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Gülsen A, Wedi B, Jappe U. Hypersensitivity reactions to biologics (part II): classifications and current diagnostic and treatment approaches*. ALLERGO JOURNAL 2020. [DOI: 10.1007/s15007-020-2567-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Gülsen A, Wedi B, Jappe U. Hypersensitivity reactions to biologics (part I): allergy as an important differential diagnosis in complex immune-derived adverse events*. ALLERGO JOURNAL 2020; 29:32-61. [PMID: 32546899 PMCID: PMC7289641 DOI: 10.1007/s15007-020-2550-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Askin Gülsen
- Division of Clinical and Molecular Allergology, Research Center Borstel, Borstel, Germany
| | - Bettina Wedi
- Klinik u. Poliklinik f. Dermatologie u. Venerologie, OE 6600 - Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Uta Jappe
- Klinische und Molekulare Allergologie - Forschungszentrum Borstel, Parkallee 35, 23845 Borstel, Germany
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Fichtner A. [Disease spectrum among guests and staff of an international luxury beach resort in the tropics]. Med Klin Intensivmed Notfmed 2020; 116:595-600. [PMID: 32383074 DOI: 10.1007/s00063-020-00691-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/24/2020] [Accepted: 04/05/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Diseases of travelers upon returning home are described in numerous publications. However, we have limited data on the disease spectrum and the reasons for medical consultations during a trip. METHODS Over the period of one year, we analyzed all patient visits to the inhouse medical center of a major 5‑star beach resort of an international chain in the Maldives. RESULTS Around 6% of all guests sought medical consultation at least once during their stay. The main reasons for consultation were sea water induced external otitis and-in some cases-severe (2nd degree) sunburn. Staff presented mainly with viral nasopharyngitis in 20%, whereby guests had symptoms of the common cold in only 7% of all consultations. The occurrence of gastroenteritis was similar in both groups and was associated in most cases with seawater but was much lower compared to the region's epidemiological data. A high incidence of allergic reactions (7%) was recognized in both groups, being more than doubled among guests compared to staff. A considerable number of complaints caused by insects and sea organisms as well as a few drowning accidents were recorded. CONCLUSION Despite the high international 5‑star standards, there is a considerable probability for a medical consultation during the stay in a tropical beach hotel setting. However, environmental and behavioral factors are the main causes of sickness among guests.
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Affiliation(s)
- Andreas Fichtner
- Notfall- und OP-Management, Kreiskrankenhaus Freiberg gGmbH, Donatsring 20, 09599, Freiberg, Deutschland.
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Abstract
BACKGROUND Personalized medicine offers new perspectives for diagnostic measurements and medical treatment, but also puts greater demands on the physician. OBJECTIVES Developments, potentials and potential pitfalls of personalized medicine in allergology. METHODS Overview, evaluation and discussion of the current state of science on the basis of selected examples. RESULTS Allergic diseases like allergic rhinitis, atopic eczema or anaphylaxis can be classified into various clinical phenotypes, which are based on different immunological endotypes. These can be captured and categorized by a wide variety of omics technologies. The identification of endotype specific biomarkers holds promising opportunities of more precise diagnostics, the implementation of novel targeted therapies or the development of optimized preventive strategies. However, individualized analysis and assessment of the significance of the measurements represent special challenges. CONCLUSIONS Findings of the complex omics technologies need to be evaluated by comprehensive prospective studies in order to validate their clinical relevance and suitability for personalized medicine in allergology.
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Affiliation(s)
- W Pfützner
- Klinik für Dermatologie und Allergologie, Allergie Zentrum Hessen, Universitätsklinikum Gießen und Marburg, Standort Marburg, Philipps-Universität Marburg, Baldinger Str., 35043, Marburg, Deutschland.
| | - J Pickert
- Klinik für Dermatologie und Allergologie, Allergie Zentrum Hessen, Universitätsklinikum Gießen und Marburg, Standort Marburg, Philipps-Universität Marburg, Baldinger Str., 35043, Marburg, Deutschland
| | - C Möbs
- Klinik für Dermatologie und Allergologie, Allergie Zentrum Hessen, Universitätsklinikum Gießen und Marburg, Standort Marburg, Philipps-Universität Marburg, Baldinger Str., 35043, Marburg, Deutschland
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Giftschlangen in Deutschland und Europa. Hautarzt 2018; 69:681-702. [DOI: 10.1007/s00105-018-4222-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Przybilla B, Ruëff F. Insektenstichprovokationen. ALLERGOLOGIE 2016. [DOI: 10.1007/978-3-642-37203-2_50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Insektengiftallergie. ALLERGOLOGIE 2016. [DOI: 10.1007/978-3-642-37203-2_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Brockow K, Przybilla B, Aberer W, Bircher AJ, Brehler R, Dickel H, Fuchs T, Jakob T, Lange L, Pfützner W, Mockenhaupt M, Ott H, Pfaar O, Ring J, Sachs B, Sitter H, Trautmann A, Treudler R, Wedi B, Worm M, Wurpts G, Zuberbier T, Merk HF. Guideline for the diagnosis of drug hypersensitivity reactions: S2K-Guideline of the German Society for Allergology and Clinical Immunology (DGAKI) and the German Dermatological Society (DDG) in collaboration with the Association of German Allergologists (AeDA), the German Society for Pediatric Allergology and Environmental Medicine (GPA), the German Contact Dermatitis Research Group (DKG), the Swiss Society for Allergy and Immunology (SGAI), the Austrian Society for Allergology and Immunology (ÖGAI), the German Academy of Allergology and Environmental Medicine (DAAU), the German Center for Documentation of Severe Skin Reactions and the German Federal Institute for Drugs and Medical Products (BfArM). ACTA ACUST UNITED AC 2015; 24:94-105. [PMID: 26120552 PMCID: PMC4479479 DOI: 10.1007/s40629-015-0052-6] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Drug hypersensitivity reactions are unpredictable adverse drug reactions. They manifest either within 1–6 h following drug intake (immediate reactions) with mild to life-threatening symptoms of anaphylaxis, or several hours to days later (delayed reactions), primarily as exanthematous eruptions. It is not always possible to detect involvement of the immune system (allergy). Waiving diagnostic tests can result in severe reactions on renewed exposure on the one hand, and to unjustified treatment restrictions on the other. With this guideline, experts from various specialist societies and institutions have formulated recommendations and an algorithm for the diagnosis of allergies. The key principles of diagnosing allergic/hypersensitivity drug reactions are presented. Where possible, the objective is to perform allergy diagnostics within 4 weeks–6 months following the reaction. A clinical classification of symptoms based on the morphology and time course of the reaction is required in order to plan a diagnostic work-up. In the case of typical symptoms of a drug hypersensitivity reaction and unequivocal findings from validated skin and/or laboratory tests, a reaction can be attributed to a trigger with sufficient confidence. However, skin and laboratory tests are often negative or insufficiently reliable. In such cases, controlled provocation testing is required to clarify drug reactions. This method is reliable and safe when attention is paid to indications and contraindications and performed under appropriate medical supervision. The results of the overall assessment are discussed with the patient and documented in an „allergy passport“ in order to ensure targeted avoidance in the future and allow the use of alternative drugs where possible.
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Affiliation(s)
- Knut Brockow
- Department of Dermatology and Allergology Biederstein, Technical University of Munich, Biedersteiner Straße 29, 80802 Munich, Germany
| | - Bernhard Przybilla
- Department of Dermatology and Allergology, Allergy Center, Ludwig Maximilian University of Munich, Munich, Germany
| | - Werner Aberer
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Andreas J Bircher
- Department of Allergology, University Hospital Basle, Basle, Switzerland
| | - Randolf Brehler
- Department of Dermatology, Münster University Hospital, Münster, Germany
| | - Heinrich Dickel
- Department of Dermatology, Venereology and Allergology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Thomas Fuchs
- Department of Dermatology, Venereology and Allergology, Göttingen University Hospital, Göttingen, Germany
| | - Thilo Jakob
- Department of Dermatology and Venereology, Freiburg University Hospital, Freiburg, Germany
| | - Lars Lange
- Department of Pediatrics, Marien Hospital Bonn, Bonn, Germany
| | - Wolfgang Pfützner
- Department of Dermatology and Allergology, Gießen and Marburg University Hospital, Marburg, Germany
| | - Maja Mockenhaupt
- German Center for the Documentation of Severe Skin Reactions, Department of Dermatology and Venereology, Freiburg University Hospital, Freiburg, Germany
| | - Hagen Ott
- Children's and Adolescents' Hospital "Auf der Bult,", Hannover, Germany
| | - Oliver Pfaar
- ENT at Mannheim University Hospital, Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Johannes Ring
- Department of Dermatology and Allergology Biederstein, Technical University of Munich, Biedersteiner Straße 29, 80802 Munich, Germany
| | - Bernhardt Sachs
- Federal Institute for Drugs and Medicinal Products, Bonn, Germany
| | - Helmut Sitter
- Institute of Theoretical Surgery, Philipps University, Marburg, Germany
| | - Axel Trautmann
- Department of Dermatology and Allergology, Mainfranken Allergy, Würzburg University Hospital, Würzburg, Germany
| | - Regina Treudler
- Department of Dermatology, Venereology and Allergology, Leipzig University, Leipzig, Germany
| | - Bettina Wedi
- Department of Dermatology, Venereology and Allergology, Hannover Medical University, Hannover, Germany
| | - Margitta Worm
- Department of Dermatology, Venereology and Allergology, Charité University Hospital, Berlin, Germany
| | - Gerda Wurpts
- Department of Dermatology and Allergology, RTWH Aachen, Aachen, Germany
| | - Torsten Zuberbier
- Department of Dermatology, Venereology and Allergology, Charité University Hospital, Berlin, Germany
| | - Hans F Merk
- Department of Dermatology and Allergology, RTWH Aachen, Aachen, Germany
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Brockow K, Przybilla B, Aberer W, Bircher AJ, Brehler R, Dickel H, Fuchs T, Jakob T, Lange L, Pfützner W, Mockenhaupt M, Ott H, Pfaar O, Ring J, Sachs B, Sitter H, Trautmann A, Treudler R, Wedi B, Worm M, Wurpts G, Zuberbier T, Merk HF. Leitlinie Allergologische Diagnostik von Überempfindlichkeitsreaktionen auf Arzneimittel. ALLERGO JOURNAL 2015. [DOI: 10.1007/s15007-015-0802-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Seifert R. Adrenaline as the medication of choice. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 112:59. [PMID: 25797424 PMCID: PMC4335491 DOI: 10.3238/arztebl.2015.0059a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Roland Seifert
- *Institut für Pharmakologie, Medizinische Hochschule Hannover,
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Worm* M, Eckermann* O, Dölle S, Aberer W, Beyer K, Hawranek T, Hompes S, Koehli A, Mahler V, Nemat K, Niggemann B, Pföhler C, Rabe U, Reissig A, Rietschel E, Scherer K, Treudler R, Ruëff F. Triggers and treatment of anaphylaxis: an analysis of 4,000 cases from Germany, Austria and Switzerland. DEUTSCHES ARZTEBLATT INTERNATIONAL 2014; 111:367-75. [PMID: 24939374 PMCID: PMC4075276 DOI: 10.3238/arztebl.2014.0367] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 03/24/2014] [Accepted: 03/24/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Anaphylaxis is the most severe manifestation of a mast cell-dependent immediate reaction and may be fatal. According to data from the Berlin region, its incidence is 2-3 cases per 100 000 persons per year. METHOD We evaluated data from the anaphylaxis registry of the German-speaking countries for 2006-2013 and data from the protocols of the ADAC air rescue service for 2010-2011 to study the triggers, clinical manifestations, and treatment of anaphylaxis. RESULTS The registry contained data on 4141 patients, and the ADAC air rescue protocols concerned 1123 patients. In the registry, the most common triggers for anaphylaxis were insect venom (n = 2074; 50.1%), foods (n = 1039; 25.1%), and drugs (n = 627; 15.1%). Within these groups, the most common triggers were wasp (n = 1460) and bee stings (n = 412), legumes (n = 241), animal proteins (n = 225), and analgesic drugs (n = 277). Food anaphylaxis was most frequently induced by peanuts, cow milk, and hen's egg in children and by wheat and shellfish in adults. An analysis of the medical emergency cases revealed that epinephrine was given for grade 3 or 4 anaphylaxis to 14.5% and 43.9% (respectively) of the patients in the anaphylaxis registry and to 19% and 78% of the patients in the air rescue protocols. CONCLUSION Wasp and bee venom, legumes, animal proteins, and analgesic drugs were the commonest triggers of anaphylaxis. Their relative frequency was age-dependent. Epinephrine was given too rarely, as it is recommended in the guidelines for all cases of grade 2 and above.
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Affiliation(s)
- Margitta Worm*
- Allergy Center Charité, Department of Dermatology, Venerology and Allergology, Charité – Universitätsmedizin Berlin
- Margitta Worm and Oliver Eckermann have equally contributed to the manuscript
| | - Oliver Eckermann*
- ADAC Air Rescue Service Senftenberg
- Margitta Worm and Oliver Eckermann have equally contributed to the manuscript
| | - Sabine Dölle
- Allergy Center Charité, Department of Dermatology, Venerology and Allergology, Charité – Universitätsmedizin Berlin
| | - Werner Aberer
- Department of Dermatology and Venereology, Medical University of Graz, Austria
| | - Kirsten Beyer
- Department of Pediatrics, Pneumonology and Immunology, Charité – Universitätsmedizin Berlin
| | - Thomas Hawranek
- Allergy Clinic, Department of Dermatology, SALK, Paracelsus Medical University, Salzburg, Austria
| | - Stephanie Hompes
- Allergy Center Charité, Department of Dermatology, Venerology and Allergology, Charité – Universitätsmedizin Berlin
| | - Alice Koehli
- Pediatric Allergology, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Vera Mahler
- Department of Dermatology, University Hospital Erlangen-Nürnberg
| | - Katja Nemat
- Department of Pediatric Pneumology and Allergology at the KID Center, Dresden-Friedrichstadt
| | - Bodo Niggemann
- Department of Pediatrics, Pneumonology and Immunology, Charité – Universitätsmedizin Berlin
| | - Claudia Pföhler
- Department of Dermatology, Venerology and Allergy at the Saarland University, Homburg/Saar
| | - Uta Rabe
- Department of Allergology, Johanniter-Krankenhaus im Fläming Treuenbrietzen GmbH, Treuenbrietzen
| | - Angelika Reissig
- Department of Internal Medicine I: Pneumology & Allergology/Immunology, Friedrich Schiller University Jena
| | - Ernst Rietschel
- Department of Pediatric Pulmonology and Allergology, Children’s Hospital of the University of Cologne
| | - Kathrin Scherer
- Allergy Unit, Department of Dermatology, University Hospital Basel, Basel, Schweiz
| | - Regina Treudler
- Department of Dermatology, Venereology and Allergology, University of Leipzig
| | - Franziska Ruëff
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich
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