Zuberbier, T. (Torsten)
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- IgE allergy diagnostics and other relevant tests in allergy, a World Allergy Organization position paper(2020) Fischer, D. (David); Valenta, R. (Rudolf); Ebisawa, M. (Motohiro); Wood, R.A. (Robert A.); Senna, G.E. (Gian-Enrico); Ledford, D.K. (Dennis K.); Antila, M. (Martti); Villa, E. (Elisa); Bousquet, J.J. (Jean J.); Rosenwasser, L. (Lanny); Luengo-Sánchez, O. (Olga); Jares, E. (Edgardo); González-Díaz, S.N. (Sandra Nora); Gerth-van-Wijk, R. (Roy); Savi, E. (Eleonora); Poulsen, L.K. (Lars K.); Thong, B.Y.H. (Bernard Yu-Hor); Pawankar, R. (Ruby); DuBuske, L.M. (Lawrence M.); Oppenheimer, J.J. (John J.); Sánchez-Borges, M. (Mario); Passalacqua, G. (Giovanni); Caraballo, L. (Luis); Romano, A.G. (Antonino G.); Gonzalez-Estrada, A. (Alexei); Cardona, V. (Victoria); Morais-Almeida, M. (Mario); Kowalski, M.L. (Marek L.); Rosário-Filho, N.A. (Nelson A.); Kalpaklioglu, A.F. (Ayse Füsun); Renz, H.E. (Harald E.); Zuberbier, T. (Torsten); Haahtela, T. (Tari); Jensen-Jarolim, E. (Erika); Sisul, J.C. (Juan Carlos); Monge-Ortega, O.P. (Olga Patricia); Chiang, W.C. (Wen Chin); Melioli, G. (Giovanni); Canonica, G.W. (Giorgio Walter); Gómez, R.M. (R. Maximiliano); Ebo, D. (Didier); Ansotegui, I.J. (Ignacio J.); Scala, E. (Enrico); Tanno, L.K. (Luciana Kase); Pfaar, O. (Oliver); Ferrer-Cardona, M. (Marta); Tang, M.L.K. (Mimi L.K.); Demoly, P.M. (Pascal M.)Currently, testing for immunoglobulin E (IgE) sensitization is the cornerstone of diagnostic evaluation in suspected allergic conditions. This review provides a thorough and updated critical appraisal of the most frequently used diagnostic tests, both in vivo and in vitro. It discusses skin tests, challenges, and serological and cellular in vitro tests, and provides an overview of indications, advantages and disadvantages of each in conditions such as respiratory, food, venom, drug, and occupational allergy. Skin prick testing remains the first line approach in most instances; the added value of serum specific IgE to whole allergen extracts or components, as well as the role of basophil activation tests, is evaluated. Unproven, non-validated, diagnostic tests are also discussed. Throughout the review, the reader must bear in mind the relevance of differentiating between sensitization and allergy; the latter entails not only allergic sensitization, but also clinically relevant symptoms triggered by the culprit allergen.
- Urticaria: Collegium Internationale Allergologicum (CIA) update 2020(Karger AG, 2020) Pejler, G. (Gunnar); Hartmann, K. (Karin); Weller, K. (Karsten); Kolkhir, P. (Pavel); Metz, M. (Martin); Eyerich, S. (Stefanie); Sánchez-Borges, M. (Mario); Eyerich, K. (Kilian); Jakob, T. (Thilo); Simon, D. (Dagmar); Simon, H.U. (Hans-Uwe); Maurer, M. (Marcus); Schäkel, K. (Knut); Zuberbier, T. (Torsten); Park, H.S. (Hae-Sim); Gutermuth, J. (Jan); Larenas-Linnemann, D. (Désirée); Kapp, A. (Alexander); Ferrer-Cardona, M. (Marta)This update on chronic urticaria (CU) focuses on the prevalence and pathogenesis of chronic spontaneous urticaria (CSU), the expanding spectrum of patient-reported outcome measures (PROMs) for assessing CU disease activity, impact, and control, as well as future treatment options for CU. This update is needed, as several recently reported findings have led to significant advances in these areas. Some of these key discoveries were first presented at past meetings of the Collegium Internationale Allergologicum (CIA). New evidence shows that the prevalence of CSU is geographically heterogeneous, high in all age groups, and increasing. Several recent reports have helped to better characterize two endotypes of CSU: type I autoimmune (or autoallergic) CSU, driven by IgE to autoallergens, and type IIb autoimmune CSU, which is due to mast cell (MC)-targeted autoantibodies. The aim of treatment in CU is complete disease control with absence of signs and symptoms as well as normalization of quality of life (QoL). This is best monitored by the use of an expanding set of PROMs, to which the Angioedema Control Test, the Cholinergic Urticaria Quality of Life Questionnaire, and the Cholinergic Urticaria Activity Score have recently been added. Current treatment approaches for CU under development include drugs that inhibit the effects of signals that drive MC activation and accumulation, drugs that inhibit intracellular pathways of MC activation and degranulation, and drugs that silence MCs by binding to inhibitory receptors. The understanding, knowledge, and management of CU are rapidly increasing. The aim of this review is to provide physicians who treat CU patients with an update on where we stand and where we will go. Many questions and unmet needs remain to be addressed, such as the development of routine diagnostic tests for type I and type IIb autoimmune CSU, the global dissemination and consistent use of PROMs to assess disease activity, impact, and control, and the development of more effective and well-tolerated long-term treatments for all forms of CU.
- Proposal of 0.5 mg of protein/100 g of processed food as threshold for voluntary declaration of food allergen traces in processed food-A first step in an initiative to better inform patients and avoid fatal allergic reactions: A GA²LEN position paper(Wiley-Blackwell, 2022) Brockow, K. (Knut); Arasi, S. (Stefania); Ebisawa, M. (Motohiro); Galvin, A.D. (Audrey Dunn); Arshad, H. (Hasan); Cianferoni, A. (Antonella); Bousquet, J.J. (Jean J.); Bindslev-Jensen, C. (Carsten); Angier, E. (Elizabeth); Custovic, A. (Adnan); Bégin, P. (Philippe); Dörr, T. (Tamara); Jong, N. (Nicolette) de; Cork, M.J. ( Michael J.); Aberer, W. (Werner); Alvaro, M. (Montserrat); Bartra, J. (Joan); Deschildre, A. (Antoine); Beck, L. (Lisa); Deleanu, D. (Diana); Giacco, S. (Stefano) del; Zuberbier, T. (Torsten); Fernández-Rivas, M. (Montserrat); Bush, A. (Andrew); Bislimovska, J. (Jovanka); Darsow, U. (Ulf); Ballmer-Weber, B. (Barbara); Ferrer-Cardona, M. (Marta)Background: Food anaphylaxis is commonly elicited by unintentional ingestion of foods containing the allergen above the tolerance threshold level of the individual. While labeling the 14 main allergens used as ingredients in food products is mandatory in the EU, there is no legal definition of declaring potential contaminants. Precautionary allergen labeling such as "may contain traces of" is often used. However, this is unsatisfactory for consumers as they get no information if the contamination is below their personal threshold. In discussions with the food industry and technologists, it was suggested to use a voluntary declaration indicating that all declared contaminants are below a threshold of 0.5 mg protein per 100 g of food. This concentration is known to be below the threshold of most patients, and it can be technically guaranteed in most food production. However, it was also important to assess that in case of accidental ingestion of contaminants below this threshold by highly allergic patients, no fatal anaphylactic reaction could occur. Therefore, we performed a systematic review to assess whether a fatal reaction to 5mg of protein or less has been reported, assuming that a maximum portion size of 1kg of a processed food exceeds any meal and thus gives a sufficient safety margin. Methods: MEDLINE and EMBASE were searched until 24 January 2021 for provocation studies and case reports in which one of the 14 major food allergens was reported to elicit fatal or life-threatening anaphylactic reactions and assessed if these occurred below the ingestion of 5mg of protein. A Delphi process was performed to obtain an expert consensus on the results. Results: In the 210 studies included, in our search, no reports of fatal anaphylactic reactions reported below 5 mg protein ingested were identified. However, in provocation studies and case reports, severe reactions below 5 mg were reported for the following allergens: eggs, fish, lupin, milk, nuts, peanuts, soy, and sesame seeds. Conclusion: Based on the literature studied for this review, it can be stated that cross-contamination of the 14 major food allergens below 0.5 mg/100 g is likely not to endanger most food allergic patients when a standard portion of food is consumed. We propose to use the statement "this product contains the named allergens in the list of ingredients, it may contain traces of other contaminations (to be named, e.g. nut) at concentrations less than 0.5 mg per 100 g of this product" for a voluntary declaration on processed food packages. This level of avoidance of cross-contaminations can be achieved technically for most processed foods, and the statement would be a clear and helpful message to the consumers. However, it is clearly acknowledged that a voluntary declaration is only a first step to a legally binding solution. For this, further research on threshold levels is encouraged.