Allergo Journal International

The focus of this review are allergic reactions to orthopaedic-surgical metal implants. The spectrum of metal implant associated potential allergic reactions encompasses eczema, impaired wound and fracture healing, infection-mimicking reactions, effusions, pain and loosening. Nickel, cobalt and chromium seem to be the predominant eliciting allergens. Despite the growing number of respective publications the topic „metal implant allergy“ remains a diagnostic challenge. Initially, differential diagnoses should always be excluded in cooperation with surgery collegues. It is recommended to perform a combined evaluation of medical history, clinical findings, patch testing and histology. The lymphocyte transformation test (LTT) can indicate metal sensitization, but it needs careful interpretation. Allergists can provide a substantial contribution to this interdisciplinary topic.

Evaluation of a lozenge for targeted micronutrition (holo-BLG), a new invention based on the farm effect, in house dust mite (HDM) allergic rhinoconjunctivitis (ARC) patients in a standardized allergen exposure chamber (AEC). Eligible HDM allergic patients were exposed to HDM raw material in an AEC for 120 min before (V1) and after (V3) 3 months of holo-BLG supplementation. Nasal, conjunctival, bronchial and other symptoms were rated by the patients every 10 min and, wellbeing, peak nasal inspiratory flow (PNIF), and lung function parameters every 30 min. Primary endpoint was the change in median Total Nasal Symptom Score (TNSS) at V3 compared to V1 at 120 min of exposure. Secondary endpoints consisted of the exploratory analysis of the temporal evolution of symptom scores using linear mixed effects models. A total of 32 patients were included in the analysis. A significant improvement of 60% (p = 0.0034) in the primary endpoint TNSS (V1 2.5 [interquartile range, IQR 1–4], V3 1.0 [IQR 1–3]) was observed. 40% improvement was seen for the Total Symptom Score (V1 5.0 [IQR 3–9], V3 3.0 [IQR 2–4]; [Wilcoxon test: confidence interval 1.5–4.0, p < 0.0003]). The analysis of the temporal evolution of all symptom scores and the personal wellbeing revealed clinically meaningful improvement over time, manifested in a lower symptom increase during the final HDM exposure. No relevant differences were observed for PNIF and lung function parameters. Safety and tolerability were rated as excellent. The effect of holo-BLG resulting in immune resilience might help to fight the allergy epidemic on a new front based on targeted micronutrition of immune cells. The study was retrospectively registered at clinicaltrials.gov (NCT04477382).

A comprehensive diagnostic work-up is essential to ensure adequate patient management for the potentially life-threatening condition of Hymenoptera venom allergy (HVA). This includes an unambiguous identification of the allergy-relevant venom as prerequisite for successful venom-specific immunotherapy (VIT). If the clinical history does not allow the identification of the culprit insect, diagnosis is often hampered by positive test results to various venoms. Modern component-resolved diagnostics (CRD) applying marker allergens of Hymenoptera venoms has created new opportunities which facilitate therapeutic decisions and may allow personalized risk stratification for individual patients. Comprehensive literature search and critical analysis of recently published studies on Hymenoptera venom allergens and CRD. Changing the research focus from whole venom extracts to individual allergenic molecules led to the development of CRD in HVA. The currently available CRD is a valuable tool to resolve cross-reactivity and primary sensitization, particularly in honeybee and vespid venom allergy. Hence, CRD has simplified therapeutic decisions in case of multiple positive test results, especially in patients who were not able to identify the culprit insect or in cases of discrepancies between clinical history and classical diagnostic results. Moreover, there is first evidence that sensitization to particular allergens might serve as biomarkers to predict risk for severe side-effects during VIT or even for VIT failure. To date, a clear limitation of CRD is the currently available allergen panel which does not allow a definite resolution of allergy to different vespid species such as yellow jackets and European paper wasps.

Along with the newly approved vaccines against coronavirus disease 2019 (COVID-19), first reports of allergic or intolerance reactions were published. Subsequently, questions arose whether these vaccines pose an increased risk for intolerance reactions and whether allergic patients may be at higher risk for this. Allergic reactions following COVID-19 vaccinations have been reported, but mostly of mild severity and at normal (Moderna®) or only slightly increased frequency (BioNTech/Pfizer®) compared to established conventional vaccines. The risk of allergic reaction to the newly licensed vector vaccines (AstraZeneca®, Johnson&Johnson®) cannot be conclusively assessed yet, but also appears to be low. There is currently no evidence that patients with allergic diseases (atopic patients) react more frequently or more severely to these vaccines. It is currently assumed that intolerance reactions of the immediate-type are either type I allergic (IgE-mediated) reactions or occur via complement activation (CARPA, “complement activation-related pseudoallergy”). Polyethylene glycol (PEG) or polysorbate, which are present as stabilizers in the vaccines, are suspected as triggers for this. The data available so far do not show a significantly increased risk of immediate-type allergic reactions in atopic persons. In almost all cases, atopic patients can be vaccinated without problems. Standardized follow-up tests after suspected allergic reactions or CARPA-mediated reactions are currently limited.

A variety of elicitors of chronic spontaneous urticaria have been identified. IgE-mediated allergy is not regarded as a major cause of chronic urticaria. We performed a retrospective search for patients simultaneously suffering from the clinical picture of urticaria and wheat allergy. Diagnostic procedures included a careful history, determination of Omega-5-gliadin-specific IgE-antibodies (ω-5-gliadin-sIgE), and skin testing. Patients with suspected wheat allergy were put on an elimination diet. After symptoms had disappeared, we performed oral challenge tests in combination with exercise or other potential trigger factors (acetylic acid, ethanol). Nine patients could be identified who had been suffering from the clinical picture of chronic urticaria for 6–72 months, and who had been suspected to be allergic to wheat. Intermittent urticaria partially with angioedema occurred in 4/9 patients, 3/9 patients reported daily attacks of urticaria, 2/9 patients also had experienced loss of consciousness. 7/9 patients had ω-5-gliadin-sIgE, 3/9 patients demonstrated sIgE to wheat flour. Prick tests with wheat were positive in 2/7 patients. Oral provocation tests with wheat were positive in 4/6 patients. In all patients urticaria resolved after eliminating wheat and spelt flour. They were surveyed for 3–8 years after wheat and spelt flour elimination. Our findings demonstrate that IgE-mediated wheat allergy may be an underestimated, hidden trigger of a reported chronic urticaria. Frequency of IgE-mediated wheat allergy in patients with the clinical picture of chronic urticaria should be examined in a prospective study.

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 …

Almost all anaphylactic reactions are associated with subjective symptoms, which are also referred to “prodromi”, and are often not taken seriously. In 100 patients categorized with different severity grades, subjective symptoms were investigated in a personal interview with free/open questions regarding subjective feelings and symptoms (duration 5–90 min). After the interview, the patients were asked to complete a questionnaire about the exact occurrence of the reaction. Special focus was given to near-death experiences in severe reactions. Patients described feelings of “elevation”, “looking at themselves from outside”, “tunnel experiences” and “bright light”. In the kinetics of the anaphylactic reaction, cutaneous symptoms were most often reported as the first or second symptom, while cardiovascular and airway symptoms were also reported as the 3rd, 4th or 5th symptom. In 37% of the patients with severe reactions, everyday life has changed since suffering the anaphylactic episode.

House dust mites and storage mites have a high allergenic potential and lead to sensitization through the formation of specific IgE antibodies. Due to their preferred residence in houses, they belong to the group of house mites, which are referred to as “domestic mites” in English. Their anatomy and biology account for their amazing adaptability to changing environmental situations (including temperature, humidity, food) and make it understandable that measures to reduce their abundance are usually difficult to implement in practice.

Even though allergies are an important health issue, wide manufacturer-dependent differences in the detected amounts of allergen-specific IgE (sIgE) have repeatedly been found. These discrepancies hinder diagnostics and research into clinically significant cutoff points for life-threatening symptoms. To evaluate whether the reported differences have led to changes in diagnostic testing, we analyzed data from six years of round robin testing (RRT, also known as proficiency testing) at the Gesellschaft zur Förderung der Qualitätssicherung in medizinischen Laboratorien e.V.  (Society for Promoting Quality Assurance in medical Laboratories) for the important allergen sources bee venom, wasp venom, and birch pollen. The results of the four main suppliers of in vitro diagnostic sIgE testing were compared in a pseudo-anonymized form using overlay images of box plot graphs for the semiquantitative data and allergen class results. Coefficients of variation (CV) were obtained to study the development of interlaboratory comparability. We found that the large differences between the manufacturer collectives remained constant between January 2010 and April 2015 without any real improvement. The CVs were good for two of the four analyzed suppliers, one was marginal and one above the quality level of 20%. The numerous publications that have found discrepancies in the sIgE results of the different suppliers did not change the status quo within the last six years. Unfortunately, this is unlikely to change until there is a characterized standard material with known values of sIgE.