Reminder system for adrenaline autoinjectors does not work

Correction to: Air pollutants and primary allergy prevention Correction to: Allergo J Int 2018 https://doi.org/10.1007/s40629-018-0078-7 An error was identified in the review on “Air pollutants and primary allergy prevention”. The given PM2.5 increment of 2 µg/m3 was wrong and should be replaced with an increment of 5 µg/m3. This was the case on: Page 9, legend …

German pollen calendar 4.0: update of the regional pollen calendars 4.0 with measurement data for the period 2011–2016

Alpha-tocopherol acetate nasal spray in the treatment of pollen-induced allergic rhinitis Abstract Background This study compared the effectiveness and tolerability of alpha-tocopherol acetate nasal spray (ATANS) to those of beclomethasone nasal spray (BNS) and loratadine (LT) for the treatment of pollen-induced allergic rhinitis. Methods This active-controlled, patient-preference, observational trial lasted 7 days. Tested variables were nasal symptoms, endoscopic examination, additional medications, general effectiveness, safety, and tolerability. Results Of 116 patients, 63 patients decided to use ATANS, 32 BNS and 21 LT. During the treatment, the mean daily rhinitis symptom score decreased significantly in all groups. The 7‑day mean score in the ATANS group (0.98) was comparable to that of the BNS group (0.92) and significantly higher than that of the LT group (0.70, P < 0.05). After treatment, the endoscopic score was significantly lower in all groups; the reductions were significantly greater in the BNS and LT groups than in the ATANS group (BNS vs. ATANS: P < 0.01; LT vs. ATANS: P < 0.05). Additional medications were not used by 60% (ATANS), 47% (BNS) and 95% (LT) of patients; the difference between ATANS and LT was significant (P < 0.01). Treatment was assessed as good or very good by 56% (ATANS), 69% (BNS) and 86% (LT) of patients; the differences between ATANS and BNS (P < 0.05) as well as between ATANS and LT (P < 0.01) were significant. Most patients (96%) did not experience any adverse events. Pollen intensity was comparable between groups and decreased marginally on day 7. Conclusion ATANS can be considered an effective symptomatic treatment for patients with allergic rhinitis who wish to avoid side effects of antihistamines and corticosteroids. Trial registration German “Register Klinischer Studien” (Reference number: DRKS00009338)

Guideline on diagnostic procedures for suspected hypersensitivity to beta-lactam antibiotics Abstract This guideline on diagnostic procedures for suspected beta-lactam antibiotic (BLA) hypersensitivity was written by the German and Austrian professional associations for allergology, and the Paul-Ehrlich Society for Chemotherapy in a consensus procedure according to the criteria of the German Association of Scientific Medical Societies. BLA such as penicillins and cephalosporins represent the drug group that most frequently triggers drug allergies. However, the frequency of reports of suspected allergy in patient histories clearly exceeds the number of confirmed cases. The large number of suspected BLA allergies has a significant impact on, e.g., the quality of treatment received by the individual patient and the costs to society as a whole. Allergies to BLA are based on different immunological mechanisms and often manifest as maculopapular exanthema, as well as anaphylaxis; and there are also a number of less frequent special clinical manifestations of drug allergic reactions. All BLA have a beta-lactam ring. BLA are categorized into different classes: penicillins, cephalosporins, carbapenems, monobactams, and beta-lactamase inhibitors with different chemical structures. Knowledge of possible cross-reactivity is of considerable clinical significance. Whereas allergy to the common beta-lactam ring occurs in only a small percentage of all BLA allergic patients, cross-reactivity due to side chain similarities, such as aminopenicillins and aminocephalosporins, and even methoxyimino cephalosporins, are more common. However, the overall picture is complex and its elucidation may require further research. Diagnostic procedures used in BLA allergy are usually made up of four components: patient history, laboratory diagnostics, skin testing (which is particularly important), and drug provocation testing. The diagnostic approach—even in cases where the need to administer a BLA is acute—is guided by patient history and risk–benefit ratio in the individual case. Here again, further studies are required to extend the present state of knowledge. Performing allergy testing for suspected BLA hypersensitivity is urgently recommended not only in the interests of providing the patient with good medical care, but also due to the immense impact of putative BLA allergies on society as a whole.

What we learned from TAO – 10 years of German therapy allergen ordinance Abstract Purpose The Therapy Allergen Ordinance (TAO) came into force in Germany in 2008 in order to ensure proven and tested quality, efficacy and safety of therapy allergens for the treatment of allergies to frequent allergen sources (birch, alder, hazel, sweet grasses (without maize), bee-, yellow jacket-venom). It excludes exemptions from marketing authorizations (MA) for AIT-products containing these allergens. Due to the particular nature of the therapeutic allergens, rather long transitional periods are legally defined to resolve deficient clinical data. The aim was to analyze the status quo of AIT products developed according to TAO. Methods Quality data and clinical trials of AIT products subjected to TAO (obtained until 2019) were analyzed and findings were clustered. Results The first two AIT products (for tree-pollen allergy) received a national MA in 2018. Of the 123 initial MA applications submitted, 65 are still active (26 for grass-, 17 for tree-, 5 for grass-/tree-pollen-mix and 17 for house dust mite allergy). Quality issues frequently identified were: Lack of comparability of the drug due to extensive changes in the manufacturing process, insufficient/missing stability data or process validation, insufficiently validated analytical methods, unsuitable in-house reference preparations, inadequate specifications and/or in-process controls. Dose-finding and phase III studies are required for MA. Doses of best benefit/risk balance were recommended for phase III studies. PEI takes measures to ensure that products of presumptive lacking efficacy based on study results do not gain access to the market. Conclusions In Germany, TAO ensures that all previously untested named patient products for the treatment of frequent allergies are subjected to an assessment of their risk/benefit ratio according to the current state of science.

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.

Case series of anaphylactic reactions after rabies vaccinations with gelatin sensitization Abstract Side effects due to allergic reactions to vaccine antigen or to additives such as chicken protein or gelatin have been known for some time. Recent findings regarding reactions mediated via the carbohydrate epitope galactose-alpha-1,3-galactose (alpha-gal), a constituent of animal gelatin, broaden the spectrum of gelatin-related allergies. This case series presents four patients who developed anaphylactic reactions following rabies vaccination using the vaccine Rabipur®. After appropriate allergy testing by skin prick testing and the determination of specific IgE to allergens in the vaccine, triggering by alpha-gal could be excluded and an allergy to gelatin was detected. The absence of allergic symptoms following the consumption of gelatin could potentially be explained through intestinal hydrolysis resulting in a loss of allergenic potency. Further implications related to the use of gelatin-containing infusions in emergency medicine are discussed.

Omalizumab as a last resort therapy for intractable, severe chronic allergic rhinosinusitis

Development of subcutaneous allergen immunotherapy (part 2): preventive aspects and innovations Abstract Background Allergen immunotherapy with subcutaneous injection (SCIT) of the relevant allergen is the classic causal treatment method for IgE-mediated allergic respiratory disease and has already been successfully used for over 100 years. Methods This publication is based on a selective literature search in PubMed and MEDLINE. Recent publications in German-language journals that are not available in literature databases were also analyzed. This literature search included original and review articles both in German and in English. Results Primary, secondary and tertiary prevention characteristics have been demonstrated for SCIT; however, these require further evaluation. In combination with biologic agents, the safety, and in some cases the efficacy, of SCIT can be increased. Adjuvants seem to offer enormous development potential for SCIT. Aluminum salts, microcrystalline tyrosine (MCT), and monophosphoryl lipid A (MPL) are already used in commercial SCIT preparations. At the same time, other adjuvants are being researched, e.g., liposomes, microspheres, CpG motifs (C: nucleotide cytosine, p: phosphate, G: nucleotide guanine), or virus-like particles (VLPs). The therapeutic extracts themselves are also undergoing further development, for instance as recombinant allergens, hypoallergenic variants such as site-directed mutants (SDM), conformational variants, allergen fragmentation, allergen oligomers, deletion mutants, and hybrid allergens/mosaic antigens. Conclusion SCIT preparations are among the most innovative treatment options in the immunotherapy of allergic diseases. Due to the numerous immunological approaches, they will make treatment safer and more effective in the future with reduced effort.