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Hintergrund: Die anhaltend hohe Prävalenz allergischer Erkrankungen in westlichen Industrienationen und die eingeschränkten Möglichkeiten einer kausalen Therapie machen eine evidenzbasierte Primärprävention notwendig. Methoden: Die Empfehlungen der in letzter Fassung 2014 veröffentlichten S3-Leitlinie Allergieprävention wurden auf der Basis einer aktuellen systematischen Literatursuche überarbeitet und konsentiert. Die Evidenzsuche erfolgte für den Zeitraum 06/2013 – 11/2020 in den elektronischen Datenbanken Cochrane und MEDLINE, sowie in den Referenzlisten von aktuellen Übersichtsarbeiten und durch Hinweise von Experten. Die aufgefundene Literatur wurde in zwei Filterprozessen zunächst nach Titel und Zusammenfassung und die verbliebenen Arbeiten im Volltext auf Relevanz hin überprüft. Die danach eingeschlossenen Studien wurden nach Evidenzgrade geordnet und die Studienqualität i.S. des Verzerrungspotenzials (niedrig/hoch) angegeben. Die überarbeiteten Empfehlungen wurden unter Beteiligung von Vertretern der relevanten Fachgesellschaften und (Selbsthilfe-)Organisationen formal abgestimmt und konsentiert (nominaler Gruppenprozess). Von 5.681 Treffern wurden 286 Studien eingeschlossen und bewertet. Ergebnisse: Einen wichtigen Stellenwert in der aktualisierten Leitlinie nehmen wieder Empfehlungen zur Ernährung der Mutter während der Schwangerschaft und Stillzeit sowie des Säuglings in den ersten Lebensmonaten ein: Dabei wurden viele der bisherigen Empfehlungen durch die aktuelle Datenlage bestätigt. Präzisiert wurde, dass für den Zeitraum der ersten 4 – 6 Monate nach Geburt nach Möglichkeit ausschließlich gestillt werden soll und auch mit Einführung von Beikost weitergestillt werden soll. Neu ist die Empfehlung, dass eine Zufütterung von kuhmilchbasierter Formulanahrung in den ersten Lebenstagen bei Stillwunsch der Mutter vermieden werden sollte. Ferner wurde festgestellt, dass die Evidenz für eine klare positive Empfehlung für hydrolysierte Säuglingsnahrung bei nicht gestillten Risikokindern aktuell nicht mehr ausreicht. Aktuell wird daher empfohlen zu prüfen, ob bis zur Einführung von Beikost eine Säuglingsanfangsnahrung mit in Studien zur Allergieprävention nachgewiesener Wirksamkeit verfügbar ist. Schließlich wurden auf Basis der EAACI-Leitlinie zur Prävention der Hühnereiallergie die Empfehlung ausgesprochen, durcherhitztes (zum Beispiel verbackenes oder hartgekochtes), aber nicht „rohes“ Hühnerei (auch kein Rührei) mit der Beikost einzuführen und regelmäßig weiter zu geben. Die Empfehlung zur Einführung von Erdnuss in der Beikost wurde für den deutschsprachigen Raum zurückhaltend formuliert: In Familien mit bereits bestehendem regelmäßigem Erdnusskonsum kann zur Prävention einer Erdnussallergie bei Säuglingen mit atopischer Dermatitis die regelmäßige Gabe von erdnusshaltigen Nahrungsmitteln in altersgerechter Form (zum Beispiel Erdnussbutter) mit der Beikost erwogen werden. Vor der Einführung muss insbesondere bei Säuglingen mit moderater bis schwerer AD eine klinisch relevante Erdnussallergie ausgeschlossen werden. Für eine allergiepräventive Wirksamkeit von Präbiotika oder Probiotika, Vitamin D oder anderen Vitaminen in Form von Präparaten fehlt weiterhin ausreichende Evidenz, sodass in der aktuellen Leitlinie erstmals Empfehlungen gegen deren Supplementierung verabschiedet wurden. Die Biodiversität spielt für die Entwicklung einer immunologischen Toleranz gegenüber Umwelt- und Nahrungsmittelallergenen eine wichtige Rolle: So gibt es deutliche Hinweise darauf, dass das Aufwachsen auf dem Bauernhof mit einem geringeren Risiko für die Entwicklung von Asthma und allergischen Erkrankungen assoziiert ist. Dies wird mit einer frühzeitigen unspezifischen Immunstimulation unter anderem durch die größere mikrobielle Biodiversität des Hausstaubs in diesem Lebensraum in Verbindung gebracht. Dieser Aspekt spiegelt sich auch in den Empfehlungen zur Tierhaltung wider, zu der eine differenzierte Stellungnahme erfolgte: In Familien ohne erkennbares erhöhtes Allergierisiko soll die Haustierhaltung mit Katzen oder Hunden nicht generell eingeschränkt werden. Familien mit erhöhtem Allergierisiko (d. h. Vater, Mutter oder Geschwisterkind sind von einer atopischen Erkrankung betroffen) oder bei Kindern mit bereits bestehender atopischer Dermatitis sollten eine Katze nicht neu anschaffen – im Gegensatz dazu sollte von einer Hundehaltung jedoch nicht abgeraten werden. Interventionen zur Reduktion der Exposition gegenüber Hausstaubmilbenallergenen im Haushalt, zum Beispiel die Verwendung milbenallergendichter Matratzenüberzüge („encasings“), sollten nicht mit dem Ziel einer primären Allergieprävention erfolgen. Kinder, die durch einen Kaiserschnitt geboren wurden, haben ein geringfügig erhöhtes Asthmarisiko – dies soll bei der Beratung zum Geburtsmodus außerhalb von Notfallsituationen berücksichtigt werden. Auch aktuelle Arbeiten stützen die Empfehlungen zu Luftschadstoffen: Die aktive und passive Exposition gegenüber Tabakrauch erhöhen das Allergierisiko und sind deshalb zu vermeiden. Die Exposition gegenüber Stickoxiden, Ozon und Feinstaub der Partikelgröße < 2,5 Mikrometer (PM 2,5) ist mit einem erhöhten Risiko, besonders für Asthma, verbunden. Daher sollte die Exposition gegenüber Emissionen gegenüber Stickoxiden, Ozon und Feinstaub (PM 2,5) gering gehalten werden. Die Autor/-innen dieser Leitlinie sprechen sich einhellig für den Erlass entsprechender Verordnungen zur Minimierung dieser Luftschadstoffe aus. Es gibt keine Belege, dass Impfungen das Allergierisiko erhöhen, umgekehrt aber Hinweise, dass Impfungen das Allergierisiko senken können. Alle Kinder, auch Risikokinder, sollen auch aus Gründen der Allergieprävention nach den aktuellen Empfehlungen der ­STIKO geimpft werden. Schlussfolgerung: Die Konsentierung von Empfehlungen in dieser Leitlinie beruht auf einer umfangreichen Evidenzgrundlage. Die Aktualisierung der Leitlinie ermöglicht evidenzbasierte und aktuelle Empfehlungen zur Prävention allergischer Erkrankungen.

The present addendum of the guideline for the diagnosis and treatment of asthma (2017) complements new insights into the diagnosis and management of asthma as well as for the newly approved drugs for the treatment of asthma. Current, evidence-based recommendations on diagnostic and therapeutic approaches are presented for children and adolescents as well as for adults with asthma.Das vorliegende Addendum zur Leitlinie zur Diagnostik und Therapie von Patienten mit Asthma (2017) ergänzt wichtige neue Erkenntnisse zur Diagnostik und Therapie von Asthma sowie zu neu für die Therapie des Asthmas zugelassenen Medikamenten. Es werden sowohl für Kinder und Jugendliche als auch für Erwachsene mit Asthma die aktuellen, Evidenz-basierten diagnostischen und therapeutischen Empfehlungen dargelegt.

The present addendum of the guideline for the diagnosis and treatment of asthma (2017) complements new insights into the diagnosis and management of asthma as well as for the newly approved drugs for the treatment of asthma. Current, evidence-based recommendations on diagnostic and therapeutic approaches are presented for children and adolescents as well as for adults with asthma. Thieme. All rights reserved.

Background: Peanut allergy has a rising prevalence in high-income countries, affecting 0.5%–1.4% of children. This study aimed to better understand peanut anaphylaxis in comparison to anaphylaxis to other food triggers in European children and adolescents. Methods: Data was sourced from the European Anaphylaxis Registry via an online questionnaire, after in-depth review of food-induced anaphylaxis cases in a tertiary paediatric allergy centre. Results: 3514 cases of food anaphylaxis were reported between July 2007-March 2018, 56% in patients younger than 18 years. Peanut anaphylaxis was recorded in 459 children and adolescents (85% of all peanut anaphylaxis cases). Previous reactions (42% vs. 38%; p = .001), asthma comorbidity (47% vs. 35%; p < .001), relevant cofactors (29% vs. 22%; p = .004) and biphasic reactions (10% vs. 4%; p = .001) were more commonly reported in peanut anaphylaxis. Most cases were labelled as severe anaphylaxis (Ring&Messmer grade III 65% vs. 56% and grade IV 1.1% vs. 0.9%; p = .001). Self-administration of intramuscular adrenaline was low (17% vs. 15%), professional adrenaline administration was higher in non-peanut food anaphylaxis (34% vs. 26%; p = .003). Hospitalization was higher for peanut anaphylaxis (67% vs. 54%; p = .004). Conclusions: The European Anaphylaxis Registry data confirmed peanut as one of the major causes of severe, potentially life-threatening allergic reactions in European children, with some characteristic features e.g., presence of asthma comorbidity and increased rate of biphasic reactions. Usage of intramuscular adrenaline as first-line treatment is low and needs to be improved. The Registry, designed as the largest database on anaphylaxis, allows continuous assessment of this condition. © 2021 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.

Background: Patients with a history of anaphylaxis are at risk of future anaphylactic reactions. Thus, secondary prevention measures are recommended for these patients to prevent or attenuate the next reaction. Methods: Data from the Anaphylaxis Registry were analyzed to identify secondary prevention measures offered to patients who experienced anaphylaxis. Our analysis included 7788 cases from 10 European countries and Brazil. Results: The secondary prevention measures offered varied across the elicitors. A remarkable discrepancy was observed between prevention measures offered in specialized allergy centers (84% of patients were prescribed adrenaline autoinjectors following EAACI guidelines) and outside the centers: Here, EAACI guideline adherence was only 37%. In the multivariate analysis, the elicitor of the reaction, age of the patient, mastocytosis as comorbidity, severity of the reaction, and reimbursement/availability of the autoinjector influence physician's decision to prescribe one. Conclusions: Based on the low implementation of guidelines concerning secondary prevention measures outside of specialized allergy centers, our findings highlight the importance of these specialized centers and the requirement of better education for primary healthcare and emergency physicians. © 2019 The Authors. Allergy published by John Wiley & Sons Ltd.

Correction to: Allergo J Int 2019 https://doi.org/10.1007/s40629-019-00110-9 Affiliation and disclaimer have been misrepresented and are hereby corrected: Vera Mahler: Affiliation: Med. Faculty, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Germany. Disclaimer: The views expressed in this. © 2020, Springer Medizin Verlag GmbH, ein Teil von Springer Nature.

Food allergens are frequent causes of anaphylaxis. In particular in children and adolescents they are the most frequent elicitors of severe allergic reactions, and in adults food allergens rank third behind insect venom and drugs. Since July 2006 severe allergic reactions from Germany, Austria, and Switzerland are collected in the anaphylaxis registry. Currently 78 hospitals and private practises are connected. From July 2006 until February 2009 1,156 severe allergic reactions were registered. Among children and adolescents (n = 187, age range from 3 months to 17 years) food allergens were the most frequent triggers, comprising 58% of cases. In the adult group (n = 968, 18 - 85 years) food allergens were in the third position (16.3%) behind insect venom and drugs. In children legumes (31%) and in particular peanuts were frequently responsible food allergens, followed by tree nuts (25%) with hazelnut being the most frequent elicitor. In adults fruits (13.4%) most often induced severe food-dependent anaphylaxis, but also animal products (12.2%); among these most frequently crustaceans and molluscs. Cofactors were often suspected in food-dependent anaphylaxis, namely in 39% of the adult group and in 14% of the pediatric group. In adults drugs (22%) and physical activity (10%) were reported to be the most frequent cofactors, in children physical activity was suspected in 8.7% and drugs in 2.6%. Concomitant diseases like atopic dermatitis, allergic asthma, or allergic rhinoconjunctivitis were reported in 78% of children and adolescents and in 67% of the adults. In conclusion, food-induced anaphylaxis, its cofactors and concomitant diseases are age-dependent. The data offers to identify risk factors of anaphylaxis.

Background: The number of patients affected by allergies is increasing worldwide. The resulting allergic diseases are leading to significant costs for health care and social systems. Integrated care pathways are needed to enable comprehensive care within the national health systems. The ARIA (Allergic Rhinitis and its Impact on Asthma) initiative develops internationally applicable guidelines for allergic respiratory diseases. Methods: ARIA serves to improve the care of patients with allergies and chronic respiratory diseases. In collaboration with other international initiatives, national associations and patient organizations in the field of allergies and respiratory diseases, real-life integrated care pathways have been developed for a digitally assisted, integrative, individualized treatment of allergic rhinitis (AR) with comorbid asthma. In the present work, these integrated care pathways have been adapted to the German situation and health system. Results: The present ICP (integrated care pathways) guideline covers key areas of the care of AR patients with and without asthma. It includes the views of patients and other healthcare providers. Discussion: A comprehensive ICP guideline can reflect real-life care better than traditional guideline models. © 2019, The Author(s).

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. © 2018 American Academy of Allergy, Asthma & Immunology

Background: Preventive measures to decrease the frequency and intensity of anaphylactic events are essential to provide optimal care for allergic patients. Aggravating factors may trigger or increase the severity of anaphylaxis and therefore need to be recognized and avoided. Objective: To identify and prioritize factors associated with an increased risk of developing severe anaphylaxis. Methods: Data from the Anaphylaxis Registry (122 centers in 11 European countries) were used in logistic regression models considering existing severity grading systems, elicitors, and symptoms to identify the relative risk of factors on the severity of anaphylaxis. Results: We identified higher age and concomitant mastocytosis (OR: 3.1, CI: 2.6-3.7) as the most important predictors for an increased risk of severe anaphylaxis. Vigorous physical exercise (OR: 1.5, CI: 1.3-1.7), male sex (OR: 1.2, CI: 1.1-1.3), and psychological burden (OR: 1.4, CI: 1.2-1.6) were more often associated with severe reactions. Additionally, intake of beta-blockers (OR: 1.9, CI: 1.5-2.2) and ACE-I (OR: 1.28, CI: 1.05, 1.51) in temporal proximity to allergen exposition was identified as an important factor in logistic regression analysis. Conclusion: Our data suggest it may be possible to identify patients who require intensified preventive measures due to their relatively higher risk for severe anaphylaxis by considering endogenous and exogenous factors. © 2018 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.

Background Anaphylaxis in children and adolescents is a potentially life-threatening condition. Its heterogeneous clinical presentation and sudden occurrence in virtually any setting without warning have impeded a comprehensive description. Objective We sought to characterize severe allergic reactions in terms of elicitors, symptoms, emergency treatment, and long-term management in European children and adolescents. Methods The European Anaphylaxis Registry recorded details of anaphylaxis after referral for in-depth diagnosis and counseling to 1 of 90 tertiary allergy centers in 10 European countries, aiming to oversample the most severe reactions. Data were retrieved from medical records by using a multilanguage online form. Results Between July 2007 and March 2015, anaphylaxis was identified in 1970 patients younger than 18 years. Most incidents occurred in private homes (46%) and outdoors (19%). One third of the patients had experienced anaphylaxis previously. Food items were the most frequent trigger (66%), followed by insect venom (19%). Cow's milk and hen's egg were prevalent elicitors in the first 2 years, hazelnut and cashew in preschool-aged children, and peanut at all ages. There was a continuous shift from food- to insect venom- and drug-induced anaphylaxis up to age 10 years, and there were few changes thereafter. Vomiting and cough were prevalent symptoms in the first decade of life, and subjective symptoms (nausea, throat tightness, and dizziness) were prevalent later in life. Thirty percent of cases were lay treated, of which 10% were treated with an epinephrine autoinjector. The fraction of intramuscular epinephrine in professional emergency treatment increased from 12% in 2011 to 25% in 2014. Twenty-six (1.3%) patients were either admitted to the intensive care unit or had grade IV/fatal reactions. Conclusions The European Anaphylaxis Registry confirmed food as the major elicitor of anaphylaxis in children, specifically hen's egg, cow's milk, and nuts. Reactions to insect venom were seen more in young adulthood. Intensive care unit admissions and grade IV/fatal reactions were rare. The registry will serve as a systematic foundation for a continuous description of this multiform condition. © 2016 American Academy of Allergy, Asthma & Immunology.

Operational ocean forecast systems provide routine marine products to an ever-widening community of users and stakeholders. The majority of users need information about the quality and reliability of the products to exploit them fully. Hence, forecast centres have been developing improved methods for evaluating and communicating the quality of their products. Global Ocean Data Assimilation Experiment (GODAE) OceanView, along with the Copernicus European Marine Core Service and other national and international programmes, has facilitated the development of coordinated validation activities among these centres. New metrics, assessing a wider range of ocean parameters, have been defined and implemented in real-time. An overview of recent progress and emerging international standards is presented here. © 2015 Institut de Recherche pour le Développement (IRD).