Allergie und Asthma Zentrum Westend

Berlin, Germany

Allergie und Asthma Zentrum Westend

Berlin, Germany
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Kleine-Tebbe J.,Allergie und Asthma Zentrum Westend | Meissner A.-M.,Allergie und Asthma Zentrum Westend | Jappe U.,Universitatshautklinik Lubeck | Herold D.A.,Allergie und Asthma Zentrum Westend
Allergo Journal | Year: 2010

The knowledge about allergenic molecules in foods facilitates new diagnostic options, which are increasingly being used for the detection of allergen-specific IgE antibodies. Classification of allergen sources of plant or animal origin, so far mainly based on phylogenetic criteria, is completed by biological structural knowledge and grouping of identified single allergens in common protein families. Only few molecule families (i. e., Bet v 1-homolog pathogenesis-related[PR]-10 family, lipid transfer proteins [LTP], various storage proteins, oleosins, profilins in plant products) consist of relevant food allergens of similar sequence and structure, carrying common IgE epitopes as the basis of cross-reactions. Cross-reactive carbohydrate determinants (CCD), mainly of plant origin, are also able to bind IgE being rarely of clinical relevance. Single allergens can be used (a) individually, (b) collectively for component-based diagnostics (CRD), i.e., with microarray technique, (c) mixed in (spiked) extracts, or (d) combined as a substitute for allergen extracts. The first two options allow a molecular specific diagnosis, while the latter ones improve analytic sensitivity and reliability. Sorting the available singe allergens, peanut storage protein Ara h 2, LTP Ara h 9, hazelnut LTP Cor a 8, Bet v 1-homolog soy protein Gly m 4, peach LTP Pru p 3, and wheat gliadin Tri a 19 represent interesting examples as risk molecules for systemic allergic reactions and, like peach profilin Pru p 4, as markers for cross-reactions. Similar promising diagnostic improvement is expected by risk molecules being not available yet: oleosins of peanut (Ara h 10/11), hazelnut (Cor a 12/13) and sesame (Ses I 4/5), LTP from carrot (Dau c 3), soy (Gly m 1), apple (Mal d 3), cherry (Pru av 3) and wheat (Tri a 14), and additional storage proteins from hazelnut (Cor a 9) and soy (Gly m 5/6). In addition, clinical study progams will define the diagnostic role of single allergens for tolerance development and the prognosis of food allergies in early childhood. Molecular diagnostics of food allergy potentially facilitates differentiation of (multiple) sensitizations by identification of species-specific reactions, uncovering of cross-reactions and of so far undiscovered allergic sensitizations to underrepresented single allergens. The subsequently improved analytic sensitivity will increase the number of positive allergen-specific IgE results; their clinical relevance is only present in case of corresponding symptoms and should be confirmed on an individual basis.


PubMed | Landesgesundheitsamt Baden Wurttemberg im Regierungsprasidium Stuttgart, University of Cologne, Universitatsklinikum Bonn, Medical University of Graz and 18 more.
Type: | Journal: International journal of hygiene and environmental health | Year: 2016

In April 2016, the German Society of Hygiene, Environmental Medicine and Preventative Medicine (Gesellschaft fr Hygiene, Umweltmedizin und Prventivmedizin (GHUP)) together with other scientific medical societies, German and Austrian medical societies, physician unions and experts has provided an AWMF (Association of the Scientific Medical Societies) guideline Medical diagnostics for indoor mold exposure. This guideline shall help physicians to advise and treat patients exposed indoors to mold. Indoor mold growth is a potential health risk, even without a quantitative and/or causal association between the occurrence of individual mold species and health effects. Apart from the allergic bronchopulmonary aspergillosis (ABPA) and the mycoses caused by mold, there is only sufficient evidence for the following associations between moisture/mold damages and different health effects: Allergic respiratory diseases, asthma (manifestation, progression, exacerbation), allergic rhinitis, exogenous allergic alveolitis and respiratory tract infections/bronchitis. In comparison to other environmental allergens, the sensitizing potential of molds is estimated to be low. Recent studies show a prevalence of sensitization of 3-10% in the total population of Europe. The evidence for associations to mucous membrane irritation and atopic eczema (manifestation, progression, exacerbation) is classified as limited or suspected. Inadequate or insufficient evidence for an association is given for COPD, acute idiopathic pulmonary hemorrhage in children, rheumatism/arthritis, sarcoidosis, and cancer. The risk of infections from indoor molds is low for healthy individuals. Only molds that are capable to form toxins can cause intoxications. The environmental and growth conditions and especially the substrate determine whether toxin formation occurs, but indoor air concentrations are always very low. In the case of indoor moisture/mold damages, everyone can be affected by odor effects and/or impairment of well-being. Predisposing factors for odor effects can be given by genetic and hormonal influences, imprinting, context and adaptation effects. Predisposing factors for impairment of well-being are environmental concerns, anxieties, conditioning and attributions as well as a variety of diseases. Risk groups that must be protected are patients with immunosuppression and with mucoviscidosis (cystic fibrosis) with regard to infections and individuals with mucoviscidosis and asthma with regard to allergies. If an association between mold exposure and health effects is suspected, the medical diagnosis includes medical history, physical examination, conventional allergy diagnosis, and if indicated, provocation tests. For the treatment of mold infections, it is referred to the AWMF guidelines for diagnosis and treatment of invasive Aspergillus infections. Regarding mycotoxins, there are currently no validated test methods that could be used in clinical diagnostics. From the perspective of preventive medicine, it is important that mold damages cannot be tolerated in indoor environments.


Kleine-Tebbe J.,Allergie und Asthma Zentrum Westend | Ackermann-Simon J.,Allergie und Asthma Zentrum Westend | Hanf G.,Allergie und Asthma Zentrum Westend
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz | Year: 2012

Allergen-specific immunotherapy (SIT, desensitization) is applied monthly with subcutaneous injections (SCIT) or sublingually (SLIT) with droplets or tablets on a daily basis. Numerous immunological changes during SIT induce long-lasting tolerance. Efficacy has been demonstrated by a number of controlled studies for insect venom hypersensitivity (SCIT), allergic rhinoconjunctivitis (SCIT, SLIT particularly in grass pollen allergy), and allergic asthma (SCIT > SLIT). SIT is indicated in children and adults with severe allergic reactions from insect venoms (e.g., bee, wasp) or cumbersome symptoms from pollen, house dust mites or mold allergens and proven immediated-type allergy. Contraindications must be considered individually. SIT is performed for 3 years, in case of venom allergy 3-5 years. Severe systemic reactions are rare after SCIT. After SLIT rather local allergic symptoms of short duration occur in the mouth and throat. At present, the number prescriptions for SIT has decreased due to inadequate reimbursement of allergy-related services (diagnostics, therapies, monitoring). In the future, inferior medical care of allergic patients in Germany is expected, who until now have benefited from the preventive effects of SIT (reduced risk of developing asthma and new allergic sensitizations). © Springer-Verlag 2012.


Kleine-Tebbe J.,Allergie und Asthma Zentrum Westend | Ackermann-Simon J.,Allergie und Asthma Zentrum Westend | Hanf G.,Allergie und Asthma Zentrum Westend
Allergologie | Year: 2016

In case of suggested IgE-mediated food allergies the anamnesis will lead to a working diagnosis, facilitate further diagnostic planning, and serve as basis for interpretation of the tests. Combined allergic signs are more indicative for systemic IgE reactions than isolated organ symptoms (i.e.; gastrointestinal tract). Exceptions are (isolated) oropharyngeal allergy-like symptoms due to watersoluable (in part labile) food allergens. Sensitization tests detect the presence of allergen- specific IgE to food allergens directly (in serum) or indirectly (i.e.; in skin Pricktests). Ideally, they are qualitatively concordant, but not necessarily quantitatively associated. Selected use of single allergens (components) for IgE-testing can increase test sensitivity and improve analytical specificity, providing risk-associated allergens, indicators for cross-reactivity, and markers for primary sensitizations. Positive test results are only clinically relevant in case of corresponding symptoms upon exposure. In case of doubt oral challenge tests will help to firmly establish or rule out a diagnosis of food allergy. © 2016 Dustri-Verlag Dr. Karl Feistle.


Kleine-Tebbe J.,Allergie und Asthma Zentrum Westend
Aktuelle Ernahrungsmedizin | Year: 2010

Due to current scientific understanding IgG and IgG4 antibodies to foods should not be missinterpreted as an indicator for disease causing mechanisms than rather as a sign of a normal (physiological) human immune response after repeated exposure to food components. Therefore, the allergen specific measurement of IgG or IgG4 antibodies to foods is useless for the work up and diagnosis of various types of food hypersensitivity. This is also true for chronic diseases and health complaints, falsly believed to be caused by an underlying food hypersensitivity, which has not yet been diagnosed. These health problems include chronic inflammatory bowel diseases like irritable bowel disease, Crohn's disease, colitis ulcerosa, inflammatory skin diseases like acne, atopic eczema, psoriasis and general symptoms like migraine, chronic fatigue, obesity and numerous others. The commonly used argumentation for IgG measurements often falsly exchanges cause and effect. More specifically, elevated physiological IgG concentrations to foods are often blamed as a cause for inflammatory responses, instead of being interpreted as a consequence of such pathology. For none of these above mentioned diseases and health complains scientific evidence based on valid, controlled studies has been established, indicating that the presence of serum IgG or IgG4 antibodies to foods might have a diagnostic value or could represent a pathological finding. Measurements of IgG antibodies to foods are therefore not recommended. This conclusion is not necessarily based on technical assay flaws, but rather rejecting the missleading interpretations of such test results, which are often abused as a reasoning to recommend unjustified and frequently drastic diets. These diets will increase the pressure of suffering, decrease the quality of life, promote uncertainty and even place these subjects at further health risks. At present there is no indication for IgG or IgG4 antibody tests to food items. This type of diagnostic procedure is strictly not recommened due to a lack of evidence from properly controlled studies. © Georg Thieme Verlag KG Stuttgart.


Treudler R.,University of Leipzig | Kramer S.,University of Leipzig | Kleine-Tebbe J.,Allergie und Asthma Zentrum Westend | Simon J.-C.,University of Leipzig
Allergo Journal | Year: 2010

In Europe, soy consumption has markedly increased over the last years. In parallel, there has been an increasing number of reports upon immediate-type allergy to soy proteins. This allergy may be the result of a primary, gastrointestinal sensitization. In adults, however, inhalative sensitization to birch and a secondary, associated soy allergy is more frequent. This allergy is due to cross-reaction between soy allergen Gly m 4 and the main birch pollen allergen Bet v 1. For diagnosis of soy allergy, standard test preparations may fail, so that prick-to-prick test with native products and assays for IgE to Gly m 4 should be included. Therapy should include avoidance of high-protein soy products. A multicenter study (BASALIT), that started in the beginning of 2010, will investigate, if immunotherapy to Bet v 1 can reduce symptoms of birch pollen-associated soy allergy.


Kleine-Tebbe J.,Allergie und Asthma Zentrum Westend | Priv.-Doz.,Allergie und Asthma Zentrum Westend | Ackermann-Simon J.,Allergie und Asthma Zentrum Westend | Hanf G.,Allergie und Asthma Zentrum Westend
Allergologie | Year: 2015

Individual clinical symptoms can be collected by taking a careful allergy history, with symptom protocols or online/mobile phone software applications. IgE sensitization is (indirectly) demonstrated by skin prick test or (directly) by allergen-specific serum IgE testing. Common allergen sources in Middle Europe are tree and grass pollen, house dust mites (Dermatophagoides pteronyssinus and farinae), animal dander and in rare cases weed pollen (mugwort > english plantane > goosefoot > ragweed etc.) and mold species alternaria. IgE-sensitizations to allergen sources in question can precisely and economically be identified based on structurally related major allergens and knowledge of homologous groups. Difficulties might occur with presumed multi-sensitizations i.e., to numerous pollen plants: 10 - 15% of pollen allergic subjects develop an IgE-sensitization to panallergens profilin (in pollen and plant foods) and/or polcalcin (only in pollen). Allergen extracts do not allow a clear separation of the responsible allergen sources (tree, grass or weed pollen) in these cases. However, marker allergens for IgE testing will facilitate differentiation: Bet v 1 for birch und beech trees, Ole e 1 for ash pollen, Phl p 1 and 5 for grass pollen, Art v 1 for mugwort and Amb a 1 for ragweed pollen. IgE-sensitizations to inhalant allergens are only clinically relevant in case of corresponding symptoms. In questionable cases conjunctival or nasal provocation tests (i.e., with alternaria, weed pollen, house dust mite extracts) will help to induce clinical symptoms and to identify the relevant allergen sources for allergen immunotherapy. © 2015 Dustri-Verlag Dr. Karl Feistle.


Kleine-Tebbe J.,Allergie und Asthma Zentrum Westend | Wassmann-Otto A.,Ernahrungsberatung und therapie | Monnikes H.,Martin Luther Krankenhaus
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz | Year: 2016

Immunologically mediated hypersensitivity to foods is defined as food allergy, mainly due to immunglobulins of class E (IgE) triggering immediate reactions (type I hypersensitivity) with possible involvement of mucosa, skin, airways, intestinal tract, and the vascular system. Primary food allergy is based on (early) IgE sensitization against animal (e. g., cow’s milk, hen’s eggs) or plant proteins (e. g. peanut, hazelnut or wheat). In the case of secondary food allergies, IgE against pollen proteins (e. g., birch) reacts to structurally related food proteins (with cross-reactions to stone and pit fruits). Non-immunological food intolerance reactions are mostly based on carbohydrate malassimilation (e. g., lactose intolerance, fructose malabsorption) and are rarely due to pseudo-allergies (e. g., flavors, dyes, preservatives) primarily in patients with chronic urticaria. Common intestinal symptoms are mainly due to functional disorders (e. g., irritable bowel disease), rarely because of inflammatory intestinal diseases (e. g., celiac disease). Histamine intolerance, gluten hypersensitivity, and so-called food type III hypersensitivities are controversial diagnoses. The aforementioned disease entities/models are of variable importance for the affected individuals, the public health system, and society in general. © 2016, Springer-Verlag Berlin Heidelberg.


PubMed | Allergie und Asthma Zentrum Westend, Ernahrungsberatung und therapie and Martin Luther Krankenhaus
Type: Journal Article | Journal: Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz | Year: 2016

Immunologically mediated hypersensitivity to foods is defined as food allergy, mainly due to immunglobulins of classE (IgE) triggering immediate reactions (typeI hypersensitivity) with possible involvement of mucosa, skin, airways, intestinal tract, and the vascular system. Primary food allergy is based on (early) IgE sensitization against animal (e.g., cows milk, hens eggs) or plant proteins (e.g. peanut, hazelnut or wheat). In the case of secondary food allergies, IgE against pollen proteins (e.g., birch) reacts to structurally related food proteins (with cross-reactions to stone and pit fruits). Non-immunological food intolerance reactions are mostly based on carbohydrate malassimilation (e.g., lactose intolerance, fructose malabsorption) and are rarely due to pseudo-allergies (e.g., flavors, dyes, preservatives) primarily in patients with chronic urticaria. Common intestinal symptoms are mainly due to functional disorders (e.g., irritable bowel disease), rarely because of inflammatory intestinal diseases (e.g., celiac disease). Histamine intolerance, gluten hypersensitivity, and so-called food typeIII hypersensitivities are controversial diagnoses. The aforementioned disease entities/models are of variable importance for the affected individuals, the public health system, and society in general.


PubMed | Allergie und Asthma Zentrum Westend
Type: Journal Article | Journal: Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz | Year: 2012

Allergen-specific immunotherapy (SIT, desensitization) is applied monthly with subcutaneous injections (SCIT) or sublingually (SLIT) with droplets or tablets on a daily basis. Numerous immunological changes during SIT induce long-lasting tolerance. Efficacy has been demonstrated by a number of controlled studies for insect venom hypersensitivity (SCIT), allergic rhinoconjunctivitis (SCIT, SLIT particularly in grass pollen allergy), and allergic asthma (SCIT>SLIT). SIT is indicated in children and adults with severe allergic reactions from insect venoms (e.g., bee, wasp) or cumbersome symptoms from pollen, house dust mites or mold allergens and proven immediated-type allergy. Contraindications must be considered individually. SIT is performed for 3years, in case of venom allergy 3-5years. Severe systemic reactions are rare after SCIT. After SLIT rather local allergic symptoms of short duration occur in the mouth and throat. At present, the number prescriptions for SIT has decreased due to inadequate reimbursement of allergy-related services (diagnostics, therapies, monitoring). In the future, inferior medical care of allergic patients in Germany is expected, who until now have benefited from the preventive effects of SIT (reduced risk of developing asthma and new allergic sensitizations).

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