(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.

Abstract Background As extract‐based skin testing as well as in vitro tests for major allergens have their own advantages, both procedures are usually performed in routine settings. In times of shortages in medical staff and supplies, we asked ourselves, how many patients would be underdiagnosed, if only one test could be used. Methods In a retrospective analysis, we investigated a cohort of 2646 patients seen by a single physician in a large Austrian outpatient allergy clinic in 2018. Only patients with an allergen source‐specific history and pairs of extract‐based skin prick (SPT) and in vitro molecular allergy tests to major allergens were included. Results For all tested allergen sources, sensitivity was higher for SPT than for sIgE‐based molecular allergy testing. Concerning 1006 birch pollen‐allergic patients, 791 (78.6%) had positive results with both tests, while 153 (15.2%) only with the SPT and 62 (6.2%) only with the sIgE to Bet v1. The other allergen sources showed similar results: For house dust mite 816/1120 (72.9%), grass pollen 1077/1416 (76.1%) and cat 433/622 (69.6%) remained test‐positive with both procedures, whereas in 276 (24.6%), 224 (15.8%) and 173 (27.8%) times only the SPT and 28 (2.5%), 115 (8.1%) and 16 (2.6%) times only the sIgE to Der p1/2/23, Phl p1/5 and Fel d1 showed a positive result. Each comparison was statistically significant (each p < 0.0001, Chi‐squared test). Conclusions Screening for allergy with major molecular allergens has lower sensitivity when compared with extract‐based skin tests. A combination of both is required for an optimal sensitivity.

Hymenoptera venom (HV) is injected into the skin during a sting by Hymenoptera such as bees or wasps. Some components of HV are potential allergens and can cause large local and/or systemic allergic reactions (SAR) in sensitized individuals. During their lifetime, ~ 3% of the general population will develop SAR following a Hymenoptera sting. This guideline presents the diagnostic and therapeutic approach to SAR following Hymenoptera stings. Symptomatic therapy is usually required after a severe local reaction, but specific diagnosis or allergen immunotherapy (AIT) with HV (VIT) is not necessary. When taking a patient's medical history after SAR, clinicians should discuss possible risk factors for more frequent stings and more severe anaphylactic reactions. The most important risk factors for more severe SAR are mast cell disease and, especially in children, uncontrolled asthma. Therefore, if the SAR extends beyond the skin (according to the Ring and Messmer classification: grade > I), the baseline serum tryptase concentration shall be measured and the skin shall be examined for possible mastocytosis. The medical history should also include questions specific to asthma symptoms. To demonstrate sensitization to HV, allergists shall determine concentrations of specific IgE antibodies (sIgE) to bee and/or vespid venoms, their constituents and other venoms as appropriate. If the results are negative less than 2 weeks after the sting, the tests shall be repeated (at least 4 - 6 weeks after the sting). If only sIgE to the total venom extracts have been determined, if there is double sensitization, or if the results are implausible, allergists shall determine sIgE to the different venom components. Skin testing may be omitted if in-vitro methods have provided a definitive diagnosis. If neither laboratory diagnosis nor skin testing has led to conclusive results, additional cellular testing can be performed. Therapy for HV allergy includes prophylaxis of reexposure, patient self treatment measures (including use of rescue medication) in the event of re-stings, and VIT. Following a grade I SAR and in the absence of other risk factors for repeated sting exposure or more severe anaphylaxis, it is not necessary to prescribe an adrenaline auto-injector (AAI) or to administer VIT. Under certain conditions, VIT can be administered even in the presence of previous grade I anaphylaxis, e.g., if there are additional risk factors or if quality of life would be reduced without VIT. Physicians should be aware of the contraindications to VIT, although they can be overridden in justified individual cases after weighing benefits and risks. The use of β-blockers and ACE inhibitors is not a contraindication to VIT. Patients should be informed about possible interactions. For VIT, the venom extract shall be used that, according to the patient's history and the results of the allergy diagnostics, was the trigger of the disease. If, in the case of double sensitization and an unclear history regarding the trigger, it is not possible to determine the culprit venom even with additional diagnostic procedures, VIT shall be performed with both venom extracts. The standard maintenance dose of VIT is 100 µg HV. In adult patients with bee venom allergy and an increased risk of sting exposure or particularly severe anaphylaxis, a maintenance dose of 200 µg can be considered from the start of VIT. Administration of a non-sedating H1-blocking antihistamine can be considered to reduce side effects. The maintenance dose should be given at 4-weekly intervals during the first year and, following the manufacturer's instructions, every 5 - 6 weeks from the second year, depending on the preparation used; if a depot preparation is used, the interval can be extended to 8 weeks from the third year onwards. If significant recurrent systemic reactions occur during VIT, clinicians shall identify and as possible eliminate co-factors that promote these reactions. If this is not possible or if there are no such co-factors, if prophylactic administration of an H1-blocking antihistamine is not effective, and if a higher dose of VIT has not led to tolerability of VIT, physicians should should consider additional treatment with an anti IgE antibody such as omalizumab as off lable use. For practical reasons, only a small number of patients are able to undergo sting challenge tests to check the success of the therapy, which requires in-hospital monitoring and emergency standby. To perform such a provocation test, patients must have tolerated VIT at the planned maintenance dose. In the event of treatment failure while on treatment with an ACE inhibitor, physicians should consider discontinuing the ACE inhibitor. In the absence of tolerance induction, physicians shall increase the maintenance dose (200 µg to a maximum of 400 µg in adults, maximum of 200 µg HV in children). If increasing the maintenance dose does not provide adequate protection and there are risk factors for a severe anaphylactic reaction, physicians should consider a co-medication based on an anti-IgE antibody (omalizumab; off-label use) during the insect flight season. In patients without specific risk factors, VIT can be discontinued after 3 - 5 years if maintenance therapy has been tolerated without recurrent anaphylactic events. Prolonged or permanent VIT can be considered in patients with mastocytosis, a history of cardiovascular or respiratory arrest due to Hymenoptera sting (severity grade IV), or other specific constellations associated with an increased individual risk of recurrent and/or severe SAR (e.g., hereditary α-tryptasemia). In cases of strongly increased, unavoidable insect exposure, adults may receive VIT until the end of intense contact. The prescription of an AAI can be omitted in patients with a history of SAR grade I and II when the maintenance dose of VIT has been reached and tolerated, provided that there are no additional risk factors. The same holds true once the VIT has been terminated after the regular treatment period. Patients with a history of SAR grade ≥ III reaction, or grade II reaction combined with additional factors that increase the risk of non response or repeated severe sting reactions, should carry an emergency kit, including an AAI, during VIT and after regular termination of the VIT.

Allergic diseases affect approximately one-quarter to one-half of the average population under 50 years of age in Central Europe. Due to the high proportion of affected individuals, allergy testing needs to be performed on a large scale, with high sensitivity and specificity at a low cost. Skin tests are the most important diagnostic measure fulfilling these requirements: they can be performed immediately and, quite in contrast to laboratory tests, the results of skin prick tests for the diagnosis of immediate allergy (IgE-mediated: Type I) can be assessed, and discussed with the patients 15–20 minutes later. Patients do not need to be called in for a second appointment to discuss the results of serum-based determination of specific IgE. Recently, we demonstrated that the sensitivity of skin prick tests is superior to the measurement of allergen-specific IgE, even for modern molecular allergens. In T cell mediated allergy of the delayed type (contact dermatitis: Type IV), patch tests read after 48–72 hours are the only available diagnostic measure.

JDDG: Journal der Deutschen Dermatologischen GesellschaftVolume 20, Issue 2 p. 247-248 ÖGDV Spezialisierung in Allergologie in Österreich: eine langwierige Geburt mit erfolgreichem Ausgang Stefan Wöhrl, Corresponding Author Stefan Wöhrl woehrl@faz.at Wien Korrespondenzanschrift Priv. Doz. Mag. Dr. Stefan Wöhrl Floridsdorfer Allergiezentrum (FAZ) Pius-Parsch-Platz 1/3 1210 Wien E-Mail: woehrl@faz.atSearch for more papers by this authorWolfram Hötzenecker, Wolfram Hötzenecker LinzSearch for more papers by this author Stefan Wöhrl, Corresponding Author Stefan Wöhrl woehrl@faz.at Wien Korrespondenzanschrift Priv. Doz. Mag. Dr. Stefan Wöhrl Floridsdorfer Allergiezentrum (FAZ) Pius-Parsch-Platz 1/3 1210 Wien E-Mail: woehrl@faz.atSearch for more papers by this authorWolfram Hötzenecker, Wolfram Hötzenecker LinzSearch for more papers by this author First published: 10 February 2022 https://doi.org/10.1111/ddg.14736_gRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume20, Issue2February 2022Pages 247-248 RelatedInformation

BACKGROUND:Anaphylaxis, which is rare, has been reported after COVID-19 vaccination, but its management is not standardized.METHOD:Members of the European Network for Drug Allergy and the European Academy of Allergy and Clinical Immunology interested in drug allergy participated in an online questionnaire on pre-vaccination screening and management of allergic reactions to COVID-19 vaccines, and literature was analysed.RESULTS:No death due to anaphylaxis to COVID-19 vaccines has been confirmed in scientific literature. Potential allergens, polyethylene glycol (PEG), polysorbate and tromethamine are excipients. The authors propose allergy evaluation of persons with the following histories: 1-anaphylaxis to injectable drug or vaccine containing PEG or derivatives; 2-anaphylaxis to oral/topical PEG containing products; 3-recurrent anaphylaxis of unknown cause; 4-suspected or confirmed allergy to any mRNA vaccine; and 5-confirmed allergy to PEG or derivatives. We recommend a prick-to-prick skin test with the left-over solution in the suspected vaccine vial to avoid waste. Prick test panel should include PEG 4000 or 3500, PEG 2000 and polysorbate 80. The value of in vitro test is arguable.CONCLUSIONS:These recommendations will lead to a better knowledge of the management and mechanisms involved in anaphylaxis to COVID-19 vaccines and enable more people with history of allergy to be vaccinated.

S2k-Leitlinie der Deutschen Gesellschaft für Allergologie und klinische Immunologie (DGAKI), der Gesellschaft für Pädiatrische Allergologie und Umweltmedizin (GPA), des Ärzteverbandes Deutscher Allergologen (AeDA), der Österreichischen Gesellschaft für Allergologie und Immunologie (ÖGAI), der Schweizerischen Gesellschaft für Allergologie und Immunologie (SGAI), der Deutschen Dermatologischen Gesellschaft (DDG), der Deutschen Gesellschaft für HNO-Heilkunde, Kopfund Halschirurgie (DGHNO-KHC), der Deutschen Gesellschaft für Kinderund Jugendmedizin (DGKJ), der Gesellschaft für Pädiatrische Pneumologie (GPP), der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), des Deutschen Berufsverbandes der HNO-Ärzte (BVHNO), des Berufsverbandes der Kinderund Jugendärzte (BVKJ), des Bundesverbandes der Pneumologen (BDP) und des Berufsverbandes der Deutschen Dermatologen (BVDD)

Hintergrund: Unter Allergologen wird oft angenommen, dass Allergien primär Kinder und junge Erwachsene betreffen und im Laufe des Lebens "verloren gehen". Methoden: Um diese Annahme zu hinterfragen, wurden in einem großen Allergieambulatorium in Wien Skin-Pricktests und Epikutantests einer großen Patientenkohorte von 5.857 konsekutiven Patienten, die im Jahr 2018 von demselben Arzt betreut worden waren, analysiert. Ergebnisse: Dabei zeigte sich eine Häufung von Inhalationsallergikern im Alter von fünf bis 59 Jahren (44,6 % = 2.155/4.828), wobei auch im Alter über 60 Jahre hinaus Inhalationsallergien mit 20,2 % (167/826) nicht selten waren. Lebensmittelallergien hatten mit 16,3 % (33/203) vor allem im Kleinkindesalter unter fünf Jahren die größte Bedeutung. Der Anteil der Kontaktallergien war im Kindesalter gering, nahm dann aber kontinuierlich über das Lebensalter zu und betraf häufiger Frauen (Frauen: 5,28 % = 187/3.544, Männer: 1,99 % = 46/2.313). Schlussfolgerung: Zusammenfassend spielen Inhalationsallergien bis ins hohe Lebensalter eine relevante Rolle. Nahrungsmittelallergien sind vor allem eine Krankheit des Kleinkindalters und Kontaktallergien betreffen überwiegend erwachsene Frauen. Zitierweise: Heindl B, Braunsteiner T, Klug L, Wantke F, Hemmer W, Wöhrl S. Frequency of positive allergy tests in children, adults and seniors. Allergo J Int 2022;31:81-7 https://doi.org/10.1007/s40629-021-00196-0

Summary Background Among allergists, it is often assumed that allergies primarily affect children and young adults and are “lost” during life. Methods To challenge this assumption, we analysed skin prick tests and patch tests from a large patient cohort of 5857 consecutive patients seen by the same physician in 2018 in a large allergy outpatient clinic in Vienna. Results We observed a clustering of patients suffering from inhalant allergy between the ages of 5 and 59 years (44.6% = 2155/4828), although inhalant allergies were still frequent beyond the age of 60 years with 20.2% (167/826). Food allergies were most relevant in infants under 5 years of age, at 16.3% (33/203). The proportion of contact allergies was low in childhood, but steadily increased over the age and affected more often women (women: 5.28% = 187/3544, men: 1.99% = 46/2313). Conclusion Inhalant allergies play a relevant role until old age. Food allergies are mainly a disease of infancy, and contact allergies predominantly affect adult women.

Read the full review for this Faculty Opinions recommended article: β-blockers and ACE inhibitors are not a risk factor for severe systemic sting reactions and adverse events during venom immunotherapy.

JDDG: Journal der Deutschen Dermatologischen GesellschaftVolume 19, Issue 5 p. 794-795 ÖGDV Allergie und COVID-19 – Daten statt Polemik Stefan Wöhrl, Corresponding Author Stefan Wöhrl [email protected] Korrespondenzanschrift Priv.-Doz. Mag. rer. nat. Dr. med. Stefan Wöhrl Floridsdorfer Allergiezentrum (FAZ) Pius-Parsch-Platz 1/3 1210 Wien E-Mail: [email protected]Search for more papers by this author Stefan Wöhrl, Corresponding Author Stefan Wöhrl [email protected] Korrespondenzanschrift Priv.-Doz. Mag. rer. nat. Dr. med. Stefan Wöhrl Floridsdorfer Allergiezentrum (FAZ) Pius-Parsch-Platz 1/3 1210 Wien E-Mail: [email protected]Search for more papers by this author First published: 12 May 2021 https://doi.org/10.1111/ddg.14519_gCitations: 3Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Literatur 1Yue J, Qin L, Zhang C, Xie M. Reply. J Allergy Clin Immunol 2020; 146: 542. 10.1016/j.jaci.2020.06.002 PubMedWeb of Science®Google Scholar 2Klimek L, Pfaar O, Worm M et al. Allergen immunotherapy in the current COVID-19 pandemic: A position paper of AeDA, ARIA, EAACI, DGAKI and GPA: Position paper of the German ARIA Group(A) in cooperation with the Austrian ARIA Group(B), the Swiss ARIA Group(C), German Society for Applied Allergology (AEDA)(D), German Society for Allergology and Clinical Immunology (DGAKI)(E), Society for Pediatric Allergology (GPA)(F) in cooperation with AG Clinical Immunology, Allergology and Environmental Medicine of the DGHNO-KHC(G) and the European Academy of Allergy and Clinical Immunology (EAACI)(H). Allergol Select 2020; 4: 44–52. 10.5414/ALX02147E PubMedGoogle Scholar 3Shimabukuro TT, Cole M, Su JR. Reports of anaphylaxis after receipt of mRNA COVID-19 vaccines in the US-December 14, 2020-January 18, 2021. JAMA 2021; https://doi.org/10.1001/jama.2021.1967 (online ahead of print). 10.1001/jama.2021.1967 Google Scholar 4Gee J, Marquez P, Su J et al. First month of COVID-19 vaccine safety monitoring - United States, December 14, 2020-January 13, 2021. MMWR Morb Mortal Wkly Rep 2021; 70: 283–88. 10.15585/mmwr.mm7008e3 CASPubMedWeb of Science®Google Scholar 5Turner PJ, Ansotegui IJ, Campbell DE et al. COVID-19 vaccine-associated anaphylaxis: A statement of the World Allergy Organization Anaphylaxis Committee. World Allergy Organ J 2021; 14: 100517. 10.1016/j.waojou.2021.100517 CASPubMedGoogle Scholar Citing Literature Volume19, Issue5May 2021Pages 794-795 ReferencesRelatedInformation

Background: Many patients report questionable drug hypersensitivity reactions (DHR) to betalactam antibiotics. A workup is required for objectivation. Direct drug provocation tests (DPTs) omitting a prior allergy workup are increasingly recommended as the primary diagnostic approach. However, apart from the risk of severe side effects, DPTs often are a scarce resource in overloaded healthcare-systems. We investigated how many cases can be solved by drug-specific history, drug-specific IgE, and skin tests obviating the need for DPT. Methods: We conducted a chart review in a retrospective cohort of 932 patients in an allergy outpatient centre from 2016 to 2017. Patients had been submitted to drug-specific history and specific IgE-, skin prick-, intradermal- and patch-tests with early and late readings with a series of penicillins and cephalosporins but DPTs were no option. Results: Overall, positive in vitro and/or skin tests were found in 96/932 (10.3%) patients. Drug-specific IgE was detected in 40/932 (4.3%) patients, 61/787 (7.8%) patients had positive skin tests. In vitro tests to Pencillin V showed the highest rate of positivity 24/479 (5.0%) and early readings of ampicillin the highest amongst the skin tests (3/49, 6.1%). Immediate skin tests were more often positive than delayed ones (75:45). The combination of all parameters including drug-specific history solved 346/932 (37.1%) cases while 586/932 (62.9%) remained unresolved. Self-reported DHR could be less often confirmed in females and young children (p < 0.05). Conclusions: Testing with betalactams applying simple, cheap, and safe skin and blood tests can solve a third of DHR-cases on a high throughput scale. Copyright (C) 2020, Japanese Society of Allergology. Production and hosting by Elsevier B.V.

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.