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In the past 10 years, IgE-mediated allergy to natural rubber latex has become a significant health problem in industrialized countries, especially among health care workers, patients with congenital malformations, and children with a history of multiple surgical interventions. Curative treatment inducing immunological tolerance in formerly sensitized patients is experimental and not yet generally available. Therefore, it is important to be aware of the seriousness of latex allergy and to understand the risk factors leading to this allergy. Preventive measures are needed to decrease the incidence of natural rubber latex sensitization. This article gives a brief review of the current state of knowledge concerning latex allergy, including a definition of latex, epidemiological data, identified allergens, the clinical spectrum, diagnostic procedures, cross-reactions, preventive measures, the legislative background, and economics. Arch Intern Med. 2001;161:105 7-1064

The phase IIIb, randomized, parallel-group, placebo-controlled ANDHI double-blind (DB) study extended understanding of the efficacy of benralizumab for patients with severe eosinophilic asthma. Patients from ANDHI DB could join the 56-week ANDHI in Practice(IP) single-arm, open-label extension substudy.

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Arzneimittelüberempfindlichkeitsreaktionen sind unvorhersehbare, durch Arzneimittel hervorgerufene Reaktionen. Sie manifestieren sich entweder innerhalb von ein bis sechs Stunden nach Arzneimittelzufuhr („Sofortreaktionen“) mit geringgradigen bis lebensbedrohlichen Symptomen der Anaphylaxie oder mehrere Stunden bis Tage später („Spätreaktionen“) vorwiegend als Exantheme. Eine Beteiligung des Immunsystems (Allergie) ist nicht immer nachweisbar. Der Verzicht auf eine Diagnostik kann einerseits schwere Reaktionen bei erneuter Exposition zur Folge haben, andererseits zu ungerechtfertigter Einschränkung der Therapiemöglichkeiten führen. Experten verschiedener Fachgesellschaften und Institutionen haben in dieser Leitlinie Empfehlungen und einen Algorithmus zur Allergiediagnostik erarbeitet. Wesentliche Prinzipien der allergologischen Diagnostik von Überempfindlichkeitsreaktionen auf Arzneimittel werden dargelegt. Die allergologische Klärung möglichst innerhalb von vier Wochen bis sechs Monaten nach der Reaktion ist anzustreben. Eine klinische Zuordnung des Krankheitsbildes anhand von Morphologie und Zeitablauf der Reaktion ist für die Planung der Diagnostik notwendig. Bei typischer Symptomatik einer Arzneimittelüberempfindlichkeitsreaktion und eindeutigen Befunden validierter Haut- und/oder Labortests kann die Zuordnung zu einem Auslöser als ausreichend angesehen werden. Häufig sind jedoch Haut- und Labortests negativ oder nicht sicher aussagekräftig. In diesen Fällen ist eine kontrollierte Provokationstestung zur Aufklärung der Reaktion erforderlich. Bei Beachtung von Indikationen und Kontraindikationen sowie angemessener ärztlicher Überwachung ist sie eine aussagekräftige und sichere Methode. Das Ergebnis der Gesamtbeurteilung wird mit dem Patienten besprochen und in einem Allergiepass dokumentiert, sodass zukünftig eine gezielte Karenz eingehalten werden kann und gegebenenfalls Ausweichmedikamente zur Verfügung stehen.

Insect venom allergy is an important cause of anaphylaxis. Venom immunotherapy assume the clear identification of the culprit insect, but this is impeded by Immunoglobulin E (IgE) antibodies to cross reactive carbohydrate determinant (CCD) epitopes of common glycoproteins. Here we give an overview about inducers, importance, and relevance of anti-N-Glycan CCD IgE antibodies.

Objective:The usual build-up phase of days or weeks in allergen-specific immunotherapy entails inconveniences for individuals with symptoms only during the pollen season. Additionally, affected individuals often appear for treatment shortly before the expected start of the season without enough time for titration. This double-blind, placebo-controlled study evaluated the safety of ultra-rush grass pollen immunotherapy with sublingual drops (Staloral)® in co-seasonal treatment over three consecutive seasons.Methods:209 patients with grass pollen allergic rhinitis received ultra-rush titration (30, 90, 150 and 300 index of reactivity (IR)) of a five grass pollen mixture or placebo every 20 min at the start of the season, followed by 300 IR daily or placebo until the end of the respective season for three consecutive years. Adverse events were documented.Results:Mean treatment duration varied between seasons (81.8 − 92.7 days). No systemic or anaphylactic reactions were reported and no unexpected adverse events were observed. Adverse events included application site irritation, oedema, abdominal pain and diarrhoea. Fourteen patients discontinued treatment due to adverse events (placebo: four (6%) patients, verum: ten (7%) patients). Adverse events decreased in frequency over each consecutive year of treatment.Conclusion:Seasonal sublingual immunotherapy with ultra-rush titration is well tolerated even when administered as co-seasonal treatment. It may be a valuable option for patients who present late.

Specific immunotherapy is the only potentially curative treatment in patients with allergic rhinitis and allergic asthma. Health economic evaluations on this treatment, particularly in a German context, are sparse.

Abstract: The prevalence of IgE mediated natural latex rubber allergy is estimated to be<1% in the general population,<17% in medical personnel and ≈0% in children with spina bifida. We review the definition, diagnosis, prevention, and treatment of NLR allergy.

Background:Insect venom immunotherapy (VIT) is initiated by a dose increase protocol administered usually over 7 to 9 days. Shorter protocols have the advantage of reducing the patient’s stay in the hospital. Very few data are currently available on the safety of shorter VIT dose increase protocols. Objective:The aim of this study was to investigate whether a reduction in the duration of the VIT dose increase protocol from 7 to 9 days to 2 days causes an increase in the incidence and severity of adverse reactions. Methods:Between 1992 and 1997 we administered VIT to 1055 patients allergic to bee or wasp venom. We shortened the 7- to 9-day rush protocol stepwise to 2 days by reducing the number of injections and increasing the initial dose and compared the incidence and severity of adverse reactions. The patients were retrospectively divided into 3 cohorts: 20 injections over 7 to 9 days (cohort 1, 317 patients), 10 to 14 injections over 3 to 6 days (cohort 2, 335 patients), and 9 injections over 2 days (cohort 3, 403 patients). Results:We observed no severe adverse reactions in any of the cohorts during VIT. Adverse reactions were treated in 7.1% of the patients by oral and in 2.9% by intravenous antihistamines and in 0.8% by systemic corticosteroids. The incidence of adverse reactions declined significantly from 22.4% in cohort 1 to 13.7% in cohort 2 and 10.7% in cohort 3 with reduced number of injections (P< .001). Conclusion:The incidence and severity of adverse reactions decline if the VIT dose increase protocol is shortened to 2 days. (J Allergy Clin Immunol 2000;105:1231-5.)

Specific antisera against three mammalian β-galactoside-specific lectins of apparent molecular weights 14.5 kDa, 18 kDa and 29 kDa have been used to localize these lectins in normal breast, and in benign and malignant mammary lesions. In normal breast tissue discrete localization of two lectins (Mrs 14.5 kDa and 18 kDa) was demonstrated in fibroblasts, smooth muscle cells, myoepithelial cells and capillary endothelium. Extracellular localization of one lectin (Mr14.5 kDa) in collagen was apparent. The third lectin (Mr29 kDa) labelled preferentially luminal cells and their secretory product. Two benign tumours (an analyzed fibroadenoma and a papilloma) revealed strong staining with two lectins (Mrs 18 kDa and 29 kDa). Of the 24 mammary carcinomas examined, the lectin (Mr14.5 kDa) was expressed by only occasional tumour cells, the lectin (Mr18 kDa) occurred in many tumour cells and the lectin (Mr29 kDa) labelled tumour cells in nearly all cases. The expression of these β-galactoside-specific endogenous lectins therefore appears to be regulated differently in normal breast compared with mammary tumours.