Bodo Niggemann

Universitätsklinikum Freiburg, Freiburg an der Elbe, Lower Saxony, Germany

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Publications (337)1731.9 Total impact

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    ABSTRACT: Background: Wheat is one of the most common food allergens in early childhood. In contrast to other food allergies, wheat-specific IgE correlates badly with clinical symptoms and relevant components have been identified mostly for wheat-depended exercise induced anaphylaxis. Moreover, a high percentage of patients present with immediate type symptoms but wheat-specific IgE cannot be detected with commercial available systems. Objective: We addressed the question whether the IgE recognition pattern between wheat allergic (WA) and clinically tolerant (WT) children differs in order to identify individual proteins useful for component resolved diagnostics. Methods: Sera of 106 children with suspected wheat allergy, of whom 44 children had clinical relevant wheat allergy and 62 were tolerant upon oral food challenge, were analysed for wheat-specific IgE using the ImmunoCap system as well as immunoblots against water and salt soluble, and water insoluble protein fractions. 40 randomly selected sera were analysed for specific IgE to ω5-gliadin. Results: 63% of the WT and 86% of the WA children were sensitized to wheat with >0.35 kUA /l in ImmunoCAP analysis. We could confirm the role of α-, ß-, γ-, and ω-gliadins, and LMW glutenin subunits as major allergens and found also IgE-binding to a broad spectrum of water and salt soluble protein bands. It is of great importance that wheat allergic and tolerant patients showed IgE-binding to the same protein bands. WT and WA did not significantly differ in levels of ω5-gliadin-specific IgE. Conclusions & clinical relevance: Children with challenge proven clinical relevant food allergy and tolerant ones had a similar spectrum of IgE-binding to the same protein bands. These findings imply that component-resolved diagnostics might not be helpful in the diagnostic work-up of wheat allergy. This article is protected by copyright. All rights reserved.
    Pediatric Allergy and Immunology 10/2015; DOI:10.1111/pai.12502 · 3.40 Impact Factor
  • C. Grüber · C. Lehmann · C. Weiss · R. Maas · R. Burghard · B. Niggemann ·

    Monatsschrift Kinderheilkunde 10/2015; DOI:10.1007/s00112-015-3386-8 · 0.23 Impact Factor
  • B. Niggemann · K. Beyer ·
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    ABSTRACT: The term “anaphylaxis” was introduced in 1902 by Richet & Portier [1], while the term “allergy” was established in 1906 by the Austrian paediatrician Clemens von Pirquet [2]. Already from an etymological point of view the two terms relate to different conditions: the translation of allergy from the Greek is “different or strange reaction”, for anaphylaxis it is “missing protection”.This article is protected by copyright. All rights reserved.
    Allergy 09/2015; DOI:10.1111/all.12765 · 6.03 Impact Factor
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    ABSTRACT: Several unmet needs have been identified in allergic rhinitis: identification of the time of onset of the pollen season, optimal control of rhinitis and comorbidities, patient stratification, multidisciplinary team for integrated care pathways, innovation in clinical trials and above all patient empowerment. MASK-rhinitis (MACVIA-ARIA Sentinel NetworK for allergic rhinitis) is a simple system centred around the patient which was devised to fill many of these gaps using Information and Communications Technology (ICT) tools and a clinical decision support system (CDSS) based on the most widely used guideline in allergic rhinitis and its asthma co-morbidity (ARIA 2015 revision). It is one of the implementation systems of the Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA). Three tools are used for the electronic monitoring of allergic diseases: a cell phone-based daily visual analogue scale (VAS) assessment of disease control, CARAT (Control of Allergic Rhinitis and Asthma Test) and the e-Allergy screening (Premedical system of early diagnosis of allergy and asthma based on online tools). These tools are combined with a clinical decision support system (CDSS) and are available in many languages. An e-CRF and an e-learning tool complete MASK. MASK is flexible and other tools can be added. It appears to be an advanced, global and integrated ICT answer for many unmet needs in allergic diseases which will improve policies and standards. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Allergy 07/2015; DOI:10.1111/all.12686 · 6.03 Impact Factor
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    ABSTRACT: Many infants with atopic dermatitis (AD) are sensitized against food or airborne allergens. The severity of AD, using the SCORAD, seems to correlate with elevated serum levels of TARC/CCL17. Other chemokines, such as CCL20 or CCL25 have been described in the context of allergic inflammation. The aim of this study was to analyze whether chemokine serum levels differ within a cohort of infants suffering from varying severities of AD with or without allergic sensitization. Chemokine serum levels (CCL8, CCL17, CCL20, CCL25) as well as food- and airborne allergen-specific IgE were analyzed in infants with AD. 60.9% (78/128) infants with AD (median age 8.8 months, 49 (38%) girls and 79 (62%) boys), showed a positive screening test to common food allergens, and 26.6% to common airborne allergens. There was a strong correlation between serum levels of CCL17 and SCORAD in food-sensitized infants (rs = 0.646, p = <1e-04) and airborne-sensitized infants (rs = 0.587, p = 0.00065) in contrast to non-sensitized ones. Moreover, food-sensitized infants showed significantly higher levels of CCL25 compared to non-food sensitized ones (p = 0.007). The strong correlation between TARC/CCL17 and SCORAD in infants with specific sensitizations may be accounted for by the impaired skin barrier. As TARC/CCL17 has been found mainly in the (inflamed) skin but not in the gut, the detection of significantly higher levels of CCL25, ligand of CCR9, localized primarily in the gastrointestinal tract, suggests its impact in food-allergen induced inflammation processes in food-sensitized infants. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Pediatric Allergy and Immunology 06/2015; 26(7). DOI:10.1111/pai.12431 · 3.40 Impact Factor

  • Allergo Journal: interdisziplinäre Zeitschrift für Allergologie und Umweltmedizin: Organ der Deutschen Gesellschaft für Allergie- und Immunitätsforschung 06/2015; 24(4):60-61. DOI:10.1007/s15007-015-0860-5
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    ABSTRACT: The identification of B-cell epitopes of food allergens can possibly lead to novel diagnostic tools and therapeutic reagents for food allergy. We sought to develop a flexible, low-tech, cost-effective and reproducible multipeptide microarray for the research environment to enable large-scale screening of IgE epitopes of food allergens. Overlapping peptides (15-mer, 4 amino acid offset) covering the primary sequence of either peanut allergen Ara h 1 or all 3 subunits of the soybean allergen Gly m 5 were simultaneously synthesized in-house on a porous cellulose matrix. Identical peptide microarrays created with up to 384 duplicate peptide-cellulose microspots each were investigated for specificity and sensitivity in IgE immunodetection and in direct experimental comparison to the formerly established SPOT™ membrane technique. The in-house microarray identified with 98% reproducibility the same IgE-binding peptides as the SPOT™ membrane technique. Additional IgE-binding peptides were identified using the microarray. While the sensitivity was increased between 2- and 20-fold, the amount of human serum required was reduced by at least two thirds over the SPOT™ membrane technique using the microarray. After subtraction of the potential background, we did not observe non-specific binding to the presented peptides on microarray. The novel peptide microarray allows simple and cost-effective screening for potential epitopes of large allergenic legume seed storage proteins, and it could be adapted for other food allergens as well, to study allergenic epitopes at the individual subject level in large paediatric and adult study groups of food allergic subjects. © 2015 S. Karger AG, Basel.
    International Archives of Allergy and Immunology 04/2015; 166(3):213-224. DOI:10.1159/000381344 · 2.67 Impact Factor
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    ABSTRACT: Epidemiological studies suggest that allergy risk is preferentially transmitted through mothers. This can be due to genomic imprinting, where the phenotype effect of an allele depends on its parental origin, or due to maternal effects reflecting the maternal genome's influence on the child during prenatal development. Loss-of-function mutations in the filaggrin gene (FLG) cause skin barrier deficiency and strongly predispose to atopic dermatitis (AD). We investigated the 4 most prevalent European FLG mutations (c.2282del4, p.R501X, p.R2447X, and p.S3247X) in two samples including 759 and 450 AD families. We used the multinomial and maximum-likelihood approach implemented in the PREMIM/EMIM tool to model parent of origin effects. Beyond the known role of FLG inheritance in AD (R1 meta-analysis = 2.4, P = 1.0 x 10 −36), we observed a strong maternal FLG genotype effect that was consistent in
    PLoS Genetics 03/2015; · 7.53 Impact Factor
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    ABSTRACT: Epidemiological studies suggest that allergy risk is preferentially transmitted through mothers. This can be due to genomic imprinting, where the phenotype effect of an allele depends on its parental origin, or due to maternal effects reflecting the maternal genome's influence on the child during prenatal development. Loss-of-function mutations in the filaggrin gene (FLG) cause skin barrier deficiency and strongly predispose to atopic dermatitis (AD). We investigated the 4 most prevalent European FLG mutations (c.2282del4, p.R501X, p.R2447X, and p.S3247X) in two samples including 759 and 450 AD families. We used the multinomial and maximum-likelihood approach implemented in the PREMIM/EMIM tool to model parent-of-origin effects. Beyond the known role of FLG inheritance in AD (R1meta-analysis = 2.4, P = 1.0 x 10-36), we observed a strong maternal FLG genotype effect that was consistent in both independent family sets and for all 4 mutations analysed. Overall, children of FLG-carrier mothers had a 1.5-fold increased AD risk (S1 = 1.50, Pmeta-analysis = 8.4 x 10-8). Our data point to two independent and additive effects of FLG mutations: i) carrying a mutation and ii) having a mutation carrier mother. The maternal genotype effect was independent of mutation inheritance and can be seen as a non-genetic transmission of a genetic effect. The FLG maternal effect was observed only when mothers had allergic sensitization (elevated allergen-specific IgE antibody plasma levels), suggesting that FLG mutation-induced systemic immune responses in the mother may influence AD risk in the child. Notably, the maternal effect reported here was stronger than most common genetic risk factors for AD recently identified through genome-wide association studies (GWAS). Our study highlights the power of family-based studies in the identification of new etiological mechanisms and reveals, for the first time, a direct influence of the maternal genotype on the offspring's susceptibility to a common human disease.
    PLoS Genetics 03/2015; 11(3):e1005076. DOI:10.1371/journal.pgen.1005076 · 7.53 Impact Factor
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    ABSTRACT: Background Currently there is no mandatory labelling of allergens for non-pre-packed foods in the EU. Therefore, consumers with food allergy rely on voluntary information provided by the staff. The aim of this study was to characterise allergic reactions to non-pre-packed foods and to investigate whether staff in baker's shops were able to give advice regarding a safe product choice.Methods Questionnaires were sent to 200 parents of children with a food allergy. Staff of 50 baker's shops were interviewed regarding selling non-pre-packed foods to food-allergic customers. Bakery products being recommended as “cow's milk free” were bought and cow's milk protein levels were measured using ELISA.Results104/200 questionnaires were returned. 25% of the children experienced an allergic reaction due to a non-pre-packed food from baker's shops and 20% from ice cream parlours. 60% of the bakery staff reported serving food-allergic customers at least once a month, 24% once a week. 84% of the staff felt able to advise food allergic consumers regarding a safe product choice. 73 “cow's milk free” products were sold in 44 baker's shops. Cow's milk could be detected in 43% of the bakery products, 21% contained >3 mg cow's milk protein per serving.Conclusion Staff in baker's shops felt confident about advising customers with food allergy. However, cow's milk was detectable in almost half of bakery products being sold as “cow's milk free”. Every fifth product contained quantities of cow's milk exceeding an amount where approximately 10% of cow's milk allergic children will show clinical relevant symptoms.This article is protected by copyright. All rights reserved.
    Allergy 02/2015; 70(5). DOI:10.1111/all.12588 · 6.03 Impact Factor
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    ABSTRACT: Background Oral challenges are the gold standard in food allergy diagnostic, but time consuming. Aim of the study was to investigate the role of peanut- and hazelnut-component-specific IgE in the diagnostics of peanut and hazelnut allergy and to identify cut-off levels to make some challenges superfluous.Methods In a prospective and multicenter study, children with suspected peanut or hazelnut allergy underwent oral challenges. Specific IgE to peanut, hazelnut and their components (Ara h 1, Ara h 2, Ara h 3, and Ara h 8, Cor a 1, Cor a 8, Cor a 9, and Cor a 14) were determined by ImmunoCAP-FEIA.Results210 children were challenged orally with peanut and 143 with hazelnut. 43% of the patients had a positive peanut and 31% a positive hazelnut challenge. With an area under the curve of 0.92 and 0.89 respectively, Ara h 2 and Cor a 14-specific IgE discriminated between allergic and tolerant children better than peanut or hazelnut-specific IgE. For the first time, probability curves for peanut and hazelnut components have been calculated. A 90% probability for a positive peanut or hazelnut challenge was estimated for Ara h 2-specific IgE at 14.4 kU/L and for Cor a 14-specific IgE at 47.8 kU/L. A 95% probability could only be estimated for Ara h 2 at 42.2 kU/L.Conclusions Ara h 2- and Cor a 14-specific IgE are useful to estimate the probability for a positive challenge outcome in the diagnostic workup of peanut or hazelnut allergy making some food challenges superfluous.This article is protected by copyright. All rights reserved.
    Allergy 10/2014; 70(1). DOI:10.1111/all.12530 · 6.03 Impact Factor
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    B. Niggemann · K. Beyer ·
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    ABSTRACT: Elicitors of anaphylactic reactions are any sources of protein with allergenic capacity. However, not all allergic reactions end up in the most severe form of anaphylaxis. Augmenting factors may explain why certain conditions lead to anaphylaxis. Augmenting factors may exhibit three effects: lowering the threshold, increasing the severity, and reversing acquired clinical tolerance. Common augmenting factors are physical exercise, menstruation, NSAIDs, alcohol, body temperature, acute infections, and antacids. Therapeutic options may address causative, preventive, pragmatic, or symptomatic considerations: avoid the eliciting food, take an antihistamine before any situation with a possible risk of augmentation, separate food and sport (at least for 2 h), and carry an adrenaline autoinjector at all times. Individual patterns include summation effects and specific patterns. In conclusion, in the case of a suggestive history but a negative oral challenge, one should consider the possible involvement of augmenting factors; after anaphylactic reactions, always ask for possible augmentation and other risk factors during the recent past; if augmentation is suspected, oral food challenges should be performed in combination with augmenting factors; and in the future, standardized challenge protocols including augmenting factors should be established. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
    Allergy 10/2014; 69(12). DOI:10.1111/all.12532 · 6.03 Impact Factor
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    ABSTRACT: Anaphylaxis is a clinical emergency, and all healthcare professionals should be familiar with its recognition and acute and ongoing management. These guidelines have been prepared by the European Academy of Allergy and Clinical Immunology (EAACI) Taskforce on Anaphylaxis. They aim to provide evidence-based recommendations for the recognition, risk factor assessment, and the management of patients who are at risk of, are experiencing, or have experienced anaphylaxis. While the primary audience is allergists, these guidelines are also relevant to all other healthcare professionals. The development of these guidelines has been underpinned by two systematic reviews of the literature, both on the epidemiology and on clinical management of anaphylaxis. Anaphylaxis is a potentially life-threatening condition whose clinical diagnosis is based on recognition of a constellation of presenting features. First-line treatment for anaphylaxis is intramuscular adrenaline. Useful second-line interventions may include removing the trigger where possible, calling for help, correct positioning of the patient, high-flow oxygen, intravenous fluids, inhaled short-acting bronchodilators, and nebulized adrenaline. Discharge arrangements should involve an assessment of the risk of further reactions, a management plan with an anaphylaxis emergency action plan, and, where appropriate, prescribing an adrenaline auto-injector. If an adrenaline auto-injector is prescribed, education on when and how to use the device should be provided. Specialist follow-up is essential to investigate possible triggers, to perform a comprehensive risk assessment, and to prevent future episodes by developing personalized risk reduction strategies including, where possible, commencing allergen immunotherapy. Training for the patient and all caregivers is essential. There are still many gaps in the evidence base for anaphylaxis.
    Allergy 06/2014; 69(8). DOI:10.1111/all.12437 · 6.03 Impact Factor
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    ABSTRACT: Food allergy can result in considerable morbidity, impact negatively on quality of life, and prove costly in terms of medical care. These guidelines have been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Guidelines for Food Allergy and Anaphylaxis Group, building on previous EAACI position papers on adverse reaction to foods and three recent systematic reviews on the epidemiology, diagnosis, and management of food allergy, and provide evidence-based recommendations for the diagnosis and management of food allergy. While the primary audience is allergists, this document is relevant for all other healthcare professionals, including primary care physicians, and pediatric and adult specialists, dieticians, pharmacists and paramedics. Our current understanding of the manifestations of food allergy, the role of diagnostic tests, and the effective management of patients of all ages with food allergy is presented. The acute management of non-life-threatening reactions is covered in these guidelines, but for guidance on the emergency management of anaphylaxis, readers are referred to the related EAACI Anaphylaxis Guidelines.
    Allergy 06/2014; 69(8). DOI:10.1111/all.12429 · 6.03 Impact Factor
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    ABSTRACT: Background: Anaphylaxis is the most severe manifestation of a mast cell-dependent immediate reaction and may be fatal. According to data from the Berlin region, its incidence is 2-3 cases per 100 000 persons per year. Method: We evaluated data from the anaphylaxis registry of the German-speaking countries for 2006-2013 and data from the protocols of the ADAC air rescue service for 2010-2011 to study the triggers, clinical manifestations, and treatment of anaphylaxis. Results: The registry contained data on 4141 patients, and the ADAC air rescue protocols concerned 1123 patients. In the registry, the most common triggers for anaphylaxis were insect venom (n = 2074; 50.1%), foods (n = 1039; 25.1%), and drugs (n = 627; 15.1%). Within these groups, the most common triggers were wasp (n = 1460) and bee stings (n = 412), legumes (n = 241), animal proteins (n = 225), and analgesic drugs (n = 277). Food anaphylaxis was most frequently induced by peanuts, cow milk, and hen's egg in children and by wheat and shellfish in adults. An analysis of the medical emergency cases revealed that epinephrine was given for grade 3 or 4 anaphylaxis to 14.5% and 43.9% (respectively) of the patients in the anaphylaxis registry and to 19% and 78% of the patients in the air rescue protocols. Conclusion: Wasp and bee venom, legumes, animal proteins, and analgesic drugs were the commonest triggers of anaphylaxis. Their relative frequency was age-dependent. Epinephrine was given too rarely, as it is recommended in the guidelines for all cases of grade 2 and above.
    Deutsches Ärzteblatt International 05/2014; 111(21). DOI:10.3238/arztebl.2014.0367 · 3.52 Impact Factor
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    ABSTRACT: Threshold levels for peanut allergy determined by using oral challenges are important for the food industry with regard to allergen labeling. Moreover, the utility of biological markers in predicting threshold levels is uncertain. We sought to use a modified oral food challenge regimen that might determine threshold levels for peanut allergy mimicking a more real-life exposure and to correlate the eliciting dose (ED) and severity of clinical reaction in children with peanut allergy with B-cell, T-cell, and effector cell markers. A modified food challenge procedure with doses scheduled 2 hours apart was used in 63 children with peanut allergy. All children received a maximum of 8 semi-log increasing titration steps of roasted peanuts ranging from 3 to 4500 mg of peanut protein until objective allergic reactions occurred. Severity of symptoms was graded from I to V. Biological markers were measured before challenge. Forty-five of 63 patients showed objective symptoms after greater than 30 minutes, with a median latency of clinical reaction of 55 minutes. By using a log-normal dose-distribution model, the ED5 was calculated to be 1.95 mg of peanut protein. The ED was significantly and inversely correlated with peanut- and Ara h 2-specific IgE levels, skin prick test responses, basophil activation, and TH2 cytokine production by PBMCs. Symptom severity did not correlate with any of the markers or the ED. This modified food challenge procedure might better reflect threshold levels for peanut allergy than the standard procedure because most of the patients reacted at a time interval of greater than 30 minutes. By using this model, threshold levels, but not severity, could be correlated with biological markers.
    The Journal of allergy and clinical immunology 05/2014; 134(2). DOI:10.1016/j.jaci.2014.03.035 · 11.48 Impact Factor
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    ABSTRACT: S2 Guideline of the German Society for Allergology and Clinical Immunology (DGAKI), the Association of German Allergologists (AeDA), the Society of Pediatric Allergy and Environmental Medicine (GPA), the German Academy of Allergology and Environmental Medicine (DAAU), the German Professional Association of Pediatricians (BVKJ), the Austrian Society for Allergology and Immunology (ÖGAI), the Swiss Society for Allergy and Immunology (SGAI), the German Society of Anaesthesiology and Intensive Care Medicine (DGAI), the German Society of Pharmacology (DGP), the German Society for Psychosomatic Medicine (DGPM), the German Working Group of Anaphylaxis Training and Education (AGATE) and the patient organization German Allergy and Asthma Association (DAAB).
    Allergo Journal International 05/2014; 23(3):96-112. DOI:10.1007/s40629-014-0009-1
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    ABSTRACT: A large proportion of immunoglobulin E (IgE)-mediated food allergies in older children, adolescents and adults are caused by cross-reactive allergenic structures. Primary sensitization is most commonly to inhalant allergens (e.g. Bet v 1, the major birch pollen allergen). IgE can be activated by various cross-reactive allergens and lead to a variety of clinical manifestations. In general, local and mild - in rare cases also severe and systemic - reactions occur directly after consumption of the food containing the cross-reactive allergen (e. g. plant-derived foods containing proteins of the Bet v 1 family). In clinical practice, sensitization to the primary responsible inhalant and/or food allergen can be detected by skin prick tests and/or in vitro detection of specific IgE. Component-based diagnostic methods can support clinical diagnosis. For individual allergens, these methods may be helpful to estimate the risk of systemic reactions. Confirmation of sensitization by oral provocation testing is important particulary in the case of unclear case history. New, as yet unrecognized allergens can also cause cross-reactions. The therapeutic potential of specific immunotherapy (SIT) with inhalant allergens and their effect on pollen-associated food allergies is currently unclear: results vary and placebo-controlled trials will be necessary in the future. Pollen allergies are very common. Altogether allergic sensitization to pollen and cross-reactive food allergens are very common in our latitudes. The actual relevance has to be assessed on an individual basis using the clinical information. Cite this as Worm M, Jappe U, Kleine-Tebbe J, Schäfer C, Reese I, Saloga J, Treudler R, Zuberbier T, Wassmann A, Fuchs T, Dölle S, Raithel M, Ballmer-Weber B, Niggemann B, Werfel T. Food allergies resulting from immunological cross-reactivity with inhalant allergens. Allergo J Int 2014; 23: 1-16 DOI 10.1007/s40629-014-0004-6.
    Allergo Journal International 05/2014; 23(1):1-16. DOI:10.1007/s40629-014-0004-6
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    ABSTRACT: ProblemstellungUnter Anaphylaxie versteht man eine akute systemische Reaktion mit Symptomen einer allergischen Sofortreaktion, die den ganzen Organismus erfassen kann und potenziell lebensbedrohlich ist [1–3].Die Definition der Anaphylaxie ist weltweit nicht einheitlich. Derzeit werden verschiedene Klassifikationssysteme verwendet. Im deutschen Sprachraum ist bislang überwiegend die hier verwendete Klassifikation eingesetzt worden.Anaphylaktische Reaktionen gehören zu den schwersten und potenziell lebensbedrohlichen, dramatischen Ereignissen in der Allergologie. Die Akutbehandlung wird auf der Grundlage internationaler Leitlinien und Empfehlungen von Lehrbüchern durchgeführt. 1994 erschien das Ergebnis einer interdisziplinären Konsensuskonferenz als Positionspapier der Deutschen Gesellschaft für Allergologie und klinische Immunologie (DGAKI) im Allergo Journal [4], welches im Jahr 2007 aktualisiert als Leitlinie veröffentlicht wurde [5].Auf Vorstandsbeschluss der DGAKI von 2009 wurde d ...
    Allergo Journal: interdisziplinäre Zeitschrift für Allergologie und Umweltmedizin: Organ der Deutschen Gesellschaft für Allergie- und Immunitätsforschung 05/2014; 23(3):36-54. DOI:10.1007/s15007-014-0542-8

Publication Stats

14k Citations
1,731.90 Total Impact Points


  • 2015
    • Universitätsklinikum Freiburg
      Freiburg an der Elbe, Lower Saxony, Germany
  • 1998-2015
    • Charité Universitätsmedizin Berlin
      • Department of Pediatrics, Division of Pneumonology and Immunology
      Berlín, Berlin, Germany
  • 1991-2015
    • University of Iowa Children's Hospital
      Iowa City, Iowa, United States
  • 2008-2014
    • Red Cross
      Washington, Washington, D.C., United States
    • Friedrich Schiller University Jena
      • Section of Pneumology / Allergology
      Jena, Thuringia, Germany
  • 2013
    • Ludwig-Maximilians-University of Munich
      München, Bavaria, Germany
  • 2009-2013
    • DRK Kliniken Berlin
      Berlín, Berlin, Germany
    • Hannover Medical School
      Hanover, Lower Saxony, Germany
  • 1996-2012
    • Humboldt-Universität zu Berlin
      • Department of Biology
      Berlín, Berlin, Germany
  • 2011
    • Seoul National University Hospital
      • Department of Internal Medicine
      Sŏul, Seoul, South Korea
  • 2005
    • Munich Re
      München, Bavaria, Germany
  • 1997-2004
    • Humboldt State University
      Arcata, California, United States
  • 2003
    • Odense University Hospital
      Odense, South Denmark, Denmark
  • 2002
    • Children´s Hospital Association
      Overland Park, Kansas, United States
    • Umeå University
      Umeå, Västerbotten, Sweden
  • 1999-2001
    • Valley Children's Hospital
      Мадера, California, United States
  • 1994
    • University of Hamburg
      • Department of Paediatrics
      Hamburg, Hamburg, Germany
  • 1993-1994
    • Freie Universität Berlin
      Berlín, Berlin, Germany