BACKGROUND:Selective allergy to eggs from specific avian species, while maintaining tolerance to hen's eggs, is rare and may present diagnostic challenges. CASE REPORT:We report the case of a 75-year-old woman with no history of atopic disease who experienced episodes of anaphylaxis after consuming duck and goose eggs, while tolerating hen's eggs. Skin prick tests with commercial hen's egg extracts were negative. Serum testing revealed very low total IgE levels (5 kU/L) and low specific IgE to ovomucoid (Gal d 1), with negative results for other egg proteins. Prick-to-prick testing showed positive reactions to raw duck and goose egg white, whereas results were negative for cooked duck and goose eggs and for both raw and cooked hen's and quail eggs. An oral food challenge confirmed tolerance to hen's eggs. CONCLUSION:This case highlights a rare presentation of selective allergy to eggs from the Anseriformes order with preserved tolerance to hen's eggs. Comprehensive allergy evaluation - including skin testing, specific IgE measurement, and oral food challenges - may be essential to identify selective sensitizations and to provide appropriate dietary recommendations.
Lately, a rise of plant-related food allergies could be observed following the increase of plant-based food consumption. This narrative review provides an overview of important plant allergens from the most common allergen sources including the "Big 9", and those gaining more clinical significance such as legumes (other than peanuts) or fruits. Both commercially available and unavailable allergens for in vitro (i.e., specific IgE) and ex vivo (e.g., basophil activation test) diagnostics described in the literature to date are included in this work. In addition, gaps in the commercially available test panels (e.g., oleosins) as well as a lack of knowledge about the clinical relevance of some allergens are highlighted using the latest publications. Furthermore, practical applications are provided in exemplary case reports. In conclusion, molecular allergology provides important tools to advance precision diagnostics of allergic diseases and consequently, patient care.
This guideline is a partial update of the S3 guideline on atopic dermatitis (AWMF register no. 013-027) published in 2023. The chapters on systemic therapy with biologics and Janus kinase inhibitors as well as the chapter on pregnancy, breastfeeding and family planning in the context of systemic therapies for atopic dermatitis have been updated. This was prompted by new approvals (lebrikizumab, nemolizumab), approval extensions (abrocitinib from 12 years of age, baricitinib from 2 years of age) and new evidence on the use of biologics before and during pregnancy. In addition, a new chapter on treatment goals, treatment expectations and criteria for treatment adjustment ("treat-to-target") in systemic therapies has been added to the guideline. This article only presents the updated and newly added chapters. The complete guideline is available on the AWMF website.
Background: Wheat allergy may present with different phenotypes. Childhood-onset wheat allergy is characterized by immediate-type IgE-mediated reactions to wheat ingestion alone. It typically affects atopic individuals and often resolves spontaneously. The predominant adult-onset phenotype is WALDA (wheat allergy dependent on augmentation factors), triggered only when wheat is consumed in combination with augmentation factors. Phenotypic transition be tween these forms is rarely described. Case report: We present the case of a 30-year-old atopic female patient with a history of wheat-induced anaphylaxis, who presented with three distinct stages, compatible with a phenotypic transition. In infancy, the patient was diagnosed with classical IgE-mediated wheat allergy. In early adulthood, she developed augmentation factor-dependent reactions compatible with WALDA. At the age of 30, comprehensive oral food challenge testing and serological analysis revealed full clinical tolerance and loss of sensitization. Conclusion: This case illustrates a possible transient clinical course of wheat allergy with WALDA as an intermediate stage prior to resolution. Such cases may be underreported, as patients with declining wheat allergy may not be identified as having WALDA reactions, but rather as having inconstant reactivity. Allergy reassessment in adult patients with food allergy in childhood is essential to detect phenotypic shifts or to confirm resolution.
This review provides an overview of recent advances in understanding T-cell inflammation in atopic dermatitis (AD), a common chronic inflammatory skin disease. After recognizing their cognate antigen in the acute phase of the disease, the homing of T cells from the circulation into the skin via cutaneous lymphocyte antigen (CLA) is the prerequisite to skin inflammation and subsequent systemic and local, tissue resident, memory (TRM) formation. Initial observations suggest that antigen presentation occurs in structures such as induced skin-associated lymphoid tissue (iSALT), in addition to lymphatic organs. Aside from environmental antigens, such as aeroallergens, other antigen sources also appear to play a role: humoral and cellular responses to microbial antigens and autoantigens are discussed to drive and shape skin inflammation in AD. In-depth characterization of differentiated, activated Th2 cells in AD shows their ability to recognize different signals from epithelial cells directly. The heterogeneity of patients with antigen sensitizations and T-cell phenotypes is believed to influence therapeutic success. This suggests that a more precise characterization of patient subgroups would enable targeted, individualized therapy.
Many patients with suspected or confirmed allergy to penicillin or β-lactam antibiotics are unnecessarily denied all β-lactam antibiotics (BLA) and instead given a less effective antibiotic with more side effects. However, cefazolin, a first-generation cephalosporin, is a safe and effective treatment option for these patients in most cases. Recent studies show that immunological cross-reactions among BLAs are primarily caused by structural similarities in the side chains and not by the common β-lactam ring. Cefazolin has unique R1 and R2 side chains that largely rule out cross-reactivity with other BLAs. In a case series, 21 patients with a history of alleged or confirmed allergy to BLAs were exposed to cefazolin under real-life conditions, and all but 1 patient (who developed an uncomplicated maculopapular rash) showed no reaction. Therefore, the use of cefazolin is acceptable under clinical supervision in cases of a previous uncomplicated delayed-type reaction. However, in cases of reported or documented clinical reactions to BLA that are indicative of a type I allergy (such as urticaria, angioedema, anaphylaxis), prior to (titrated) administration of cefazolin under appropriate monitoring measures, a diagnostic evaluation in accordance with guidelines, including a negative skin test for cefazolin, is advisable. This procedure avoids the use of less suitable reserve antibiotics and ensures effective treatment without incalculable risk for anaphylaxis.
Various delayed-type hypersensitivity reactions have been reported following teicoplanin administration, including drug rash with eosinophilia and systemic symptoms (DRESS syndrome), and acute generalized exanthematous pustulosis (AGEP). Until recently, IgE-mediated hypersensitivity reactions to teicoplanin were considered to be rare. However, reports of such reactions have increased in recent years. These case reports also suggest that teicoplanin skin testing can predict IgE-mediated hypersensitivity reactions. In the present case, teicoplanin skin prick and intradermal tests were negative, yet an immediate skin reaction occurred during provocation.
BACKGROUND:Hereditary angioedema (HAE) is a rare, potentially life-threatening disease caused in most cases by C1 inhibitor deficiency. Lanadelumab, a monoclonal antibody targeting plasma kallikrein, is an effective long-term prophylactic (LTP) treatment for HAE. However, consensus on best practices remains lacking. OBJECTIVES:This study aimed to report consensus statements on key principles on long-term lanadelumab therapy for HAE in Germany developed at an HAE LTP Expert Meeting in the year 2024 in Frankfurt, Germany. MATERIALS AND METHODS:A multidisciplinary panel of seven German HAE experts participated in a consensus process to align current guidelines with real-world clinical practice. Following literature review and debate, keynotes were drafted, refined, and voted on. Consensus was defined as ≥ 70% agreement. Key domains included: shared decision-making; flexibility in initiating or adjusting prophylaxis; structured patient education; self-administration; individualized dosing; emergency medication availability; and proactive follow-up, including specific guidance for women of childbearing age. RESULTS:Ten core consensus statements were developed, achieving unanimous (100%, n = 9/10 statements) or strong (≥ 85%, n = 1/10 statements) agreement. It is recommended that the decision to initiate long-term prophylaxis be made through shared decision-making and that the decision made can and should be adjusted again in the further course of treatment. It is advisable to train patients in the technique of self-injection and to start therapy with lanadelumab with a 2-week injection interval in accordance with the product information. The injection interval should be adjusted to the individual patient, and all well-controlled patients should be offered the option of extending the interval without compromising the goal of complete disease control. Even and especially when the prophylaxis is well tolerated, emergency medication must not be neglected. CONCLUSION:These consensus statements provide a practical, expert-endorsed framework for implementing lanadelumab LTP in clinical practice emphasizing individualized treatment aligned with international guidelines and patient needs.
In vitro assays are essential tools in diagnosing IgE-mediated allergic diseases and complement clinical history and skin testing across food, inhalant, venom, and drug allergies. This methodological review is intended for clinicians seeking a more detailed understanding of current laboratory-based allergy diagnostics. It summarizes current humoral and cellular diagnostic methods, including total IgE, singleplex and component-resolved specific IgE testing, multiplex IgE platforms, and functional cellular assays such as the basophil activation test and T-cell-based approaches. Humoral assays remain the quantitative foundation of molecular allergy diagnostics, while multiplex arrays broaden diagnostic scope and map sensitization profiles, although platform variability requires cautious interpretation. Cellular assays may add functional information in selected constellations but remain technically demanding, insufficiently standardized, and are best regarded as adjunctive tools in specialized or research settings, with evidence largely derived from selected cohorts. Additional areas - immunotherapy monitoring, mast cell disorders, contact allergy, and oncology - illustrate the broader methodological spectrum of in vitro methods. Persistent unmet needs include harmonization, validated reference standards, and robust interpretive frameworks. Disease-specific applications are discussed in companion articles in this issue.
Introduction: Biological agents used in the treatment of rheumatic diseases and malignancies cause an increase in herpes zoster susceptibility. This may also be the case for monoclonal antibody treatments used in asthma based on recent pharmacovigilance data. Case report: Herpetic lesions occurred on the anterior chest wall of a 43-year-old patient who was initiated on benralizumab treatment for severe eosinophilic asthma. The patient received diagnosis of herpes zoster and showed significant clinical improvement with oral valacyclovir treatment. Since it was not certain whether the herpes eruption was directly related to benralizumab treatment, benralizumab treatment was continued at the patient's request and with the approval of the dermatology department. The patient did not experience recurrent herpes eruptions or any other clinical problems with the repeated doses given.
OBJECTIVE:To investigate changes in demographic characteristics, parental smoking habits, and the prevalence of asthma, atopic dermatitis, and rhinitis among children in South Korea before and after the COVID-19 pandemic. MATERIALS AND METHODS:A retrospective analysis of national health survey data from 2019 and 2021 was conducted, including children aged 3 - 18 years. Factors such as gender, age, location, housing type, family size, income, body mass index, subjective health status, influenza vaccination, family structure, and parental smoking habits were analyzed. RESULTS:No significant differences were found in most demographic characteristics and parental features between 2019 and 2021, except for influenza vaccination rates and mothers' age at first childbirth. The influenza vaccination rate increased from 69.3% in 2019 to 77.8% in 2021, and the average maternal age at first birth increased from 28.46 years to 29.22 years. Asthma diagnoses showed no significant differences between the 2 years after adjusting for general and parent-related characteristics. For atopic dermatitis, significant differences in gender distribution were observed in 2021. Rhinitis diagnoses showed significant differences in age, area, and breastfeeding status between the two years. CONCLUSION:The COVID-19 pandemic may have influenced certain demographic characteristics, such as influenza vaccination rates and mothers' age at first childbirth, but the prevalence of asthma, atopic dermatitis, and rhinitis among children remained largely unchanged between 2019 and 2021. This study underscores the importance of monitoring the impact of social changes on children's health, particularly during significant events like the COVID-19 pandemic. Further research is required to understand the long-term effects of these changes on child health.
The rising demand for sustainable diets has led to an increased consumption of alternative protein sources. While ecologically promising, these foods may pose new allergenic risks. We surveyed 127 European allergy experts regarding their clinical perception towards emerging allergenic food sources. Allergic reactions to non-priority allergenic foods were most frequently reported for legumes (83%), followed by hemp (33%), edible insects (21%), and jackfruit (20%). Experts highlighted risks related to cross-reactivity, particularly between edible insects and crustaceans or house dust mites, and between non-priority legumes and peanut, soy, or lupine. Legumes other than peanut, soy, and lupine, as well as edible insects and hempseeds/cannabis, were also rated as most clinically relevant for future practice. Experts also noted rising symptoms due to changes in pollen exposure and insect distribution linked to climate change. Our data underscore the need for the diagnosis of emerging allergenic sources.
Background: Wheat is a frequent cause of food-induced allergic reactions in adults. In this study we aimed to assess the diagnostic value of skin prick test (SPT), specific immunoglobulin E (sIgE), but also quality of life in wheat-sensitized and allergic patients. Materials and methods: In this prospective, clinical study 80 patients were screened for eligibility. Subsequently, 36 wheat-sensitized patients underwent oral food challenges (OFCs) with supraphysiological amounts of gluten at rest and in combination with exercise. The challenge was stopped when objective symptoms occurred. Prior to the challenge, sIgE measurement and a SPT were conducted. The Food Allergy Quality of Life Questionnaire (FAQLQ), Food Allergy Independent Measure (FAIM), and Beck Anxiety Inventory (BAI) were used to assess the quality of life, perceived disease severity, and anxiety of the patients. Results: The OFC was performed with increasing amounts of gluten reaching a supraphysiological level. 24 patients (67%) were OFC positive with 21 reacting at rest. 3 patients reacted after the implementation of exercise. 60% of patients with a self-reported exercise dependency reacted in the OFC at rest. 8 of 21 patients who reacted at rest were rechallenged with exercise and lower doses of gluten, of which 5 reacted again. Exercise lowered the reaction threshold by 50% in these 5 patients. OFC positive patients had stronger sensitization to gluten and its constituents and showed higher impairment in their quality of life and perceived burden of disease than OFCnegative patients. The receiver operator characteristics model including gluten SPT, omega-5-gliadin sIgE, and the FAIM score to predict OFC positivity yielded a 95.2% sensitivity and 83.3% specificity. Males displayed a higher degree of sensitization, but females had higher FAQLQ and FAIM scores. Conclusion: Although a high rate of exercise dependency was reported, most reactions were elicited at rest when the amount of gluten was upscaled. However, the eliciting amount and reaction threshold was lowered in the presence of exercise. Food allergy-related quality-of-life data can indicate psychological impairment due to the disease but may also serve as a patient-reported outcome tool which can support the diagnostic accuracy of wheat allergy.
Background: Hereditary angioedema (HAE) is a rare genetic disease characterized by recurrent swelling attacks. Current guidelines for HAE management emphasize achieving complete disease control to normalize patients' lives. Quality of life (QoL) differences between patients with 0 attacks and those with persistent attacks remain to be explored. Materials and methods: The German patient organization for individuals affected by hereditary angioedema, HAE Vereinigung e.V. conducted an online survey with 122 HAE patients in Germany in 2024. Participants were categorized according to their therapy-long-term prophylaxis (LTP) or on-demand therapy (ODT)-and according to their attack frequency over the last 6 months. Patient-reported outcomes for functional, emotional, and social impacts were analyzed to evaluate QoL. Results: Although 83% of patients expressed satisfaction with their treatment, 59% of patients still had attacks. Patients on LTP reported significantly fewer attacks (p < 0.001) and higher QoL compared to those on ODT (p < 0.001). Patients with 0 attacks consistently showed significantly better outcomes across all QoL domains than those with 1 or more attacks (p < 0.001). Conclusion: The findings highlight that even minimal residual disease activity can meaningfully reduce QoL. Achieving complete attack freedom, rather than partial control, is necessary to restore normalcy for patients with HAE. Hence, regular adjustments of the HAE management plans based on patient-reported outcomes are crucial to ensure that treatment strategies address both medical and QoL needs.
Background: Kounis syndrome is a rare type of allergic or hypersensitivity-induced acute coronary syndrome. The release of numerous inflammatory mediators induces vasospasms and potential thrombosis leading to myocardial infarction. Case history: We present the case of a 65-year-old woman with metastatic melanoma who experienced chest tightness and dyspnea after her 3rd infliximab infusion and who had transitory ST elevations. Suspecting allergic reactions and acute coronary syndrome she was simultaneously treated for both conditions with complete resolution of symptoms and electrocardiographic alternations without the need for further percutaneous coronary intervention. Conclusion: This case highlights the importance of considering Kounis syndrome as a potentially life-threatening complication during monoclonal antibody infusion, even in the absence of a prior allergic history and typical skin manifestations. Early recognition and treatment are crucial and spared our patient further invasive diagnostical and therapeutical interventions.
BACKGROUND:Hymenoptera venom allergy represents a potentially life-threatening condition. Venom immunotherapy (VIT) is the treatment of choice in patients with systemic reactions. CASE PRESENTATION:We report the case of a 65-year-old male, who experienced systemic reactions following hymenoptera stings. In vitro and in vivo allergy tests revealed sensitization predominantly to Polistes dominula and specific VIT was initiated. During VIT, the patient experienced two subsequent stings with only local reactions. After 5 years of VIT, repeated serological evaluation and skin tests turned negative, leading to the decision to discontinue therapy. CONCLUSION:This case underlines the efficacy and safety of VIT in patients with severe hymenoptera venom allergy in preventing systemic reactions. A comprehensive diagnostic work-up, including laboratory and skin tests, is crucial in the management and subsequent evaluation of therapeutic efficacy.
The Therapy Allergen Ordinance (TAO) aims to migrate allergen immunotherapy (AIT) products for the treatment of common allergies, which were previously marketed in Germany as named patient products (NPP), into authorized products if their quality, efficacy, and safety are adequately shown. The TAO applies to all NPP containing active ingredients based on the following allergen sources: house dust mites, bee venom, wasp venom, pollen from sweet grasses (excluding maize), birch, alder, or hazel. The last product-specific deadlines granted under the TAO for the submission of clinical data relevant to the marketing authorization process will expire in 2026. The subsequent final assessment of the updated marketing authorization application (MAA) is carried out by the competent authority, the Paul-Ehrlich-Institut. During this period of processing by the competent authority, the products remain marketable until the marketing authorization application has been decided on. Currently (as of 08.08.2025), 40 AIT products are still marketable under the transitional provisions of the TAO (10 preparations for the treatment of allergies to house dust mites, 10 against tree pollen allergies, 16 against grass pollen allergies and 4 mixed preparations containing non-homologous allergen groups). For 8 of these products, the pharmaceutical companies have initiated the withdrawal of MAA as of 01.10.2025 or 31.01.2026, respectively. Prior to the final assessment of the updated MAAs, the competent authority is unable to make any public statements as to whether the individual applications for the remaining 32 products under the transitional provision will be concluded positively with the granting of MA or MA rejection. With the rejection of a MA, the product-specific marketability ends immediately, i.e., there is no additional sell-off period for the TAV products concerned. If a marketing authorization is granted, the marketability of the specific product is sustained.
(3-lactam antibiotics (BLAs) are still the antibiotics of first choice for the treatment of many bacterial infections. Treatment with a BLA is often hindered by a suspected allergy, up to 10% of the population report an allergy to penicillin. After allergological evaluation of the suspected allergic reaction to a BLA, most patients show a low probability of a BLA allergy; only in a minority of cases an allergic reaction to the repeated administration of a BLA appear likely in view of the previous history.
BACKGROUND:Artificial intelligence (AI) offers a wide range of applications in allergology, including diagnostics and disease course prediction, consultations, real-time monitoring of allergic reactions, and support for decentralized clinical studies. MATERIALS AND METHODS:This review aims to highlight not only the potential applications but also the ethical aspects of using AI in allergology. RESULTS:Initial studies demonstrate potential applications of AI in predicting provocation tests and antibiotic delabeling. However, these models from research and development have not yet been established in clinical practice, partly because ethical considerations, alongside technical challenges, and data quality issues, must be addressed. Key ethical dilemmas include bias and fairness, the principle of non-maleficence, data protection and autonomy, transparency of AI models, and questions of accountability. AI applications must be robust and reliable to prevent harm caused by erroneous recommendations. CONCLUSION:The use of AI in allergology requires clear guidelines based on principles such as autonomy, justice, and non-maleficence. General bioethical principles must be complemented by specific regulations for AI.
Adrenaline is the drug of choice for the treatment of anaphylaxis. Up to now, intramuscular administration using an autoinjector has been recommended in national and international guidelines as the first-line treatment for anaphylaxis. Various adrenaline autoinjectors are available on the German market as emergency medication for immediate treatment by medical laypersons and specialists. Recently, a nasally administered adrenaline preparation was introduced for the first time and is available on the market. There are mainly data on healthy control subjects, which show a good adrenaline level and an expected effect on blood pressure and heart rate. To date, there is little clinical experience in the world literature for patients with anaphylaxis in children/adolescents and none in adults or from Germany. Therefore, we would like to discuss theoretically the use of adrenaline via the nasal route of administration in the care of anaphylaxis patients and compare it with the intramuscular administration of adrenaline autoinjectors.
