Allergo

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.

Update of reference values for IgG antibodies against typical antigens of hypersensitivity pneumonitis Abstract Background Specific (s)IgG antibodies against environmental and occupational antigens, especially from bacteria, moulds, yeasts, birds and chemicals play an important role for hypersensitivity pneumonitis (HP). An increased serum level of sIgG is one criterion in the diagnostic procedure of HP and crucial for the detection of the triggering antigen for successful avoidance of further exposure. In contrast to specific IgE, sIgG concentrations in healthy individuals vary greatly depending on the antigen, which makes it difficult to differentiate from patients with HP. The aim of this study is to update or establish sIgG-reference values for important HP antigens in a healthy blood donor group. Methods Therefore a study including six clinical centres in Germany was conducted to collect sera from 121 subjects without any signs of HP and without obvious exposure to potential HP antigens. Specific IgG to 32 typical HP antigens were quantified by ImmunoCAP (ThermoFisher Scientific; Phadia, Uppsala, Sweden). For validation selected measurements were repeated, total IgG was determined, sera were tested for unspecific binding with the human serum albumin ImmunoCAP Ro401, and influence of potential confounders was analysed. Statistical distribution of the antigen-specific IgG values was evaluated and the nonparametric method of percentile calculation was applied. Results The levels of IgG antibodies to the different antigens varied considerably in the study group from <0.02 to 726 mgA/L. Low sIgG levels were found against the chemicals and the highest levels to fungal antigens, especially to Aspergillus fumigatus and Botrytis cinerea. For three isocyanates, three acid anhydrides, Trichosporon pullulans and Acremonium kiliense reference values were proposed for the first time. For several avian antigens, moulds, and bacteria pre-existing reference values nearly could be confirmed without significant deviations, but already the 90% quantile for sIgG against Penicillium chrysogenum, Aspergillus fumigatus and pigeon antigen (Ge91) clearly exceeded the pre-existing values. In contrast, the 97.5% quantile value for Candida albicans was nearly half of the pre-existing cut-off value. Discussion In most cases specific IgG values were not significantly influenced by smoking and gender and most of them were unaffected by age. For implementation of these sIgG reference values into the routine diagnosis of HP, we provide an online available calculator to rank measured sIgG concentrations to the 32 different ImmunoCAP antigens.

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

Occupational asthma due to tampico fiber bystander exposure in a brush production company—case report and literature review Abstract Background A female machine operator in a brush factory presented for an expert medical examination due to suspected occupational obstructive pulmonary disease. She reported the occurrence of severe respiratory distress whenever colleagues in the same working area processed tampico fibers or a mixture of tampico fibers and bassine. The challenge posed in terms of the expert appraisal was to either prove or rule out occupational causality and IgE-mediated (IgE, immunglobulin E) sensitization in relation to the reported workplace-related symptoms. Methods As part of the further diagnostic work-up, tampico fibers were isolated from the workplace and the proteins biotinylated and coupled to a streptavidin ImmunoCAP for specific IgE testing. The material taken from the workplace was checked for mite allergen contamination. In addition, a systematic literature search was conducted in PubMed on "agave-/tampico fibers and diseases." Results Tampico-specific IgE antibodies (10.5 kU/l and immunoblot labeling of protein bands in the 25-kDa range) were detected in the patient's serum. The inhibition assay showed that mite-allergen contamination of the tampico materials was not responsible for the IgE reactivity. Conclusion Tampico fibers are robust fibers obtained from the leaves of the Mexican Agave lechugilla. The literature describes several cases of skin reactions in the form of irritant contact dermatitis due to occupational exposure to agave leaves or contact with agave sap. In the present case, the asthma symptoms of a female worker in a brush factory were attributed to inhalant bystander exposure to tampico fibers in the workplace. The unequivocal evidence of sensitization to tampico fibers met the medical requirements for the recognition of an occupational disease (BK 4301).

Safety of a high-dose house dust mite allergoid in pediatric patients

Evolution of subcutaneous allergen immunotherapy (part 1): from first developments to mechanism-driven therapy concepts Abstract Background Subcutaneous allergen immunotherapy (SCIT) is the classic causal treatment method for IgE-mediated allergic respiratory disease. A growing understanding of the fundamentals of immunological mechanisms sets the path for further clinical improvement of this treatment. Innovations in SCIT comprise both treatment schedules and new forms of allergen extracts applied. Nonmodified allergen preparations in the form of aqueous or physically coupled (semidepot) extracts, as well as chemically modified allergens (allergoids) are currently on the market for SCIT in Germany. However, to date the clinical documentation of SCIT products in clinical studies is heterogeneous. Methods A selective literature search was conducted in PubMed and Medline, and recent publications in German-language journals not available in these literature databases were also analyzed. This literature search comprised original and review articles both in German and in English. Results SCIT is a long-established and well-documented treatment method for inhalant and insect venom allergies, with its efficacy and safety demonstrated in both the adult as well as in the pediatric population. In line with the German Therapy Allergen Ordinance (TAV) several products for SCIT are currently being investigated in clinical trials. Treatment schedules are continuous year-round (perennial), preseasonal, and combined pre-/coseasonal. The initial up-dosing phase can be performed with standard, cluster or rush procedures. SCIT is particularly well established for frequently occurring inhalant allergens such as pollen from grasses, Betula sp. (birch, alder, hazel), house dust mites (Dermatophagoides sp.), and insect venoms (bee and wasp venoms). However, good data are also available for a number of other therapeutic allergens, e.g., weed pollen such as ragweed, mugwort, etc., molds, e.g., Alternaria, Cladosporium, etc., storage mites, and animal dander (e.g., cat). Moreover, further clinical investigations on new indications such as treatment effects on e.g., oral allergy syndrome or atopic dermatitis are currently underway. Conclusion When adequately administered by physicians with allergological expertise, SCIT preparations are safe, well-tolerated, and clinically effective.

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.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com