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Indications for epicutaneous patch testing include the detection or exclusion of allergic contact dermatitis of the skin, transitional mucosa or oral mucosa, suspected delayed-type immune reactions to ingredients of implants, and certain drug reactions (maculopapular exanthema, symmetrical drug-related intertriginous and flexural exanthema [SDRIFE], acute generalized exanthematous pustulosis [AGEP], and fixed drug eruption). When available, allergen preparations that have been pharmaceutically tested and that are approved or marketable as medicinal products should be used. Existing diagnostic gaps can be closed by testing the patient’s own materials in a suitable preparation. Interferences of ultraviolet (UV) light exposure or drugs with patch test reactions have to be considered. In addition to the reading after 48 h and 72 h, a further reading between day 7 (168 h) and day 10 (240 h) is useful, since about 15% of the positive test reactions remain undetected without this late reading. All positive patch test reactions considered allergic must be evaluated with regard to their clinical relevance based on existing exposures.

SummaryAnaphylaxis in connection with the administration of vaccines occurs only very rarely. Triggers of immunoglobulin IgE-mediated and non-IgE-mediated anaphylaxis—in addition to the active ingredient itself—may be excipients contained in the vaccine due to their special properties. Some of the excipients in medicinal products are the same compounds used as additives in food. Furthermore, residues from the manufacturing process (e.g., chicken egg white, casein, antibiotics, formaldehyde) or contaminants (e.g., from the primary packaging material) may be potential triggers of anaphylaxis in vaccines. This review article provides an overview of ingredients in vaccines that pose an allergenic risk potential. The components of COVID-19 vaccines approved and marketed in Germany are discussed with regard to their potential for triggering anaphylaxis and possible pathophysiological mechanisms involved.

BackgroundEffectiveness studies with biological therapies for asthma lack standardised outcome measures. The COMSA (Core Outcome Measures sets for paediatric and adult Severe Asthma) Working Group sought to develop Core Outcome Measures (COM) sets to facilitate better synthesis of data and appraisal of biologics in paediatric and adult asthma clinical studies.MethodsCOMSA utilised a multi-stakeholder consensus process among patients with severe asthma, adult and paediatric clinicians, pharmaceutical representatives, and health regulators from across Europe. Evidence included a systematic review of development, validity and reliability of selected outcome measures plus a narrative review and a pan-European survey to better understand patients’ and carers’ views about outcome measures. It was discussed using a modified GRADE (Grading of Recommendations Assessment, Development and Evaluation) Evidence to Decision framework. Anonymous voting was conducted using predefined consensus criteria.ResultsBoth adult and paediatric COM sets include forced expiratory volume in 1 s (FEV1) as z-scores, annual frequency of severe exacerbations and maintenance oral corticosteroid use. Additionally, the paediatric COM set includes the Paediatric Asthma Quality of Life Questionnaire and Asthma Control Test or Childhood Asthma Control Test, while the adult COM set includes the Severe Asthma Questionnaire and Asthma Control Questionnaire-6 (symptoms and rescue medication use reported separately).ConclusionsThis patient-centred collaboration has produced two COM sets for paediatric and adult severe asthma. It is expected that they will inform the methodology of future clinical trials, enhance comparability of efficacy and effectiveness of biological therapies, and help assess their socioeconomic value. COMSA will inform definitions of non-response and response to biological therapy for severe asthma.

Das Kontaktekzem (syn. Kontaktdermatitis) ist eine durch äußere Einwirkungen ausgelöste Entzündung der Epidermis und der Dermis am Ort der Einwirkung. Die beiden Hauptformen sind das irritative und das allergische Kontaktekzem, die neben einer ausgeprägten Verminderung der Lebensqualität auch erhebliche gesundheits- und sozioökonomische Kosten verursachen. Wegweisend für die erforderlichen diagnostischen Maßnahmen sind die Anamnese und das klinische Bild. Eine möglichst genaue diagnostische Einordnung des Kontaktekzems mittels allergologischer Testung ist wichtig für das Krankheitsmanagement, da hier nicht nur die klassische Ekzemtherapie, sondern auch das Meiden der exogenen auslösenden Faktoren von großer Bedeutung sind. Die Wahl der Therapie sollte sich nach der Akuität, dem klinischen Schweregrad, der Morphologie der Läsionen und der Lokalisation des Kontaktekzems richten. Erforderlich ist eine bedarfsadaptierte Kombination aus Basistherapie, topischer, physikalischer und systemischer Therapie, wobei nicht alle Therapieformen gleichzeitig durchgeführt werden müssen, sondern variierend eingesetzt werden können. Primäre, sekundäre und tertiäre Präventionsstrategien zielen auf die Erkennung der auslösenden Noxen beziehungsweise der auslösenden Allergene mit nachfolgender Kontaktvermeidung oder -minimierung. Die vorliegende S1-Leitlinie zum Kontaktekzem soll vor allem Dermatologen, Allergologen sowie allergologisch und berufsdermatologisch tätigen Ärzten eine Entscheidungshilfe für die Auswahl sowie die Durchführung einer geeigneten und suffizienten Diagnostik, Therapie und Prävention zur Verfügung zu stellen.

The European baseline series was last updated in 2019. This article discusses the reasoning behind a further iteration of the series for 2023.

Background All currently available products for diagnosis and therapy of type I allergies are protein extracts from allergenic source material. The extracted proteins have different properties and their structure is differently labile to temperature variations. Despite various pharmaceutical formulations to increase product stability, with few exceptions, allergen products must be refrigerated to ensure that their quality and native protein structure do not change during storage and transport. Maintaining quality is a challenge in complex distribution chains. Methods Regulatory requirements and guidelines that apply to cold storage and transport of allergen products are summarized and the responsibilities of the stakeholders are explained. Results The storage conditions determined in stability studies correspond to the transport conditions. These stability data can also be used to assess tolerable conditions during transport. According to a good distribution practice (GDP) contracts must be concluded between the responsible pharmaceutical entrepreneur and the qualified distribution service provider that regulate storage and transport in accordance with the product requirements. Conclusion Monitoring of storage and transport conditions is achieved by transport in qualified means of transport (e.g. truck). Alternatively, qualified transport packaging with active or passive cooling (e.g. cold packs) and qualified “data loggers” that record the transport temperatures can be used. Regardless of the system used, it must be demonstrated—by validating the transport conditions, routes and packaging at different times of the year and over the entire duration of transport—that regulatory requirements are met and that the quality of the products is maintained during shipment.

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Carrot (Daucus carota) allergy is caused by the major carrot allergen Dau c 1, which is a mixture of several isoallergens and variants with sequence identities of67% or90%, respectively. However, little is known about the qualitative and quantitative composition of natural Dau c 1.Mass spectrometry of isolated natural Dau c 1 reveals the existence of several yet unknown Dau c 1-like proteins. The study expresses four Dau c 1-like proteins in Escherichia coli. Two of the purified proteins, designated Dau c 1.0501 and 1.0601, exhibit sequence identities to Dau c 1.0101 and 1.0401 between 54% and 87%. They possess allergenic potential and are accepted as new isoallergens. One protein, designated as Dau c 1-like is50% identical with the new isoallergens but exhibits no allergenicity. Sequence and structural comparisons of this protein with the known Dau c 1 isoallergens offer relevant clues about putative structural IgE epitopes.Identification of new isoallergens and the identification of IgE epitopes may contribute to a more refined component resolved diagnosis and may lay ground for further epitope mapping and personalized targeted treatment approaches of carrot allergy in preclinical and clinical studies.

Die Umwelt ist kontinuierlich einem Wandel unterworfen. Expositionen im Arbeitsumfeld und damit verbunden die Bedeutung von beruflichen Typ-I- und Typ-IV-Allergenen konnen sich andern. Die wichtigsten Berufsallergene betreffenden Trends, neue arbeitsplatzbezogene Allergene/Allergenexpositionen, das diagnostische Vorgehen zum Nachweis neuer Allergene in der Praxis und regulatorische Entwicklungen werden dargestellt. Aufbauend auf bekannten, berufsdermatologisch relevanten Allergenexpositionen werden publizierte Trends aus klinischen Kohorten ausgewertet, und erganzend wird eine systematische Literaturrecherche (PubMed 2016–2021) nach neuen Berufsallergenen durchgefuhrt. Zu den Berufen mit der hochsten Inzidenz von arbeitsbedingter allergischer Kontakturtikaria und/oder Proteinkontaktdermatitis gehoren Backer, Landwirte und Landarbeiter, veterinarmedizinisch-technische Assistenten, Tierarzte, Koche, Molkerei- und Viehzuchtarbeiter, Gartner und Friseure. Das hochste Risiko, ein berufliches Kontaktekzem zu entwickeln, besteht im Gesundheitswesen, in der Landwirtschaft, in metallverarbeitenden Berufen und bei Maschinenfuhrern, im Nahrungsmittelsektor, im Dienstleistungsgewerbe und in Bauberufen. Die Suchstrategie „new occupational allerg*“ ergab 603 Hits, „novel occupational allerg*“ 158 Hits; 25 Arbeiten beinhalteten fur die Fragestellung relevante Ergebnisse und werden aufbereitet. Neue berufsdermatologisch relevante proteinbasierte Soforttypallergene wie auch Kontaktallergene werden dargestellt. Es sind aktuelle Trends zu bekannten Berufsallergenen und neue Berufsallergene im Zeitraum 2016 bis 2021 festzustellen. Nur eine eingehende individuelle Arbeitsplatzanamnese und Testung patienteneigener Materialien konnen neue Allergene in der Berufsdermatologie identifizieren.

Hintergrund Der Zusammenhang zwischen atopischer Dermatitis (AD) und allergischer Kontaktdermatitis ist nach wie vor nicht abschliesend geklart. Studien ergeben sehr unterschiedliche Resultate; sie reichen vom Fehlen jeglichen Zusammenhangs bis hin zu einer vermehrten Sensibilisierung auf multiple Allergene. Konsistente Assoziationen mit bestimmten Allergenen wurden jedoch bisher nicht gefunden. ZIEL: Wir haben eine grose Kohorte von Patienten, stratifiziert nach atopischer Hautdiathese gemas dem Erlanger Atopiescore (EAS), unabhangig von einer aktiven Hauterkrankung, durch Epikutantests untersucht. Methoden Retrospektive Multicenter-Datenanalyse aus funf dermatologischen Zentren in Deutschland mit 4.509 Patienten. Die Patienten wurden nach dem EAS eingeteilt in eine Gruppe ohne atopische Hautdiathese (n = 2.165) und eine mit atopischer Hautdiathese (n = 1.743). Ergebnisse In der Gruppe mit atopischer Hautdiathese zeigten signifikant mehr Personen mindestens eine positive Epikutantest-Reaktion in der Standardreihe als in der Gruppe ohne atopische Hautdiathese (49,1 % vs. 38,3 %). In der logistischen Regressionsanalyse war die atopische Hautdiathese mit einem signifikant erhohten Sensibilisierungsrisiko gegen Methylchloroisothiazolinon/Methylisothiazolinon (OR 2.383) und Methylisothiazolinon (OR 1.891), Thiuram-Mix (OR 1.614) sowie Nickel (OR 1.530), Kobalt (OR 1.683) und Chrom (OR 2.089) assoziiert. Schlussfolgerungen Die atopische Hautdiathese zeigte sich als der wichtigste intrinsische Risikofaktor fur eine Kontaktsensibilisierung gegen einige spezifische Antigene. Eine fruhere oder derzeit bestehende AD erwies sich als weniger relevante Grose.

Not available.

Not available.

Background and Objective: Self-assessment of general health status includes a variety of verifiable objective and subjective criteria and shows a significant influence on patient-related outcomes such as quality of life. The objective of this study was to investigate how patients assess the severity of their chronic hand eczema compared to physicians.Patients and method: Data for 1281 patients and their physicians from the German registry “CARPE” was available at baseline. At a 2-year follow-up, the remaining 788 cases served as a comparison. Concordance analysis was performed using Bangdiwala's B.Results:Only 16.62% (baseline) and 11.47% (follow-up) of the severity ratings showed complete concordance. The baseline shows a more pessimistic, the follow-up a more optimistic assessment from the patients compared to the physicians. Women and older patients had lower agreement. Bangdiwala's B value lies at the lower border of a substantial agreement ( B̂ω(baseline)=0.573, B̂ω(follow-up)=0.498).Conclusion:The assessment of the severity of hand eczema often differs between physician and patient. To ensure successful therapy and adherence, dermatologists should inquire about their patients' individual perception of the severity of the hand eczema, especially in older patients and women.

Zusammenfassung Die Allergenimmuntherapie (AIT) wirkt als einzige kausale, krankheitsmodifizierende Therapieform neben einer Symptomlinderung der Progression allergischer Erkrankungen entgegen. Dieser Beitrag liefert einen Überblick zu aktuellen immunologischen, regulatorischen und praxisbezogenen Aspekten der AIT. Die neueste Fachliteratur wurde einbezogen. Zudem werden konzeptionelle regulatorische Entwicklungen aus der Abteilung Allergologie der zuständigen Bundesoberbehörde Paul-Ehrlich-Institut dargestellt. Die derzeit in Deutschland zugelassenen 62 und die weiteren 61 AIT-Produkte, die sich im Entwicklungsprogramm der Therapieallergene-Verordnung (TAV) befinden, umfassen 95 Produkte zur subkutanen (SCIT) und 28 zur sublingualen Behandlung (SLIT) von Allergien gegen Birken‑/Erlen‑/Haselpollen, Gräser- und Kräuterpollen sowie Hausstaubmilben und Insektengifte. Als Wirkstoffe kommen native und chemisch modifizierte Allergenextrakte (Allergoide), adsorbiert an Aluminium, Tyrosin (z. T. Monophosphoryl-Lipid-A-adjuvantiert) oder Laktose, oder als Lyophilisate zum Einsatz. Die 123 AIT-Produkte unterliegen der staatlichen Chargenprüfung. Individualrezepturen zur Behandlung weniger prävalenter Allergien (z. B. gegen Olivenpollen, Tierhaare, Speichermilben oder Schimmelpilze) unterliegen nicht der behördlichen Chargenprüfung. Besonderer Entwicklungsbedarf besteht für AIT-Produkte zur Behandlung von Kindern. Als neue Wirkstoffklasse befinden sich Nahrungsmittelallergene in klinischen Phase-II- und Phase-III-Studien. Ein erstes Präparat zur oralen AIT der Erdnussallergie bei Kindern ist derzeit in einem zentralen europäischen Zulassungsverfahren. Die Zulassung kann nur bei positiver Nutzen-Risiko-Bilanz erfolgen. Wissenschaft und Regulation stehen in kontinuierlichem Austausch über die Entwicklung von AIT-Produkten, die dem aktuellen Stand der klinischen Forschung und Regulation in der Europäischen Union entsprechen und eine frühzeitige Kausalbehandlung weitverbreiteter Allergien ermöglichen.

Zusammenfassung Aktuell werden extraktbasierte Therapieallergene aus natürlichen Allergenquellen (z. B. Hausstaubmilben, Baum- und Gräserpollen) zur allergenspezifischen Immuntherapie (AIT) eingesetzt, dem einzigen kausalen Therapieansatz, der durch Toleranzentwicklung allergische Erkrankungen positiv verändern und langfristig eine Krankheitsprogression verhindern kann. Aufgrund von Schwankungen in der natürlichen Zusammensetzung der Ausgangsmaterialien und unterschiedlichen Herstellungsprozessen ergeben sich Varianzen in Proteingehalt, Allergenkomposition und allergener Aktivität gleichlautender Produkte, was spezifische Herausforderungen an ihre Standardisierung stellt. Die Aufklärung der Nukleotidsequenzen allergieauslösender Proteine führte zur Entwicklung molekularer AIT-Ansätze. Dies ermöglicht die Applikation von ausschließlich allergologisch relevanten Strukturen und schließt chemisch synthetisierte Peptide, rekombinante Einzelallergene und Therapiemoleküle mit hypoallergenen Eigenschaften ein, die potenziell eine Auftitration mit höheren Allergendosen ohne allergische Nebenwirkungen und schnelleres Erreichen der wirksamen kumulativen Dosis ermöglichen. Zudem lassen sich weitere Modifikationen der AIT-Ansätze zur Verbesserung der allergenen und immunogenen Eigenschaften, wie zum Beispiel durch Verwendung von Virus-like Particles (VLP), erreichen. Bis dato sind die hier beschriebenen AIT-Ansätze ausschließlich in der klinischen Erprobung. Dieser Artikel gibt eine Übersicht über die publizierten, in klinischen AIT-Studien eingesetzten molekularen Allergietherapeutika. Ihr Mehrwert sowie Herausforderungen gegenüber etablierten Therapieallergenen werden diskutiert. Ziel ist die Entwicklung hochwirksamer und verträglicher AIT-Präparate mit einer verbesserten Patientenakzeptanz und -adhärenz.

Background Metalworkers are exposed to a variety of contact allergens by handling tools, metals, metalworking fluids (MWFs), oils and greases, rubber materials, and so on. Most large‐scale reports on contact allergy due to MWFs are more than 10‐years‐old, and there are only few studies on contact allergy in mechanics and other metal workers not exposed to MWFs. Objectives To describe a current spectrum of contact sensitization in metalworkers with occupational dermatitis (OD). Patients and Methods Retrospective analysis of patch test data collected by the Information Network of Departments of Dermatology (IVDK; 2010–2018), stratifying for 804 cutting metalworkers, 2197 mechanics, and 355 other metalworkers. Results Cutting metalworkers were most frequently sensitized to monoethanolamine (12.6%), colophonium/abietic acid (11.4%) and formaldehyde releasers (up to 8.5%) from the MWF series, and formaldehyde (4.6%) and iodopropynyl butylcarbamate (4.6%) from the baseline series. Sensitization among mechanics and other metalworkers indicates possible occupational exposure to MWFs, glues, and resins, although this may not be expected from their job titles. Conclusions The spectrum of MWF contact allergens remained largely unchanged during the last years. Taking a comprehensive occupational history is indispensable in order to not miss relevant allergen exposures.

Background The PEPITES (Peanut EPIT Efficacy and Safety) trial, a 12-month randomized controlled study of children with peanut allergy and 4 to 11 years old, previously reported the safety and efficacy of epicutaneous immunotherapy (EPIT) for peanut allergy (250 μg, daily epicutaneous peanut protein; DBV712 250 μg). Objective We sought to assess interim safety and efficacy of an additional 2 years of EPIT from the ongoing (5-year treatment) PEOPLE (PEPITES Open-Label Extension) study. Methods Subjects who completed PEPITES were offered enrollment in PEOPLE. Following an additional 2 years of daily DBV712 250 μg, subjects who had received DBV712 250 μg in PEPITES underwent month-36 double-blind, placebo-controlled food challenge with an optional month-38 sustained unresponsiveness assessment. Results Of 213 eligible subjects who had received DBV712 250 μg in PEPITES, 198 (93%) entered PEOPLE, of whom 141 (71%) had assessable double-blind, placebo-controlled food challenge at month 36. At month 36, 51.8% of subjects (73 of 141) reached an eliciting dose of ≥1000 mg, compared with 40.4% (57 of 141) at month 12; 75.9% (107 of 141) demonstrated increased eliciting dose compared with baseline; and 13.5% (19 of 141) tolerated the full double-blind, placebo-controlled food challenge of 5444 mg. Median cumulative reactive dose increased from 144 to 944 mg. Eighteen subjects underwent an optional sustained unresponsiveness assessment; 14 of those (77.8%) maintained an eliciting dose of ≥1000 mg at month 38. Local patch-site skin reactions were common but decreased over time. There was no treatment-related epinephrine use in years 2 or 3. Compliance was high (96.9%), and withdrawals due to treatment-related adverse events were low (1%). Conclusions These results demonstrate that daily EPIT treatment for peanut allergy beyond 1 year leads to continued response from a well-tolerated, simple-to-use regimen.

Background There is considerable variability across European patch test centres as to which allergens are included in local and national cosmetics series. Objectives To propose a standardised, evidence-based cosmetic series for Europe based on up-to-date analysis of relevant contact allergens. Methods We collated data from the European Surveillance System on Contact Allergies (ESSCA) from 2009-2018 to determine which cosmetic allergens produce a high yield of contact allergy. Contact allergens with a prevalence of >0.3% that were considered relevant were included. Rare contact allergens were excluded if deemed no longer relevant or added to a supplemental cosmetic series for further analysis. Results Sensitisation prevalence rates of 39 cosmetic contact allergens are tabulated. Thirty of these allergens yield >0.3% positive reactions and are therefore included in our proposed European Cosmetic Series. Six are considered no longer relevant and therefore excluded. Three are included in a supplementary European cosmetic series. An additional 9 allergens are included in either the core or supplemental European cosmetic series following literature review. Conclusion We have derived a potential European cosmetic series based upon the above methods. This will require ongoing investigation based upon the changing exposure profiles of cosmetic allergens as well as new and evolving substances. This article is protected by copyright. All rights reserved.

Hintergrund: Eltern von schulpflichtigen Kindern mit Nahrungsmittelallergien und dem Risiko anaphylaktischer Reaktionen wunschen sich einen

BACKGROUND: Person-to-person transmitted infectious diseases can cause occupational diseases (OD). These are subsumed as BK-No. 3101 in the German list of OD which applies for individuals with a considerably higher risk for infection as a consequence of their professional activity compared to the general population. OBJECTIVES: The special medical and insurance law aspects of a work-related MRSA colonization are presented using the example of an expert opinion case and an evaluation of the BK reports of suspected occupational disease (BK No. 3101) of the German Social Accident Insurance (DGUV). PATIENTS AND METHODS: The BK documentation of the DGUV from 2007–2012 and the patient cohort from the Department of Dermatology, University Hospital Erlangen, presenting for expert assessment from 2007–2012 were retrospectively analysed for human-to-human transmitted infectious diseases of the skin (BK-No. 3101). RESULTS: Person-to-person transmission of infectious diseases of the skin is rare in the field of occupational dermatology. In the DGUV cohort, suspected BK-No. 3101cases amounted to 2.6% of all notified cases; recognized BK-No. 3101 cases accounted for 4.2% of all recognized cases, amongst which 9 were caused by MRSA. In contrast to a symptomatic infection, an asymptomatic MRSA colonization is not being recognized as BK-No. 3101. Bacterial superantigens can trigger atopic dermatitis (AD). In particular cases, occupationally acquired MRSA can elicit AD and may justify classification as an OD (BK-No. 3101). CONCLUSIONS: Early detection of MRSA colonization and eradication are necessary for rehabilitation. Management of skin diseases due to infectious diseases within the framework of OD is presented. HINTERGRUND: Von Mensch zu Mensch übertragene Infektionskrankheiten können eine Berufskrankheit(BK)-Nr. 3101 bedingen, wenn sie bei Versicherten auftreten, die infolge der Ausübung ihrer Arbeitstätigkeit in bestimmten Bereichen einer gegenüber der allgemeinen Bevölkerung wesentlich erhöhten Infektionsgefahr ausgesetzt sind. ZIEL DER ARBEIT: Es erfolgt die Darstellung der besonderen medizinischen und versicherungsrechtlichen Aspekte einer beruflichen MRSA-Kolonisation am Beispiel eines Gutachtenfalles und Auswertung der BK-Verdachtsanzeigen (BK-Nr. 3101) der gewerblichen Berufsgenossenschaften und Unfallversicherungsträger. PATIENTEN UND METHODEN: Die Geschäftsergebnisse und BK-Dokumentation der gewerblichen Berufsgenossenschaften und Unfallversicherungsträger 2007 bis 2012 wurden zur BK-Nr. 3101 ausgewertet sowie das Patientenkollektiv berufsdermatologischer Begutachtungsfälle 2007 bis 2012 der Hautklinik Universitätsklinikum Erlangen zum Vorliegen von Mensch zu Mensch übertragener Infektionskrankheiten der Haut retrospektiv untersucht. ERGEBNISSE: Von Mensch zu Mensch übertragene Infektionskrankheiten der Haut sind in der berufsdermatologischen Begutachtung selten. Von den 2007 bis 2012 erfassten BK-Verdachtsanzeigen waren 2,6 % BK-Nr. 3101-Verdachtsfälle; 4,2 % aller anerkannten BKen entfielen auf BK-Nr. 3101-Fälle, darunter 9 Fälle von MRSA (Methicillin-resistenter Staphylococcus aureus). Eine symptomlose MRSA-Besiedlung wird im Gegensatz zur manifesten Infektionskrankheit nicht als BK-Nr. 3101 anerkannt. Bakterielle Superantigene können eine atopische Dermatitis (AD) triggern. Im Einzelfall kann eine AD infolge einer beruflich erworbenen MRSA-Ansteckung auftreten und eine BK-Nr. 3101 begründen. DISKUSSION: Ein frühzeitiger Nachweis einer MRSA-Kolonisation und Eradikation sind notwendig für eine Rehabilitation. Der Umgang mit Hauterkrankungen als Folge einer Infektionskrankheit im Berufskrankheitenverfahren wird dargelegt.

Summary Background Acetylsalicylic acid (ASA) may cause difficult-to-treat symptoms of the airways, skin, or gastrointestinal tract in hypersensitive patients. Due to the chemical relationship between salicylic acid and ASA, a role of a low-salicylate diet has been discussed. Methods This review evaluates whether low salicylate diets are meaningful from an allergological or nutritional–physiological perspective. Results The body’s arachidonic acid metabolism plays a crucial role in the pathogenesis of ASA intolerance. Despite their chemical affinity, ASA and salicylic acid affect the arachidonic pathway differently. The intake of salicylic acid with food is low compared to therapeutic doses of ASA. There is increasing evidence that protective effects of a high fruit and vegetables diet is related in part to the intake of salicylates. In salicylate-low diets, fruit and vegetables are reduced, harboring the risk of an insufficient diet and malnutrition. Conclusion Dietary therapy in ASA-intolerant patients is not recommended.

Since the introduction of allergen immunotherapy (AIT) over 100 years ago, focus has been on standardization of allergen extracts, with reliable molecular composition of allergens receiving the highest attention. While adjuvants play a major role in European AIT, they have been less well studied. In this Position Paper, we summarize current unmet needs of adjuvants in AIT citing current evidence. Four adjuvants are used in products marketed in Europe: aluminium hydroxide (Al(OH)(3)) is the most frequently used adjuvant, with microcrystalline tyrosine (MCT), monophosphoryl lipid A (MPLA) and calcium phosphate (CaP) used less frequently. Recent studies on humans, and using mouse models, have characterized in part the mechanisms of action of adjuvants on pre-existing immune responses. AIT differs from prophylactic vaccines that provoke immunity to infectious agents, as in allergy the patient is presensitized to the antigen. The intended mode of action of adjuvants is to simultaneously enhance the immunogenicity of the allergen, while precipitating the allergen at the injection site to reduce the risk of anaphylaxis. Contrasting immune effects are seen with different adjuvants. Aluminium hydroxide initially boosts Th2 responses, while the other adjuvants utilized in AIT redirect the Th2 immune response towards Th1 immunity. After varying lengths of time, each of the adjuvants supports tolerance. Further studies of the mechanisms of action of adjuvants may advise shorter treatment periods than the current three-to-five-year regimens, enhancing patient adherence. Improved lead compounds from the adjuvant pipeline are under development and are explored for their capacity to fill this unmet need.

BACKGROUND Changing patterns of exposure lead to changes in the spectrum of contact allergy in the general population and in patients patch tested for suspected contact allergy. The main contact allergens (haptens) are assembled in the so-called 'baseline series'. OBJECTIVES To present the current spectrum of contact allergy to baseline series allergens, and its temporal development over the last 12 years, based on data collected by the 56 active departments of the trinational Information Network of Departments of Dermatology (IVDK). METHODS Patch-test data, along with core demographic and clinical information, subdivided into 4-year periods for all patients patch tested with the baseline series in the IVDK, were analysed descriptively. Moreover, log-binomial regression analysis addressed temporal trends of specific contact allergies, adjusted for potentially confounding factors. RESULTS Among the 125 436 patients tested with the German baseline series, the most common allergens were nickel (14·7%), fragrance mix I (8·1%), Myroxylon pereirae resin (7·5%) and cobalt (5·2%), with no conclusive trend. The rise and fall of contact allergy to methylchloroisothiazolinone/methylisothiazolinone (MI), following (self-) regulation in the European Union, reflected the MI contact allergy epidemic. Propolis showed a marked upward trend with a prevalence of 3·94% during the period 2015-2018. CONCLUSIONS Decreases in sensitization prevalence likely reflect reduced exposure, with some lag, as seen with hydroxyisohexyl 3-cyclohexene carboxaldehyde. If no (sufficient) decrease can be observed despite interventions, such as for nickel and chromium, affected subgroups should be identified and their causative exposures explored. Finally, increases such as that observed with propolis, certainly warrant targeted investigation of the exposures driving sensitization, and possibly intervention. What is already known about this topic? Contact allergy is prevalent in the general population. Surveillance based on clinical data offers timely information on trends concerning certain allergens or subgroups at risk. What does this study add? This analysis provides an update of the current contact allergy prevalence in Central Europe, including time trends. This study describes the demographic and clinical profile of patients tested from 2007 to 2018. This research identifies contact allergens that require (further) preventive efforts. Linked Comment: Schuttelaar. Br J Dermatol 2020; 183:800-801.

Die Anzahl der von Allergien betroffenen Patienten nimmt weltweit zu. Hiermit gehen erhebliche Kosten fur die Gesundheits- und Sozialsysteme durch allergische Erkrankungen einher. Integrierte Versorgungskonzepte sind erforderlich, die innerhalb der nationalen Gesundheitssysteme eine umfassende Versorgung ermoglichen. Die ARIA-Initiative entwickelt international gultige Leitlinien fur allergische Atemwegserkrankungen. ARIA dient der verbesserten Versorgung von Patienten mit Allergien und chronischen Atemwegserkrankungen. In Zusammenarbeit mit anderen internationalen Initiativen, nationalen Fachgesellschaften und Patientenorganisationen im Bereich Allergien und Atemwegserkrankungen wurde eine realitatsnahe, integrative Versorgungsleitlinie („integrated care pathways“, ICPs) fur eine digital unterstutzte, integrative, individualisierte Behandlung von allergischer Rhinitis (AR) mit komorbidem Asthma entwickelt, die in der vorliegenden Arbeit auf das deutsche Gesundheitssystem ubertragen wird. Die vorliegende ICP-Versorgungsleitlinie umfasst wesentliche Bereiche der Versorgung von Patienten mit AR mit und ohne Asthma einschlieslich der Sicht von Patienten und weiterer versorgungsnaher Gesundheitsdienstleister. Eine umfassende ICP-Leitlinie kann die Versorgungsrealitat wesentlich besser abbilden als herkommliche Leitlinienmodelle.

Bei einer Kontaktallergie gibt es anstelle einer kausalen Therapie nur die Allergenmeidung. Wenn das Allergen nicht identifiziert wird, besteht das Ekzem fort, was eine grose Belastung fur die Patienten darstellt. Der Epikutantest (ECT) ist der diagnostische Standard zum Nachweis einer Kontaktallergie. Basierend auf einer systematischen Literaturrecherche, erhielt die deutsche Epikutantestleitlinie ein inhaltliches Update und methodisches Upgrade. Die wichtigsten praxisrelevanten Aspekte bei der Epikutantestung mit Kontaktallergenen und Arzneimitteln werden dargestellt. Es erfolgen die Aufbereitung von aktuellem konsentiertem Leitlinienwissen zur Durchfuhrung des ECT sowie eine erganzende selektive Literaturrecherche. Nach Epikutantestleitlinie (AWMF[Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V.]-Register-Nr.: 013-018, 2019) sind neben der Standardreihe stets anamnesegeleitet Spezialreihen und ggf. patienteneigene Testpraparationen zu testen. Als evidenzbasierte Neuerung wird eine Spatablesung nach 7 bis 10 Tagen empfohlen, da ansonsten zahlreiche Epikutantestreaktionen unerkannt bleiben. Antihistaminika konnen die zellularen Reaktionen im Epikutantest abschwachen. Es kann daher das Absetzen mit einer Latenz von 5 Halbwertszeiten vor dem ECT empfohlen werden. Schlieslich wird bei Verdacht auf ein falsch negatives Epikutantestergebnis die Durchfuhrung eines Abriss-Epikutantests gemas validiertem Protokoll empfohlen. Alle Patienten mit Verdacht auf eine Kontaktallergie sollen fruhzeitig eine leitliniengerechte, d. h. aussagekraftige und risikoarme Epikutantestung erhalten. Durch die gezielte Epikutantestung werden klinisch relevante Allergene identifiziert und so auch Anstose fur weitere systematische Untersuchungen gegeben.

The recent developments in the manufacturing and quality assessment of allergenic extracts in Europe are summarized.Quality assessment has always been a fundamental part of allergen product evaluation. New analytical methods have been reported that fill currently existing gaps in the characterization of commonly used allergen products. New types of products require innovative considerations and concepts for their assessment. Advanced standardization efforts aim at increasing reliability and comparability of analytical tools applied for allergen product characterization. In consequence, regulatory requirements are updated in line with such developments.Current demands on the quality of allergen products ensure production of well characterized products of consistent quality. While experience with manufacturing processes and successful product characterization approaches increase, accompanying and continuous re-evaluation of underlying quality control and assessment concepts is being performed.

Notable scientific developments have taken place in the field of anaphylaxis and urticaria in recent years; they are highlighted in this review. Case-control studies, genome-wide association studies, and large omics analyses have promoted further insights into not only the underlying genetics but also the biomarkers of both anaphylaxis and urticaria. New evidence regarding IgE-dependent and non-IgE-dependent mechanisms of anaphylaxis and urticaria, including the Mas-related G protein-coupled receptor (MRGPR [formerly MRG]) signaling pathway, has been gained. Putative elicitors of anaphylactic reactions in the context of coronavirus disease 2019 (COVID-19) vaccination and impact of the COVID-19 pandemic on the management and course of chronic urticaria have been reported. Clinical progress has also been made regarding the severity grading and risk factors of anaphylaxis, as well as the distinction of phenotypes and elicitors of both diseases. Furthermore, novel treatment approaches for anaphylaxis and subtypes of urticaria have been assessed, with different outcome and potential for a better disease control or prevention.

This chapter summarises all relevant aspects of patch testing, closely following recommendations outlined in a recent European, and a German S3 guideline on diagnostic patch testing with contact allergens and medicinal products (drugs). Patch testing is indicated in patients suspected of suffering, or having been suffering, from delayed-type hypersensitivity leading to allergic contact dermatitis or other skin and mucosal diseases. Sections of this chapter include detailed indications, reasons for possibly postponing the test, considerations on choosing haptens (contact allergens) to test, various aspects of the application of patch test allergen preparations (storage, dosing) and of testing with individual materials provided by the patients. Special aspects of patch testing in cutaneous adverse drug reactions, children, or occupational contact dermatitis are outlined. Supplemental test methods, notably the repeated open application test, are briefly described. Finally, the final evaluation in terms of assessment of clinical relevance of reactions and patient counselling are outlined.

Immune modulation is a key therapeutic tool for allergic diseases and asthma. It can be achieved in an antigen-specific way via allergen immunotherapy (AIT) or in endotype-driven approach using biologicals that target the major pathways of the type 2 (T2) immune response: IgE, IL-5 and IL-4/IL-13. COVID-19 vaccine provides an excellent opportunity to tackle the global pandemics and is currently being applied in an accelerated rhythm worldwide. It works as well through immune modulation. Thus, as there is an obvious interference between these treatment modalities recommendations on how they should be applied in sequence are expected. The European Academy of Allergy and Clinical Immunology (EAACI) gathered an outstanding expert panel under its Research and Outreach Committee (ROC). This expert panel was called to evaluate the evidence and formulate recommendation on the administration of COVID-19 vaccine in patients with allergic diseases and asthma receiving AIT or biologicals. The panel also formulated recommendations for COVID-19 vaccine in association with biologicals targeting the type 1 or type 3 immune response. In formulating recommendations, the panel evaluated the mechanisms of COVID-19 infection, of COVID-19 vaccine, of AIT and of biologicals and considered the data published for other anti-infectious vaccines administered concurrently with AIT or biologicals.

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-Nurnberg, Germany. Disclaimer: The views expressed in this …

Die Anzahl der von Allergien betroffenen Patienten nimmt weltweit zu. Hiermit gehen erhebliche Kosten fur die Gesundheits- und Sozialsysteme durch allergische Erkrankungen einher. Integrierte Versorgungskonzepte sind erforderlich, die innerhalb der nationalen Gesundheitssysteme eine umfassende Versorgung ermoglichen. Die ARIA-Initiative entwickelt international gultige Leitlinien fur allergische Atemwegserkrankungen. ARIA dient der verbesserten Versorgung von Patienten mit Allergien und chronischen Atemwegserkrankungen. In Zusammenarbeit mit anderen internationalen Initiativen, nationalen Fachgesellschaften und Patientenorganisationen im Bereich Allergien und Atemwegserkrankungen wurde eine realitatsnahe, integrative Versorgungsleitlinie („integrated care pathways“, ICPs) fur eine digital unterstutzte, integrative, individualisierte Behandlung von allergischer Rhinitis (AR) mit komorbidem Asthma entwickelt, die in der vorliegenden Arbeit auf das deutsche Gesundheitssystem ubertragen wird. Die vorliegende ICP-Versorgungsleitlinie umfasst wesentliche Bereiche der Versorgung von Patienten mit AR mit und ohne Asthma einschlieslich der Sicht von Patienten und weiterer versorgungsnaher Gesundheitsdienstleister. Eine umfassende ICP-Leitlinie kann die Versorgungsrealitat wesentlich besser abbilden als herkommliche Leitlinienmodelle.

Epicutaneous patch testing is the diagnostic standard for the detection of allergic contact dermatitis. The present guidelines are aimed at residents and board-certified physicians in the fields of dermatology and allergology as well as other medical specialties involved in establishing the indication for patch testing and its execution in patients with contact dermatitis and other forms of delayed-type hypersensitivity. The target audience also includes other health care providers and insurance funds. Based on a systematic literature search and a formal consensus process (S3), the guidelines were developed by dermatologists in collaboration with pediatricians, occupational medicine physicians, nursing staff as well as patient representatives. The systematic methodological approach and appraisal of evidence upon which the recommendations are based are outlined in a separate method report that also contains evidence tables. The guidelines address general aspects of patch testing as well as medicolegal issues. The recommendations given relate to topics such as the indication for patch testing, informed patient consent, as well as the choice of test substances, test chambers and test site, duration of exposure, reading times and interpretation of test reactions. Furthermore, recommendations are provided with respect to endogenous and exogenous factors, specific patient groups (children, pregnant women, immunosuppressed individuals) as well as possible risks and adverse events associated with patch testing using contact allergens.