B Niggemann

Charité Universitätsmedizin Berlin, Berlín, Berlin, Germany

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Publications (304)1448.19 Total impact

  • B. Niggemann, K. Beyer
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    ABSTRACT: Elicitors of anaphylactic reactions are any sources of protein with allergenic capacity, such as foods, drugs, insect venoms, pollen, animal dander, occupational allergens, or seminal fluid. However, not all allergic reactions end up in the most severe form of anaphylaxis. Accompanying factors may explain, why some conditions lead to anaphylaxis while in other cases the allergen is tolerated.This article is protected by copyright. All rights reserved.
    Allergy 10/2014; · 5.88 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; · 5.88 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; · 5.88 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; · 5.88 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; · 12.05 Impact Factor
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    ABSTRACT: In a large randomised trial in patients with seasonal allergic rhinitis (SAR), acupuncture was superior compared to sham acupuncture and rescue medication. The aim of this paper is to describe the characteristics of the trial's participating physicians and to describe the trial intervention in accordance with the STRICTA (Standards for Reporting Interventions in Controlled Trials of Acupuncture) guidelines, to make details of the trial intervention more transparent to researchers and physicians. ACUSAR (Acupuncture in Seasonal Allergic Rhinitis) was a three-armed, randomised, controlled multicentre trial. 422 SAR patients were randomised to semi-standardised acupuncture plus rescue medication (RM, cetirizine), sham acupuncture plus RM or RM alone. We sent a questionnaire to trial physicians in order to evaluate their characteristics regarding their education about and experience in providing acupuncture. During the trial, acupuncturists were asked to diagnose all of their patients according to Chinese Medicine (CM) as a basis for the semi-standardised, individualized intervention in the acupuncture group. Every acupuncture point used in this trial had to be documented after each session RESULTS: Acupuncture was administered in outpatient clinics by 46 (mean age 47 +/- 10 years; 24 female/ 22 male) conventionally-trained medical doctors (67% with postgraduate specialization such as internal or family medicine) with additional extensive acupuncture training (median 500 hours (1st quartile 350, 3rd quartile 1000 hours with 73% presenting a B-diploma in acupuncture training (350 hours)) and experience (mean 14 years in practice). The most reported traditional CM diagnosis was 'wind-cold invading the lung' (37%) and 'wind-heat invading the lung' (37%), followed by 'lung and spleen qi deficiency' (9%). The total number of needles used was higher in the acupuncture group compared to the sham acupuncture group (15.7 +/- 2.5 vs. 10.0 +/- 1.6). The trial interventions were provided by well educated and experienced acupuncturists. The different number of needles in both intervention groups could be possibly a reason for the better clinical effect in SAR patients. For future trials it might be more appropriate to ensure that acupuncture and sham acupuncture groups should each be treated by a similar number of needles.Trial registration: ClinicalTrials.gov: NCT00610584.
    BMC Complementary and Alternative Medicine 04/2014; 14(1):128. · 2.08 Impact Factor
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    ABSTRACT: The gold standard in the diagnosis of food allergy is the double-blind, placebo-controlled oral food challenge (DBPCFC). During this challenge, patients receive the allergenic food and placebo on separate randomized days, while being monitored for clinical reactions. Interestingly, some reactions are assessed as positive although the patients had received placebo. The aim of our study was to analyze incidence and characteristics of positive placebo reactions during DBPCFCs. In food-allergic children, we retrospectively analyzed positive placebo reactions in DBPCFCs in 740 placebo challenges in our department. Individual characteristics were compared, such as age or IgE levels, as well as clinical symptoms. 2.8% (21 out of 740) of all placebo challenges were assessed as positive. Young children (age <= 1.5 yrs) had more (p = .047) positive placebo challenges (4.0%) compared to older children (age > 1.5 yrs; 1.5%). Children with positive placebo challenges had higher levels of total IgE (median 201 kU/l) compared to negatively classified children (median 110 kU/l). In children with positive placebo reactions, skin symptoms were observed significantly more often, with a worsening of atopic eczema (AE) as the most reported symptom. Placebo reactions in DBPCFC are not common. Worsening of AE is the most frequent clinical reaction associated with positive placebo challenges, and young children (age <= 1.5 yrs) seem to be affected more often. Therefore - contrary to current recommendations - DBPCFC tests should be considered in infants and young children, especially those with a history of AE. This article is protected by copyright. All rights reserved.
    Clinical & Experimental Allergy 01/2014; · 4.79 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 inci-dence is 2–3 cases per 100 000 persons per year.
    Deutsches Ärzteblatt International 01/2014; · 3.54 Impact Factor
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  • Sibylle Koletzko, Bodo Niggemann
    Journal of pediatric gastroenterology and nutrition 11/2013; · 2.18 Impact Factor
  • Lars Lange, Niggemann B, Blühmchen K
    Allergologie 11/2013; 36(11):492-501. · 0.34 Impact Factor
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    ABSTRACT: It has been hypothesized that high environmental exposure to peanut allergens may be a potent risk factor for cutaneous sensitization. Therefore, we wanted to investigate whether peanut proteins are detectable in house dust of different household areas. Peanut levels of dust samples were measured with ELISA. Overall, peanut was detectable in 19 of 21 households in the eating area and/or in bed. The frequency of peanut consumption correlated with peanut levels. Forty-eight hours after intentional peanut consumption, peanut levels were highly increased. Nevertheless, further research is required to prove whether peanut allergen in house dust can cause sensitization via skin.
    Allergy 11/2013; 68(11):1460-2. · 5.88 Impact Factor
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    ABSTRACT: Reported food-related symptoms of patients may sometimes be misleading. A correct delineation of food-induced symptoms is often difficult and various differential diagnoses have to be considered. We report on two cases of food-induced, predominantly respiratory symptoms (in one case life-threatening) in children with food allergy. First, a two-year-old boy with no history of allergies and suspected foreign body aspiration which was finally diagnosed as an anaphylactic reaction to fish, and secondly a six-year-old girl with multiple food allergies and allergic asthma who during an electively performed oral food challenge developed severe respiratory distress, drop in blood pressure, and asphyxia not due to an anaphylactic reaction but due to choking on an unnoticed sweet. These two cases represent challenging, life-threatening symptom constellations involving food-induced reactions in food allergic children, reminding us to question first impressions. Pediatr Pulmonol. 2013 9999:XX-XX. © 2013 Wiley Periodicals, Inc.
    Pediatric Pulmonology 10/2013; · 2.38 Impact Factor
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    ABSTRACT: Anaphylaxis is an acute, potentially fatal, multi-organ system, allergic reaction caused by the release of chemical mediators from mast cells and basophils. Uncertainty exists around epidemiological measures of incidence and prevalence, risk factors, risk of recurrence, and death due to anaphylaxis. This systematic review aimed to (1) understand and describe the epidemiology of anaphylaxis and (2) describe how these characteristics vary by person, place, and time. Using a highly sensitive search strategy, we identified systematic reviews of epidemiological studies, descriptive and analytical epidemiological investigations, and studies involving analysis of routine data. Our searches identified a total of 5 843 potentially eligible studies, of which 49 satisfied our inclusion criteria. Of these, three were suitable for pooled estimates of prevalence. The incidence rates for all-cause anaphylaxis ranged from 1.5 to 7.9 per 100 000 person-years. These data indicated that an estimated 0.3% (95% CI 0.1-0.5) of the population experience anaphylaxis at some point in their lives. Food, drugs, stinging insects, and latex were the most commonly identified triggers. Anaphylaxis is a common problem, affecting an estimated 1 in 300 of the European population at some time in their lives. Future research needs to focus on better understanding of the trends across Europe and identifying those most likely to experience fatal reactions.
    Allergy 10/2013; · 5.88 Impact Factor
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    Clinical and Translational Allergy. 07/2013; 3(3).
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    J Bellach, B Niggemann, K Beyer, B Ahrens
    Clinical and Translational Allergy. 07/2013; 3(3).
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    ABSTRACT: Chinese translation Acupuncture is frequently used to treat seasonal allergic rhinitis (SAR) despite limited scientific evidence. To evaluate the effects of acupuncture in patients with SAR. Randomized, controlled multicenter trial. (ClinicalTrials.gov: NCT00610584) 46 specialized physicians in 6 hospital clinics and 32 private outpatient clinics. 422 persons with SAR and IgE sensitization to birch and grass pollen. Acupuncture plus rescue medication (RM) (cetirizine) (n = 212), sham acupuncture plus RM (n = 102), or RM alone (n = 108). Twelve treatments were provided over 8 weeks in the first year. Changes in the Rhinitis Quality of Life Questionnaire (RQLQ) overall score and the RM score (RMS) from baseline to weeks 7 and 8 and week 16 in the first year and week 8 in the second year after randomization, with predefined noninferiority margins of -0.5 point (RQLQ) and -1.5 points (RMS). Compared with sham acupuncture and with RM, acupuncture was associated with improvement in RQLQ score (sham vs. acupuncture mean difference, 0.5 point [97.5% CI, 0.2 to 0.8 point; P < 0.001]; RM vs. acupuncture mean difference, 0.7 point [97.5% CI, 0.4 to 1.0 point; P < 0.001]) and RMS (sham vs. acupuncture mean difference, 1.1 points [97.5% CI, 0.4 to 1.9 points; P < 0.001]; RM vs. acupuncture mean difference, 1.5 points [97.5% CI, 0.8 to 2.2 points; P < 0.001]). There were no differences after 16 weeks in the first year. After the 8-week follow-up phase in the second year, small improvements favoring real acupuncture over the sham procedure were noted (RQLQ mean difference, 0.3 point [95% CI, 0.03 to 0.6 point; P = 0.032]; RMS mean difference, 1.0 point [95% CI, 0.2 to 1.9 points; P = 0.018]). The study was not powered to detect rare adverse events, and the RQLQ and RMS values were low at baseline. Acupuncture led to statistically significant improvements in disease-specific quality of life and antihistamine use measures after 8 weeks of treatment compared with sham acupuncture and with RM alone, but the improvements may not be clinically significant. German Research Foundation.
    Annals of internal medicine 02/2013; 158(4):225-34. · 13.98 Impact Factor
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    ABSTRACT: Background To avoid unnecessary oral food challenges, which are time consuming, stressful, and risky, improved in vitro diagnostic methods for food allergy such as component resolved diagnostics are still under investigation. Objective To investigate the role of whole peanut- and peanut-component (Ara h 1, Ara h 2, Ara h 3, Ara h 6 and Ara h 8)–specific IgE levels in the diagnostic procedure of peanut allergy as well as the diagnostic properties of peanut-specific IgG and IgG4. Methods Sixty-one children underwent oral peanut challenge tests for diagnostic purposes irrespective of their peanut-specific IgE levels. Peanut-specific serum IgE, IgG, and IgG4 levels were determined by ImmunoCAP FEIA and specific IgE against individual peanut proteins by Immuno Solid-phase Allergen Chip. Results Thirty-four of 61 patients (56%) had a peanut allergy. No significant difference was observed for peanut-specific IgG or peanut-specific IgG4 levels between patients who were allergic and tolerant patients, whereas peanut-specific IgE was significant higher in patients who were allergic than in tolerant patients (P < .005). Twenty-five of 61 children had peanut-specific IgE above a previously proposed cutoff level of 15 kUA/L; however, 7 of these 25 children (28%) were clinically tolerant. Ara h 2-specific IgE was significantly lower in tolerant than in patients with allergies (P < .0001). Interestingly, 94% of the patients with peanut allergies showed IgE-binding to Ara h 2. Unfortunately, 26% of the sensitized but tolerant patients have shown IgE binding to Ara h 2 too. Conclusions Neither the level of specific IgE to peanut nor to Ara h 2 was able to clearly distinguish patients with clinical relevant peanut allergy from those who were clinical tolerant in our population. As expected, peanut-specific IgG and IgG4 did not improve the diagnostic procedure.
    The Journal of Allergy and Clinical Immunology: In Practice. 01/2013; 1(4):394–398.
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    Allergic Rhinitis and Its Impact on Asthma (ARIA). 01/2013;

Publication Stats

9k Citations
1,448.19 Total Impact Points

Institutions

  • 1999–2014
    • Charité Universitätsmedizin Berlin
      • Department of Pediatrics, Division of Pneumonology and Immunology
      Berlín, Berlin, Germany
  • 2013
    • The University of Edinburgh
      • Centre for Population Health Sciences
      Edinburgh, Scotland, United Kingdom
    • Ludwig-Maximilians-University of Munich
      München, Bavaria, Germany
  • 2009–2013
    • DRK Kliniken Berlin
      Berlín, Berlin, Germany
  • 2012
    • Imperial College London
      Londinium, England, United Kingdom
  • 2008–2012
    • Red Cross
      Washington, Washington, D.C., United States
    • Friedrich-Schiller-University Jena
      Jena, Thuringia, Germany
  • 1996–2012
    • Humboldt-Universität zu Berlin
      • Department of Biology
      Berlín, Berlin, Germany
    • Technische Universität Berlin
      Berlín, Berlin, Germany
    • HELIOS Klinikum Berlin-Buch
      Berlín, Berlin, Germany
  • 1991–2012
    • University of Iowa Children's Hospital
      Iowa City, Iowa, United States
  • 2011
    • Seoul National University Hospital
      • Department of Internal Medicine
      Sŏul, Seoul, South Korea
  • 2010
    • University of Cologne
      • Department of Medical Statistics
      Köln, North Rhine-Westphalia, Germany
  • 1996–2009
    • Hannover Medical School
      • Department for Dermatology and Allergy
      Hanover, Lower Saxony, Germany
  • 2004–2008
    • Odense University Hospital
      Odense, South Denmark, Denmark
    • University of Padova
      • Department of Pediatrics
      Padova, Veneto, Italy
  • 2007
    • University of Tampere
      • Department of Dermatology
      Tampere, Western Finland, Finland
    • Högskolan Väst
      THN, Västra Götaland, Sweden
  • 2006
    • Centre Hospitalier Universitaire de Reims
      Rheims, Champagne-Ardenne, France
  • 2005
    • Munich Re
      München, Bavaria, Germany
  • 1997–2004
    • Humboldt State University
      Arcata, California, United States
    • Children's Hospital of Michigan
      Detroit, Michigan, United States
  • 2002
    • Umeå University
      Umeå, Västerbotten, Sweden
  • 1999–2001
    • University of Vienna
      • Universitätsklinik für Innere Medizin I
      Vienna, Vienna, Austria
  • 1993
    • Freie Universität Berlin
      Berlín, Berlin, Germany