K Beyer

Charité Universitätsmedizin Berlin, Berlín, Berlin, Germany

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Publications (95)518.56 Total impact

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    ABSTRACT: Cows milk allergy (CMA) is one of the most commonly reported childhood food problems. Community-based incidence and prevalence estimates vary widely, due to possible misinterpretations of presumed reactions to milk and differences in study design, particularly diagnostic criteria. Children from the EuroPrevall birth cohort in 9 European countries with symptoms possibly related to CMA were invited for clinical evaluation including cows' milk-specific IgE antibodies (IgE), skin prick test (SPT) reactivity and double-blind, placebo-controlled food challenge. Across Europe 12,049 children were enrolled, 9,336 (77.5%) were followed up to 2 years of age. CMA was suspected in 358 children and confirmed in 55 resulting in an overall incidence of challenge-proven CMA of 0.54% (95% CI 0.41-0.70). National incidences ranged from 1% (in Netherlands and UK) to less than 0.3% (in Lithuania, Germany and Greece). Of all children with CMA, 23.6% had no cows milk specific IgE in serum, especially those from UK, Netherlands, Poland and Italy. Of children with CMA who were reevaluated one year after diagnosis 69% (22/32) tolerated cow's milk, including all children with non-IgE-associated CMA and 57% of those children with IgE-associated CMA. This unique pan-European birth cohort study using the gold-standard diagnostic procedure for food allergies confirmed challenge-proven CMA in less than 1% of children up to age 2. Affected infants without detectable specific antibodies to cows milk were very likely to tolerate cows milk one year after diagnosis, whereas only half of those with specific antibodies in serum "outgrew" their disease so soon. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Allergy 04/2015; DOI:10.1111/all.12630 · 6.00 Impact Factor
  • 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; DOI:10.1111/all.12532 · 6.00 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; DOI:10.1111/all.12530 · 6.00 Impact Factor
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    ABSTRACT: Background Occurrence, elicitors and treatment of severe allergic reactions are recognized and reported differently between countries. We aimed to collect standardized data throughout Europe on anaphylaxis referred for diagnosis and counselling. Methods Tertiary allergy, dermatology and paediatric units in 10 European countries took part in this pilot phase of the first European Anaphylaxis Registry, from June 2011 to March 2014. An online questionnaire was used to collect data on severe allergic reactions based on the medical history and diagnostics. ResultsFifty-nine centres reported 3333 cases of anaphylaxis, with 26.7% below 18years of age. Allergic reactions were mainly caused by food (children and adults 64.9% and 20.2%, respectively) and insect venom (20.2% and 48.2%) and less often by drugs (4.8% and 22.4%). Most reactions occurred within 30min of exposure (80.5%); a delay of 4+ hours was mainly seen in drug anaphylaxis (6.7%). Symptom patterns differed by elicitor, with the skin being affected most often (84.1%). A previous, usually milder reaction to the same allergen was reported by 34.2%. The mainstay of first-line treatment by professionals included corticoids (60.4%) and antihistamines (52.8%). Only 13.7% of lay- or self-treated reactions to food and 27.6% of insect anaphylaxis received on-site adrenaline. Conclusion This pilot phase of a pan-European registry for severe allergic reactions provides for the first time data on anaphylaxis throughout Europe, demonstrates its potential functionality and allows a comparison of symptom patterns, elicitors and treatment habits between referral centres and countries.
    Allergy 07/2014; 69(10). DOI:10.1111/all.12475 · 6.00 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; DOI:10.1111/all.12429 · 6.00 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; DOI:10.1111/all.12437 · 6.00 Impact Factor
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    ABSTRACT: Assessing maternal dietary habits across Europe during pregnancy in relation to their national pregnancy recommendations. A collaborative, multi-centre, birth cohort study in nine European countries was conducted as part of European Union funded EuroPrevall project. Standardised baseline questionnaire data included details of food intake, nutritional supplement use, exposure to cigarette smoke during pregnancy and socio-demographic data. Pregnancy recommendations were collected from all nine countries from the appropriate national organisations. The most commonly taken supplement in pregnancy was folic acid (55.6 % Lithuania-97.8 % Spain) and was favoured by older, well-educated mothers. Vitamin D supplementation across the cohort was very poor (0.3 % Spain-5.1 % Lithuania). There were significant differences in foods consumed in different countries during pregnancy e.g. only 2.7 % Dutch mothers avoided eating peanut, while 44.4 % of British mothers avoided it. Some countries have minimal pregnancy recommendations i.e. Lithuania, Poland and Spain while others have similar, very specific recommendations i.e. UK, the Netherlands, Iceland, Greece. Allergy specific recommendations were associated with food avoidance during pregnancy [relative rate (RR) 1.18 95 % CI 0.02-1.37]. Nutritional supplement recommendations were also associated with avoidance (RR 1.08, 1.00-1.16). Maternal dietary habits and the use of dietary supplements during pregnancy vary significantly across Europe and in some instances may be influenced by national recommendations.
    Maternal and Child Health Journal 04/2014; 18(10). DOI:10.1007/s10995-014-1480-5 · 2.24 Impact Factor
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    ABSTRACT: Food allergy can have significant effects on morbidity and quality of life and can be costly in terms of medical visits and treatments. There is therefore considerable interest in generating efficient approaches that may reduce the risk of developing food allergy. This guideline has been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Taskforce on Prevention and is part of the EAACI Guidelines for Food Allergy and Anaphylaxis. It aims to provide evidence-based recommendations for primary prevention of food allergy. A wide range of antenatal, perinatal, neonatal, and childhood strategies were identified and their effectiveness assessed and synthesized in a systematic review.Based on this evidence, families can be provided with evidence-based advice about preventing food allergy, particularly for infants at high risk for development of allergic disease. The advice for all mothers includes a normal diet without restrictions during pregnancy and lactation. For all infants, exclusive breastfeeding is recommended for at least first 4–6 months of life. If breastfeeding is insufficient or not possible, infants at high-risk can be recommended a hypoallergenic formula with a documented preventive effect for the first 4 months. There is no need to avoid introducing complementary foods beyond 4 months, and currently, the evidence does not justify recommendations about either withholding or encouraging exposure to potentially allergenic foods after 4 months once weaning has commenced, irrespective of atopic heredity. There is no evidence to support the use of prebiotics or probiotics for food allergy prevention.
    Allergy 04/2014; 69(5). DOI:10.1111/all.12398 · 6.00 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 03/2014; 49(3). DOI:10.1002/ppul.22816 · 2.30 Impact Factor
  • Allergologie 01/2014; 37(07):293-300. DOI:10.5414/ALX01665 · 0.30 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. DOI:10.1111/all.12226 · 6.00 Impact Factor
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    Allergy 08/2013; 68(8):1081-3. DOI:10.1111/all.12178 · 6.00 Impact Factor
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    07/2013; 3(3). DOI:10.1186/2045-7022-3-S3-P38
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    07/2013; 3(3). DOI:10.1186/2045-7022-3-S3-P113
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    07/2013; 3(3). DOI:10.1186/2045-7022-3-S3-P139
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    ABSTRACT: Background Anaphylaxis is a severe potentially life‐threatening hypersensitivity reaction with an estimated lifetime prevalence of 0.5–2.0%. The prevalence and incidence of anaphylactic reactions in Germany are unknown. We therefore assessed anaphylactic patients seen by emergency physicians in the Berlin area covering 4 million people. MethodsA standardised questionnaire was filled from 2008 to 2010 by the emergency physicians. ResultsA total of 333 cases of anaphylaxis were reported. 295 of these met the inclusion criteria for severity and were analysed. 13.9% (n = 41) were reactions with respiratory symptoms, 25.4% (n = 75) with cardiovascular, and in 60.7% (n = 179) of cases, respiratory and cardiovascular symptoms were reported. Two reactions were fatal. The most common elicitors were food products (32.2%), drugs (29.2%) and insect venom (19.3%). The most frequently given drugs were corticoids and antihistamines, but not adrenaline. For 2008, the calculated incidence was 4.5 per 100 000. Conclusions Our data show that food products are frequent elicitors of severe allergic reactions in the general population including children and adults. It unravels a strong underuse of adrenaline by emergency physicians, not reflecting treatment protocols according to the current guidelines. As data obtained from allergists reveal a different rank order of elicitors, this study suggests that food‐allergic adult patients may present a risk population and should receive more attention by allergists.
    Allergy 11/2012; 67(11). DOI:10.1111/all.12012 · 6.00 Impact Factor
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    ABSTRACT: Cow's milk allergy (CMA) is one of the most common causes of food allergy in the first years of life. Fortunately, the majority of children with CMA develop clinical tolerance with time. However, no good individual markers exist to predict whether this will occur. Therefore, a prognosis to identify children with persistent CMA at diagnosis would be helpful. In this study, we sought to assess whether measurement of IgE to individual allergens of cow's milk (CM) would separate patients with persistent CMA from those who became clinically tolerant to CM over time. A total of 52 patients ranging from 3 months to 114 months of age with proven CMA by DBPCFC were followed over time. From these 52 patients, 32 (61.5%) patients became tolerant in the analysed time period. All patients were rechallenged at least once, some were rechallenged two or three times. Serum was analysed prior to each challenge for specific IgE, IgG and IgG4 binding to crude CM protein as well as to individual allergens of CM. The individual likelihood of outgrowing CMA significantly correlates with a low level of CM-specific IgE as well as a low level of specific IgE to α-lactalbumin, β-lactoglobulin (Bos d5.0102), κ-casein and α(s1) -casein. No significant correlation was found for IgE levels to total casein, lactoferrin, β-casein and β-lactoglobulin (Bos d5.0101) as well as IgG and IgG4 levels to α-lactalbumin, β-lactoglobulin and total casein. CM-specific IgE is a good prognostic marker for persistence of CMA. In addition, component-resolved diagnostic showed similar results. However, in our view, the rising laboratory costs do not justify a measurement on a daily basis. Additional determination of specific IgG or IgG4 levels was not useful in predicting tolerance development in our study population.
    Clinical & Experimental Allergy 11/2012; 42(11):1630-7. DOI:10.1111/cea.12001 · 4.32 Impact Factor
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    ABSTRACT: The measurement of specific serum immunoglobulin E (sIgE) and the skin prick test (SPT) are accepted tools in the diagnostic work-up of suspected food allergy. Often only one of the methods is used to determine sensitization; however, it is still under debate whether these two methods can be used interchangeably. To investigate the concordance of SPT and sIgE serum assays with regard to suspected food allergy. In 395 children referred to our clinic with suspected cow's milk allergy and in 268 children with suspected hen's egg allergy specific immunoglobulin E (IgE) was measured, a SPT and an oral food challenge performed. A weal size ≥ 3 mm and sIgE ≥ 0.35 kU/L were considered positive. The weal size of the SPT and the level of food-specific IgE were tested for correlation for each allergen. Of the 395 (23%) children orally challenged with cow's milk, 92 showed no corresponding results for SPT and sIgE as either positive or negative. For hen's egg, in 27 of 268 (10%) children differing test results for SPT and sIgE in serum were obtained. Moreover, regarding the quantitative values for sIgE and SPT in children with or without clinically relevant food allergy, sIgE and SPT correlated badly. The concordance between SPT and sIgE is surprisingly low for cow's milk and hen's egg on an individual basis. Therefore, the tests should not be used interchangeably. Especially in children who receive a negative test result the alternative test should also be used. Furthermore, our data indicate again that oral food challenges are still the method of choice to diagnose food allergies.
    Clinical & Experimental Allergy 08/2012; 42(8):1266-72. DOI:10.1111/j.1365-2222.2012.04046.x · 4.32 Impact Factor
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    ABSTRACT: This article is the result of consensus reached by a working group of clinical experts in paediatric allergology as well as representatives from an ethical committee and the European Medicine Agency (EMA). The manuscript covers clinical, scientific, regulatory and ethical perspectives on allergen-specific immunotherapy in childhood. Unmet needs are identified. To fill the gaps and to bridge the different points of view, recommendations are made to researchers, to scientific and patient organizations and to regulators and ethical committees. Working together for the benefit of the community is essential. The European Academy of Allergy and Clinical Immunology (EAACI) serves as the platform of such cooperation.
    Pediatric Allergy and Immunology 06/2012; 23(4):300-6. DOI:10.1111/j.1399-3038.2012.01313.x · 3.86 Impact Factor

Publication Stats

3k Citations
518.56 Total Impact Points

Institutions

  • 2004–2014
    • Charité Universitätsmedizin Berlin
      • Department of Pediatrics, Division of Pneumonology and Immunology
      Berlín, Berlin, Germany
  • 1993–2014
    • Freie Universität Berlin
      Berlín, Berlin, Germany
  • 1996–2010
    • Humboldt-Universität zu Berlin
      • Department of Biology
      Berlín, Berlin, Germany
  • 2003–2008
    • Icahn School of Medicine at Mount Sinai
      • Department of Pediatrics
      Manhattan, New York, United States
  • 2000–2007
    • Mount Sinai Medical Center
      New York, New York, United States
  • 1994–1999
    • University of Iowa Children's Hospital
      Iowa City, Iowa, United States