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The number of patients suffering from a sexually transmitted disease (STD) in Germany is rising steadily. Mostly MSM (men who have sex with men) are affected. We report the case of an HIV-positive patient with syphilis, in whom the implantation of permanent fillers into the buttocks and thighs, for cosmetic purposes, prevented standard therapy of syphilis by intramuscular penicillin administration. According to current guidelines intravenous ceftriaxone (2 g once daily) was administered instead.

Background: The precise mapping of multiple antibody epitopes recognized by patients' sera allows a more detailed and differentiated understanding of immuno-logical diseases. It may lead to the development of novel therapies and diagnostic tools. Objective: Mapping soy bean specific epitopes relevant for soy bean allergy patients and persons sensitized to soy bean, and analysis of their IgE/IgG binding spectrum. Methods: Identification of epitopes using sera, applying an optimized peptide phage display library followed by next‐generation sequencing, specially designed in silico data analysis and subsequent peptide microarray analysis. Results: We were able to identify more than 400 potential epitope motifs in soybean proteins. More than 60% of them have not yet been described as potential epitopes. Eighty‐three peptides, representing the 42 most frequently found epitope candidates, were validated by microarray analysis using 50 sera from people who have been tested positive in skin prick test (SPT). Of these peptides, 56 were bound by antibodies, 55 by serum IgE, 43 by serum IgG and 30 by both. Person‐specific epitope patterns were found for each individual and protein. Conclusions: For individuals with clinical symptoms, epitope resolved analyses reveal a high prevalence of IgE binding to a few soy bean specific epitopes. Evaluation of individual immune profiles of patients with soy bean sensitization allows the identification of peptides that do facilitate studying individual IgE/ IgG epitope binding patterns. This enables discrimination of sensitization from disease, such assay test has the potential to replace SPT assays.

Background: Current guidelines recommend intramuscular administration of epinephrine as the first-line drug for the emergency treatment of severe allergic reactions (anaphylaxis), but no randomized trial evidence supports this consensus. Objective: We aimed to assess anaphylaxis treatment practices over 10 years, covering several European regions, all allergen sources, and all age groups. Methods: The European Anaphylaxis Register tracks elicitors, symptoms, emergency treatment, diagnostic workups, and long-term counseling for anaphylaxis incidents through web-based data entry from tertiary allergy specialists, covering information from the emergency respondent, patient, tertiary referral, and laboratory/clinical test results. Results: We analyzed 10,184 anaphylaxis incidents. In total, 27.1% of patients treated by a health professional received epinephrine and, in total, 10.5% received a second dose. Successful administration was less frequent in German-speaking countries (minimum 19.6%) than in Greece, France, and Spain (maximum 66.7%). Over the last decade, epinephrine administration from a health professional almost doubled to reach 30.6% in 2015-2017, half of which was applied intramuscularly. A total of 14.7% of lay- or self-treated cases were treated with an autoinjector. Of those without treatment, 22.4% carried a device for administration. No change in successful administration by lay emergency respondents was found over the last 10 years. Of the reaction and patient characteristics analyzed, only clinical severity considerably influenced the likelihood of receiving epinephrine, with 66.9% of successful administrations in near-fatal (grade IV) reactions. Conclusions: Despite clear recommendations, only a small proportion of anaphylaxis incidents are treated with epinephrine. We demonstrated a slight increase in treated patients when handled by professionals, but stagnation in lay- or self-treated anaphylaxis. The reaction circumstances, the respondent's professional background, and patient characteristics did not explain which reactions were treated.

S2k-Leitlinie der Deutschen Gesellschaft fur Allergologie und klinische Immunologie (DGAKI) in Zusammenarbeit mit dem Arzteverband Deutscher Allergologen (AeDA), dem Berufsverband der Kinder- und Jugendarzte (BVKJ), dem Deutschen Allergie- und Asthmabund (DAAB), der Deutschen Dermatologischen Gesellschaft (DDG), der Deutschen Gesellschaft fur Ernahrung (DGE), der Deutschen Gesellschaft fur Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS), der Deutschen Gesellschaft fur Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, der Deutschen Gesellschaft fur Kinder- und Jugendmedizin (DGKJ), der Gesellschaft fur Padiatrische Allergologie und Umweltmedizin (GPA), der Deutschen Gesellschaft fur Pneumologie und Beatmungsmedizin (DGP), der Deutschen Gesellschaft fur Gastroenterologie und Ernahrung (GPGE), der Deutschen KontaktallergieGruppe (DKG), der Osterreichischen Gesellschaft fur Allergologie und Immunologie (OGAI), dem BerufsVerband Oecotrophologie e.V. (VDOE) und der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF)

Drug hypersensitivity reactions are unpredictable adverse drug reactions. They manifest either within 1–6 h following drug intake (immediate reactions) with mild to life-threatening symptoms of anaphylaxis, or several hours to days later (delayed reactions), primarily as exanthematous eruptions. It is not always possible to detect involvement of the immune system (allergy). Waiving diagnostic tests can result in severe reactions on renewed exposure on the one hand, and to unjustified treatment restrictions on the other. With this guideline, experts from various specialist societies and institutions have formulated recommendations and an algorithm for the diagnosis of allergies. The key principles of diagnosing allergic/hypersensitivity drug reactions are presented. Where possible, the objective is to perform allergy diagnostics within 4 weeks–6 months following the reaction. A clinical classification of symptoms based on the morphology and time course of the reaction is required in order to plan a diagnostic work-up. In the case of typical symptoms of a drug hypersensitivity reaction and unequivocal findings from validated skin and/or laboratory tests, a reaction can be attributed to a trigger with sufficient confidence. However, skin and laboratory tests are often negative or insufficiently reliable. In such cases, controlled provocation testing is required to clarify drug reactions. This method is reliable and safe when attention is paid to indications and contraindications and performed under appropriate medical supervision. The results of the overall assessment are discussed with the patient and documented in an „allergy passport“ in order to ensure targeted avoidance in the future and allow the use of alternative drugs where possible.

Arzneimitteluberempfindlichkeitsreaktionen 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 spater („Spatreaktionen“) 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 Einschrankung der Therapiemoglichkeiten fuhren. Experten verschiedener Fachgesellschaften und Institutionen haben in dieser Leitlinie Empfehlungen und einen Algorithmus zur Allergiediagnostik erarbeitet. Wesentliche Prinzipien der allergologischen Diagnostik von Uberempfindlichkeitsreaktionen auf Arzneimittel werden dargelegt. Die allergologische Klarung moglichst 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 fur die Planung der Diagnostik notwendig. Bei typischer Symptomatik einer Arzneimitteluberempfindlichkeitsreaktion und eindeutigen Befunden validierter Haut- und/oder Labortests kann die Zuordnung zu einem Ausloser als ausreichend angesehen werden. Haufig sind jedoch Haut- und Labortests negativ oder nicht sicher aussagekraftig. In diesen Fallen ist eine kontrollierte Provokationstestung zur Aufklarung der Reaktion erforderlich. Bei Beachtung von Indikationen und Kontraindikationen sowie angemessener arztlicher Uberwachung ist sie eine aussagekraftige und sichere Methode. Das Ergebnis der Gesamtbeurteilung wird mit dem Patienten besprochen und in einem Allergiepass dokumentiert, sodass zukunftig eine gezielte Karenz eingehalten werden kann und gegebenenfalls Ausweichmedikamente zur Verfugung stehen.

Background Aluminium tubes for pharmaceutical use are internally lacquered with epoxy resins (ER) based on bisphenol A diglycidyl ether (BADGE). Recently, it was shown that remnants of ER polymerization like BADGE are extractable from epoxy-based coatings of commercially available tubes and may leach into semi-solid drug preparations. We aimed to evaluate the safety of BADGE-contaminated macrogol ointments in individuals sensitized to ER based on BADGE by use tests. Methods Repeated open application testing (ROAT) in 11 patients sensitized to ER based on BADGE with BADGE in macrogol ointments (3 mg/kg; 30 mg/kg, equivalent to BADGE concentration determined in macrogol ointment after storage in a commercially available tube; 300 mg/kg). Results The 30 mg/kg BADGE ointment elicited reactions in three patients, and another three patients reacted to 300 mg/kg BADGE ointment. No reactions to the vehicle control and 3 mg/kg BADGE were observed. Conclusions Elevated BADGE concentrations in ER-coated aluminium tubes pose a risk of developing contact dermatitis to patients sensitized to ER based on BADGE. Quality standards are deemed necessary for the production of ER-coated aluminium tubes intended for pharmaceutical use and should consider the results of the present ROAT study.

Background Omalizumab, a recombinant anti-IgE antibody, effectively treats chronic spontaneous urticaria. Evidence is lacking in patients with chronic inducible urticarias (CIndUs), which are frequently H 1 -antihistamine resistant. Objective From the current published literature, we aimed to determine the strength of evidence for omalizumab efficacy and safety in the treatment of CIndUs. Methods We performed a PubMed search to identify evidence on omalizumab use in the following 9 CIndU subtypes: symptomatic dermographism, cold urticaria, delayed-pressure urticaria, solar urticaria, heat urticaria, vibratory angioedema, cholinergic urticaria, contact urticaria, and aquagenic urticaria. Results Forty-three trials, case studies, case reports, and analyses were identified. Our review indicates that omalizumab has substantial benefits in patients with various CIndUs. The evidence is strongest for symptomatic dermographism, cold urticaria, and solar urticaria. Little/no evidence was available on vibratory angioedema and aquagenic and contact urticaria. Our review supports rapid onset of action demonstrated through early symptom control in most cases, sometimes within 24 hours. Many patients gained complete/partial symptom relief and substantially improved quality of life. Adverse events were generally low, with omalizumab being well tolerated by most patients, including children. Conclusions A strong body of evidence supports the use of omalizumab in the treatment of patients with therapy-refractory CIndU. More data from randomized controlled studies are warranted.

Zusammenfassung Der demographische Wandel in unserer Gesellschaft fuhrt zu einer Zunahme des Anteils alter Menschen. Die mit dem Alter einhergehende Multimorbiditat resultiert haufig in einer Polypharmakotherapie, die das Risiko fur unerwunschte Arzneimittelwirkungen birgt. Im Alter kommt es zu entscheidenden Veranderungen der Pharmakokinetik und -dynamik, allen voran einer Abnahme des Korperwassers, einem veranderten Verhaltnis von Muskel- zu Fettgewebe und einer reduzierten Nierenfunktion. Zudem konnten Veranderungen der Magen-Darm-Passage, der Plasmaproteinbindung, der hepatischen Metabolisierung und eine erhohte Anfalligkeit fur Medikamenten-induzierte kognitive Storungen nachgewiesen werden. All dies muss bei der dermatologischen Pharmakotherapie im Alter berucksichtigt werden, um iatrogene Komplikationen durch Uber- oder Unterdosierung und Arzneimittelinteraktionen zu minimieren.

Summary Demographic changes in our society will lead to an increasing proportion of elderly people. Age-associated multimorbidity often results in polypharmacy and elevates the risk of adverse drug reactions. Decisive alterations in pharmacokinetics and pharmacodynamics are detectable in old age, primarily a decrease in total body water, an altered ratio of muscle mass to fatty tissue, and decreased renal function. Changes in gastrointestinal transit, plasma protein binding, hepatic drug metabolism, and an increased susceptibility to drug-induced cognitive decompensation have also been reported. All these alterations should be considered in geriatric dermatotherapy to minimize drug-related complications caused by over- or underdosage and drug interactions.

A large proportion of immunoglobulin E (IgE)-mediated food allergies in older children, adolescents and adults are caused by cross-reactive allergenic structures. Primary sensitization is most commonly to inhalant allergens (e.g. Bet v 1, the major birch pollen allergen). IgE can be activated by various cross-reactive allergens and lead to a variety of clinical manifestations. In general, local and mild — in rare cases also severe and systemic — reactions occur directly after consumption of the food containing the cross-reactive allergen (e. g. plant-derived foods containing proteins of the Bet v 1 family). In clinical practice, sensitization to the primary responsible inhalant and/or food allergen can be detected by skin prick tests and/or in vitro detection of specific IgE. Component-based diagnostic methods can support clinical diagnosis. For individual allergens, these methods may be helpful to estimate the risk of systemic reactions. Confirmation of sensitization by oral provocation testing is important particulary in the case of unclear case history. New, as yet unrecognized allergens can also cause cross-reactions. The therapeutic potential of specific immunotherapy (SIT) with inhalant allergens and their effect on pollen-associated food allergies is currently unclear: results vary and placebo-controlled trials will be necessary in the future. Pollen allergies are very common. Altogether allergic sensitization to pollen and cross-reactive food allergens are very common in our latitudes. The actual relevance has to be assessed on an individual basis using the clinical information. Cite this as Worm M, Jappe U, Kleine-Tebbe J, Schafer C, Reese I, Saloga J, Treudler R, Zuberbier T, Wassmann A, Fuchs T, Dolle S, Raithel M, Ballmer-Weber B, Niggemann B, Werfel T. Food allergies resulting from immunological cross-reactivity with inhalant allergens. Allergo J Int 2014; 23: 1–16 DOI 10.1007/s40629-014-0004-6

Bei alteren Kindern, Jugendlichen und Erwachsenen wird ein groser Teil Immunglobulin-E(IgE)-vermittelter Nahrungsmittelallergien durch kreuzreaktive allergene Strukturen ausgelost. Die primare Sensibilisierung ist vorrangig gegen Inhalationsallergene gerichtet (z. B. Bet v 1 als Hauptallergen der Birkenpollen). IgE kann uber verschiedene kreuzreaktive Allergene aktiviert werden und zu unterschiedlichen klinischen Manifestationen fuhren. In der Regel treten lokale und milde, selten auch schwere systemische Reaktionen direkt nach Verzehr des Nahrungsmittels auf, welches das kreuzreaktive Allergen enthalt (z. B. pflanzliche Nahrungsmittel mit Proteinanteil aus der Bet-v-1-Familie). In der klinischen Praxis konnen Sensibilisierungen gegen die primar verantwortlichen Inhalations- und/oder Nahrungsmittelallergene mit dem Pricktest und/oder der Bestimmung von spezifischem IgE in vitro erfasst werden. Die komponentenbasierte Diagnostik kann die klinische Diagnostik unterstutzen. Fur einzelne Allergene ermoglicht sie eine Risikoabschatzung fur das Auftreten systemischer Reaktionen. Sensibilisierungen mussen insbesondere bei unklarer Anamnese durch orale Provokationstests bestatigt werden. Auch neue, bisher unerkannte Allergene konnen Kreuzreaktionen hervorrufen. Das therapeutische Potenzial der spezifischen Immuntherapie mit inhalativen Allergenen und deren Wirkung auf die pollenassoziierte Nahrungsmittelallergie ist im klinischen Alltag variabel und letztlich nicht geklart. Placebokontrollierte Studien sind zukunftig erforderlich. Insgesamt treten allergische Sensibilisierungen gegen Pollen- und kreuzreaktive Nahrungsmittelallergene in unseren Breiten sehr haufig auf. Ihre aktuelle Relevanz ist mit Hilfe der klinischen Angaben individuell zu ermitteln.

Background Conflicting results exist on the effect of allergen immunotherapy (AIT) on pollen-related food allergy. We aimed to investigate the efficacy of one-year AIT with the folding variant (FV) of recombinant (r) Bet v 1 on birch-related soya allergy. Methods Of 138 subjects with Bet v 1 sensitization, 82 were positive at double-blind placebo-controlled food challenge (DBPCFC) with soya. A total of 56 of 82 were randomized in the ratio of 2:1 (active: placebo). Per-protocol population (PPP) had received ≥150 μg of allergen or placebo preparation. Outcome measures: lowest observed adverse effect levels (LOAEL), postinterventional occurrence of objective signs (objS) at any dose level, sIgE/IgG4 against Bet v 1 and Gly m 4. Between-group changes were investigated (ancova, Mann–Whitney U-test, Fisher exact test). Results Baseline characteristics including LOAELs were comparable in both groups with objS and subjS occurring in 82% and 95% of active (n = 38) vs 78% and 83% of placebo group (n = 18). After AIT, objS occurred in 24% and 47%, respectively. LOAEL group differences showed a beneficial tendency (P = 0.081) for LOAELobjective in PPP (30 active, 15 placebo). sIgG4 raised only in active group (Bet v 1: P = 0.054, Gly m 4: P = 0.037), and no relevant changes occurred for sIgE. Only 56% of the intended sample size was recruited. Conclusion For the first time, we present data on the effect of rBet v 1-FV on birch-related soya allergy. rBet v 1-FV AIT induced significant immunogenic effects. Clinical assessment showed a tendency in favour of the active group but did not reach statistical significance.

Hintergrund Aufgrund von anamnestisch angegebenen unerwunschten Arzneimittelwirkungen (UAW) werden bei Patienten Expositionstestungen zur Identifikation von Ausweichpraparaten vorgenommen. In der Untersuchung wurde der Frage nachgegangen, ob psychosomatische Faktoren in Sinne einer erhohten psychovegetativen Labilitat bei Patienten mit UAW gehauft auftreten.

BACKGROUND Patients with chronic leg ulcers typically experience contact allergy to topical treatments. Although declared as hypoallergenic, modern wound dressings have caused several reported cases of contact allergy. OBJECTIVE The aim of the study was to evaluate any allergenic potential of modern wound dressings in patients with leg ulcers. METHODS Seventy-one patients were included in our prospective observation. Patch tests were performed with a selection of 10 modern wound dressings and with selected allergens according to series of the German Contact Dermatitis Research Group (DKG). RESULTS Of 70 patients eligible for evaluation, 12 (17%) were positive for the hydrogel NuGel, followed by the hydrocolloid NuDerm (n = 7/70, 10%) and the ionic silver-containing wound dressing Aquacel Ag and the gauze Adaptic (both n = 4/70, 5%). Patients with recalcitrant ulcers of prolonged duration showed a significant higher number of epicutaneous sensitizations to wound dressings than patients with shorter ulcer duration. CONCLUSIONS The allergenic potential of modern wound dressings should not be underestimated. There is need for precise declaration of all ingredients.

Detailed IgE-binding epitope analysis is a key requirement for the understanding and development of diagnostic and therapeutic agents to address food allergies. An IgE-specific linear peptide microarray with random phage peptide display for the high-resolution mapping of IgE-binding epitopes of the major soybean allergen Gly m 4, which is a homologue to the birch pollen allergen Bet v 1 is combined. Three epitopes are identified and mapped to a resolution of four key amino acids, allowing the rational design and the production of three Gly m 4 mutants with the aim to abolish or reduce the binding of epitope-specific IgE. In ELISA, the binding of the mutant allergens to polyclonal rabbit-anti Gly m 4 serum as well as IgE purified from Gly m 4-reactive soybean allergy patient sera is reduced by up to 63% compared to the wild-type allergen. Basophil stimulation experiments using RBL-SX38 cells loaded with patient IgE are showed a decreased stimulation from 25% for the wild-type Gly m 4 to 13% for one mutant. The presented approach demonstrates the feasibility of precise mapping of allergy-related IgE-binding epitopes, allowing the rational design of less allergenic mutants as potential therapeutic agents.

Background: Data on the long-term outcome of children after specific venom immunotherapy (VIT) are limited. Therefore, we assessed sting recurrence and anaphylaxis relapse rates as well as adherence to anaphylaxis guidelines with regard to the availability of emergency equipment and education status. Methods: For this long-term survey, data of 311 children with a history of anaphylactic reactions to hymenoptera stings were collected by chart review. We included patients who were treated with a 3-year VIT between 1993 and 2009 and had completed a questionnaire. Results: Forty of the 311 patients were included. Mean VIT duration was 3.1 years. Of the 40 patients included, 29 children (72.5%) received VIT with vespid venom, 9 with bee venom, and 2 patients with both venoms. During a mean follow-up period of 13 years, 20/40 patients (50%) suffered re-stings. Six of the 20 (30%) patients developed again anaphylactic symptoms (grade 1 n = 5, grade 3 n = 1); 2 were allergic to vespid and 4 to bee venom. Of the entire cohort, only 5/40 (12.5%) had appropriate emergency kits according to the guidelines of the European Academy of Allergy and Clinical Immunology. Among the patients who had emergency kits available, one third (5/15) felt uncertain about the correct application of the medication. Less than two thirds of our population (25/40) affirmed that they have been educated in emergency management. The vast majority (95%; 38/40) of our patients did not have allergy follow-ups after VIT completion. Conclusions: Anaphylactic relapses are not uncommon, and there are considerable deficits in the emergency management of patients. Hence, comprehensive standardized anaphylaxis education programs as well as regular follow-ups of the allergy status are crucial.

cope : The BASALIT clinical trial (EudraCT 2009-011737-27) investigated efficacy of birch allergen immunotherapy on lowest observed adverse effect levels (LOAEL) after soy food challenge in patients with birch-associated and Gly m 4 allergen-mediated soy allergy. Thus, consistently stable Gly m 4 levels were required in standardised challenge meals. Methods and results : Soy meal included soy protein isolate (SPI, 88% total protein). A Gly m 4-specific ELISA was developed and validated. 6 SPI and 24 meal batches were analysed for Gly m 4. (Repeated-measures) analyses of variance were done to identify potential changes between batches/ in time. Gly m 4 was below the ELISA detection limit (2 ng/ml) in placebo batches. With

Background Birch pollen-related soy allergy is mediated by Gly m 4. Conformational IgE epitopes of Gly m 4 are unknown. Objective To identify the IgE epitope profile of Gly m 4 in subjects with birch pollen-related soy allergy utilizing an epitope library presented by Gly m 4-type model proteins. Methods Sera from patients with (n = 26) and without (n = 19) allergy to soy as determined by oral provocation tests were studied. Specific IgE (Bet v 1/Gly m 4) was determined by ImmunoCAP. A library of 59 non-allergenic Gly m 4-type model proteins harboring individual and multiple putative epitopes for IgE was tested in IgE binding assays. Primary, secondary, and tertiary protein structures were assessed by mass spectrometry, CD and NMR spectroscopy. Results All subjects were sensitized to Gly m 4 and Bet v 1. Allergen-specific serum IgE levels ranged from 0.94 to >100 kUA/L. The avidities of serum IgE were 5.06 ng (allergic) and 1.8 ng (tolerant) as determined by EC50 for IgE binding to Gly m 4. 96% (46/48) of the protein variants bound IgE. Model proteins had Gly m 4-type conformation and individual IgE binding clustered in six major surface areas. Gly m 4-specific IgE binding could be inhibited to up to 80% by model proteins harboring individual IgE binding sites in an epitope-wise equimolar fashion. ROC analysis revealed an AUC of up to 0.88 for model proteins and 0.66 for Gly m 4. Conclusion and Clinical Relevance Serum levels and avidity of Gly m 4-specific IgE do not correlate with clinical reactivity to soy. Six IgE binding areas, represented by 23 amino acids, account for more than 80% of total IgE binding capacity of Gly m 4. Model proteins may be used for epitope-resolved diagnosis to differentiate birch-soy allergy from clinical tolerance. This article is protected by copyright. All rights reserved.

Background: Multicentre trials investigating food allergies by double blind placebo controlled food challenges (DBPCFC) need standardized procedures, challenge meals and evaluation criteria. We aimed at developing a standardized approach for identifying patients with birch related soy allergy by means of DBPCFC to soy, including determination of threshold levels, in a multicentre setting. Methods: Microbiologically stable soy challenge meals were composed of protein isolate with consistent Gly m 4 levels. Patients sensitized to main birch allergen Bet v 1 and concomitant sensitization to its soy homologue Gly m 4 underwent DBPCFC. Outcome was defined according to presence and/or absence of ten objective signs and intensity of eight subjective symptoms as measured by visual analogue scale (VAS). Results: 138 adult subjects (63.8% female, mean age 38 years) underwent DBPCFC. Challenge meals and defined evaluation criteria showed good applicability in all centres involved. 45.7% presented with objective signs and 65.2% with subjective symptoms at soy challenge. Placebo challenge meals elicited non-cardiovascular objective signs in 11.6%. In 82 (59.4%) subjects DBPCFC was judged as positive. 70.7% of DPBCFC+ showed objective signs and 85.4% subjective symptoms at soy challenge. Subjective symptoms to soy challenge meal in DBPCFC+ subjects started at significantly lower dose levels than objective signs (p

A 68-year-old woman presented with unilateral herpetiform skin lesions of the face. She also showed reduced eye lid and mimic function as well as hearing loss. In addition grouped vesicles were seen in the outer ear canal. We diagnosed Ramsay Hunt syndrome and administered intravenous acyclovir, prednisolone and pentoxifylline. Within a few weeks, there was complete remission including the neurological symptoms.

Zusammenfassung Hintergrund: Birkenpollenallergiker leiden oft unter Nahrungsmittelallergien in Form eines oralen Allergiesyndroms beim Verzehr von Kern- und Steinobst. Diese Beschwerden beruhen auf einer immunologischen Kreuzreaktion zwischen Pollen- und Nahrungsmittelallergenen. In den letzten Jahren konnte gezeigt werden, dass auch proteinreiche Sojaprodukte von vielen Birkenpollenallergikern nicht vertragen werden können. Dabei sind zum Teil sehr schwere anaphylaktische Symptome beschrieben worden. Als Ursache dieser Soforttypreaktionen auf Soja wurde ein mit dem Hauptallergen der Birke, dem Bet v 1, kreuzreagierendes Sojaallergen mit dem Namen Gly m 4 identifiziert. Methoden: Am Beispiel eines Kollektives von 73 Leipziger Birkenpollenallergikern mit begleitender Nahrungsmittelallergie werden Ergebnisse einer Patientenbefragung, eines Prick-zu-Prick-Tests mit Sojadrink, der Bestimmung von spezifischem IgE gegen Gly m 4 und des Basophilenstimulationstests mit Gly m 4 vorgestellt. Ergebnisse und Schlussfolgerungen: Wir konnten zeigen, dass sich kommerziell erhältliche Prick-Test-Extrakte sowie die Bestimmung von spezifischem IgE gegen Sojabohnenmix/f14 nicht zur Diagnostik der pollenassoziierten Sojaallergie eignen. Deutlich häufiger kann durch einen Prick-zu-Prick-Test mit Sojadrink und die Bestimmung von spezifischem IgE gegen rGly m 4 eine Sojaensibilisierung nachgewiesen werden. So reagierten 79% (55/70) der eingeschlossenen Birkenpollenallergiker positiv im Prick-zu-Prick-Test mit Sojadrink und 89% (65/73) zeigten spezifisches IgE gegen rGly m 4 (CAP-Klasse>1). Obwohl nicht jede Sensibilisierung klinisch relevant zu sein scheint, konnte dennoch bei jedem dritten Patienten mit einer nachgewiesenen Sojasensibilisierung eine klinisch relevante Sojaallergie diagnostiziert werden.

In den letzten Jahren wurden vermehrt allergische Reaktionen beim Verzehr von Sojaprodukten beobachtet. Aufgrund einer Kreuzreaktion zwischen dem Birkenpollenallergen Bet v 1 und dem Sojaallergen Gly m 4 haben Birkenpollenallergiker ein besonderes Risiko, eine Sojaallergie zu entwickeln. Schwere klinische Reaktionen auf Soja wurden auch mit Sensibilisierungen auf die Sojaspeicherproteine Gly m 5 und Gly m 6 assoziiert. Eine Allergenkarenz sollte insbesondere eiweisreiche, nicht fermentierte Produkte (z. B. Getranke) betreffen. Studien zum Einsatz einer spezifischen Immuntherapie (SIT) gegen das kreuzreagierende Birkenpollenallergen bei der birkenassoziierten Nahrungsmittelallergie (NMA) wurden bisher nun in Hinblick auf die Apfel- und die Haselnussallergie durchgefuhrt. Nur ein Teil der Studien konnte eine Wirksamkeit der SIT auf die pollenassoziierte NMA zeigen. Diese Resultate werden kritisch im Hinblick auf die Fallzahl, das Studiendesign und die verwendeten Prufpraparate diskutiert. Der Einsatz einer SIT mit 80 µg der gefalteten Variante (FV) des rekombinanten Bet v 1 bei der birkenassoziierten Sojaallergie ist Gegenstand einer aktuellen Multicenterstudie (BASALIT).