Background One hundred years ago Rackemann published the first description of Intrinsic Asthma. This was the beginning of a process of phenotyping the disease.

Allergen-specific immunotherapy (AIT) is the single disease-modifying treatment for allergy. Clinical trials show AIT to be safe and effective for many patients; however, it still faces problems related to efficacy, safety, long treatment duration and low patient adherence. There has been intensive research to develop alternative strategies, including novel administration routes, adjuvants or hypoallergenic molecules. Promising results are reported for some of them, but clinical progress is still moderate. Allergoids conjugated to nonoxidized mannan from Saccharomyces cerevisiae have emerged as a novel concept of vaccine targeting dendritic cells (DCs). Preclinical human and animal models demonstrated that allergoids conjugated to mannan enhance allergen uptake, promote healthy responses to allergens by inducing Th1 and T regulatory (Treg) cells, and show clinical efficacy in veterinary medicine. Dose-finding phase II clinical trials in humans are currently ongoing. We review the current stage of allergoids conjugated to mannan as next generation vaccines for AIT.

Correction to: Allergo J Int 2015 https://doi.org/10.1007/s40629-015-0052-6 Suspected drug hypersensitivity reactions require allergological investigation in order, firstly, to prevent severe reactions upon renewed exposure or, secondly, to avoid unnecessary drug restrictions. Skin tests are …

Non-steroidal anti-inflammatory drugs (NSAID) are the second most common trigger of drug hypersensitivity in adults and children and are considered the most common or second most common cause of drug-induced anaphylaxis. NSAID hypersensitivity reactions are classified according to the latency of symptoms in relation to ingestion and on the basis of symptoms, potential underlying disease (chronic urticaria, bronchial asthma/chronic rhinosinusitis/nasal polyps), cross-reactivity to other NSAID, and the suspected pathomechanism. The diagnosis and management of NSAID hypersensitivity depend on the confirmed or suspected type of reaction. The pathomechanism for the majority of hypersensitivity reactions to NSAID has not been elucidated in detail; preferential COX-1 inhibition, which causes a shift in arachidonic acid metabolism, is considered relevant to an extent in immediate-type reactions. Delayed reactions to NSAID are rarer, diverse, and considered to be T cell mediated. All NSAIDs are essentially able to trigger all types of reaction. Immediate-type reactions involving cutaneous (urticaria/angioedema) and/or respiratory symptoms (rhinitis, bronchial asthma), as well as anaphylactic reactions are the most common. A careful allergy diagnostic work-up enables hypersensitivity to be excluded in the majority of affected individuals. In vitro testing and skin testing, as well as the gold standard, provocation testing with the suspected NSAID, or exposure testing to identify safe alternatives are used in a stepwise approach. It is important to bear in mind that standardized and validated in vitro test methods (e. g., specific IgE determination, basophil activation test, lymphocyte transformation test) and skin testing are not available for most NSAID and often prove negative. Except in the case of severe index reactions, provocation testing (with emergency response measures in place) to establish the diagnosis, evaluate possible cross-reactivity, and identify safe alternatives should be performed. Avoidance measures should only be recommended if the diagnosis has been reliably established. Patients should receive recommendations (avoidance measures, alternatives) in written form.

Clonal mast cell disease is detected in up to 5% of adult patients with insect venom allergy. Mastocytosis and monoclonal mast cell activation syndrome (MMAS) are considered high-risk diseases in Hymenoptera venom allergy (HVA). Literature review. Mastocytosis or MMAS are detected in HVA patients more frequently than random chance would permit. Patient histories in mast cell disease often reveal particularly severe sting reactions. Moreover, the risk of side effects is higher and the likelihood that specific immunotherapy (SIT) using Hymenoptera venom (HV) will fail is greater. The determination of baseline serum tryptase (bST) and an examination of the skin are recommended in all adult patients with a previous history of systemic sting reactions. Patients with mastocytosis of the skin and/or bST elevated above 20 µg/l should always undergo further investigation. If bST is elevated in the absence of mastocytosis, or if a more accurate diagnosis of the mast cell disease is relevant, a so-called liquid biopsy can be performed, enabling a KIT mutation (tyrosine kinase receptor) to be investigated in peripheral blood. Bone marrow biopsy, bone density measurement, and upper abdominal ultrasound are also indicated. Due to the specific hazards posed by clonal mast cell diseases, HV-SIT is of particular relevance to this patient group. Patients with clonal mast cell disease are at greater risk of treatment failure and should therefore undergo sting challenge. In bee venom allergy, one should try to achieve a higher maintenance dose (200 µg bee venom) from the start, likewise in patients with wasp venom allergy and sting reactions requiring resuscitation. Lifelong continuation of HV-SIT is recommended in mast cell disease.

PurposeAllergic respiratory diseases represent a global health problem. The two major treatment strategies are symptom treatment and specific immunotherapy (SIT). SIT is considered the only causal treatment option available with the ability to alter the course of the disease. This study aims to describe the course of disease and medication of respiratory allergy across treatment strategies and disease groups.MethodsThe analysis is based on routine data from a German statutory health insurance. The patient cohort is observed from 2007–2012. For each year based on assured outpatient diagnoses patients are assigned to a disease group: rhinitis, asthma or both diseases. Additionally, prescribed medication is considered. Treatment comparisons are based on matched pairs.ResultsThe study population comprises 165,446 patients with respiratory allergy. In 2007 the most frequent disease group is rhinitis (70%), followed by asthma (16%) and both diseases (14%). During the observation period a second allergic respiratory diagnosis occurs only in about 12% of rhinitis patients and 28% of asthma patients. In about 50% of patients with both diseases one of the diagnoses is omitted. These patients are more likely to no longer report their asthma diagnosis when receiving immunotherapy compared to symptom treatment. Furthermore immunotherapy reduces the frequency of asthma medication use.ConclusionsResults of detailed analysis of diagnoses reflect the alternating nature of allergic diseases. Although limited by accuracy of documentation and the lack of clinical information, the comparison of treatment strategies shows some advantages of immunotherapy regarding course of disease and asthma medication use.