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Background: Venom immunotherapy (VIT) is highly efficient in subjects suffering from IgE-mediated allergy to hymenoptera venom (HV), and VIT results in substantial improvement of quality of life (QoL). However, VIT-induced tolerance may be lost over time after cessation of treatment, putting patients at risk of re-sting anaphylaxis. Materials and methods: To study the effect of VIT on maintenance of HV tolerance we evaluated the natural history of 54 patients who were treated with VIT up to 29 years ago, with a special focus on re-stings and their subsequent course. Furthermore, we analyzed HV-specific IgE, IgG, and IgG4 antibody titers. Finally, we assessed the long-term impact of VIT on various psychosocial aspects like dealing with hymenoptera exposures, daily life activities, self-assurance, and personal environment. Results: 29 (53.7%) subjects experienced at least one re-sting after stopping VIT, with 23 (79%) showing no systemic reaction (SR). Eleven of these (37.9%) took emergency drugs as a safety measurement. Six individuals (21%) showed loss of tolerance experiencing an anaphylactic reaction. No difference in HV-specific IgE, IgG4, or IgG antibody concentrations was noticed among the different patients. Subjects who tolerated a re-sting without applying emergency drugs felt least affected in their social-behavioral leisure activities when hymenoptera were around or by anxiety for new stings. Conclusion: VIT leads to long-term tolerance in the majority of HV-allergic patients, however, ~ 1/5 may lose protection over time, arguing for continued follow-up on VIT-treated subjects and keeping them equipped with an emergency kit. Notably, VIT also results in a lasting, strong impact on self-assurance and sense of well-being in individuals who tolerated a re-sting without employing emergency drugs, which emphasizes the need to use them only in case of systemic symptoms after stopping successful VIT.

With the advent of biologicals, more and more therapeutics are available that specifically address specific switch points in the pathomechanism of immunologically dominated diseases. Thus, the focus of diagnostics and therapy (precision medicine) is more on the individual disease characteristics of the individual patient. Regarding the different phenotypes of atopic diseases, severe asthma was the first entity for which biologicals were approved, followed by urticaria, and finally atopic dermatitis and chronic rhinosinusitis with nasal polyps. Experience in the treatment of severe bronchial asthma has shown that the intensity of the response to biological therapy depends on the quality of clinical and immunological phenotyping of the patients. This also applies to different diseases of the atopic form, as patients can suffer from several atopic diseases at the same time, each with different characteristics. Biologics are already emerging that may represent a suitable therapy for allergic bronchial asthma, which often occurs together with severe neurodermatitis, and chronic rhinosinusitis with nasal polyps. In practice, however, the question of possible combinations of biologicals for the therapy of complex clinical pictures of individual patients is increasingly arising. In doing so, the side effect profile must be taken into account, including hypersensitivity reactions, whose diagnostic and logistical management must aim at a safe and efficient therapy of the underlying disease. Increased attention must also be paid to biological therapy in pregnancy and planned (predictable) vaccinations as well as existing infections, such as SARS-CoV-2 infection. Before starting a biological therapy, the immune status should be checked with regard to chronic viral and bacterial infections and, if necessary, the vaccination status should be refreshed or missing vaccinations should be made up for before starting therapy. Currently, reliable data on the effect of biologicals on the immunological situation of SARS-CoV-2 infection and COVID-19 are not available. Therefore, research and development of suitable diagnostic methods for detection of immunologically caused side effects as well as detection of potential therapy responders and non-responders is of great importance.

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.

Die Insektengiftallergie ist mit einem Vorkommen von 3-5 % in der Bevölkerung häufig und kann bei bis zu 1 % der Betroffenen potenziell lebensbedrohliche allergische Reaktionen auslösen [1]. Patienten, die eine systemische allergische Reaktion nach einem Insektenstich erlitten haben, sollten allergologisch vorgestellt und versorgt werden. Aufgrund der vielerorts in den letzten Monaten durch die COVID-19-Pandemie reduzierten ambulanten und stationären Versorgungskapazitäten wurden länderspezifisch unterschiedliche Maßnahmen ergriffen, um auch Patienten mit einer Insektengiftallergie fortwährend optimal allergologisch zu versorgen. Eine aktuelle Datenanalyse zeigt, dass es 2020 zu einer Einschränkung von Neueinleitungen der Insektengiftimmuntherapie gekommen ist (März-Juni 2019 im Vergleich März-Juni 2020: Rückgang 48,5 %; Daten aus verschiedenen Zentren in Deutschland, Österreich und Schweiz). Es werden konkrete organisatorische (z. B. Telefon- und Videosprechstunden, die Umgestaltung von Wartebereichen mit Umsetzung von Hygienemaßnahmen und Abstandsregeln bei stabiler Patientenzahl) und medizinische Maßnahmen (Zusammenarbeit mit niedergelassenen Ärzten bzgl. primärer Diagnostik, kurzfristige COVID-19-Testung, die ambulante Fortführung einer begonnenen Insektengiftimmuntherapie unter Ausnutzung der zulässigen Injektionsintervalllängen, Neueinleitung einer Insektengiftimmuntherapie zeitnah innerhalb der Saison, ggf. Einsatz ambulanter Schemata vor allem außerhalb der Saison) zur Betreuung von Insektengiftallergikern während der COVID-19-Pandemie vorgeschlagen.

In dem Symposium "Adventure meets Experience", das auf dem 14. Deutschen Allergiekongress stattgefunden hat, beleuchteten die Redner die Probleme der Allergologie aus Sicht unterschiedlicher Generationen. Jung und Alt diskutierten uber …

Background Chronic urticaria (CU) is a frequent skin disease characterized by relapsing appearance of pruritic hives. While clinical symptoms are due to the release of histamine by cutaneous mast cells, the underlying pathophysiology is still unknown. However, previous studies indicate that basophils might be of relevance. Besides, the occurrence of autoantibodies against IgE or its receptor, FceRI, and the therapeutic efficacy of anti-IgE antibodies imply that IgE-mediated mechanisms also play an important role in CU. Methods Reactivity of CU patients’ peripheral blood basophils (n=60) to specific anti-FceRI and IgE-independent fMLP stimulation was determined by basophil activation test in comparison to patients suffering from IgE-mediated allergic rhinitis (n=10) and healthy controls (n=10). In addition, immunoglobulin receptor (FceRI, FcγRII) expression and surface bound antibodies (IgE, IgG) were quantified on basophils. Furthermore, the autoreactive capacity of CU sera was evaluated and urticaria-related symptoms were assessed by both UCT and CU-Q2oL. Results Stimulating CU patients’ basophils via FceRI, we identified three distinct immunological phenotypes. One subgroup of patients' basophils reacted to FceRI stimulation, whereas the others had anti-FceRI non-reactive basophils. Among the latter a subgroup with pronounced basopenia was identified. Of note, this group was characterized by augmented serum-induced basophil activation, increased levels of autoantibodies against thyroid peroxidase and also exhibited the strongest disease impact on their quality of life. Conclusions CU patients can be categorized into three immunological subgroups based on their basophil reactivity and frequency. These phenotypes are associated with different clinical characteristics, pointing to basophils as important players in CU pathophysiology. This article is protected by copyright. All rights reserved.

Mit uber 28 eingereichten Posterbeitragen, dem 7. Junior-Member-Symposium und dem neuen Junior-Alumni-Symposium war der 14. Deutsche Allergiekongress in Hannover ein voller Erfolg fur die Junior Members der DGAKI. Die Sektion der Junior Members vertritt fast ein Viertel der gesamten DGAKI-Mitglieder und ist oft das Eingangstor fur junge, engagierte Arzte. Durch die vielfaltige Beteiligung konnte die Sichtbarkeit in diesem Jahr deutlich gesteigert werden.

Auf dem diesjahrigen 13. Deutschen Allergiekongress (DAK) in der sachsischen Landeshauptstadt Dresden haben sich die Junior Members der DGAKI gleich mit vier Veranstaltungen am Programm beteiligt: mit einem Junior-Member-Symposium, einem Joint-Symposium in Zusammenarbeit mit den Junioren des AeDA sowie der GPA, einer speziell fur die Junioren der DGAKI ausgerichteten ePoster-Session sowie der Junior-Member-Sektionssitzung.

While allergen-specific immunotherapy (AIT) is very efficient in hymenoptera venom (HV)-allergic patients, long-term outcome after finishing AIT is not well investigated, especially regarding mechanisms that are suggested to contribute to allergen-specific tolerance. Here, we analyse the Ves v 5-inhibitory activity of sera from wasp venom-allergic patients using the novel cell-free enzyme-linked immunosorbent facilitated antigen binding (ELIFAB) assay. Compared to pre-AIT, sera from patients undergoing AIT displayed an increased ability to inhibit Ves v 5 binding by IgE antibodies. In contrast, this inhibitory activity was reduced in patients having finished AIT 5-12years ago. Allergen-blocking capacity correlated with serum concentrations of Ves v 5-specific IgG4 which rose during AIT but almost reached pretreatment levels in patients who had stopped AIT more than 5years ago. These data raise questions about how long allergen tolerance is maintained in AIT-treated HV-allergic patients and suggest that the ELIFAB assay might be an easy-to-use tool assessing long-term tolerance in patients treated with HV-AIT.

Background Differential diagnosis is a crucial skill for primary care physicians. General practice plays an increasing important role in undergraduate medical education. Via general practice, students may be presented with an overview of the whole spectrum of differential diagnosis in regard to common symptoms encountered in primary care. This project evaluated the impact of a blended learning program (using the inverted classroom approach) on student satisfaction and development of skills and knowledge. Methods An elective seminar in differential diagnosis in primary care, which utilized an inverted classroom design, was offered to students. Evaluation followed a mixed methods design: participants completed a pre- and post-test, a questionnaire, and a focus group discussion. Interviews were transcribed verbatim and answers were grouped according to different themes. Test results were analysed using the Wilcoxon matched-pairs signed-ranks test. Results Participants (n = 17) rated the course concept very positively. Especially the inverted classroom approach was appreciated by all students, as it allowed for more time during the seminar to concentrate on interactive and practice based learning. Students (n = 16) showed a post-test significant overall gain in skills and knowledge of 33%. Conclusions This study showed a positive effect of the inverted classroom approach on students’ satisfaction and skills and knowledge. Further research is necessary in order to explore the potentials of this approach, especially the impact on development of clinical skills. Electronic supplementary material The online version of this article (doi:10.1186/s12909-015-0346-x) contains supplementary material, which is available to authorized users.