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Objectives Dialysis patients suffer from xerostomia based on hyposalivation even in stimulated saliva testing. It was, therefore, the aim (i) to evaluate an optimized oral hygiene system with an oral care gel on oral dryness, dental plaque control and number of gingivitis teeth, (ii) to document the efficacy in a randomized controlled trial with dental indices and (iii) to record the individual oral health related quality of life.MethodsAfter ethical approval (EC-UWH 103/2019) 44 dialysis patients signed informed consent and were divided into two groups followed up for four weeks. Subjects of the verum group A were taking daily oral care gel OROFAN® based on biopolymers with mild antibacterial and saliva stimulating action. They were compared to control group B executing routine oral hygiene with conventional dentifrice and toothbrushes. Oral Health Impact Profile was documented at baseline and at end of study.ResultsTwenty two subjects were allocated to group A and to group B. At baseline there were no statistical differences concerning renal insufficiency (years on dialysis, complications), systemic diseases, dental background (caries experience, periodontal diseases, plaque index, number of gingivitis teeth). All subjects exhibited hyposalivation (< 0.7-1.0 ml/min).The control group B showed no statistical differences from baseline to end of study in dry mouth parameters, in all dental plaque and inflammation indices, and in the Oral Health Impact Profile. In contrast, verum group A exhibited highly significant (pSignificance of ResultsTerminally ill patients may gain better oral health and, consequently, improved quality of live by rather simple oral care including long lasting, eatable anti-inflammatory oral hygiene gel and dentist`s devotion.

Not available.

BACKGROUND Preservatives in cosmetics are often suspected as contact sensitizers and hence frequently patch tested in dermatitis patients. Exposure in this field has changed over the course of years. OBJECTIVE To describe the frequency of contact sensitization to various preservatives. MATERIALS AND METHODS Retrospective data analysis from the Information Network of Departments of Dermatology (IVDK) for the years 2009-2018. RESULTS Frequency of sensitization to methylisothiazolinone (MI) has increased from 2.0% in 2009 to 7.2% in 2013. Since 2014, the rate has been falling again. Increasing the patch test concentration of methyldibromo glutaronitrile (MDBGN) in 2016 has caused a sudden rise in positive patch test reactions from 2.0% to more than 4.5%. Allergic reactions to other preservatives occurred in less than 1% of the patients tested. DISCUSSION Since 2014, the worldwide "epidemic" of sensitization to MI has been subsiding in Central Europe, thanks to corresponding restrictions on use. Since 2008, there is no longer any widespread exposure to MDBGN; the new, higher test concentration elicits many false-positive test reactions and explains the sudden rise in positive patch test reactions since 2016. Despite widespread use, phenoxyethanol, benzoates, benzyl alcohol, parabens and sorbates rarely cause allergic reactions. Therefore, they can be recommended for cosmetics from the epidemiological-allergological point of view.

Der diagnostische Standard zum Nachweis einer bestehenden allergischen Kontaktdermatitis ist der Epikutantest. Die vorliegende Leitlinie richtet sich an Assistenz- und Facharzte der Dermatologie, Allergologie und Arzte weiterer Fachgruppen in Klinik und Praxis, die an der Indikationsstellung oder Durchfuhrung von Epikutantests bei Patienten mit Kontaktekzemen und weiteren Spattypallergien beteiligt sind, sowie Kooperationspartner der Arzteschaft (Fachberufe im Gesundheitswesen, Kostentrager). Die Leitlinie zur Durchfuhrung des Epikutantests mit Kontaktallergenen wurde auf der Basis einer systematischen Literatursuche zu definierten Schlusselfragen evidenzbasiert und im formellen Konsensusverfahren (S3) von Dermatologen unter Einbindung von Padiatern, Arbeitsmedizinern, Assistenzpersonal und Patientenvertretern erstellt. Bezuglich der methodischen und inhaltlichen Arbeit, auf denen die Empfehlungen basieren, wird auf Methodenbericht und Evidenztabellen verwiesen. Die Leitlinie stellt allgemeine Aspekte der Epikutantestung sowie medizinrechtliche Aspekte dar. Es werden Empfehlungen gegeben zur Indikationsstellung, Patientenaufklarung, Auswahl von Testsubstanzen und Kammersystemen, Expositionsort, -dauer und Ablesezeitpunkten, Interpretation von Testreaktionen, endogenen und exogenen Einflussfaktoren, Testung besonderer Personengruppen (Kinder, Schwangere, Immunsupprimierte) sowie Risiken und unerwunschten Nebenwirkungen bei der Durchfuhrung des Epikutantests mit Kontaktallergenen.

Epicutaneous patch testing is the diagnostic standard for the detection of allergic contact dermatitis. The present guidelines are aimed at residents and board-certified physicians in the fields of dermatology and allergology as well as other medical specialties involved in establishing the indication for patch testing and its execution in patients with contact dermatitis and other forms of delayed-type hypersensitivity. The target audience also includes other health care providers and insurance funds. Based on a systematic literature search and a formal consensus process (S3), the guidelines were developed by dermatologists in collaboration with pediatricians, occupational medicine physicians, nursing staff as well as patient representatives. The systematic methodological approach and appraisal of evidence upon which the recommendations are based are outlined in a separate method report that also contains evidence tables. The guidelines address general aspects of patch testing as well as medicolegal issues. The recommendations given relate to topics such as the indication for patch testing, informed patient consent, as well as the choice of test substances, test chambers and test site, duration of exposure, reading times and interpretation of test reactions. Furthermore, recommendations are provided with respect to endogenous and exogenous factors, specific patient groups (children, pregnant women, immunosuppressed individuals) as well as possible risks and adverse events associated with patch testing using contact allergens.

Epicutaneous patch testing is the diagnostic standard for the detection of allergic contact dermatitis. The present guidelines are aimed at residents and board-certified physicians in the fields of dermatology and allergology as well as other medical specialties involved in establishing the indication for patch testing and its execution in patients with contact dermatitis and other forms of delayed-type hypersensitivity. The target audience also includes other health care providers and insurance funds. Based on a systematic literature search and a formal consensus process (S3), the guidelines were developed by dermatologists in collaboration with pediatricians, occupational medicine physicians, nursing staff as well as patient representatives. The systematic methodological approach and appraisal of evidence upon which the recommendations are based are outlined in a separate method report that also contains evidence tables. The guidelines address general aspects of patch testing as well as medicolegal issues. The recommendations given relate to topics such as the indication for patch testing, informed patient consent, as well as the choice of test substances, test chambers and test site, duration of exposure, reading times and interpretation of test reactions. Furthermore, recommendations are provided with respect to endogenous and exogenous factors, specific patient groups (children, pregnant women, immunosuppressed individuals) as well as possible risks and adverse events associated with patch testing using contact allergens. Note: This publication is part 1 of the short version of the S3 guidelines for "Epicutaneous patch testing using contact allergens and drugs" (registry no. 013 - 018; date: March 20, 2019; valid until December 31, 2021). Part 2 of the short version will be published in the next issue. The long version of these guidelines can be accessed at www.awmf.org. The method report is available as online publication (https://www.awmf.org/leitlinien/detail/ll/013-018.html) and contains the evidence tables in its appendix.

Der diagnostische Standard zum Nachweis einer bestehenden allergischen Kontaktdermatitis ist der Epikutantest. Die vorliegende Leitlinie richtet sich an Assistenz- und Facharzte der Dermatologie, Allergologie und Arzte weiterer Fachgruppen in Klinik und Praxis, die an der Indikationsstellung oder Durchfuhrung von Epikutantests bei Patienten mit Kontaktekzemen und weiteren Spattypallergien beteiligt sind, sowie Kooperationspartner der Arzteschaft (Fachberufe im Gesundheitswesen, Kostentrager). Die Leitlinie zur Durchfuhrung des Epikutantests mit Kontaktallergenen wurde auf der Basis einer systematischen Literatursuche zu definierten Schlusselfragen evidenzbasiert und im formellen Konsensusverfahren (S3) von Dermatologen unter Einbindung von Padiatern, Arbeitsmedizinern, Assistenzpersonal und Patientenvertretern erstellt. Bezuglich der methodischen und inhaltlichen Arbeit, auf denen die Empfehlungen basieren, wird auf Methodenbericht und Evidenztabellen verwiesen. Die Leitlinie stellt allgemeine Aspekte der Epikutantestung sowie medizinrechtlicher Aspekte dar. Es werden Empfehlungen gegeben zur Indikationsstellung, Patientenaufklarung, Auswahl von Testsubstanzen und Kammersystemen, Expositionsort, -dauer und Ablesezeitpunkten, Interpretation von Testreaktionen, endogenen und exogenen Einflussfaktoren, Testung besonderer Personengruppen (Kinder, Schwangere, Immunsupprimierte) sowie Risiken und unerwunschten Nebenwirkungen bei der Durchfuhrung des Epikutantests mit Kontaktallergenen.

Die vorliegende Leitlinie (S2k) zur Diagnostik bei Verdacht auf eine Betalaktamantibiotika-Uberempfindlichkeit wurde von den deutschen allergologischen Fachverbanden und der osterreichischen allergologischen Fachgesellschaft sowie der Paul-Ehrlich-Gesellschaft fur Chemotherapie im Konsens nach den Kriterien der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) erarbeitet. Betalaktamantibiotika (BLA) wie Penicilline und Cephalosporine sind die Substanzgruppe, welche am haufigsten Arzneimittelallergien auslost. Die anamnestische Angabe einer vermuteten Allergie ubersteigt jedoch in ihrer Haufigkeit deutlich die bestatigten Falle. Die grose Anzahl vermuteter BLA-Allergien hat einen grosen Einfluss, unter anderem auf die Behandlungsqualitat des einzelnen Patienten sowie die Kosten fur die Allgemeinheit. Allergien auf BLA beruhen auf unterschiedlichen immunologischen Mechanismen und ausern sich haufig als makulopapulose Exantheme, aber auch als Anaphylaxien; daneben finden sich verschiedene Sonderformen der Arzneimittelallergien. Allen BLA gemeinsam ist der Betalaktamring. Eingeteilt werden die BLA in verschiedene Klassen: die Penicilline, Cephalosporine, Carbapeneme, Monobactame und Betalaktamaseinhibitoren mit unterschiedlichen Strukturmerkmalen. Von groser klinischer Bedeutung ist die Kenntnis uber mogliche Kreuzreaktivitaten. Eine Unvertraglichkeit gegenuber allen BLA tritt nur bei einem geringen Prozentsatz aller Allergiker auf, haufiger sind Kreuzreaktivitaten bei Seitenkettenahnlichkeiten wie Aminopenicillinen und Aminocephalosporinen oder auch den Methoxyiminocephalosporinen. Das Bild insgesamt ist jedoch komplex und bedarf weiterer Studien zur Aufklarung. Die Diagnostik besteht ublicherweise aus vier Bausteinen: der Anamnese, der Labordiagnostik, Hauttestungen, welchen ein groser Stellenwert zukommt, sowie der Arzneimittelprovokationstestung. Das Vorgehen der Diagnostik, aber auch im akuten Bedarfsfall der BLA-Gabe ist an der Patientenhistorie und dem Einzelfall orientiert. Erganzend zu den bisherigen Erkenntnissen besteht auch hier weiterer Studienbedarf. Die Durchfuhrung der allergologischen Diagnostik bei Verdacht auf eine BLA-Uberempfindlichkeit ist zugunsten einer guten medizinischen Versorgung des Einzelnen, aber auch aufgrund der immensen Auswirkungen mutmaslicher BLA-Allergien fur die Allgemeinheit dringend zu empfehlen.

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.

BACKGROUND Contact urticaria (CU) is an infrequent, mostly occupational disease that may be life-threatening (CU syndrome stage 4). OBJECTIVES To identify the current frequency, elicitors and cofactors of CU. PATIENTS Three cohorts were retrospectively analysed for CU: (a) patients from the Information Network of Departments of Dermatology (IVDK) database (2000-2014; n = 159 947); (b) patients from an allergy unit (Department of Dermatology, University Hospital Erlangen, 2000-2015; n = 4741); and (c) patients from the Anaphylaxis Registry (2007-2015: 6365 reported cases, including 2473 patients with Ring and Messmer grade III-IV reactions) for severe cases with skin/mucosal manifestations occurring at the workplace vs cases not occurring at the workplace (n = 68 vs n = 1821). RESULTS Four hundred and forty-eight CU patients (0.28%) were diagnosed in the IVDK cohort, and 16 (0.34%) (10 of immunological aetiology, and 6 of non-immunological aetiology) in the Erlangen cohort. The most frequent elicitors in the IVDK cohort were cosmetics, creams, sun protection agents (although these were less frequent in CU patients than in controls without CU; 26.8% vs 35.6%, P

Atopic dermatitis is a chronic inflammatory disease that arises from polygenic disposition, a dysfunction of the physicochemical epithelial barrier, a cutaneous dysbiosis, and a faulty neurosensory activity and shows a highly individual acuity due to epigenetic factors. An essential component of therapeutic management is the application of anti-inflammatory topical medication. Currently, topical glucocorticoids and topical calcineurin inhibitors are routinely used in reactive and proactive therapy. In recent years, the development of molecular medicine has identified several new therapeutic targets that have enabled the development of innovative therapeutic approaches. In addition to phosphodiesterase-4 inhibitors and aryl hydrocarbon receptor modulators, it is mainly Janus kinase inhibitors with different selectivity that are emerging as new effective and safe options for topical therapy. The current data suggests that in the coming months and years representatives of the above-mentioned substance classes will be approved for topical use.

Despite limited evidence on clinical efficacy and increasing resistance problems, topical antibiotics are still used in everyday clinical practice. However, topical antiseptic agents such, as octenidine and polyhexanide, often have a broader efficacy spectrum. They also have a broader target tropism because of their non-specific cellular mechanisms of action. Repeated use of topical antibiotics also carries the risk of contact sensitization, which could limit potential subsequent use as systemic antibiotics. Contact allergy is a clinically relevant problem, particularly in patients with barrier-damaged skin, pre-existing dermatosis, or occupational exposure. It can be concluded that with the use of modern antiseptics, topical antibiotic therapy is rarely indicated and should be avoided, not only because of the risk of contact sensitization but also because of the unfavorable and potentially consequential resistance problem.

Background Wheat is one of the most commonly consumed foods and a known elicitor of anaphylaxis in children and adults. Reactions in adults are often cofactor dependent and characterized by a prolonged time between food intake and the onset of symptoms making the diagnosis of wheat anaphylaxis challenging. Objective To characterize a cohort of patients with the history of wheat anaphylaxis to better understand this atypical phenotype of anaphylaxis. Methods Data from the European Anaphylaxis Registry from 2007 to 2019 (n = 10,636) including 250 patients (213 adults and 37 children) with a history of anaphylaxis caused by wheat were analyzed. Results Wheat was the most common food elicitor of anaphylaxis in adults in the registry in Central Europe. Reactions to wheat in adults were frequently associated with exercise as a cofactor (82.8%) and partially delayed (57.5%). Only 36.9% of patients had atopic comorbidities, which was uncommonly low for adult patients allergic to other kinds of foods (63.2%). Anaphylaxis to wheat presented frequently with cardiovascular symptoms (86.7%) including severe symptoms such as loss of consciousness (41%) and less often with respiratory symptoms (53.6%). The reactions to wheat were more severe than reactions to other foods (odds ratio [OR] = 4.33), venom (OR = 1.58), or drugs (OR = 2.11). Conclusions Wheat is a relevant elicitor of anaphylaxis in adults in Central Europe. Wheat anaphylaxis is highly dependent on the presence of cofactors and less frequently associated with atopic diseases compared with other food allergies. More data on mechanisms of wheat-induced anaphylaxis are required to develop preventive measures for this potentially life-threatening disease.

Ocular manifestations of syphilis with visual impairment symptoms may occur already at the stage of secondary syphilis. They may also be the only manifestation of syphilis and mimic other diseases of the eye. Therefore, in all patients with uveitis, optic neuritis, optic atrophy, acute ocular muscle paresis, or loss of visual acuity, syphilis infection should be ruled out, even if the medical history does not initially raise suspicion. Ocular involvement should be treated as neurosyphilis. Delayed diagnosis and inadequate therapy are often associated with irreversible consequences for the affected patient. As with any syphilis infection, HIV infection should be considered and excluded, especially in the case of ocular manifestations.

Die Hyperhidrose tritt meist als primare, selten als sekundare symptomatische Hyperhidrose auf. Die primare Hyperhidrose wird als komplexe neuropathische Dysregulation mit genetischer Disposition verstanden, die ein pathologisches Schwitzverhalten mit vermehrter Schweissekretion uber mindestens 6 Monate bedingt und mindestens 4 der folgenden Diagnosekriterien erfullt: Betroffenheit der Axillae und/oder der Handinnenflachen und/oder der Fussohlen und/oder des Stirnbereiches, symmetrisches Auftreten, kein nachtliches Schwitzen, Haufigkeit des Auftretens mindestens wochentlich, Beginn der Erkrankung vor dem 25. Lebensjahr, positive Familienanamnese sowie Beeintrachtigung der taglichen Aktivitaten. Zur Therapie der primaren Hyperhidrose werden v. a. topisch Aluminiumsalze und Anticholinergika, Leitungswasseriontophorese sowie intrakutan Botulinumtoxin angewendet. In der systemischen Therapie kommen ebenfalls verschiedene Anticholinergika zum Einsatz. Meist als Ultima-Ratio-Therapie werden chirurgische Verfahren angewendet. Auserdem sind Verfahren zur Thermolyse entwickelt worden.

Background Glycoproteins and glycolipids of some mammalian species contain the disaccharide galactosyl-α-(1,3)-galactose (α-Gal). It is known that α-Gal is immunogenic in humans and causes glycan-specific IgG and also IgE responses with clinical relevance. α-Gal is part of the IgE-reactive monoclonal therapeutic antibody cetuximab (CTX) and is associated with delayed anaphylaxis to red meat. In this study, different α-Gal-containing analytes are examined in singleplex and multiplex assays to resolve individual sensitization patterns with IgE against α-Gal. Methods Three serum groups, α-Gal-associated meat allergy (MA) patients, idiopathic anaphylaxis (IA) patients with suspected MA, and non-meat-allergic healthy control individuals (HC), were analyzed via singleplex allergy diagnostics and a newly established immunoblot diagnostic system. The new dot blot detection system resolved individual IgE sensitization profiles for α-Gal-containing analytes CTX, bovine thyroglobulin (Bos d TG), and human serum albumin (HSA)-conjugated α-Gal. Results Singleplex allergy diagnostics using the α-Gal analytes CTX and Bos d TG confirms the history of MA patients in 91% and 88% of the cases, respectively. A novel dot blot-based assay system for the detection of IgE against α-Gal reveals individual IgE sensitization profiles for α-Gal-containing analytes. An α-Gal-associated IgE cross-reactivity profile (IgE against CTX, Bos d TG, and HSA-α-Gal) was identified, which is associated with MA. Conclusions Detection of individual sensitization patterns with different α-Gal-containing analytes provides the basis for an individual allergy diagnosis for α-Gal-sensitized patients. Higher amounts of α-Gal in pork and beef innards compared to muscle meat as indicated by a higher staining intensity are a plausible explanation for the difference in allergic symptom severity.

SummaryBackground The standardized protocol for performing the strip patch test has proven to be valid, but evidence on its reliability is still missing. Objective To estimate the parallel-test reliability of the strip patch test as compared with the conventional patch test. Methods In this multicentre, prospective, randomized, investigator-blinded reliability study, 132 subjects were enrolled. Simultaneous duplicate strip and conventional patch tests were performed with the Finn Chambers® on Scanpor® tape test system and the patch test preparations nickel sulfate 5% pet., potassium dichromate 0.5% pet., and lanolin alcohol 30% pet. Reliability was estimated by the use of Cohen's kappa coefficient. Results Parallel-test reliability values of the three standard patch test preparations turned out to be acceptable, with slight advantages for the strip patch test. The differences in reliability were 9% (95%CI: −8% to 26%) for nickel sulfate and 23% (95%CI: −16% to 63%) for potassium dichromate, both favouring the strip patch test. Conclusions The standardized strip patch test method for the detection of allergic contact sensitization in patients with suspected allergic contact dermatitis is reliable. Its application in routine clinical practice can be recommended, especially if the conventional patch test result is presumably false negative.

Summary Background Hereditary factors may influence individual susceptibility to contact allergy (CA). Objectives To investigate genetic variants with impacts on early inflammatory reactions and T cell functions that possibly increase the risk of CA. Patients and Methods Three hundred and seventy two patients undergoing patch testing were recruited from the Information Network of Departments of Dermatology (IVDK). Of these, 133 were monosensitized and 239 were polysensitized, defined as reacting to three or more unrelated sensitizers. Within the polysensitized individuals, a subgroup with at least one particularly strong patch test reaction (strong reactors; n = 194) was considered. Three hundred and forty-seven blood bank donors served as controls. Fifteen genetic variants in 13 genes were analysed. Results The homozygous variant CXCL11 AA genotype (rs6817952) was significantly more frequent among polysensitized patients (10 of 239 = 4.2%; p = 0.0048; odds ratio 7.49; 95%CI: 1.7–36.1) than among monosensitized patients (2.2%) and in the control group (0.6%). None of the remaining genetic variants investigated were characterized by similarly strong associations. However, the significance was lost after correction for multiple comparisons. Conclusions The homozygous variant CXCL11 genotype is associated with an increased risk of CA. To confirm this exploratory finding, further independent studies are needed.

Zur modernen Elektrotherapie von Herzrhythmusstorungen werden verschiedene Schrittmachersysteme eingesetzt. Dabei lassen sich antibradykarde Herzschrittmacher von antitachykarden Systemen wie den implantierbaren oder tragbaren Kardioverter-Defibrillatoren und kombiniert antibradykarden/antitachykarden Systemen abgrenzen. Hautreaktionen bei Tragern von Herzschrittmachern und Defibrillatoren werden oft als Pacemaker-Dermatitis bezeichnet. Differenzialdiagnostisch gilt es dabei, verschiedene Ursachen voneinander abzugrenzen. Entscheidend ist, durch eine klinische Untersuchung und Erfassung laborchemischer Parameter eine Infektion auszuschliesen. Auch an eine durch den Schrittmacher induzierte Druckschadigung oder an das klinisch meist symptomlose Schrittmachererythem mit Teleangiektasien sollte gedacht werden. Eine histologische Untersuchung von lasionaler Haut kann zur Diagnosefindung beitragen. Bei Verdacht auf eine immunologisch ausgeloste Implantatunvertraglichkeit ist eine allergologische Abklarung indiziert. Neben der Epikutantestung mit kommerziell verfugbaren Kontaktallergenen werden gelegentlich produktbezogene Substanzen vom Hersteller des Schrittmachers zur allergologischen Testung zur Verfugung gestellt. Aufgrund fehlenden Zusatznutzens gegenuber einer standardisierten Epikutantestung wird allerdings von der Deutschen Kontaktallergie Gruppe (DKG) insbesondere der Einsatz von Metalllegierungsplattchen nicht empfohlen. Erganzend kann in ausgewahlten Verdachtsfallen eine Sensibilisierung uber den Lymphozytentransformationstest hinterfragt werden. Positive Reaktionen sind vor dem Hintergrund einer entsprechenden Klinik zu interpretieren. Abhangig von der Ursache sind die Hautveranderungen gelegentlich selbstlimitierend. Oft ist die Schrittmacherentfernung allerdings unvermeidlich.

Allergo journal international 28(5), 121-151 (2019). doi:10.1007/s40629-019-0100-8, Published by Urban & Vogel, München

Intolerance reactions to metal implants may be caused by metal allergy. However, prior to implantation, patch testing should not be done in a prophylactic-prophetic approach. Pre-implant patch testing should only be performed to verify or exclude metal allergy in patients with a reported respective history. In the case of implant-in particular arthroplasty-related complications like, for example, pain, effusion, skin changes, reduced range of motion, or loosening, orthopedic-surgical differential diagnostics should be performed first. Allergological workup of suspected metal implant allergy should be done with the DKG baseline series which contains nickel-, cobalt- and chromium-preparations. Various studies assessing the usefulness of metal alloy discs for patch testing proved that this approach does not give reliable information about metal allergy. Positive patch test reactions to the discs cannot be assigned to a specific metal within the disc alloy components. Furthermore, availability of such metal discs might be an invitation to uncritical testing. Accordingly, due to lack of benefit in comparison to patch testing with standardized metal salt preparations, we do not recommend patch testing with metal alloy discs.

Zusammenfassung Eine Metallallergie kann zu Unvertraglichkeit von Metallimplantaten fuhren. Vor Implantation sollte eine Epikutantestung aber nicht prophetisch-prophylaktisch, sondern nur bei anamnestischen Hinweisen auf eine potenzielle Metallallergie erfolgen. Sofern nach Einsetzen von Metallimplantaten – speziell Endoprothesen – Komplikationen wie Schmerzen, Ergusse, Hauterscheinungen, Bewegungseinschrankung oder Lockerung auftreten, empfiehlt sich bei Verdacht auf das Vorliegen einer Metallimplantatallergie nach orthopadisch-chirurgischer Differenzialdiagnostik ein Epikutantest mit der Nickel-, Cobalt-, Chrom-Praparationen enthaltenden DKG-Standardreihe. Studien zum Einsatz von Metalllegierungsplattchen haben gezeigt, dass damit kein verlasslicher Nachweis einer Metallallergie moglich ist, und bei einer allergischen Epikutantestreaktion auf ein Metallplattchen diese auch keinem konkreten Legierungs-Metall der Plattchen zugeordnet werden kann. Zudem besteht die Gefahr der unkritischen, breiten Testanwendung der leicht zuganglichen Metalllegierungsplattchen. Aufgrund fehlenden Zusatznutzens gegenuber der Epikutantestung mit standardisierten Metallsalzpraparationen empfehlen wir die Testung mit Legierungsplattchen nicht.

Intolerance reactions to metal implants may be caused by metal allergy. However, prior to implantation, 'prophetic'/prophylactic patch testing should not be performed. Pre-implant patch testing should only be done to verify or exclude metal allergy in patients with a corresponding history. In case of implant-related complications - in particular following replacement arthroplasty - such as pain, effusion, skin lesions, reduced range of motion or implant loosening, orthopedic causes should be ruled out first. Workup of suspected metal implant allergy should then be done using the DKG standard series, which includes nickel, cobalt, and chromium preparations. Various studies assessing the usefulness of metal alloy discs for patch testing have shown this particular approach to be ineffective with respect to providing reliable information on metal allergy. Any positive reaction in such tests cannot be assigned to a specific metal contained within the alloy. Furthermore, there is a risk of broad and indiscriminate use of these readily available discs. Accordingly, given the lack of additional benefit compared to patch testing with standardized metal salt preparations, we do not recommend patch testing with metal alloy discs.

Summary Background It has been hypothesized that positive reactions in the strip patch test are irritant rather than allergic. Objective To study reaction profiles of the baseline series patch test substances applied routinely on tape-stripped skin according to the reaction index (RI) and the positivity ratio (PR). Patients and methods One thousand two hundred and twenty-eight consecutive patients were routinely strip patch tested with the baseline series between January 2011 and June 2013 (intervention group). On the basis of test reactions at D3/D4, the RI, and the PR, 25 standard allergens were analysed, and the results were compared with those obtained in 1161 patients patch tested conventionally from July 2008 to December 2010 (historical control group). Results Nickel sulfate, fragrance mix I, cobalt chloride, Myroxylon pereirae (balsam of Peru) and colophonium showed the highest frequencies of positive reactions in both groups, without any significant differences. Of 25 patch test substances of the baseline series, 18 showed good reaction profiles in the intervention group, and 16 in the historical control group. Conclusions Reaction profiles of baseline series patch test substances remained largely unaffected by tape stripping the skin prior to patch testing. Thus, if conventional patch test results are presumed to be false-negative, performance of the strip patch test can be recommended independently of the standard allergen.

BACKGROUND Global travel increasis practitioner's confrontation with very special infectious diseases, like hemorrhagic viral diseases that are traditionally rare in European countries. Prompt diagnosis and subsequent induction of therapy are essential to prevent high rates of severe and lethal complications. ANAMNESIS A 59-year-old man complained deterioration of general health after a 3-week vacation to South Africa. He presented fever and hemorrhagic erythema with pustula surrounded by necrotic margin on the right calf. COURSE AND THERAPY: On the second day of inpatient treatment, a papulovesiculous, partly hemorrhagic exanthema appeared. With a tentative diagnosis of Rickettsiosis, we performed specific diagnostics by serology and biopsy. Therapy was initiated with doxycycline (200 mg/d) for 7 days. Under this regimen clinical symptoms healed without consequences. Rickettsioses are ubiquitious zoonoses that are caused by various Rickettsia subtypes. The stay in endemic regions together with signs of fever, reduced general health, eschar and exanthema are suspicious for this disease. Therapy should be initiated immediately in cases of clinical suspicion with a characteristic case history. The seroconversion, which appears later in course, should not give reason for avoiding early skin biopsy due to the potentially fatal course of the disease. Biopsy enables early histological proof of a dermal vasculitic inflammation pattern and PCR analysis before subsequent serological controls and proofs.