Publications by authors named "Axel Trautmann"

95 Publications

Treating Through of Drug-Associated Exanthem in Drug Allergy Management: Current Evidence and Clinical Aspects.

J Allergy Clin Immunol Pract 2021 Apr 17. Epub 2021 Apr 17.

Department of Dermatology and Allergy, University Hospital Würzburg, Würzburg, Germany.

In the setting of an acute cutaneous adverse drug reaction there is increasing interest in selected phenotypes and hosts to continue drug therapy, especially in settings in which there are limited therapeutic options. This concept of "treating through," defined as the continued use of a drug in the setting of, in particular maculopapular exanthema, potentially avoids unnecessary drug discontinuation. A review of the recent literature, historical viewpoints, and expert opinion are provided within to form recommendations and algorithms for a "treating-through" approach.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jaip.2021.04.008DOI Listing
April 2021

β-blockers and ACE inhibitors are not a risk factor for severe systemic sting reactions and adverse events during venom immunotherapy.

Allergy 2021 Feb 19. Epub 2021 Feb 19.

Department of Internal Diseases, Pulmonology and Allergology, Medical University of Wroclaw, Wroclaw, Poland.

Background: There is controversy whether taking β-blockers or ACE inhibitors (ACEI) is a risk factor for more severe systemic insect sting reactions (SSR) and whether it increases the number or severity of adverse events (AE) during venom immunotherapy (VIT).

Methods: In this open, prospective, observational, multicenter trial, we recruited patients with a history of a SSR and indication for VIT. The primary objective of this study was to evaluate whether patients taking β-blockers or ACEI show more systemic AE during VIT compared to patients without such treatment.

Results: In total, 1,425 patients were enrolled and VIT was performed in 1,342 patients. Of all patients included, 388 (27.2%) took antihypertensive (AHT) drugs (10.4% took β-blockers, 11.9% ACEI, 5.0% β-blockers and ACEI). Only 5.6% of patients under AHT treatment experienced systemic AE during VIT as compared with 7.4% of patients without these drugs (OR: 0.74, 95% CI: 0.43-1.22, p = 0.25). The severity of the initial sting reaction was not affected by the intake of β-blockers or ACEI (OR: 1.14, 95% CI: 0.89-1.46, p = 0.29). In total, 210 (17.7%) patients were re-stung during VIT and 191 (91.0%) tolerated the sting without systemic symptoms. Of the 19 patients with VIT treatment failure, 4 took β-blockers, none an ACEI.

Conclusions: This trial provides robust evidence that taking β-blockers or ACEI does neither increase the frequency of systemic AE during VIT nor aggravate SSR. Moreover, results suggest that these drugs do not impair effectiveness of VIT. (Funded by Medical University of Graz, Austria; Clinicaltrials.gov number, NCT04269629).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/all.14785DOI Listing
February 2021

Healthcare provision for insect venom allergy patients during the COVID-19 pandemic.

Allergo J Int 2020 8;29(8):257-261. Epub 2020 Dec 8.

Department and Outpatient Clinic for Dermatology and Allergology, University Hospital Munich, Munich, Germany.

The population prevalence of insect venom allergy ranges between 3-5%, and it can lead to potentially life-threatening allergic reactions. Patients who have experienced a systemic allergic reaction following an insect sting should be referred to an allergy specialist for diagnosis and treatment. Due to the widespread reduction in outpatient and inpatient care capacities in recent months as a result of the COVID-19 pandemic, the various allergy specialized centers in Germany, Austria, and Switzerland have taken different measures to ensure that patients with insect venom allergy will continue to receive optimal allergy care. A recent data analysis from the various centers revealed that there has been a major reduction in newly initiated insect venom immunotherapy (a 48.5% decline from March-June 2019 compared to March-June 2020: data from various centers in Germany, Austria, and Switzerland). The present article proposes defined organizational measures (e.g., telephone and video appointments, rearranging waiting areas and implementing hygiene measures and social distancing rules at stable patient numbers) and medical measures (collaboration with practice-based physicians with regard to primary diagnostics, rapid COVID-19 testing, continuing already-initiated insect venom immunotherapy in the outpatient setting by making use of the maximal permitted injection intervals, prompt initiation of insect venom immunotherapy during the summer season, and, where necessary, using outpatient regimens particularly out of season) for the care of insect venom allergy patients during the COVID-19 pandemic.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s40629-020-00157-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7722411PMC
December 2020

Predominant patterns of β-lactam hypersensitivity in a single German Allergy Center: exanthem induced by aminopenicillins, anaphylaxis by cephalosporins.

Allergy Asthma Clin Immunol 2020 Nov 17;16(1):102. Epub 2020 Nov 17.

Department of Dermatology and Allergy, Allergy Center Mainfranken, University Hospital Würzburg, 97080, Würzburg, Germany.

Background: Penicillins and other β-lactam antibiotics are the most common elicitors of allergic drug reaction. However, data on the pattern of clinical reaction types elicited by specific β-lactams are scarce and inconsistent. We aimed to determine patterns of β-latam allergy, i.e. the association of a clinical reaction type with a specific β-lactam antibiotic.

Methods: We retrospectively evaluated data from 800 consecutive patients with suspected β-lactam hypersensitivity over a period of 11 years in a single German Allergy Center.

Results: β-lactam hypersensitivity was definitely excluded in 595 patients, immediate-type (presumably IgE-mediated) hypersensitivity was diagnosed in 70 and delayed-type hypersensitivity in 135 cases. Most (59 out of 70, 84.3%) immediate-type anaphylactic reactions were induced by a limited number of cephalosporins. Delayed reactions were regularly caused by an aminopenicillin (127 out of 135, 94.1%) and usually manifested as a measles-like exanthem (117 out of 135, 86.7%). Intradermal testing proved to be the most useful method for diagnosing β-lactam allergy, but prick testing was already positive in 24 out of 70 patients with immediate-type hypersensitivity (34.3%). Patch testing in addition to intradermal testing did not provide additional information for the diagnosis of delayed-type hypersensitivity. Almost all β-lactam allergic patients tolerated at least one, usually several alternative substances out of the β-lactam group.

Conclusions: We identified two patterns of β-lactam hypersensitivity: aminopenicillin-induced exanthem and anaphylaxis triggered by certain cephalosporins. Intradermal skin testing was the most useful method to detect both IgE-mediated and delayed-type β-lactam hypersensitivity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13223-020-00488-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7672956PMC
November 2020

Guideline on diagnostic procedures for suspected hypersensitivity to beta-lactam antibiotics: Guideline of the German Society for Allergology and Clinical Immunology (DGAKI) in collaboration with the German Society of Allergology (AeDA), German Society for Pediatric Allergology and Environmental Medicine (GPA), the German Contact Dermatitis Research Group (DKG), the Austrian Society for Allergology and Immunology (ÖGAI), and the Paul-Ehrlich Society for Chemotherapy (PEG).

Allergol Select 2020 28;4:11-43. Epub 2020 May 28.

Department of Dermatology and Allergology am Biederstein, School of Medicine, Technical University of Munich, Munich, Germany.

This guideline on diagnostic procedures for suspected beta-lactam antibiotic (BLA) hypersensitivity was written by the German and Austrian professional associations for allergology, and the Paul-Ehrlich Society for Chemotherapy in a consensus procedure according to the criteria of the German Association of Scientific Medical Societies. BLA such as penicillins and cephalosporins represent the drug group that most frequently triggers drug allergies. However, the frequency of reports of suspected allergy in patient histories clearly exceeds the number of confirmed cases. The large number of suspected BLA allergies has a significant impact on, e.g., the quality of treatment received by the individual patient and the costs to society as a whole. Allergies to BLA are based on different immunological mechanisms and often manifest as maculopapular exanthema, as well as anaphylaxis; and there are also a number of less frequent special clinical manifestations of drug allergic reactions. All BLA have a beta-lactam ring. BLA are categorized into different classes: penicillins, cephalosporins, carbapenems, monobactams, and beta-lactamase inhibitors with different chemical structures. Knowledge of possible cross-reactivity is of considerable clinical significance. Whereas allergy to the common beta-lactam ring occurs in only a small percentage of all BLA allergic patients, cross-reactivity due to side chain similarities, such as aminopenicillins and aminocephalosporins, and even methoxyimino cephalosporins, are more common. However, the overall picture is complex and its elucidation may require further research. Diagnostic procedures used in BLA allergy are usually made up of four components: patient history, laboratory diagnostics, skin testing (which is particularly important), and drug provocation testing. The diagnostic approach - even in cases where the need to administer a BLA is acute - is guided by patient history and risk - benefit ratio in the individual case. Here again, further studies are required to extend the present state of knowledge. Performing allergy testing for suspected BLA hypersensitivity is urgently recommended not only in the interests of providing the patient with good medical care, but also due to the immense impact of putative BLA allergies on society as a whole.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5414/ALX02104EDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7304290PMC
May 2020

Metamizole-induced reactions as a paradigm of drug hypersensitivity: Non-allergic reactions, anaphylaxis, and delayed-type allergy.

Clin Exp Allergy 2020 09 2;50(9):1103-1106. Epub 2020 Jul 2.

Department of Dermatology and Allergy, University Hospital Würzburg, Würzburg, Germany.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/cea.13689DOI Listing
September 2020

De-labelling antibiotic allergy through five key questions.

Clin Exp Allergy 2020 04 3;50(4):532-535. Epub 2020 Feb 3.

Department of Dermatology and Allergy, University Hospital Würzburg, Würzburg, Germany.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/cea.13576DOI Listing
April 2020

Risk factors and indicators of severe systemic insect sting reactions.

Allergy 2020 03 16;75(3):535-545. Epub 2019 Jul 16.

Department of Dermatology, Venereology and Allergy & Allergy Center Mainfranken, University Hospital Würzburg, Würzburg, Germany.

Hymenoptera venom allergy ranks among the top three causes of anaphylaxis worldwide, and approximately one-quarter of sting-induced reactions are classified as severe. Fatal sting reactions are exceedingly rare, but certain factors may entail a considerably higher risk. Delayed administration of epinephrine and upright posture are situational risk factors which may determine an unfavorable outcome of the acute anaphylactic episode and should be addressed during individual patient education. Systemic mastocytosis and senior age are major, unmodifiable long-term risk factors and thus reinforce the indication for venom immunotherapy. Vespid venom allergy and male sex likewise augment the risk of severe or even fatal reactions. Further studies are required to assess the impact of specific cardiovascular comorbidities. Available data regarding potential effects of beta-blockers and/or ACE inhibitors in coexisting venom allergy are inconclusive and do not justify recommendations to discontinue guideline-directed antihypertensive treatment. The absence of urticaria/angioedema during sting-induced anaphylaxis is indicative of a severe reaction, serum tryptase elevation, and mast cell clonality. Determination of basal serum tryptase levels is an established diagnostic tool for risk assessment in Hymenoptera venom-allergic patients. Measurement of platelet-activating factor acetylhydrolase activity represents a complementary approach but is not available for routine diagnostic use.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/all.13945DOI Listing
March 2020

Radiocontrast Media Hypersensitivity: Skin Testing Differentiates Allergy From Nonallergic Reactions and Identifies a Safe Alternative as Proven by Intravenous Provocation.

J Allergy Clin Immunol Pract 2019 Sep - Oct;7(7):2218-2224. Epub 2019 Apr 10.

Department of Dermatology and Allergy, University Hospital Würzburg, Würzburg, Germany.

Background: Hypersensitivity reactions occurring within minutes after intravascular injection of iodinated radiocontrast media (RCM) are not rare and have been previously considered to be nonallergic. However, in the last decades, evidence is increasing that genuine RCM allergy may present as either full-blown anaphylaxis or delayed exanthematous skin reaction.

Objectives: We aimed to assess whether allergy diagnostics including skin and provocation testing can differentiate between nonallergic and allergic RCM hypersensitivity by identifying the causative RCM as well as tolerated alternative RCM.

Methods: We retrospectively evaluated clinical and diagnostic data from 45 consecutive patients with RCM hypersensitivity.

Results: Immediate nonallergic RCM hypersensitivity was diagnosed in 21 patients, immediate-type RCM allergy in 11, delayed-type RCM allergy in 11, and delayed-type iodine allergy in 2. All patients with immediate-type RCM allergy had a history of moderate to severe anaphylaxis. Eleven of 13 patients with delayed-type allergic reactions including the 2 cases of iodine allergy suffered from maculopapular exanthem developing several hours to days after exposure, 1 was a systemic hypersensitivity syndrome, and 1 a fixed drug eruption. Of 18 RCM-allergic patients tested, all tolerated an alternative RCM in the intravenous provocation.

Conclusions: The diagnostic sensitivity of intradermal RCM testing to identify allergic patients is high in both immediate-type and delayed-type RCM allergy. Intravenous provocation with a skin test-negative RCM is safe and enables identification of a tolerated alternative RCM. Additional skin testing of iodine solution is required to identify patients with iodine allergy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jaip.2019.04.005DOI Listing
September 2020

Lessons from times of shortage: Interchangeability of venom preparations and dosing protocols.

Allergy 2019 07 5;74(7):1392-1395. Epub 2019 Mar 5.

Department of Dermatology, Venereology, and Allergology, Allergy Center Mainfranken, University Hospital Würzburg, Würzburg, Germany.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/all.13739DOI Listing
July 2019

Controversies in Drug Allergy: Radiographic Contrast Media.

J Allergy Clin Immunol Pract 2019 01 17;7(1):61-65. Epub 2018 Dec 17.

Department of Dermatology and Allergy, University Hospital Würzburg, Würzburg, Germany.

The risk for developing immediate or delayed hypersensitivity reactions to radiocontrast media (RCM) interferes with the diagnosis and treatment of a number of patients requiring imaging diagnostic methods for many common diseases. A group of experts met in Orlando, Florida, in March 2018 to analyze the similarities and differences in the management of RCM reactions in different areas of the world. This paper presents a summary of the recommendations provided by this consensus group, highlighting controversial issues and unmet needs that require further research.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jaip.2018.06.030DOI Listing
January 2019

Differential diagnosis of late-type reactions to injected local anaesthetics: Inflammation at the injection site is the only indicator of allergic hypersensitivity.

Contact Dermatitis 2019 Feb 11;80(2):118-124. Epub 2018 Oct 11.

Department of Dermatology and Allergy, University Hospital, Würzburg, Germany.

Background: Anaphylaxis-like reactions developing within a few minutes are the most frequent complications of subcutaneous or submucosal injections of local anaesthetics (LAs), and topically applied LAs are potential contact allergens. In addition, injected LAs have been reported to induce delayed reactions, including local inflammation at the injection site, and various general symptoms.

Objectives: To assess the frequency and symptoms of late-type hypersensitivity occurring several hours after LA injections.

Methods: We retrospectively evaluated clinical data and test results from all patients referred to our allergy clinic in a period of 20 years for diagnostic work-up of LA-associated late-type reactions.

Results: Of 202 patients reporting symptoms with onset at least 1 hour after LA injection, 40 had cutaneous inflammation confined to the injection site, and 162 reported various systemic symptoms. LA hypersensitivity could be excluded in all patients with systemic complaints by means of skin testing and subsequent subcutaneous provocation. In 8 of the 40 patients (20%) with local inflammatory reactions, late-type allergic LA hypersensitivity was confirmed.

Conclusions: Late-type LA allergy commonly causes inflammatory skin reactions confined to the injection site. Conversely, LAs are highly unlikely to trigger delayed systemic symptoms such as urticarial or exanthematous skin eruptions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/cod.13130DOI Listing
February 2019

Sensitization to Hymenoptera venom marker allergens: Prevalence, predisposing factors, and clinical implications.

Clin Exp Allergy 2018 12 10;48(12):1735-1743. Epub 2018 Sep 10.

Department of Dermatology, Venereology, and Allergology, University Hospital Würzburg, Würzburg, Germany.

Background: The prevalence and predisposing factors of asymptomatic sensitization to Hymenoptera venom marker allergens are largely unknown.

Objective: To evaluate sensitization profiles in a group of 490 dermatologic patients without a history of sting-induced anaphylaxis.

Methods: Clinical data were collected using a structured questionnaire; sera were tested for total IgE and specific IgE to venom preparations, recombinant venom marker allergens, inhalative allergens, and cross-reactive carbohydrate determinants.

Results: The lifetime prevalence of Hymenoptera stings was 85.3%. IgE rates exceeding cut-off values of 0.35 kU /L were 17.3% for rVes v 1, 18.0% for rVes v 5, and 3.5% for rApi m 1. Median specific/total IgE ratios for the above mentioned marker allergens were 0.05%, 0.02%, and 0.00%, respectively. Marker allergen-directed sensitization was detectable in 85.5% of 138 Vespula venom-reactive sera. Of 68 bee venom-reactive participants, 23.5% were sensitized to rApi m 1 and 64.7% to any one or several of five commercially available bee venom allergens. Although double reactivity to bee and Vespula venom was clearly associated with sensitization to cross-reactive carbohydrate determinants (P < 0.001), sensitization to marker allergens of both species was detectable in most double-reactive sera (56.5%). Vespula venom marker allergen-directed sensitization was associated with recent stings (P = 0.010), large local reactions (P = 0.009), total IgE elevation (P < 0.001), and sensitization to cross-reactive carbohydrate determinants (P = 0.008).

Conclusions And Clinical Relevance: The high sensitization rates observed in individuals without a history of sting-induced anaphylaxis as well as total IgE levels and cross-reactive carbohydrate determinant-directed reactivity as potential confounders need to be considered in any interpretation of positive test results for Hymenoptera venom marker allergens.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/cea.13237DOI Listing
December 2018

Twenty Years' Experience with Anaphylaxis-Like Reactions to Local Anesthetics: Genuine Allergy is Rare.

J Allergy Clin Immunol Pract 2018 Nov - Dec;6(6):2051-2058.e1. Epub 2018 Apr 12.

Department of Dermatology, Venereology and Allergy, University Hospital Würzburg, Würzburg, Germany.

Background: Anaphylaxis-like reactions occur within minutes after the application of local anesthetics (LA), most commonly during dental interventions. Impressive symptoms including respiratory distress or loss of consciousness frequently give rise to a suspicion of allergy and may prompt patients and treating physicians to refuse future LA injections.

Objective: Nonallergic mechanisms are responsible for the majority of LA-induced immediate-type reactions. In view of the preponderance of nonallergic reactions, the question arises whether genuine LA allergy may be missed during routine testing procedures.

Methods: We retrospectively evaluated clinical data and test results from patients referred to our allergy clinic within the past 20 years for diagnostic workup of LA-induced immediate-type reactions.

Results: Of 402 evaluated patients, 29 had an episode of acute urticaria within 30 minutes after LA injections, and the remaining 373 had a history of mainly subjective cutaneous, respiratory, cardiovascular, and neurological complaints. Of the patients reporting urticaria with or without angioedema, 14 were diagnosed with a spontaneous episode of urticaria, 13 had allergic or nonallergic reactions to other agents, and 2 had IgE-mediated LA allergy. LA allergy was definitely excluded by 771 subcutaneous provocation tests with skin test negative LA, thereby demonstrating the high predictive value of negative intradermal testing.

Conclusions: Skin testing and provocative LA challenge are useful to exclude LA allergy, and this testing procedure seems to be appropriate to identify the extremely rare cases with IgE-mediated LA allergy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jaip.2018.04.005DOI Listing
November 2019

Safety of 100 µg venom immunotherapy rush protocols in children compared to adults.

Allergy Asthma Clin Immunol 2017 12;13:32. Epub 2017 Jul 12.

Department of Dermatology, Venereology, and Allergology, University Hospital Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany.

Background: There is a paucity of studies examining the safety of venom immunotherapy (VIT) in children. We aimed to assess the incidence of anaphylactic side effects during rush VIT in a cohort of pediatric patients and adult controls.

Methods: 72 consecutive cycles of VIT-buildup in 71 children/adolescents aged 7-17 years were retrospectively evaluated and compared to an adult control group (n = 981) with regard to baseline parameters (sex, causative venom, severity of index sting reaction, results of allergy testing, comorbidities) and the incidence of anaphylactic adverse reactions.

Results: Compared to adults, severe index sting-induced anaphylaxis was significantly less common in children ( = .001). Children were more likely to suffer from bee venom allergy ( < .001) and showed higher levels of bee venom-specific IgE ( = .013), but lower serum tryptase concentrations ( = .014). The overall rate of VIT-induced anaphylactic reactions was higher in children than in adults (6.9% vs 2.5%,  = .046 by univariate analysis). In the final binary logistic regression model, however, only bee VIT ( = .039; odds ratio 2.25; confidence interval 1.04-4.87) and 5-day compared to 3-day buildup protocols ( = .011; odds ratio 2.64; confidence interval 1.25-5.57) were associated with an increased risk of treatment-induced anaphylaxis. All pediatric patients finally reached and tolerated the target maintenance dose of 100 µg.

Conclusions: The higher anaphylactic reaction rate observed in pediatric patients may be attributed to a greater prevalence of bee venom allergy. VIT-induced anaphylaxis in children is usually mild and does not affect further updosing and maintenance of VIT.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13223-017-0204-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5506672PMC
July 2017

"Treating Through" Decision and Follow-up in Antibiotic Therapy-Associated Exanthemas.

J Allergy Clin Immunol Pract 2017 Nov - Dec;5(6):1650-1656. Epub 2017 May 9.

Department of Dermatology, Venereology, and Allergy, University Hospital Würzburg, Würzburg, Germany.

Background: Immediate discontinuation or replacement of suspected drugs is considered standard medical care in acute exanthematous skin reactions. In the treatment of bacterial infections, structurally different alternative antibiotics, however, are commonly second choice options due to a suboptimal antimicrobial activity or an unfavorable side effect profile. Nonetheless, "treating through," the continuation of antibiotic treatment despite an objective exanthema, is practiced only rarely.

Objective: We aimed to assess whether "treating through" is an option for patients with severe bacterial soft tissue infections (severe cellulitis) who experience maculopapular exanthema (MPE) during antibiotic therapy.

Methods: We retrospectively reviewed clinical data from 18 patients who developed MPE within a few days after initiation of intravenous antibiotic treatment. A decision to "treat through" was made when the suspected antibiotics (β-lactams, clindamycin, ciprofloxacin) were clinically effective and the benefits of continued treatment outweighed potential risks. Clinical and laboratory findings were closely monitored in an inpatient setting.

Results: In 2 patients, a modification of antibiotic therapy was deemed necessary due to a significant increase of liver enzymes within 4 days after the initial decision to "treat through." Because of a progression of MPE under ongoing treatment with cefuroxime and clindamycin, clindamycin was discontinued in 1 patient. In another 3 patients, antibiotic treatment was modified because of insufficient improvement of the soft tissue infection. In the remaining 12 "treated through" cases, the skin symptoms improved despite unchanged continued antibiotic treatment, and relevant laboratory parameters remained within the normal range.

Conclusions: Careful risk-benefit assessment may enable the continuation of antibiotic therapy despite MPE, provided that patients are under close medical observation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jaip.2017.03.032DOI Listing
June 2018

Reply.

J Allergy Clin Immunol Pract 2017 Mar - Apr;5(2):535-536

Department of Dermatology and Allergy, University Hospital Würzburg, Würzburg, Germany.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jaip.2016.12.020DOI Listing
December 2018

Dermpath & Clinic: Multiple reactive eccrine syringofibroadenomas.

Eur J Dermatol 2017 Feb;27(1):102-104

Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1684/ejd.2017.2965DOI Listing
February 2017

Potent NLRP3 Inflammasome Activation by the HIV Reverse Transcriptase Inhibitor Abacavir.

J Biol Chem 2017 02 5;292(7):2805-2814. Epub 2017 Jan 5.

From the Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, 97080 Würzburg, Germany

There is experimental and clinical evidence that some exanthematous allergic drug hypersensitivity reactions are mediated by drug-specific T cells. We hypothesized that the capacity of certain drugs to directly stimulate the innate immune system may contribute to generate drug-specific T cells. Here we analyzed whether abacavir, an HIV-1 reverse transcriptase inhibitor often inducing severe delayed-type drug hypersensitivity, can trigger innate immune activation that may contribute to its allergic potential. We show that abacavir fails to generate direct innate immune activation in human monocytes but potently triggers IL-1β release upon pro-inflammatory priming with phorbol ester or Toll-like receptor stimulation. IL-1β processing and secretion were sensitive to Caspase-1 inhibition, NLRP3 knockdown, and K efflux inhibition and were not observed with other non-allergenic nucleoside reverse transcriptase inhibitors, identifying abacavir as a specific inflammasome activator. It further correlated with dose-dependent mitochondrial reactive oxygen species production and cytotoxicity, indicating that inflammasome activation resulted from mitochondrial damage. However, both NLRP3 depletion and inhibition of K efflux mitigated abacavir-induced mitochondrial reactive oxygen species production and cytotoxicity, suggesting that these processes were secondary to NLRP3 activation. Instead, depletion of cardiolipin synthase 1 abolished abacavir-induced IL-1β secretion, suggesting that mitochondrial cardiolipin release may trigger abacavir-induced inflammasome activation. Our data identify abacavir as a novel inflammasome-stimulating drug allergen. They implicate a potential contribution of innate immune activation to medication-induced delayed-type hypersensitivity, which may stimulate new concepts for treatment and prevention of drug allergies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1074/jbc.M116.749473DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5314176PMC
February 2017

Aggregierte orangefarbene Papeln im Gesicht.

J Dtsch Dermatol Ges 2016 Nov;14(11):1152-1154

Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ddg.12528_gDOI Listing
November 2016

Agminated orange papules on the face.

J Dtsch Dermatol Ges 2016 Nov;14(11):1149-1151

Department of Dermatology, Venereology, and Allergology, University Hospital, Würzburg, Germany.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ddg.12528DOI Listing
November 2016

H-Antihistamine Premedication in NSAID-Associated Urticaria.

J Allergy Clin Immunol Pract 2016 Nov - Dec;4(6):1205-1212. Epub 2016 Jun 30.

Department of Dermatology and Allergy, University Hospital Würzburg, Würzburg, Germany.

Background: Therapeutic options for pain management are restricted in patients with nonsteroidal anti-inflammatory drug (NSAID)-induced or NSAID-exacerbated urticaria because strong cyclooxygenase (COX)-I inhibiting NSAID cannot be used. Alternative NSAID such as weak COX-I inhibitors or selective COX-II inhibitors are sometimes not sufficiently effective or have potentially troublesome adverse effects.

Objective: To date, prophylactic premedication with H-antihistamines is rarely practiced in patients concurrently suffering from recurrent pain and NSAID-associated urticaria. Our data analysis aims to clarify whether prophylactic premedication before the intake of NSAID is effective, safe, and practicable.

Methods: Data of 21 patients with NSAID-induced or NSAID-exacerbated urticaria who underwent single dose NSAID provocation 30 minutes after premedication with 5 mg desloratadine were retrospectively evaluated.

Results: After H-antihistamine premedication, 17 patients tolerated 16 single dose provocation tests with strong COX-I inhibitors and 2 tests with weak COX-I inhibitors. Despite H-antihistamine premedication, 2 patients developed acute urticaria after intake of 400 mg ibuprofen. Another 2 patients with acute urticaria after intake of 800 mg ibuprofen tolerated 400 mg ibuprofen and 1000 mg paracetamol, respectively.

Conclusions And Clinical Relevance: In the majority of patients with NSAID-induced or NSAID-exacerbated urticaria concurrently suffering from intermittent pain, a premedication regimen with 5 mg desloratadine 30 minutes before intake of a strong COX-I inhibitor seems to be effective, safe, and practicable.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jaip.2016.05.018DOI Listing
October 2017

Dangerous Leg Cramps: Severe Pustular Exanthema Caused by an Over-the-Counter Drug.

Acta Derm Venereol 2016 06;96(5):703-4

Department of Dermatology, Venereology, and Allergology, University Hospital Würzburg, Josef-Schneider-Straße 2, DE-97080 Würzburg, Germany.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2340/00015555-2324DOI Listing
June 2016

Swollen Ears and Nose Bleeding Accompanied by Skin Papules.

Pediatr Dermatol 2015 Nov-Dec;32(6):863-4

Department of Dermatology and Allergy, University Hospital Würzburg, Würzburg, Germany.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/pde.12630DOI Listing
September 2016

Bet v 1- and Bet v 2-Associated Plant Food Sensitization in Uganda and Germany: Differences and Similarities.

Int Arch Allergy Immunol 2015 6;167(4):264-9. Epub 2015 Oct 6.

Department of Dermatology, University Hospital Mbarara, Mbarara, Uganda.

Background: Birch pollen allergy and concomitant plant food sensitization are well documented in Europe. However, there are currently no data available on pollen-associated plant food sensitization or even pollen allergy in tropical Africa. Our study aimed to investigate Bet v 1- and Bet v 2-associated plant food sensitization in atopic patients from Uganda and compare it with sensitization rates in German patients.

Methods: Sera from 83 Ugandan and 97 German atopic patients were analysed using UniCAP100™ for allergen-specific IgE against the birch tree pollen allergens Bet v 1 and Bet v 2 as well as the plant foods hazelnut, apple, kiwi, pea, peach, cherry, litchi, peanut, and soy.

Results: As expected, sensitization to Bet v 1 and cross-reactive plant food allergens was more common in German atopic patients. In contrast, the prevalence of sensitization against Bet v 2 was remarkably similar in Ugandan and German patients. Interestingly, in Ugandan patients we found IgE-mediated sensitization against plant foods such as hazelnut, pea, peach, cherry, and litchi that are neither cultivated nor consumed in Uganda.

Conclusions: For Ugandan atopic patients, sensitization against the Bet v 2 allergen (a plant profilin) may explain cross-reactivity to several plant foods which are not consumed in Uganda. Additionally, it is probable that sensitization of Ugandan atopics to alder pollen (Alnus acuminata, plant family Betulaceae) caused serological cross-reactivity with Betula verrucosa-related allergens.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000439533DOI Listing
April 2016

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).

Allergo J Int 2015;24(3):94-105

Department of Dermatology and Allergology, RTWH Aachen, Aachen, Germany.

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s40629-015-0052-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4479479PMC
January 2015

Hymenoptera venom immunotherapy while maintaining cardiovascular medication: safe and effective.

Ann Allergy Asthma Immunol 2015 May;114(5):411-6

Department of Dermatology and Allergy, University Hospital Würzburg, Würzburg, Germany.

Background: The hypothetical risks of cardiovascular medication during Hymenoptera venom immunotherapy (VIT) are still a matter of controversy.

Objective: To assess the potential influence of β-blockers (BBs) and/or angiotensin-converting enzyme inhibitors (ACEIs) on the long-term safety and outcome of VIT.

Methods: Data on the course of VIT maintenance phase, Hymenoptera re-stings, and concurrent medication were retrospectively derived from standardized questionnaires in a cohort of patients with significant cardiovascular comorbidity.

Results: Of 225 patients, 125 (55.6%) were taking cardiovascular medication at the time of data collection: 71 (31.6%) took an ACEI, and 40 (17.8%) took a BB. A total of 3,397 months of maintenance VIT during intake of an ACEI and 1,418 months during BB therapy were evaluated. Cumulative VIT-related reaction rates, including subjective symptoms, were 9.1% per treatment cycle and 0.31% per injection, with objective reaction rates of 1.7% and 0.06%, respectively. The incidence of adverse events was significantly higher in patients with a previous history of systemic reactions at VIT buildup (P = .004). Surprisingly, reaction rates were lower in patients taking any kind of cardiovascular medication (P = .04) or an ACEI (P = .03). The overall reexposure rate to Hymenoptera stings was 42.7%, and the field sting-induced objective reaction rate was 7.3%. There was no evidence of an increase of field sting-related relapse or hospitalization rates by concurrent cardiovascular medication.

Conclusion: Cardiovascular medication does not impair the safety and/or the efficacy of Hymenoptera VIT.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.anai.2015.03.001DOI Listing
May 2015