@article{StoevesandtHospKerstanetal.2017,
  author    = {Stoevesandt, Johanna and Hosp, Christine and Kerstan, Andreas and Trautmann, Axel},
  title     = {Safety of 100 µg venom immunotherapy rush protocols in children compared to adults},
  series = {Allergy, Asthma \& Clinical Immunology},
  volume    = {13},
  journal   = {Allergy, Asthma \& Clinical Immunology},
  number    = {32},
  doi       = {10.1186/s13223-017-0204-y},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-157830},
  year      = {2017},
  abstract  = {Background: There is a paucity of studies examining the safety of venom immunotherapy (VIT) in children. We aimed to assess the incidence of anaphylactic side effects during rush VIT in a cohort of pediatric patients and adult controls. Methods: 72 consecutive cycles of VIT-buildup in 71 children/adolescents aged 7-17 years were retrospectively evaluated and compared to an adult control group (n = 981) with regard to baseline parameters (sex, causative venom, severity of index sting reaction, results of allergy testing, comorbidities) and the incidence of anaphylactic adverse reactions. Results: Compared to adults, severe index sting-induced anaphylaxis was significantly less common in children (P = .001). Children were more likely to suffer from bee venom allergy (P < .001) and showed higher levels of bee venom-specific IgE (P = .013), but lower serum tryptase concentrations (P = .014). The overall rate of VIT-induced anaphylactic reactions was higher in children than in adults (6.9\% vs 2.5\%, P = .046 by univariate analysis). In the final binary logistic regression model, however, only bee VIT (P = .039; odds ratio 2.25; confidence interval 1.04-4.87) and 5-day compared to 3-day buildup protocols (P = .011; odds ratio 2.64; confidence interval 1.25-5.57) were associated with an increased risk of treatment-induced anaphylaxis. All pediatric patients finally reached and tolerated the target maintenance dose of 100 µg. Conclusions: The higher anaphylactic reaction rate observed in pediatric patients may be attributed to a greater prevalence of bee venom allergy. VIT-induced anaphylaxis in children is usually mild and does not affect further updosing and maintenance of VIT.},
  language  = {en}
}
@article{SchrueferStoevesandtTrautmann2022,
  author    = {Schr{\"u}fer, Philipp and Stoevesandt, Johanna and Trautmann, Axel},
  title     = {Outcome of a de-labelling algorithm compared with results of penicillin (β-lactam) allergy testing},
  series = {Allergy, Asthma \& Clinical Immunology},
  volume    = {18},
  journal   = {Allergy, Asthma \& Clinical Immunology},
  issn      = {1710-1484},
  doi       = {10.1186/s13223-022-00659-1},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-299840},
  year      = {2022},
  abstract  = {Background Penicillin allergy labels frequently impede guideline-directed treatment with a penicillin or other β-lactam antibiotics. Despite presumed allergy, targeted questioning may indicate a low probability of sensitization and permit reasonably safe administration of the antibiotic in question. In this study, we evaluated a standardized algorithm aiming to differentiate non-allergic patients from those with true allergic β-lactam hypersensitivity. Methods We retrospectively applied a de-labelling algorithm in 800 consecutive patients with suspected β-lactam hypersensitivity. All had undergone complete allergy work-up permitting to definitely exclude or diagnose β-lactam allergy between 2009 and 2019. Results In 595 (74.4\%) out of 800 cases evaluated, β-lactam allergy could be excluded by negative challenge testing. IgE-mediated anaphylaxis was diagnosed in 70 (8.7\%) patients, delayed-type hypersensitivity in 135 (16.9\%). In 62 (88.6\%) anaphylaxis cases, the algorithm correctly advised to use an alternative antibiotic. Accuracy was higher in patients with moderate to severe anaphylaxis (97.7\%) compared to those with a history of mild reactions (73.1\%). The algorithm correctly identified 122 (90.4\%) patients with proven delayed-type hypersensitivity. It permitted de-labelling in 330 (55.5\%) out of 595 patients with diagnostic exclusion of penicillin hypersensitivity, but failed to identify the remaining 265 (44.5\%) as low-risk cases. Conclusions The algorithm detected 89.8\% of cases with penicillin (β-lactam) allergy, sensitivity was optimal for moderate to severe anaphylaxis. Study data justify the implementation of a standardized de-labelling algorithm under close supervision in order to permit guideline-directed treatment and reduce the use of broad-spectrum antibiotics as part of an antibiotic stewardship program.},
  language  = {en}
}