Anwendung von Biologika bei allergischen und Typ-2-entzündlichen Erkrankungen in der aktuellen Covid-19-Pandemiea, b, c

Epithelial immune regulation of inflammatory airway diseases: Chronic rhinosinusitis with nasal polyps (CRSwNP)

BACKGROUND

The epithelial immune regulation is an essential and protective feature of the barrier function of the mucous membranes of the airways. Damage to the epithelial barrier can result in chronic inflammatory diseases, such as chronic rhinosinusitis (CRS) or bronchial asthma. Thymic stromal lymphopoietin (TSLP) is a central regulator in the epithelial barrier function and is associated with type 2 (T2) and non-T2 inflammation.

MATERIALS AND METHODS

The immunology of chronic rhinosinusitis with polyposis nasi (CRSwNP) was analyzed in a literature search, and the existing evidence was determined through searches in Medline, Pubmed as well as the national and international study and guideline registers and the Cochrane Library. Human studies or studies on human cells that were published between 2010 and 2020 and in which the immune mechanisms of TSLP in T2 and non-T2 inflammation were examined were considered.

RESULTS

TSLP is an epithelial cytokine (alarmin) and a central regulator of the immune reaction, especially in the case of chronic airway inflammation. Induction of TSLP is implicated in the pathogenesis of many diseases like CRS and triggers a cascade of subsequent inflammatory reactions.

CONCLUSION

Treatment with TSLP-blocking monoclonal antibodies could therefore open up interesting therapeutic options. The long-term safety and effectiveness of TSLP blockade has yet to be investigated.

The impact of the first COVID-19 wave on office-based dermatological care in Germany: a focus on diagnosis, therapy and prescription of biologics

Background

The COVID-19 pandemic has led to widespread changes in medical care. However, it is still unclear to what extent the care of patients suffering from moderate-to-severe psoriasis, chronic spontaneous urticaria or atopic dermatitis has been affected.

Objectives

This study was conducted to determine the impact of the SARS-CoV-2 pandemic on medical care in dermatological practices, focusing on physicians’ concerns related to susceptibility to infections in combination with different treatment modalities.

Materials & Methods

Dermatologists working in medical offices in the German federal states of Bavaria and Lower Saxony participated in a cross-sectional, non-interventional, questionnaire-based study investigating the influence of COVID-19 on dermatological care. The study was performed after the first wave of the coronavirus pandemic in July/August, 2020.

Results

A total of 195 dermatologists participated in the study. Almost one in five practices were closed for at least one week during the pandemic. The care of patients with chronic inflammatory skin diseases was impaired, affecting diagnostic investigation. Physicians stated that the pandemic substantially influenced systemic therapy. Nearly half of physicians surveyed were concerned about increased susceptibility to infections under biological therapy. No significant differences were identified between the German federal states of Bavaria and Lower Saxony in the south and north of Germany, respectively.

Conclusion

This study reveals a significant impact of the COVID-19 pandemic on the care of dermatological patients in medical offices in Germany. New management modalities and continuous education are needed to improve care in pandemic situations.

COVID-19 vaccination and allergen immunotherapy (AIT) - A position paper of the German Society for Applied Allergology (AeDA) and the German Society for Allergology and Clinical Immunology (DGAKI)

Background: Vaccinations against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) are intended to induce an immune response to protect against infection/disease. Allergen immunotherapy (AIT) is thought to induce a (different) immune response, e.g., to induce tolerance to allergens. In this position paper we clarify how to use AIT in temporal relation to COVID-19 vaccination. Four SARS-CoV-2 vaccines are currently approved in the EU, and their possible immunological interactions with AIT are described together with practical recommendations for use. Materials and methods: Based on the internationally published literature, this position paper provides specific recommendations for the use of AIT in temporal relation to a SARS-CoV-2 vaccination. Results: AIT is used in 1) allergic rhinitis, 2) allergic bronchial asthma, 3) insect venom allergy, 4) food allergy (peanut). Conclusion: For the continuation of an ongoing AIT, we recommend an interval of 1 week before and after vaccination for subcutaneous immunotherapy (SCIT). For sublingual immunotherapy (SLIT) and oral immunotherapy (OIT), we recommend taking them up to the day before vaccination and a break of 2 – 7 days after vaccination. Initiation of a new SCIT, SLIT, or OIT should be delayed until 1 week after the day of the second vaccination. For SCIT, we generally recommend an interval of ~ 1 week to COVID-19 vaccination.

Antworten auf brennende Fragen an klinische Allergolog*innen im Zusammenhang mit den neuen COVID-19-Impfstoffen

Hintergrund: Mit den neu zugelassenen Impfungen gegen COVID-19 kam es zu ersten Berichten über allergische beziehungsweise Unverträglichkeitsreaktionen. In der Folge stellte sich die Frage, ob von diesen Impfstoffen eine erhöhte Gefahr für Unverträglichkeitsreaktionen ausgeht und ob Allergiker gegebenenfalls hierfür ein höheres Risiko aufweisen.

Ergebnisse: Allergische Reaktionen nach COVID-19-Impfungen wurden berichtet, jedoch meist von mildem Ausprägungsgrad und in bei Impfstoffen normaler (Moderna®) oder nur gering erhöhter Frequenz (BioNTech/Pfizer®). Das Risiko einer allergischen Reaktion auf die neu zugelassenen Vektorimpfstoffe (AstraZeneca®, Johnson & Johnson®) kann noch nicht abschließend beurteilt werden, scheint jedoch ebenfalls gering. Es gibt aktuell keinen Hinweis, dass Patienten mit Allergien häufiger oder schwerer reagieren. Man geht momentan davon aus, dass Unverträglichkeitsreaktionen vom Soforttyp einerseits Typ-I-allergisch (IgE-vermittelt) oder über Komplement-Aktivierung (CARPA, "complement activation-related pseudoallergy") stattfinden. Als Auslöser hierfür werden Polyethylenglycol (PEG) oder Polysorbat, die als Stabilisatoren in den Impfstoffen vorhanden sind, vermutet.

Diskussion: Die bisher verfügbaren Daten zeigen kein wesentlich erhöhtes Risiko hinsichtlich allergischer Reaktionen vom Soforttyp bei Allergikern. Allergiker können zumeist problemlos geimpft werden. Standardisierte Testungen zur Nachverfolgung möglicher Allergien oder CARPA-vermittelten Reaktionen sind derzeit nur begrenzt verfügbar.

Zitierweise: Altrichter S, Wöhrl S, Horak F, Idzko M, Jordakieva G, Untersmayr E, Szepfalusi Z, Zieglmayer P, Jensen-Jarolim E, Wiedermann U, Rosenkranz A, Hötzenecker W. Answers to burning questions for clinical allergologists related to the new COVID-19 vaccines. Allergo J Int 2021; 30:169-75

https://doi.org/10.1007/s40629-021-00177-3

Praktischer Umgang mit allergischen Reaktionen auf COVID-19-Impfstoffe

Hintergrund: Zur vorbeugenden Behandlung von COVID-19 (Coronaviruserkrankung 2019) wurden in einer beispiellosen weltweiten Forschungsanstrengung Sicherheit und Wirksamkeit neuer Impfstoffplattformen studiert, die noch nie zuvor am Menschen eingesetzt wurden. Weniger als ein Jahr nach der Entdeckung der SARS-CoV-2-Virussequenz (SARS-CoV-2, "severe acute respiratory syndrome coronavirus type 2") wurden diese in zahlreichen Ländern für den Einsatz zugelassen und es wurde mit Massenimpfungen begonnen. Die bislang in der Europäischen Union (EU) zugelassenen mRNA-Impfstoffe (mRNA, "messenger"-RNA) gegen SARS-CoV-2 BNT162b2 und mRNA-1273 basieren auf einer ähnlichen lipidbasierten Nanopartikelträgertechnologie; die Lipidkomponenten unterscheiden sich jedoch. Schwere allergische Reaktionen und Anaphylaxien nach COVID-19-Impfungen sind sehr seltene unerwünschte Nebenwirkungen, die aber aufgrund potenziell letaler Ausgänge viel Aufmerksamkeit erhalten und ein hohes Maß an Verunsicherung ausgelöst haben.

Methoden: Das aktuelle Wissen zu anaphylaktischen Reaktionen auf Impfstoffe und speziell zu den derzeit neuen mRNA-COVID-19-Impfstoffen wurde zusammengestellt mittels einer Literaturanalyse durch Recherchen in Medline, Pubmed sowie den nationalen und internationalen Studien- und Leitlinienregistern, der Cochrane Library und dem Internet unter besonderer Berücksichtigung offizieller Webseiten der World Health Oranization (WHO), der Centers for Disease Control and Prevention (CDC), der European Medicines Agency (EMA), des Robert-Koch-Instituts (RKI) und des Paul-Ehrlich-Instituts (PEI).

Ergebnisse: Basierend auf der internationalen Literatur und bisheriger Erfahrungen zu schweren allergischen Reaktionen im Kontext der COVID-19-Impfungen werden von einem Expertengremium Empfehlungen für Prophylaxe, Diagnostik und Therapie dieser allergischen Reaktionen gegeben.

Schlussfolgerung: Vor einer COVID-19-Impfung mit den derzeit zugelassenen Impfstoffen sind Allergietests für die allermeisten Allergiker nicht notwendig. Bei allergischer/anaphylaktischer Reaktion auf den verabreichten COVID-19-Impfstoff wird eine allergologische Abklärung empfohlen, wie auch für eine kleine potenzielle Risikopopulation vor der ersten Impfung. Die Evaluierung und Zulassung von Testverfahren sollten hierfür erfolgen.

Zitierweise: Klimek L, Bergmann K-C, Brehler R, Pfützner W, Zuberbier T, Hartmann K, Jakob T, Novak N, Ring J, Merk H; Hamelmann E, Ankermann T, Schmidt S, Untersmayr E, Hötzenecker W, Jensen-Jarolim E, Brockow K, Mahler V, Worm M. Practical Handling of Allergic Reactions to COVID-19 vaccines. A Position Paper from German and Austrian Allergy Societies AeDA, DGAKI, GPA and ÖGAI. Allergo J Int 2021;30:79-95

https://doi.org/10.1007/s40629-021-00165-7

Expert consensus on practical aspects in the treatment of chronic urticaria

Background

Chronic urticaria (CU) is a common disease which represents a considerable burden for many patients. The current urticaria guideline describes the evidence-based diagnosis and treatment of CU. In addition, however, questions often arise in everyday practice that are not addressed by the guideline.

Methods

In May 2020, a digital meeting with German urticaria experts was held, in which practical aspects of CU treatment were discussed and supporting aids for everyday clinical treatment formulated. The resulting advice in this document focus on practical questions and the available literature and experiences of the participants.

Results

The diagnosis of CU can be made in a short time by means of a thorough anamnesis, a physical examination, and a basic laboratory chemical diagnosis. For this purpose, practical recommendations for everyday practice are given in this paper. An extended diagnosis is only indicated in a few cases and should always be carried out in parallel with an effective therapy. In general, CU should always be treated in the same way, regardless of whether wheals, angioedema or both occur. Symptomatic therapy should be carried out according to the treatment steps recommended by the guidelines. This publication provides practical advice on issues in everyday practice, such as the procedure in the current coronavirus disease 2019 (COVID-19) pandemic, the cardiac risk under higher dosed H1 antihistamines, the self-administration of omalizumab as well as vaccination under omalizumab therapy. In addition to treatment recommendations, topics such as documentation in the practice and family planning with urticaria will be discussed.

Discussion

These supporting treatment recommendations serve as an addendum to the current CU guideline and provide support in dealing with CU patients in everyday practice. The aim is to ensure that patients suffering from CU achieve complete freedom of symptoms with the help of an optimal therapy.

Supplementary Information

The online version of this article (10.1007/s40629-021-00162-w) contains supplementary material, which is available to authorized users.