chloride and methyl methacrylate. However, the epidemiological value of these data is limited. A second part of this paper will review the various groups of allergens.

As a basis for the investigation of new substances in respect of their photosensitization effects, we established and standardized 3 microbiological test systems, which enabled us to do without animal experiments. Using several furocumarines and various sources of light, we performed a comparative study on the eukaryotes, Chlamydomonas reinhardii (CR) and Candida albicans, and the prokaryote, Bacillus subtilis. We found that, if different light qualities were employed, our test systems also allowed a comparison of different substances by means of half-quantitative evaluation of the inhibiting areolas, which appear after exposure. With regard to the furocumarines, 8- and 5-methoxypsoralene (MOP) had the strongest photosensitizing effect under all test conditions. The remaining furocumarines showed decreasing effectiveness from psoralene to trimethylpsoralene (TMP) and imperatorine; psoralene, however, was slightly more effective in CR than 5-MOP. With the exception of CR, TMP had a stronger effect on the micro-organisms than imperatorine.

We present 9 patients with contact urticaria due to rubber gloves. Others have reported an increasing incidence of the disease among females, patients with atopic dermatitis, and hospital personnel. Our data confirm these results. Scarification with water, in which the suspected glove was incubated, is a simple diagnostic method, both reliable and cheap, in order to test the solubility of the allergen(s) in water. In one of our patients, we proved a type-I allergy caused by tetramethyl thiuram disulfide.