[Role of allergen-specific immunotherapy (desensitization) for the treatment of allergies in Germany. Current situation]

[Mucosal diseases from an allergological perspective]

The oral allergy syndrome is one of the most common form of food allergy and manifests as contact urticaria of the oral mucosa after consumption of cross reacting foods. Whereas allergic contact stomatitis often occurs due to dental materials, allergic contact cheilitis is usually a reaction due to topical therapeutics like herpes ointments or lip care products. As late type reactions are more frequent than immediate type reactions in the anogenital mucosa, contact dermatitis in this area should be identified via epicutaneous testing. In case of contact urticaria at the genital mucosa, a semen allergy or a latex allergy should be given due consideration as a possible cause. Angioedemas, which are mostly common histamine mediated, usually prefer skin areas with loose connective tissue such as the oral or genital mucosa. Fixed drug eruption also occurs preferentially in these areas. Bullous drug-induced skin reactions (e.g., SJS and TEN) are characterized by severe hemorrhagic, erosive affections of mucous membranes.

Use of specific immunotherapy--a survey of 15 164 employed persons in Germany

BACKGROUND

The high prevalence of allergic rhinitis (AR) leads to high morbidity and costs. Specific immunotherapy (SIT) is a potentially curative therapy for AR. The -decision whether or not to employ SIT is often not totally clear.

PATIENTS AND METHODS

In 2012/13, as part of company skin cancer screening -programs, employed persons between the ages of 16-70 were asked about use of allergy-related medications and atopic conditions, as well as the use of SIT or possible reasons preventing its use.

RESULTS

Of the 15,164 persons surveyed, 26.2% (n = 3,966) reported they had allergies that might benefit from SIT therapy. Of these, only 31.7% (n = 1,470) had undergone SIT therapy, with 63.3% (n = 931) describing the treatment as successful. The main reasons given for not undergoing SIT were relatively minor symptoms (51.2%; n = 1,278), little confidence in the success of therapy, and lack of time (12%; n = 300). Only 5.2%, n = 129) stated that avoiding allergens was sufficient or that they could not undergo SIT because of other health problems. Another 5.2% (n = 130) said they had either not heard of SIT, or had not found a place to undergo treatment.

CONCLUSIONS

Although about one-quarter of respondents reported allergies that might benefit from SIT, less than one-third had undergone treatment. The main -reason was having mild symptoms; guideline or healthcare-related issues were -responsible only to a limited extent.

Food allergies resulting from immunological cross-reactivity with inhalant allergens: Guidelines from the German Society for Allergology and Clinical Immunology (DGAKI), the German Dermatology Society (DDG), the Association of German Allergologists (AeDA) and the Society for Pediatric Allergology and Environmental Medicine (GPA)

A large proportion of immunoglobulin E (IgE)-mediated food allergies in older children, adolescents and adults are caused by cross-reactive allergenic structures. Primary sensitization is most commonly to inhalant allergens (e.g. Bet v 1, the major birch pollen allergen). IgE can be activated by various cross-reactive allergens and lead to a variety of clinical manifestations. In general, local and mild — in rare cases also severe and systemic — reactions occur directly after consumption of the food containing the cross-reactive allergen (e. g. plant-derived foods containing proteins of the Bet v 1 family). In clinical practice, sensitization to the primary responsible inhalant and/or food allergen can be detected by skin prick tests and/or in vitro detection of specific IgE. Component-based diagnostic methods can support clinical diagnosis. For individual allergens, these methods may be helpful to estimate the risk of systemic reactions. Confirmation of sensitization by oral provocation testing is important particulary in the case of unclear case history. New, as yet unrecognized allergens can also cause cross-reactions.

The therapeutic potential of specific immunotherapy (SIT) with inhalant allergens and their effect on pollen-associated food allergies is currently unclear: results vary and placebo-controlled trials will be necessary in the future. Pollen allergies are very common. Altogether allergic sensitization to pollen and cross-reactive food allergens are very common in our latitudes. The actual relevance has to be assessed on an individual basis using the clinical information.

Cite this as Worm M, Jappe U, Kleine-Tebbe J, Schäfer C, Reese I, Saloga J, Treudler R, Zuberbier T, Wassmann A, Fuchs T, Dölle S, Raithel M, Ballmer-Weber B, Niggemann B, Werfel T. Food allergies resulting from immunological cross-reactivity with inhalant allergens. Allergo J Int 2014; 23: 1–16 DOI 10.1007/s40629-014-0004-6