Correction to: Guideline on diagnostic procedures for suspected hypersensitivity to beta-lactam antibiotics Correction to: Allergo J Int 2019 https://doi.org/10.1007/s40629-019-0100-8 In the “Guideline on diagnostic procedures for suspected hypersensitivity to beta-lactam antibiotics” Figs. 5 and 6 (allergy passports) are in German. Here you will find the allergy passports in …

Ash pollen allergy and aerobiology Abstract Background Allergy to ash pollen is common in some parts of Europe. Sensitization is overlooked if Oleaceae pollen allergens are not included in screening tests. Methods Between 1983 and 2007, sensitization to aeroallergens was systematically investigated using serological methods in 15-year-old school children (Immuno-CAP [carrier polymer] test). Samples from 1986 and 2006 were also tested using the immuno-solid-phase allergen chip (ISAC) assay. School children with sensitizations in 1986 were retested in 2010. Airborne pollen concentrations were determined by the Swiss pollen measuring network. Results Sensitization (>0.7 kU/l) to ash pollen (Fraxinus americana t15)—16.3% (102/627)—was more frequent than to birch pollen (Betula verrucosa t3): 15.3% (96/627). ISAC assays performed in children in 1986 and 2006 revealed higher molecular seroprevalence for nOle e 1 (15%; 15/100) compared to rBet v 1 (12%; 12/100). Followed-up subjects (age, 39) showed an increase in sensitizations to ash pollen. IgE levels to pollen from indigenous ash (Fraxinus excelsior t25) were higher than to pollen from American ash (Fraxinus americana t15). Low ash pollen emission levels were recorded at all measuring sites in Switzerland every 2–4 years. The infection of ashes by Chalara fraxinea resulted in increased emission of ash pollen. Conclusion Symptoms in individuals sensitized to ash pollen vary according to the pollen count and may be masked by pollen from other trees that flower at the same time of year. Sensitization to ash/Ole e 1 can be higher than to birch/Bet v 1. The determination of IgE to common ash (Fraxinus excelsior) is more sensitive than to American ash (Fraxinus americana). Ash dieback due to Chalara appears to increase pollen emission. Allergies to ash pollen can be significantly underestimated due to a failure to (correctly) identify them; they can also be masked by other pollen families (birch). Harmful organisms such as Chalara can intensify pollen emissions at least temporarily.

Atopic eczema score of emotional consequences—a questionnaire to assess emotional consequences of atopic eczema Abstract Purpose Atopic eczema (AE, atopic dermatitis), one of the most common chronic skin diseases worldwide, can dramatically influence the lives of affected patients as well as the lives of their families. Despite the availability of several questionnaires for assessing the impairment of quality of life, so far the emotional consequences of AE have received limited attention. The purpose therefore was to develop an instrument to assess the emotional consequences of AE in affected adults. Methods The Atopic Eczema Score of Emotional Consequences (AESEC) was developed based on a review of available instruments and by consulting individuals with AE about the emotional consequences of AE through social media. Validation was performed in a test-sample, followed by a large cross-sectional study in patients with AE across nine European countries. AESEC results were compared with the Patient Oriented Eczema Measure (POEM), the Dermatology Life Quality Index (DLQI) and the Hospital Anxiety and Depression Scale (HADS). Results A 28-item questionnaire on emotional consequences of having AE was developed. Applied to 1189 participants, AESEC showed high reliability and correlated well with DLQI, HADS and POEM. More than half (57%) of the respondents were emotionally burdened. Large to very large emotional consequences were reported by 43.8% of those with currently moderate AE, 62.2% with severe AE and 66.7% with very severe AE-symptoms. Conclusion AESEC is a questionnaire for assessing the emotional consequences of living with AE. It may prove useful in evaluating the burden of disease, beyond skin symptoms and time-specific quality of life.

Effectiveness of a portable air filtration device in reducing allergen exposure during household chores Abstract Background Exposure to airborne allergens is an important risk factor for sensitization, allergic rhinitis and asthma. The aim of this study is to verify whether the use of an air filtration device, called “air purifier” (AP) is able to reduce indoor allergen exposure. Methods In three rooms of one household with pets (a cat and a dog), inhalable dust was sampled with transportable pumps for 1–2 h during typical household chores on 15 days—either in the morning without the AP or in the afternoon using an AP. In addition to sampling inhalable dust both with a stationary and a personally carried pump with Teflon filters, nasal filters were used. Inhalable dust on the Teflon filters was quantified gravimetrically, and allergen content was measured on all filters (n = 90) using fluorescence enzyme immunoassays for domestic mites (DM), the cat allergen Fel d 1, and the dog allergen Can f 1. Results The use of the AP significantly reduced inhalable dust in both personal and stationary samples by 40 or 20%, respectively. In most cases, allergen exposure was also reduced; the median allergen concentrations in the air were up to 60% lower with the AP than without. Allergen exposure varied greatly, and with the exception of Can f 1 sampled with the personally carried pump, and DM allergens in the nasal samples, there was no significant difference with or without an AP. Discussion Typical household chores can result in high levels of exposure to indoor dust and allergens. The use of an AP however can reduce the inhalable dust concentrations, but the effect on allergen exposure was in most cases not large enough to achieve statistical significance.

ARIA guideline 2019: treatment of allergic rhinitis in the German health system Abstract 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.

Drug-induced anaphylaxis—elicitors, mechanisms and diagnosis Abstract Drugs are one of the major causes of anaphylaxis. For example 2346 cases of drug-induced anaphylaxis were reported to the anaphylaxis register as of March 2019. The most common triggers of drug-induced anaphylaxis were nonsteroidal anti-inflammatory drugs (NSAIDs; n = 902) and antibiotics (n = 721). Drug-induced anaphylaxis can be caused by IgE-dependent (e.g., penicillins) and IgE-independent mechanisms. Recently MRG-PX2 has been identified as a receptor for non-IgE-dependent mechanisms. Drug-induced anaphylaxis results more frequently in lethal reactions and is more commonly associated with cardiovascular symptoms. Also therapy refractory anaphylaxis is more frequently triggered by drugs. For the diagnosis of drug-induced anaphylaxis current national and international guidelines should be followed including provocation tests to avoid future reactions.

Characterization of a cohort of storage mite sensitized subjects Abstract Purpose Storage mites (SM) are ubiquitously found close to human habitation and are a source of allergic reactions ranging from allergic rhinitis and asthma to anaphylactic reactions. Methods Data on 3997 patients with suspected allergic rhinitis were included. We performed correlation of intradermal testing and specific IgE-test results using Cohen’s kappa and univariate logistic regression to evaluate the probability of symptoms and the point of time symptoms were reported. In some patients nasal provocation was performed to prove allergic rhinitis. Results Patients with storage mite sensitization show a high degree of cross reactivity between different storage mite species. Cross reactivity of storage mite species with house dust mites (HDM) was found in 56% and is only slightly higher than that of other common allergens such as grasses (45%) or birch (42%). A correlation of intradermal testing and specific IgE testing could not be found. The most common symptoms of sensitized subjects were nasal obstruction and hyposmia and symptoms were dependent on presence of chronic sinusitis. Nasal provocation was positive in 16 to 33% of subjects tested. Conclusions SM are a common sensitization in the study population and should be included in standard skin prick test arrays. Cross sensitization to house dust mites is limited and nasal symptoms are most frequent. Nasal provocation testing is necessary to secure clinical diagnosis of allergy and further research is needed to evaluate the clinical relevance of the high sensitization rates found for intradermal testing.

IgE-mediated hypersensitivity to chlorhexidine among first-year dental students Abstract Purpose To investigate immunoglobulin E (IgE)-mediated hypersensitivity to chlorhexidine (CHX), and association between CHX exposure and serum specific IgE (SIgE) levels, among first-year dental students. Methods Participants completed a questionnaire on medical health, history of allergies/hypersensitivities and CHX exposure. A sample of venous blood (3 mL) was drawn and subjected to SIgE test to CHX; sensitisation defined as SIgE level of ≥0.10 kUA/L. Results Fifty-eight (98.3%) participants, consisting of 69% (n = 40) female with a mean age of 21, were recruited; three quarters (84%) reported no known health issue, and over half had no history of allergies (57%); less than 20% reported having had exposure to CHX-containing products with the majority from toothpaste (9%) and mouthwash (12%). The CHX SIgE test showed that 8.6% (n = 5) were sensitised. No association between CHX exposure history and the level of SIgE antibody was noted. Conclusions Although most participants reported no known exposure to CHX, 8.6% showed CHX sensitisation suggesting unknown exposure and the potential risk of developing hypersensitivity and adverse reactions in the future.

Consumer protection and risk assessment: sensitising substances in consumer products Abstract Background The human immune system is confronted daily with a large, chemically-varied range of potentially sensitising substances. Skin sensitising substances are found, above all, in a plethora of consumer products, e. g. cosmetics, jewellery, earrings, toys, textiles, leather, other everyday commodities and, in some cases, also tattoos. These products may contain sensitisers such as fragrances, preservatives, dyes, or other additives. To provide a greater degree of consumer protection, there is a need for specific legal regulation and risk assessment, which covers each possible human exposure to a sensitising substance or mixture. This review article describes the background and pathway towards the development and implementation of an international legal framework for the classification and labelling of chemicals that contain potentially skin sensitising substances. This includes the implementation of the globally harmonized system of classification and labelling of chemicals (GHS), the classification, labelling and packaging (CLP) regulation, registration, evaluation, authorisation and restriction of chemicals (REACH), and the regulation of cosmetics, among other national laws and regulations. Assessment criteria for classification is derived from a suite of in vitro and in vivo assays, in addition to in silico approaches—validated by the organisation for economic cooperation and development (OECD)—as well as data derived from human studies. Results New legislation for chemical and product safety is reflected in the classification and labelling of skin sensitising substances under Category 1, Subcategory 1A or 1B, within which the threshold concentrations of several materials are regulated, e. g. p‑phenylenediamine in hair dyes, nickel in piercings, chromium VI in leather and methylisothizolinone in cosmetics. In order to minimise the risk of human contact allergy from consumer products, the scientific committee on consumer safety (SCCS) and the German federal institute for risk assessment (BfR) investigate pathways of exposure and perform risk assessments using new in vitro approaches and new (immuno-) toxicological concepts (i. e. adverse outcome pathways [AOPs], key events as well as an integrated approach to testing and assessment [IATA]). In comparison to cosmetics, substances in textiles and other consumer products are less regulated. Major efforts in research and development are necessary to decode complex substance-specific molecular mechanisms in allergic responses and to define new substance-specific thresholds. Such efforts have been continuously proposed by the BfR with regard to fragrances for over 10 years. Conclusions Today, skin sensitising substances can be legally regulated and labelled and, depending on the exposure, their content in consumer products can be reduced or eliminated. Furthermore, the risk assessment of potentially sensitising substances makes consumer products safer. Further improvements in research approaches are required in the area of health and consumer protection with regard to allergy.

Prevalence of Hymenoptera venom allergy and sensitization in the population-representative German KORA cohort Abstract Purpose Allergic reactions to Hymenoptera venoms represent potentially life-threatening conditions. However, studies on their prevalence in Germany and their relation to specific IgE sensitization are rare. The aim of this study was to evaluate the prevalence of Hymenoptera venom allergy as well as the frequency of venom-specific IgE sensitization in a large population-based adult German cohort. Methods Questionnaire data were collected from the participants of the German population-based KORA (Cooperative Health Research in the Region of Augsburg) S4 baseline study population (n = 4261) and the follow-up F4 study population (n = 3074), which was conducted seven years later. Moreover, sIgE antibodies to honeybee (HBV) and yellow jacket venom (HJV) as well as to common aeroallergens were measured in the S4 study population. Results The prevalence of systemic sting reactions ranged between 2.3% and 2.6%. sIgE sensitization (≥0.35kUA/L) to HBV and YJV was demonstrated in 23.1% and 31.7% of the population, respectively (41.6% to HBV and/or YJV). Double-sensitization to both venoms occurred in 13.2% of the individuals. Approximately 53% and 77% of the individuals who reported shock symptoms after honeybee and yellow jacket stings, respectively, exhibited sIgE ≥ 0.35kUA/L to the culprit venom. In contrast, only 2.8% of the venom-sensitized individuals reported symptoms exceeding local reactions. Local reactions were reported by 4.4 to 4.8% of the population. Conclusions Self-reported Hymenoptera sting reactions and venom sensitization are frequent in the general German population. In many cases, sensitization and clinically relevant allergy are not observed in the same individual, indicating that comprehensive diagnostic approaches are a prerequisite for the identification of patients at risk for severe reactions.