@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}
}
@article{StoevesandtTrautmann2022,
  author    = {Stoevesandt, Johanna and Trautmann, Axel},
  title     = {Risk factors in bee and Vespula venom allergy: state of the art},
  series = {Allergo Journal International},
  volume    = {31},
  journal   = {Allergo Journal International},
  number    = {1},
  issn      = {2197-0378},
  doi       = {10.1007/s40629-021-00187-1},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-270498},
  pages     = {1-10},
  year      = {2022},
  abstract  = {Background Correct recognition of risk factors enables individualized management and treatment of venom allergic patients. Methods Systematic research and review of current literature regarding the risk of (1) severe sting-induced anaphylaxis, (2) anaphylactic adverse event during venom immunotherapy (VIT), and (3) treatment failure. Results and discussion (1) Mastocytosis is the most important risk factor for severe sting-induced anaphylaxis. Hereditary α‑tryptasemia was recently identified as a genetic predictor of severe reactions. Older age is clearly associated with an increased risk; the respective impact of defined cardiovascular comorbidities has yet to be determined. Recent data do not support an aggravation of venom-induced anaphylaxis by intake of β‑blockers or angiotensin-converting enzyme (ACE) inhibitors. A higher risk in men can be attributed to more intensive exposure to stinging insects. (2) Anaphylactic side effects of VIT are most common during the buildup phase, particularly in the course of (ultra-)rush protocols involving a high number of injections and high cumulative daily doses. They are significantly more frequent during honeybee compared to Vespula VIT. Data supporting a negative effect of mastocytosis on the tolerability of VIT are scarce. Older age and cardiovascular medication are not associated with a higher incidence of VIT-induced anaphylaxis. (3) Relapsing anaphylactic reactions to both field and challenge stings are significantly more common during and after honeybee compared to Vespula VIT. Reports of severe field-sting reactions in mastocytosis patients suggest an increased risk of treatment failure which may be overcome by higher maintenance doses and longer duration of VIT.},
  language  = {en}
}
@article{TrautmannBrockowStoevesandt2020,
  author    = {Trautmann, Axel and Brockow, Knut and Stoevesandt, Johanna},
  title     = {Metamizole-induced reactions as a paradigm of drug hypersensitivity: Non-allergic reactions, anaphylaxis, and delayed-type allergy},
  series = {Clinical \& Experimental Allergy},
  volume    = {50},
  journal   = {Clinical \& Experimental Allergy},
  number    = {9},
  doi       = {10.1111/cea.13689},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-217997},
  pages     = {1103 -- 1106},
  year      = {2020},
  language  = {en}
}
@article{ReichelRoedingStoevesandtetal.2020,
  author    = {Reichel, Alexandra and R{\"o}ding, Kristina and Stoevesandt, Johanna and Trautmann, Axel},
  title     = {De-labelling antibiotic allergy through five key questions},
  series = {Clinical \& Experimental Allergy},
  volume    = {50},
  journal   = {Clinical \& Experimental Allergy},
  number    = {4},
  doi       = {10.1111/cea.13576},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-215508},
  pages     = {532 -- 535},
  year      = {2020},
  language  = {en}
}
@article{SchrueferBrockowStoevesandtetal.2020,
  author    = {Schr{\"u}fer, Philipp and Brockow, Knut and Stoevesandt, Johanna and Trautmann, Axel},
  title     = {Predominant patterns of beta-lactam hypersensitivity in a single German Allergy Center: exanthem induced by aminopenicillins, anaphylaxis by cephalosporins},
  series = {Allergy, Asthma \& Clinical Immunology},
  volume    = {16},
  journal   = {Allergy, Asthma \& Clinical Immunology},
  doi       = {10.1186/s13223-020-00488-0},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-231306},
  year      = {2020},
  abstract  = {Background Penicillins and other beta-lactam antibiotics are the most common elicitors of allergic drug reaction. However, data on the pattern of clinical reaction types elicited by specific beta-lactams are scarce and inconsistent. We aimed to determine patterns of beta-latam allergy, i.e. the association of a clinical reaction type with a specific beta-lactam antibiotic. Methods We retrospectively evaluated data from 800 consecutive patients with suspected beta-lactam hypersensitivity over a period of 11 years in a single German Allergy Center. Results beta-lactam hypersensitivity was definitely excluded in 595 patients, immediate-type (presumably IgE-mediated) hypersensitivity was diagnosed in 70 and delayed-type hypersensitivity in 135 cases. Most (59 out of 70, 84.3\%) immediate-type anaphylactic reactions were induced by a limited number of cephalosporins. Delayed reactions were regularly caused by an aminopenicillin (127 out of 135, 94.1\%) and usually manifested as a measles-like exanthem (117 out of 135, 86.7\%). Intradermal testing proved to be the most useful method for diagnosing beta-lactam allergy, but prick testing was already positive in 24 out of 70 patients with immediate-type hypersensitivity (34.3\%). Patch testing in addition to intradermal testing did not provide additional information for the diagnosis of delayed-type hypersensitivity. Almost all beta-lactam allergic patients tolerated at least one, usually several alternative substances out of the beta-lactam group. Conclusions We identified two patterns of beta-lactam hypersensitivity: aminopenicillin-induced exanthem and anaphylaxis triggered by certain cephalosporins. Intradermal skin testing was the most useful method to detect both IgE-mediated and delayed-type beta-lactam hypersensitivity.},
  language  = {en}
}
@article{StolzeTrautmannGoebeleretal.2016,
  author    = {Stolze, Ina and Trautmann, Axel and Goebeler, Matthias and Stoevesandt, Johanna},
  title     = {Dangerous Leg Cramps: Severe Pustular Exanthema Caused by an Over-the-Counter Drug},
  series = {Acta Dermato-Venereologica},
  volume    = {96},
  journal   = {Acta Dermato-Venereologica},
  doi       = {10.2340/00015555-2324},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-171285},
  pages     = {703-704},
  year      = {2016},
  abstract  = {Abstract is missing},
  language  = {en}
}
@article{PoppeBroeckerTrautmann2013,
  author    = {Poppe, Lidia M. and Br{\"o}cker, Eva-Bettina and Trautmann, Axel},
  title     = {The One-nail Brown Band: Macro- and Micro-morphology},
  series = {Acta Dermato-Venereologica},
  volume    = {93},
  journal   = {Acta Dermato-Venereologica},
  number    = {4},
  doi       = {10.2340/00015555-1505},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-128566},
  pages     = {479-480},
  year      = {2013},
  abstract  = {No abstract available.},
  language  = {en}
}
@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{TrautmannSeitzBrockowetal.2014,
  author    = {Trautmann, Axel and Seitz, Cornelia S. and Brockow, Knut and Hain, Johannes},
  title     = {Non-steroidal anti-inflammatory drug hypersensitivity: association with elevated basal serum tryptase?},
  doi       = {10.1186/1710-1492-10-19},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-110399},
  year      = {2014},
  abstract  = {Background It is hypothesized that because of higher mast cell numbers and mediator release, mastocytosis predisposes patients for systemic immediate-type hypersensitivity reactions to certain drugs including non-steroidal anti-inflammatory drugs (NSAID). Objective To clarify whether patients with NSAID hypersensitivity show increased basal serum tryptase levels as sign for underlying mast cell disease. Methods As part of our allergy work-up, basal serum tryptase levels were determined in all patients with a diagnosis of NSAID hypersensitivity and the severity of the reaction was graded. Patients with confirmed IgE-mediated hymenoptera venom allergy served as a comparison group. Results Out of 284 patients with NSAID hypersensitivity, 26 were identified with basal serum tryptase > 10.0 ng/mL (9.2\%). In contrast, significantly (P = .004) more hymenoptera venom allergic patients had elevated tryptase > 10.0 ng/mL (83 out of 484; 17.1\%). Basal tryptase > 20.0 ng/mL was indicative for severe anaphylaxis only in venom allergic subjects (29 patients; 4x grade 2 and 25x grade 3 anaphylaxis), but not in NSAID hypersensitive patients (6 patients; 4x grade 1, 2x grade 2). Conclusions In contrast to hymenoptera venom allergy, NSAID hypersensitivity do not seem to be associated with elevated basal serum tryptase levels and levels > 20 ng/mL were not related to increased severity of the clinical reaction. This suggests that mastocytosis patients may be treated with NSAID without special precautions.},
  language  = {en}
}
@article{StoevesandtHofmannHainetal.2013,
  author    = {Stoevesandt, Johanna and Hofmann, Bernd and Hain, Johannes and Kerstan, Andreas and Trautmann, Axel},
  title     = {Single venom-based immunotherapy effectively protects patients with double positive tests to honey bee and Vespula venom},
  series = {Allergy, Asthma \& Clinical Immunology},
  journal   = {Allergy, Asthma \& Clinical Immunology},
  doi       = {10.1186/1710-1492-9-33},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-96808},
  year      = {2013},
  abstract  = {Background Referring to individuals with reactivity to honey bee and Vespula venom in diagnostic tests, the umbrella terms "double sensitization" or "double positivity" cover patients with true clinical double allergy and those allergic to a single venom with asymptomatic sensitization to the other. There is no international consensus on whether immunotherapy regimens should generally include both venoms in double sensitized patients. Objective We investigated the long-term outcome of single venom-based immunotherapy with regard to potential risk factors for treatment failure and specifically compared the risk of relapse in mono sensitized and double sensitized patients. Methods Re-sting data were obtained from 635 patients who had completed at least 3 years of immunotherapy between 1988 and 2008. The adequate venom for immunotherapy was selected using an algorithm based on clinical details and the results of diagnostic tests. Results Of 635 patients, 351 (55.3\%) were double sensitized to both venoms. The overall re-exposure rate to Hymenoptera stings during and after immunotherapy was 62.4\%; the relapse rate was 7.1\% (6.0\% in mono sensitized, 7.8\% in double sensitized patients). Recurring anaphylaxis was statistically less severe than the index sting reaction (P = 0.004). Double sensitization was not significantly related to relapsing anaphylaxis (P = 0.56), but there was a tendency towards an increased risk of relapse in a subgroup of patients with equal reactivity to both venoms in diagnostic tests (P = 0.15). Conclusions Single venom-based immunotherapy over 3 to 5 years effectively and long-lastingly protects the vast majority of both mono sensitized and double sensitized Hymenoptera venom allergic patients. Double venom immunotherapy is indicated in clinically double allergic patients reporting systemic reactions to stings of both Hymenoptera and in those with equal reactivity to both venoms in diagnostic tests who have not reliably identified the culprit stinging insect.},
  language  = {en}
}