Guido J. Burbach

The skin prick test – European standards

Skin prick testing is an essential test procedure to confirm sensitization in IgE-mediated allergic disease in subjects with rhinoconjunctivitis, asthma, urticaria, anapylaxis, atopic eczema and food and drug allergy. This manuscript reviews the available evidence including Medline and Embase searches, abstracts of international allergy meetings and position papers from the world allergy literature. The recommended method of prick testing includes the appropriate use of specific allergen extracts, positive and negative controls, interpretation of the tests after 15 – 20 minutes of application, with a positive result defined as a wheal ≥3 mm diameter. A standard prick test panel for Europe for inhalants is proposed and includes hazel (Corylus avellana), alder (Alnus incana), birch (Betula alba), plane (Platanus vulgaris), cypress (Cupressus sempervirens), grass mix (Poa pratensis, Dactilis glomerata, Lolium perenne, Phleum pratense, Festuca pratensis, Helictotrichon pretense), Olive (Olea europaea), mugwort (Artemisia vulgaris), ragweed (Ambrosia artemisiifolia), Alternaria alternata (tenuis), Cladosporium herbarum, Aspergillus fumigatus, Parietaria, cat, dog, Dermatophagoides pteronyssinus, Dermatophagoides farinae, and cockroach (Blatella germanica). Standardization of the skin test procedures and standard panels for different geographic locations are encouraged worldwide to permit better comparisons for diagnostic, clinical and research purposes.

GA2LEN skin test study II: clinical relevance of inhalant allergen sensitizations in Europe.

Background:  Skin prick testing is the standard for diagnosing IgE‐mediated allergies. A positive skin prick reaction, however, does not always correlate with clinical symptoms. A large database from a Global Asthma and Allergy European Network (GA2LEN) study with data on clinical relevance was used to determine the clinical relevance of sensitizations against the 18 most frequent inhalant allergens in Europe. The study population consisted of patients referred to one of the 17 allergy centres in 14 European countries (n = 3034, median age = 33 years). The aim of the study was to assess the clinical relevance of positive skin prick test reactions against inhalant allergens considering the predominating type of symptoms in a pan‐European population of patients presenting with suspected allergic disease.

Ragweed sensitization in Europe - GA(2)LEN study suggests increasing prevalence.

Ambrosia has now reached threshold for high prevalence allergen in Europe.

GA2LEN skin test study III: Minimum battery of test inhalent allergens needed in epidemiological studies in patients

Background:  The number of allergens to be tested in order to identify sensitized patients is important in order to have the most cost‐effective approach in epidemiological studies.

Clinical relevance is associated with allergen-specific wheal size in skin prick testing.

Within a large prospective study, the Global Asthma and Allergy European Network (GA2LEN) has collected skin prick test (SPT) data throughout Europe to make recommendations for SPT in clinical settings.

Evaluation of optical coherence tomography as a non-invasive diagnostic tool in cutaneous wound healing.

The monitoring of wound‐healing processes is indispensable for the therapeutic effectiveness and improved care of chronic wounds. Histological sections provide the best morphological assessment of wound recovery, but cause further tissue destruction and increase the risk of infection. Therefore, it is reasonable to apply a diagnostic tool that allows a non‐invasive and reliable observation of morphological changes in wound healing.

Drug allergy passport and other documentation for patients with drug hypersensitivity - An ENDA/EAACI Drug Allergy Interest Group Position Paper

The strongest and best‐documented risk factor for drug hypersensitivity (DH) is the history of a previous reaction. Accidental exposures to drugs may lead to severe or even fatal reactions in sensitized patients. Preventable prescription errors are common. They are often due to inadequate medical history or poor risk assessment of recurrence of drug reaction. Proper documentation is essential information for the doctor to make sound therapeutic decision. The European Network on Drug Allergy and Drug Allergy Interest Group of the European Academy of Allergy and Clinical Immunology have formed a task force and developed a drug allergy passport as well as general guidelines of drug allergy documentation. A drug allergy passport, a drug allergy alert card, a certificate, and a discharge letter after medical evaluation are adequate means to document DH in a patient. They are to be handed to the patient who is advised to carry the documentation at all times especially when away from home. A drug allergy passport should at least contain information on the culprit drug(s) including international nonproprietary name, clinical manifestations including severity, diagnostic measures, potential cross‐reactivity, alternative drugs to prescribe, and where more detailed information can be obtained from the issuer. It should be given to patients only after full allergy workup. In the future, electronic prescription systems with alert functions will become more common and should include the same information as in paper‐based documentation.

Establishing a standardized quality management system for the European Health Network GA2LEN.

To cite this article: Heinzerling L, Burbach G, van Cauwenberge P, Papageorgiou P, Carlsen K‐H, Lødrup Carlsen KC, Zuberbier T. Establishing a standardized quality management system for the European Health Network GA2LEN. Allergy 2010; 65: 743–752.

Diagnosis of drug-induced skin reactions: a future role for computer-aided systems?

Purpose of reviewThe diagnosis of drug-induced hypersensitivity reactions is a common clinical challenge and the skin is considered a signal organ for a large percentage of these reactions. In order to assure clinical improvement of the patient, nondermatologists in primary or intensive care settings attending to patients receiving several drugs are often confronted with the need for an immediate decision which drug to stop and which drug to continue. As reliable allergological tests are missing for most drugs and are not available for immediate interventions, computer-aided diagnostic systems might be of assistance. Recent findingsThis review highlights the evolution of automated diagnostic aides in dermatology, emphasizes prerequisites for the development of appropriate computational algorithms and discusses the specific requirements and chances for the development of computer-aided diagnostic systems as a supportive approach in the diagnosis of culprit drugs for putative drug-induced hypersensitivity reactions. SummaryAs complex computational algorithms have to be created integrating both image and data analysis, the development of a computer-aided system for supporting nondermatologists in the diagnosis of drug-related hypersensitivity reactions is an ambitious task but might represent an achievable goal for the medium-term future.

Celecoxib desensitization: continued temozolomide/celecoxib chemotherapy after a celecoxib-induced hypersensitivity reaction.

Cox-2 inhibitors have been identified as promising candidates for cancer therapy. Several studies have recently proposed the use of celecoxib in long-term low-intensity chemotherapy protocols for recurrent tumors. However, drug-induced hypersensitivity reactions may force discontinuation of the medication and, thus, significantly complicate successful care. Here, we report on celecoxib desensitization after a celecoxib-induced skin reaction, thereby allowing the continuation of temozolomide/celecoxib chemotherapy in a young patient with recurrent astrocytoma.