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5. Contributors

Author

Akdis, Cezmi A., primary, Akdis, Mübeccel, additional, Baroody, Fuad M., additional, Boguniewicz, Mark, additional, Brown, Simon G.A., additional, Burks, A. Wesley, additional, Chiriac, Anca-Mirela, additional, Corren, Jonathan, additional, Custovic, Adnan, additional, Demoly, Pascal, additional, Fonacier, Luz, additional, Golden, David B.K., additional, Grattan, Clive E.H., additional, Hausmann, Oliver V., additional, Khurana Hershey, Gurjit K., additional, Holgate, Stephen T., additional, Joerg, Lukas, additional, Lemière, Catherine, additional, Leung, Donald Y.M., additional, Mersha, Tesfaye B., additional, Nowak-Węgrzyn, Anna, additional, O'Hehir, Robyn E., additional, Robinson, Clive, additional, Sahiner, Umit, additional, Saini, Sarbjit S., additional, Sampson, Hugh A., additional, Sheikh, Aziz, additional, Sherenian, Michael G., additional, Smith, Helen E., additional, Stewart, Geoffrey A., additional, Suojalehto, Hille, additional, and Turner, Paul J., additional

Published
2022
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6. Spatial proteomics identifies JAKi as treatment for a lethal skin disease

Author

Nordmann, Thierry M., Anderton, Holly, Hasegawa, Akito, Schweizer, Lisa, Zhang, Peng, Stadler, Pia-Charlotte, Sinha, Ankit, Metousis, Andreas, Rosenberger, Florian A., Zwiebel, Maximilian, Satoh, Takashi K., Anzengruber, Florian, Strauss, Maximilian T., Tanzer, Maria C., Saito, Yuki, Gong, Ting, Thielert, Marvin, Kimura, Haruna, Silke, Natasha, Rodriguez, Edwin H., Restivo, Gaetana, Nguyen, Hong Ha, Gross, Annette, Feldmeyer, Laurence, Joerg, Lukas, Levesque, Mitchell P., Murray, Peter J., Ingen-Housz-Oro, Saskia, Mund, Andreas, Abe, Riichiro, Silke, John, Ji, Chao, French, Lars E., and Mann, Matthias

Abstract

Toxic epidermal necrolysis (TEN) is a fatal drug-induced skin reaction triggered by common medications and is an emerging public health issue1–3. Patients with TEN undergo severe and sudden epidermal detachment caused by keratinocyte cell death. Although molecular mechanisms that drive keratinocyte cell death have been proposed, the main drivers remain unknown, and there is no effective therapy for TEN4–6. Here, to systematically map molecular changes that are associated with TEN and identify potential druggable targets, we utilized deep visual proteomics, which provides single-cell-based, cell-type-resolution proteomics7,8. We analysed formalin-fixed, paraffin-embedded archived skin tissue biopsies of three types of cutaneous drug reactions with varying severity and quantified more than 5,000 proteins in keratinocytes and skin-infiltrating immune cells. This revealed a marked enrichment of type I and type II interferon signatures in the immune cell and keratinocyte compartment of patients with TEN, as well as phosphorylated STAT1 activation. Targeted inhibition with the pan-JAK inhibitor tofacitinib in vitro reduced keratinocyte-directed cytotoxicity. In vivo oral administration of tofacitinib, baricitinib or the JAK1-specific inhibitors abrocitinib or upadacitinib ameliorated clinical and histological disease severity in two distinct mouse models of TEN. Crucially, treatment with JAK inhibitors (JAKi) was safe and associated with rapid cutaneous re-epithelialization and recovery in seven patients with TEN. This study uncovers the JAK/STAT and interferon signalling pathways as key pathogenic drivers of TEN and demonstrates the potential of targeted JAKi as a curative therapy.

Published
2024
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7. Allergies and COVID-19 vaccines : An ENDA/EAACI Position paper

Author

Barbaud, Annick, Garvey, Lene Heise, Arcolaci, Alessandra, Brockow, Knut, Mori, Francesca, Mayorga, Cristobalina, Bonadonna, Patrizia, Atanaskovic-Markovic, Marina, Moral, Luis, Zanoni, Giovanna, Pagani, Mauro, Soria, Angele, Jost, Maja, Caubet, Jean-Christoph, Carmo, Abreu, Mona, Al-Ahmad, Alvarez-Perea, Alberto, Bavbek, Sevim, Benedetta, Biagioni, Bilo, M. Beatrice, Blanca-Lopez, Natalia, Bogas, Herrera Gador, Buonomo, Alessandro, Calogiuri, Gianfranco, Carli, Giulia, Cernadas, Josefina, Cortellini, Gabriele, Celik, Gulfem, Demir, Semra, Dona, Inmaculada, Dursun, Adile Berna, Eberlein, Bernadette, Faria, Emilia, Fernandes, Bryan, Garcez, Tomaz, Garcia-Nunez, Ignacio, Gawlik, Radoslaw, Gelincik, Asli, Gomes, Eva, Gooi, Jimmy H. C., Grosber, Martine, Gulen, Theo, Hacard, Florence, Hoarau, Cyrille, Janson, Christer, Johnston, Sebastian L., Joerg, Lukas, Ozdemir, Secil Kepil, Klimek, Ludger, Kosnik, Mitja, Kowalski, Marek L., Kuyucu, Semanur, Kvedariene, Violeta, Laguna, Jose Julio, Lombardo, Carla, Marinho, Susana, Merk, Hans, Meucci, Elisa, Morisset, Martine, Munoz-Cano, Rosa, Murzilli, Francesco, Nakonechna, Alla, Popescu, Florin-Dan, Porebski, Grzegorz, Radice, Anna, Regateiro, Frederico S., Rockmann, Heike, Romano, Antonino, Sargur, Ravishankar, Sastre, Joaquin, Hofmeier, Kathrin Scherer, Sedlackova, Lenka, Sobotkova, Marta, Terreehorst, Ingrid, Treudler, Regina, Walusiak-Skorupa, Jolanta, Wedi, Bettina, Wohrl, Stefan, Zidarn, Mihael, Zuberbier, Torsten, Agache, Ioana, Torres, Maria J., Barbaud, Annick, Garvey, Lene Heise, Arcolaci, Alessandra, Brockow, Knut, Mori, Francesca, Mayorga, Cristobalina, Bonadonna, Patrizia, Atanaskovic-Markovic, Marina, Moral, Luis, Zanoni, Giovanna, Pagani, Mauro, Soria, Angele, Jost, Maja, Caubet, Jean-Christoph, Carmo, Abreu, Mona, Al-Ahmad, Alvarez-Perea, Alberto, Bavbek, Sevim, Benedetta, Biagioni, Bilo, M. Beatrice, Blanca-Lopez, Natalia, Bogas, Herrera Gador, Buonomo, Alessandro, Calogiuri, Gianfranco, Carli, Giulia, Cernadas, Josefina, Cortellini, Gabriele, Celik, Gulfem, Demir, Semra, Dona, Inmaculada, Dursun, Adile Berna, Eberlein, Bernadette, Faria, Emilia, Fernandes, Bryan, Garcez, Tomaz, Garcia-Nunez, Ignacio, Gawlik, Radoslaw, Gelincik, Asli, Gomes, Eva, Gooi, Jimmy H. C., Grosber, Martine, Gulen, Theo, Hacard, Florence, Hoarau, Cyrille, Janson, Christer, Johnston, Sebastian L., Joerg, Lukas, Ozdemir, Secil Kepil, Klimek, Ludger, Kosnik, Mitja, Kowalski, Marek L., Kuyucu, Semanur, Kvedariene, Violeta, Laguna, Jose Julio, Lombardo, Carla, Marinho, Susana, Merk, Hans, Meucci, Elisa, Morisset, Martine, Munoz-Cano, Rosa, Murzilli, Francesco, Nakonechna, Alla, Popescu, Florin-Dan, Porebski, Grzegorz, Radice, Anna, Regateiro, Frederico S., Rockmann, Heike, Romano, Antonino, Sargur, Ravishankar, Sastre, Joaquin, Hofmeier, Kathrin Scherer, Sedlackova, Lenka, Sobotkova, Marta, Terreehorst, Ingrid, Treudler, Regina, Walusiak-Skorupa, Jolanta, Wedi, Bettina, Wohrl, Stefan, Zidarn, Mihael, Zuberbier, Torsten, Agache, Ioana, and Torres, Maria J.

Abstract

Background Anaphylaxis, which is rare, has been reported after COVID-19 vaccination, but its management is not standardized. Method Members of the European Network for Drug Allergy and the European Academy of Allergy and Clinical Immunology interested in drug allergy participated in an online questionnaire on pre-vaccination screening and management of allergic reactions to COVID-19 vaccines, and literature was analysed. Results No death due to anaphylaxis to COVID-19 vaccines has been confirmed in scientific literature. Potential allergens, polyethylene glycol (PEG), polysorbate and tromethamine are excipients. The authors propose allergy evaluation of persons with the following histories: 1-anaphylaxis to injectable drug or vaccine containing PEG or derivatives; 2-anaphylaxis to oral/topical PEG containing products; 3-recurrent anaphylaxis of unknown cause; 4-suspected or confirmed allergy to any mRNA vaccine; and 5-confirmed allergy to PEG or derivatives. We recommend a prick-to-prick skin test with the left-over solution in the suspected vaccine vial to avoid waste. Prick test panel should include PEG 4000 or 3500, PEG 2000 and polysorbate 80. The value of in vitro test is arguable. Conclusions These recommendations will lead to a better knowledge of the management and mechanisms involved in anaphylaxis to COVID-19 vaccines and enable more people with history of allergy to be vaccinated.

Published
2022
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8. Allergies and COVID-19 vaccines:An ENDA/EAACI Position paper

Author

Barbaud, Annick, Garvey, Lene Heise, Arcolaci, Alessandra, Brockow, Knut, Mori, Francesca, Mayorga, Cristobalina, Bonadonna, Patrizia, Atanaskovic-Markovic, Marina, Moral, Luis, Zanoni, Giovanna, Pagani, Mauro, Soria, Angèle, Jošt, Maja, Caubet, Jean-Christoph, Carmo, Abreu, Mona, Al Ahmad, Alvarez-Perea, Alberto, Bavbek, Sevim, Benedetta, Biagioni, Bilo, M Beatrice, Blanca-López, Natalia, Bogas, Herrera Gádor, Buonomo, Alessandro, Calogiuri, Gianfranco, Carli, Giulia, Cernadas, Josefina, Cortellini, Gabriele, Celik, Gülfem, Demir, Semra, Doña, Inmaculada, Dursun, Adile Berna, Eberlein, Bernadette, Faria, Emilia, Fernandes, Bryan, Garcez, Tomaz, Garcia-Nunez, Ignacio, Gawlik, Radoslaw, Gelincik, Asli, Gomes, Eva, Gooi, Jimmy H. C., Grosber, Martine, Gülen, Theo, Hacard, Florence, Hoarau, Cyrille, Janson, Christer, Johnston, Sebastian L, Joerg, Lukas, Kepil Özdemir, Seçil, Klimek, Ludger, Košnik, Mitja, Kowalski, Marek L, Kuyucu, Semanur, Kvedariene, Violeta, Laguna, Jose Julio, Lombardo, Carla, Marinho, Susana, Merk, Hans, Meucci, Elisa, Morisset, Martine, Munoz-Cano, Rosa, Murzilli, Francesco, Nakonechna, Alla, Popescu, Florin Dan, Porebski, Grzegorz, Radice, Anna, Regateiro, Frederico S., Röckmann, Heike, Romano, Antonino, Sargur, Ravishankar, Sastre, Joaquin, Hofmeier, Kathrin Scherer, Sedláčková, Lenka, Sobotkova, Marta, Terreehorst, Ingrid, Treudler, Regina, Walusiak-Skorupa, Jolanta, Wedi, Bettina, Wöhrl, Stefan, Zidarn, Mihael, Zuberbier, Torsten, Agache, Ioana, Torres, Maria J., Barbaud, Annick, Garvey, Lene Heise, Arcolaci, Alessandra, Brockow, Knut, Mori, Francesca, Mayorga, Cristobalina, Bonadonna, Patrizia, Atanaskovic-Markovic, Marina, Moral, Luis, Zanoni, Giovanna, Pagani, Mauro, Soria, Angèle, Jošt, Maja, Caubet, Jean-Christoph, Carmo, Abreu, Mona, Al Ahmad, Alvarez-Perea, Alberto, Bavbek, Sevim, Benedetta, Biagioni, Bilo, M Beatrice, Blanca-López, Natalia, Bogas, Herrera Gádor, Buonomo, Alessandro, Calogiuri, Gianfranco, Carli, Giulia, Cernadas, Josefina, Cortellini, Gabriele, Celik, Gülfem, Demir, Semra, Doña, Inmaculada, Dursun, Adile Berna, Eberlein, Bernadette, Faria, Emilia, Fernandes, Bryan, Garcez, Tomaz, Garcia-Nunez, Ignacio, Gawlik, Radoslaw, Gelincik, Asli, Gomes, Eva, Gooi, Jimmy H. C., Grosber, Martine, Gülen, Theo, Hacard, Florence, Hoarau, Cyrille, Janson, Christer, Johnston, Sebastian L, Joerg, Lukas, Kepil Özdemir, Seçil, Klimek, Ludger, Košnik, Mitja, Kowalski, Marek L, Kuyucu, Semanur, Kvedariene, Violeta, Laguna, Jose Julio, Lombardo, Carla, Marinho, Susana, Merk, Hans, Meucci, Elisa, Morisset, Martine, Munoz-Cano, Rosa, Murzilli, Francesco, Nakonechna, Alla, Popescu, Florin Dan, Porebski, Grzegorz, Radice, Anna, Regateiro, Frederico S., Röckmann, Heike, Romano, Antonino, Sargur, Ravishankar, Sastre, Joaquin, Hofmeier, Kathrin Scherer, Sedláčková, Lenka, Sobotkova, Marta, Terreehorst, Ingrid, Treudler, Regina, Walusiak-Skorupa, Jolanta, Wedi, Bettina, Wöhrl, Stefan, Zidarn, Mihael, Zuberbier, Torsten, Agache, Ioana, and Torres, Maria J.

Abstract

Background: Anaphylaxis, which is rare, has been reported after COVID-19 vaccination, but its management is not standardized. Method: Members of the European Network for Drug Allergy and the European Academy of Allergy and Clinical Immunology interested in drug allergy participated in an online questionnaire on pre-vaccination screening and management of allergic reactions to COVID-19 vaccines, and literature was analysed. Results: No death due to anaphylaxis to COVID-19 vaccines has been confirmed in scientific literature. Potential allergens, polyethylene glycol (PEG), polysorbate and tromethamine are excipients. The authors propose allergy evaluation of persons with the following histories: 1—anaphylaxis to injectable drug or vaccine containing PEG or derivatives; 2—anaphylaxis to oral/topical PEG containing products; 3—recurrent anaphylaxis of unknown cause; 4—suspected or confirmed allergy to any mRNA vaccine; and 5—confirmed allergy to PEG or derivatives. We recommend a prick-to-prick skin test with the left-over solution in the suspected vaccine vial to avoid waste. Prick test panel should include PEG 4000 or 3500, PEG 2000 and polysorbate 80. The value of in vitro test is arguable. Conclusions: These recommendations will lead to a better knowledge of the management and mechanisms involved in anaphylaxis to COVID-19 vaccines and enable more people with history of allergy to be vaccinated.

Published
2022

9. Part I: Insect stings and bites—Beyond the realm of bee and wasp allergies

Author

Guillet, Carole; https://orcid.org/0000-0003-3809-0526, Martin, Oliver Yves, Meincke, Cordula, Joerg, Lukas; https://orcid.org/0000-0003-1512-4279, Schmid-Grendelmeier, Peter; https://orcid.org/0000-0003-3215-3370, Guillet, Carole; https://orcid.org/0000-0003-3809-0526, Martin, Oliver Yves, Meincke, Cordula, Joerg, Lukas; https://orcid.org/0000-0003-1512-4279, and Schmid-Grendelmeier, Peter; https://orcid.org/0000-0003-3215-3370

Abstract

Background Insects are a very diverse group of animals and valuable members of any ecosystem. Allergies to bees and wasps (order: Hymenoptera) are well known in Europe. Allergies, toxicities, and the spread of diseases by other insects are also possible but quite frequently are not diagnosed. Sources A MEDLINE search on allergy caused by stinging and biting insects apart from bees and wasps was conducted. All relevant articles were evaluated, and a selection of relevant publications and cases from our outpatient units are used to illustrate our arguments. Content and implications Allergies to insects following bites and stings are common. Ant stings, mainly from imported fire ants, frequently lead to severe anaphylaxis, and their venom can elicit systemic toxic effects. Stings and bites of various other ant species can also lead to severe allergic reactions. Mosquito stings and horsefly or other Diptera stings may elicit severe local and IgE-mediated systemic reactions. True bugs (Hemiptera) are hematophagous insects and can also cause severe allergic reactions, in addition to being feared for transmitting diseases.

Published
2022

10. Part II: Insect allergies—Inhalation and ingestion

Author

Guillet, Carole; https://orcid.org/0000-0003-3809-0526, Martin, Oliver Yves, Meincke, Cordula, Joerg, Lukas; https://orcid.org/0000-0003-1512-4279, Schmid-Grendelmeier, Peter; https://orcid.org/0000-0003-3215-3370, Guillet, Carole; https://orcid.org/0000-0003-3809-0526, Martin, Oliver Yves, Meincke, Cordula, Joerg, Lukas; https://orcid.org/0000-0003-1512-4279, and Schmid-Grendelmeier, Peter; https://orcid.org/0000-0003-3215-3370

Abstract

Background Allergies to insect stings and bites are common and were partly discussed in part I of this article series. Other mechanisms leading to allergen contact, sensitization, and potential allergy to insects or insects’ compounds can be hard to suspect and diagnose due to their sometimes-hidden character in food or dust. Aims We aim to provide an overview of allergic reactions to insects elicited by mechanisms other than sting or bite reactions. Sources A PubMed search on allergy and insects apart from bees and wasps was conducted, articles were selected and included, and a series of relevant publications and cases of our outpatient units are used as examples. Content and implications Allergies to insects following direct contact, inhalation, and accidental and deliberate ingestion are common and various insect species can elicit these allergies. Sensitization may occur transcutaneously, upon inhalation, and through ingestion. Allergic reactions to edible insects, such as grasshoppers and mealworms, as genuine allergies or as tropomyosin or other protein cross-reactivities in seafood or house dust mite allergic individuals are possible. In Europe, with the licensing of mealworms to be consumed as food and sold commercially in January 2021, allergies and cross-reactivity to insects or insect compounds as foods will become more common and relevant.

Published
2022

11. Allergies and COVID‐19 vaccines: An ENDA/EAACI Position paper

Author

Barbaud, Annick, primary, Garvey, Lene Heise, additional, Arcolaci, Alessandra, additional, Brockow, Knut, additional, Mori, Francesca, additional, Mayorga, Cristobalina, additional, Bonadonna, Patrizia, additional, Atanaskovic‐Markovic, Marina, additional, Moral, Luis, additional, Zanoni, Giovanna, additional, Pagani, Mauro, additional, Soria, Angèle, additional, Jošt, Maja, additional, Caubet, Jean‐Christoph, additional, Carmo, Abreu, additional, Mona, Al‐Ahmad, additional, Alvarez‐Perea, Alberto, additional, Bavbek, Sevim, additional, Benedetta, Biagioni, additional, Bilo, M.Beatrice, additional, Blanca‐López, Natalia, additional, Bogas, Herrera Gádor, additional, Buonomo, Alessandro, additional, Calogiuri, Gianfranco, additional, Carli, Giulia, additional, Cernadas, Josefina, additional, Cortellini, Gabriele, additional, Celik, Gülfem, additional, Demir, Semra, additional, Doña, Inmaculada, additional, Dursun, Adile Berna, additional, Eberlein, Bernadette, additional, Faria, Emilia, additional, Fernandes, Bryan, additional, Garcez, Tomaz, additional, Garcia‐Nunez, Ignacio, additional, Gawlik, Radoslaw, additional, Gelincik, Asli, additional, Gomes, Eva, additional, Gooi, Jimmy H. C., additional, Grosber, Martine, additional, Gülen, Theo, additional, Hacard, Florence, additional, Hoarau, Cyrille, additional, Janson, Christer, additional, Johnston, Sebastian L., additional, Joerg, Lukas, additional, Kepil Özdemir, Seçil, additional, Klimek, Ludger, additional, Košnik, Mitja, additional, Kowalski, Marek L., additional, Kuyucu, Semanur, additional, Kvedariene, Violeta, additional, Laguna, Jose Julio, additional, Lombardo, Carla, additional, Marinho, Susana, additional, Merk, Hans, additional, Meucci, Elisa, additional, Morisset, Martine, additional, Munoz‐Cano, Rosa, additional, Murzilli, Francesco, additional, Nakonechna, Alla, additional, Popescu, Florin‐Dan, additional, Porebski, Grzegorz, additional, Radice, Anna, additional, Regateiro, Frederico S., additional, Röckmann, Heike, additional, Romano, Antonino, additional, Sargur, Ravishankar, additional, Sastre, Joaquin, additional, Scherer Hofmeier, Kathrin, additional, Sedláčková, Lenka, additional, Sobotkova, Marta, additional, Terreehorst, Ingrid, additional, Treudler, Regina, additional, Walusiak‐Skorupa, Jolanta, additional, Wedi, Bettina, additional, Wöhrl, Stefan, additional, Zidarn, Mihael, additional, Zuberbier, Torsten, additional, Agache, Ioana, additional, and Torres, Maria J., additional

Published
2022
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13. Part II: Insect allergies—Inhalation and ingestion

Author

Guillet, Carole, Martin, Oliver Yves, Meincke, Cordula, Joerg, Lukas, Schmid-Grendelmeier, Peter, University of Zurich, and Guillet, Carole

Subjects
2723 Immunology and Allergy, 10177 Dermatology Clinic, Immunology and Allergy, 610 Medicine & health
Published
2022
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17. 75% negative skin test results in patients with suspected hypersensitivity to beta-lactam antibiotics: Influencing factors and interpretation of test results

Author

Benno Schnyder, Anna Gschwend, Arthur Helbling, Cordula Meincke, Peter Schmid-Grendelmeier, Michelle Heilig, Thierry M Nordmann, Martin Glatz, Susann Hasler, Lukas Joerg, University of Zurich, and Joerg, Lukas

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, Allergy, Lymphocyte transformation test, Basophil activation test, Provocation test, Drug allergy, Immunology, 610 Medicine & health, Penicillins, Patch test, Gastroenterology, Article, Skin test, Intradermal skin test, T-cell, Internal medicine, medicine, Immunology and Allergy, Beta-lactams, Adverse effect, Anaphylaxis, 2403 Immunology, Angioedema, business.industry, Maculopapular exanthema, Amoxicillin, 10177 Dermatology Clinic, RC581-607, medicine.disease, Cephalosporins, Negative Skin Test, 2740 Pulmonary and Respiratory Medicine, Drug provocation test, 2723 Immunology and Allergy, IgE, medicine.symptom, Immunologic diseases. Allergy, business, Drug hypersensitivity
Abstract

Background The diagnostic approach for beta-lactam (BL) drug hypersensitivity reactions (DHR) is based on the history, clinical signs, skin tests (ST), in vitro tests, and drug provocation tests (DPT). The aim of this study was to assess the performance of an allergy workup with ST in a real-world use. Methods In this cross-sectional study the rate of positive ST in subjects with suspected DHR to penicillins and cephalosporins was investigated. Of special interest were correlations of ST positivity: 1) to the time intervals between index reaction and the allergic work-up, 2) time interval from drug exposure to the onset of signs, 3) pattern of manifestation in delayed DHR and involvement of test area in the index reaction, and 4) potential advantage of patch testing in delayed DHR. Results 175 patients were included between January 2018 and April 2019 (63.4% female), 45 (25.7%) with immediate DHR manifestation and 130 with delayed DHR manifestation (74.3%). A total of 44 patients (25.1%) had a positive ST (immediate DHR 37.8% versus 20.0% in delayed DHR). ST positivity decreased in both groups after 3 years from 47.8% [95%CI 29.2–67] to 23.5% [95%CI 9.6–47.3] in immediate DHR and 23.0% [95%CI 15-4-32.9] to 12.9% [95%CI 5.1–28.9] in delayed DHR. The proportion of positive ST was higher in patients with more severe forms of delayed DHR, and in subjects with a shorter latency period of onset of symptoms after drug exposure: 0-3d: 29.5% [95%CI 19.6–41.9] vs. >3d: 11.6% [95%CI 6.0–21.2]). No sensitization was shown in delayed urticaria or angioedema. ST done outside the skin area involved during the index reaction were negative in all cases (0/38 vs. 26/84 in cases with involved area). The combination of patch test and intradermal test (IDT) revealed an additional positive result in 2/77 cases. Additional in vitro testing reduced the proportion of negative test results to 72%. Conclusion In most patients with negative test results, we could not clarify the cause of the BL-associated adverse events even with further investigations (including DPT). How to prevent new drug-induced adverse events in such patients has hardly been investigated yet. Corresponding cohort studies could improve the data situation.

Published
2021

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