Search

Zusammenfassung Hintergrund Obwohl allergologische Erkrankungen zu den wichtigen Gesundheitsstörungen laut ärztlicher Approbationsordnung zählen, ist die Allergologie in Deutschland nicht als selbstständiges Fach im Studium der Humanmedizin verankert. Ziel der Arbeit Da sämtliche Universitäts- und Hochschulstandorte mit dieser Herausforderung umgehen müssen, war es Ziel unseres Lehrprojekts, eine exemplarische und mit allen beteiligten Kliniken und Instituten abgestimmte Koordination und Verzahnung der allergologischen Lehre an einem Standort zu etablieren. Insbesondere Comprehensive Allergy Centers (CAC) bieten eine bereits vorhandene Infrastruktur, in der diese Neukonzeption der allergologischen Lehre auf andere Standorte übertragen werden könnte. Material und Methoden Nach umfangreicher Bestandsaufnahme der aktuellen allergologischen Lehre an der Universitätsmedizin Göttingen wurde im interdisziplinären Konsens ein neues Lehrkonzept entwickelt, durch die Bereitstellung zusätzlicher digitaler Lehr- und Lernanteile ergänzt („blended learning“) und schließlich evaluiert. Ergebnisse Die allergologische Lehre im klinischen Studienabschnitt zeigte eine starke Fragmentierung, die ohne Koordination der zwölf beteiligten Kliniken/Institute und ohne Abstimmung der jeweiligen Lerninhalte stattfand. In der etablierten Struktur des interdisziplinären CAC erfolgte eine Neukonzeption, Koordination und Schwerpunktsetzung der studentischen Lehre zur klinischen Allergologie. Die Bereitstellung von neuen interaktiven Lerneinheiten sowie ergänzender Materialien zum Selbststudium wurden von den Studierenden positiv bewertet. Eine vergleichende Evaluation von Studierenden nach Absolvieren der unterschiedlichen Curricula zeigte signifikante Verbesserungen im Erreichen der gewünschten Lernziele.

Background Allergy evaluation by patch testing with povidone-iodine (PVP-I) or iodine remains challenging, because current patch test preparations frequently lead to false positive or irritant skin reactions. Objectives To investigate different preparations for iodine patch tests and to assess their clinical relevance with repeated open application tests (ROATs). Methods We monocentrically analyzed 95 patients with suspected allergy to disinfectants in retrospect who underwent parallel iodine patch testing with four preparations: PVP-I 2% aq., 5% aq., 10% aq. and iodine 0.5% pet. Results In 27/95 (28.4%) patients, we found positive reactions to one of the four test preparations. After ROATs in 22 of these 27 positively tested individuals, only one patient was diagnosed with iodine allergy. In contrast, 31/95 (32.6%) patients showed irritant or questionable patch test reactions on day 2 (D2) and/or D3 and/or D7 to one or more test preparations. Testing with PVP-I 2% aq. resulted in the lowest number of questionable skin reactions while detecting the single allergic patient. Conclusion PVP-I 2% aq. was found to be the optimal patch test preparation. In general, iodine allergy appears to be substantially overestimated, and positive patch test responses to iodine should prompt an urgent ROAT for confirmation before diagnosing iodine allergy. This article is protected by copyright. All rights reserved.

Hintergrund Die Sensibilisierungsraten fur Aeroallergene steigen weltweit. Die Pravalenz nimmt insbesondere in den westlichen Landern zu. Ziel dieser Arbeit war es, (1) Sensibilisierungsraten und (2) Kreuzsensibilisierungsmuster in Haut-Prick-Tests (HPTs) fur die wichtigsten Inhalationsallergene in Mitteldeutschland, angepasst an den regionalen Pollenflug, uber 20 Jahre hinweg zu untersuchen. Patienten und methodik In dieser monozentrischen Studie wurden HPTs fur Baumpollen, Graserpollen und Hausstaubmilben (HDM) bei 4315 Patienten, darunter auch Kinder, mit Verdacht auf Atemwegsallergien von 1998-2017 ausgewertet. Ergebnisse Die Sensibilisierungsraten fur fast alle Aeroallergene zeigten einen signifikanten Anstieg uber die Jahre, ohne relevante Veranderungen der regionalen Pollenzahlen. Die aktuellen Sensibilisierungsraten bei allen symptomatischen Patienten waren am hochsten fur Graser- (55,3 %) und Roggenpollen (59,6 %), wobei die HDM-Sensibilisierung im Laufe der Zeit am starksten zunahm (von 37,8 % auf aktuell 50,1 %). Ein geringer, aber konsistenter Anteil der Baumpollen-sensibilisierten Patienten (3,6-7,8 %) zeigte jedoch isolierte positive HPTs auf Erlen- und/oder Haselpollen ohne Sensibilisierung auf Birkenpollen. Schlussfolgerungen Wir zeigen einen signifikanten Anstieg der Gesamtzahl der sensibilisierten Patienten sowie eine Zunahme der Kreuzsensibilisierung gegen eng verwandte Allergene. Patienten mit ungewohnlichen Monosensibilisierungsprofilen gegenuber haufigen Inhalationsallergenen mussen genauer untersucht werden, da diese Patienten derzeit von klinischen Studien zur Allergen-Immuntherapie ausgeschlossen sind.

Background Sensitization rates to aeroallergens are rising worldwide. The prevalence is increasing, especially in Western countries. We aimed to investigate (1) sensitization rates and (2) cross-sensitization patterns in skin prick tests (SPTs) for the most relevant inhaled allergens in central Germany over 20 years, adjusted for regional pollen counts. Patients and methods This monocentric study evaluated SPTs for tree pollen, grass pollen and house dust mites (HDMs) in 4,315 patients (including children) with suspected airway allergies, from 1998-2017. Results Sensitization rates to almost all aeroallergens have increased significantly over time, without relevant changes in regional pollen counts. Current sensitization rates in all our symptomatic patients were highest for grass (55.3 %) and rye pollen (59.6 %), with most pronounced increases in HDM sensitization over time (from 37.8 % to the current figure of 50.1 %). However, a low but consistent proportion of tree-sensitized patients (3.6-7.8 %) showed isolated positive SPTs to alder and/or hazel pollen without sensitization to birch pollen. Conclusions We demonstrate a significant rise in the total number of sensitized patients as well as increases in cross-sensitization between closely related allergens. Individuals with unusual mono-sensitization profiles to common inhaled allergens should be studied in more detail, since these patients are currently excluded from clinical trials for allergen immunotherapy.

Allergen immunotherapy (AIT) involves the application of increasing doses of allergen extract (as oral, sublingual, or subcutaneous immunotherapy) until immunologic tolerance is reached. Successful AIT relies on the consistent administration of allergen extract; therefore, adherence to these treatments is vital for compelling long-term results. Our review discusses the current terminology from adherence research in general, summarizes 25 current studies on adherence research in AIT in a scoping literature review, and delineates recommendations for tools and parameters for adherence research, aiming to improve outcomes in AIT. Almost every adherence study in AIT published to date used different tools, parameters, and data sources for measuring adherence and persistence rates. Unfortunately, an easily accessible, objective parameter or biomarker for monitoring treatment adherence and success has not yet been established for AIT. This situation calls for the development of an international core outcomes set for AIT that defines what is exactly meant by AIT adherence and how AIT adherence should be consistently measured. Therefore, we exemplarily present results and conclusions from adherence research in chronic diseases other than allergology. We aim to facilitate the development of advanced methods, considering the challenging disease specificities of these parameters in a routine care setting of AIT.

Caroline Beutner,1 Susann Forkel,1 Sidhi Gupta,1 Thomas Fuchs,1 Michael P Schön,1,2 Johannes Geier,2,3 Timo Buhl1,2 1Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany; 2Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen, Göttingen, Germany; 3Information Network of Departments of Dermatology (IVDK), University of Göttingen, Göttingen, GermanyCorrespondence: Caroline BeutnerDepartment of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Georg August University, Robert Koch-Str. 40, Göttingen D-37075, GermanyTel +495513966402Email caroline.beutner@med.uni-goettingen.deIntroduction: The prevalence of airway allergies in Europe has increased from 23% to 31% in recent years. Polysensitization is associated with the development and severity of relevant allergies, particularly allergic asthma.Objective: We investigated age- and sex-dependent monosensitization and polysensitization profiles as well as patterns of sensitization using skin prick test (SPT) reactivity to the most common aeroallergens.Patients and Methods: From 1998 to 2017, SPTs were retrospectively analyzed in 2886 symptomatic patients, referred to the University Medical Center Göttingen, located in central Germany. The major aeroallergen groups early flowering tree pollen, grass pollen, and house dust mites were evaluated in this study. Wheal diameters ≥ 2 mm were considered positive during the entire study period.Results: Polysensitization to the most common aeroallergen groups increased significantly over 20 years. Boys and young men displayed the most remarkable rise in total sensitization rates in our study group over time.Discussion: Our patient-based study demonstrates a continuing increase in polysensitization rates over the last 20 years, with boys and young men being most frequently affected. Our data—without being a population-based study—suggest a scenario with climbing rates of allergic rhinitis and asthma.Keywords: aeroallergens, polysensitization, sensitization pattern, skin prick test

Background: Fungal spores are ubiquitous allergens. Severe forms of asthma are particularly highly associated with fungal sensitization. National and international asthma guidelines recommend the implementation of allergen immunotherapy if indicated. Thus, detection and treatment of relevant allergies are key components of primary care of these patients. Objectives: The aims of the study were (i) to investigate trends in the prevalence of sensitization to twelve fungi in central Germany over the last 20 years and (ii) to dissect specific sensitization patterns among the 3 most important fungi: Aspergillus, Alternaria, and Cladosporium. Methods: This single-center study evaluated skin prick test (SPT) results of 3,358 patients with suspected airway allergies over a period of 20 years (1998–2017). Results: While 19.2% of all study patients had positive test results to at least 1 of the 3 fungi (Alternaria, Aspergillus, or Cladosporium) in the first study decade, this rate increased to 22.5% in the second decade. Slight increases in sensitization rates to almost all fungi were observed over the 20-year period. In the last decade, polysensitization to Alternaria, Aspergillus, and Cladosporium increased significantly. Sensitization to fungi is age-dependent and peaks in the age-group of 21–40 years during the second decade. Conclusion: Fungi are relevant allergens for perennial and seasonal allergy symptoms. We currently recommend including Aspergillus, Alternaria, and Cladosporium in the standard series of SPTs for airway allergies.

The measures taken to cope with the COVID-19 pandemic by governments worldwide have vast consequences on all areas of life. To assess the impact of the COVID-19 pandemic on long-term career development, we evaluated the work-family balance of medical doctors at nine German university clinics. The results indicate a severely disturbed work-family balance, which was mostly due to insufficient childcare, based on restrictions in school operations and childcare. Despite the newly created emergency childcare options, aiming to ensure the functioning of the “systematically important” professional groups, medical doctors feel that they are not sufficiently supported by the measures taken by local governments. Women, in particular, see their professional development at risk. Our results underline that proper and flexible childcare is essential for the career advancement of female medical doctors and is particularly important in times of crises such as the current COVID-19 pandemic. At university medicine clinics, increased work time flexibility and optimized schooling and childcare are needed to promote the career development of female as well as male medical doctors in the early stage of their careers.

Background: In contrast to the 3 major aeroallergens tree pollen, grass pollen, and house dust mites, allergic rhinitis caused by herbal pollen has received comparatively little attention in recent clinical studies. Since various weeds flower during summer until fall, allergic rhinitis to weeds may be underdiagnosed and/or mistakenly diagnosed as grass pollen allergy. Objective: To investigate (i) the currently most frequent weed allergy between mugwort, ragweed, plantain, chamomile, nettle, and oilseed rape and (ii) time trends in prevalence of sensitization to weed pollen in the middle of Germany over the last 20 years. Methods: This study, the largest of its kind to date, monocentrically evaluated the prick test results of a total of 6,220 patients with suspected RCA over a period of 20 years (1998–2017). Results: In the study cohort, sensitization rates to plantain almost doubled from 26.6% in the decade 1998–2007 to 50.5% in 2008–2017. Identical increases were observed for ragweed, while sensitization rates for mugwort stayed largely unchanged. The most prominent increase in positive skin prick tests to plantain and ragweed pollen was mainly observed in younger patients. Further, we identified a trend toward polysensitization, currently dominated by plantain and ragweed. Sensitization to weed pollen was found to be highly associated with additional sensitizations to grass and/or birch pollen. Conclusion: Plantain is currently the best choice to screen rhinitis patients for weed allergy which identifies 86% of all weed-sensitized individuals, at least in Germany. Over the last 20 years, we demonstrate a significant rise in the total number of weed pollen sensitization as well as increases in polysensitization, predominantly in younger patients.

Objectives: In this retrospective analysis, we explored the effect of botulinum toxin A (BTA) injection to treat oropharyngeal dysphagia or esophageal dysfunction caused by diseases of the upper (UES) and lower (LES) esophageal sphincter. Methods: In total, 48 patients (17 patients with UES disorders, and 31 patients with LES dysfunction; mean age 64 years) were treated between 1996 and 2007 in our hospital. Comorbid diseases as well as maintenance medication were documented to evaluate the overall health status of our patients. The mean duration of symptoms, the number of pre-treatments and the specification of dysphagia were considered. Results: One month after injection, the response rates were 73.3% (UES group) and 76.6% (LES group). Most patients in the UES group received 30-40 units BTA (Botox?) whereas most patients in the LES group were treated with 100 units BTA. In cases of re-injection, 50% of patients in the UES group experienced an escalation of dosage (up to 75 units), whereas the other 50% received the same dosage. The dosages in the LES group were mostly kept constant. Conclusion: Comparing the two groups with esophageal dysfunction of fundamentally different etiologies (UES/LES), a discrepancy in the level of symptom relief, onset and a longer cessation of clinical benefit were observed in the LES group. In this analysis, we were able to show that injection of BTA is an effective and safe treatment for disorders of the UES and LES.

The objective of the study was to determine the temporal occurrence of cochlear obliteration following translabyrinthine vestibular schwannoma resection. A retrospective chart review, cross-sectional study, and sequential analysis of the time series were performed. The retrospective study included patients undergoing translabyrinthine resection for stage T1–T2 vestibular schwannoma from 2007 to 2010 without prior therapy and postoperative follow-up including MRI of the brain and the cerebellopontine angle. Already 3 months after surgery a radiographic labyrinthine change was observed in 66.7 %, a partial obstruction in 50 %, and an obstruction limited to the saccule in 16.7 %. Only 33.3 % of the patients showed an unchanged inner ear. In consideration of early cochlear obstruction after translabyrinthine vestibular schwannoma resection, temporary follow-up is necessary. Since the indications for cochlear implantation (CI) have been extended, especially concerning patients with single-side deafness, a simultaneous or early second-stage CI after tumour removal should be discussed.