Höflich Conny, Balakirski Galina, Hajdu Zuzanna, Baron Jens Malte, Fietkau Katharina, Merk Hans F, Strassen Ulrich, Bier Henning, Dott Wolfgang, Mücke Hans-Guido, Straff Wolfgang, Wurpts Gerda, Yazdi Amir S, Chaker Adam, Röseler Stefani T M
German Environment Agency Section II 1.5 Environmental Medicine and Health Effects Assessment Berlin Germany.
Department of Dermatology and Allergology University Hospital RWTH Aachen Aachen Germany.
Clin Transl Allergy. 2021 Oct 4;11(8):e12058. doi: 10.1002/clt2.12058. eCollection 2021 Oct.
Diagnosis of pollen allergies is mainly based on test allergens for skin prick testing. In the minimum battery of test inhalant allergens recommended by the Global Allergy and Asthma European Network 10 pollen allergens are included. Complementary other pollen allergens may need to be considered; however, respective awareness may not always be granted. Furthermore, at least in Germany, the situation may be even more complicated by the fact that test allergens need regulatory approval. A decline in commercially available test allergens may result in a diagnostic gap regarding patients with non-frequent allergies. How many patients with non-frequent pollen allergies would be affected by this gap? The data presented here partly answer this question.
The study consisted of a descriptive and an analytical part. In the descriptive part, sensitization to frequent pollen allergens (alder, hazel, birch, sweet grasses; according to the German Therapy Allergen Ordinance) and to respective non-frequent pollen allergens (cypress, Japanese cedar, ash, plane tree, olive, Bermuda grass, wall pellitory, plantain, goosefoot, mugwort, ragweed, and saltwort) was measured in adult patients with physician-diagnosed allergic rhinitis from two German federal states, namely North-Rhine Westphalia ( = 360) and Bavaria ( = 339), using skin prick testing and/or ISAC technology. Furthermore, respective regional pollen data were assessed. In the analytical part, sensitization data were correlated with each other and with anamnestic data on symptom periods.
Sensitization to frequent pollen allergens ranged from 45% (sIgE to Aln g 1/Alder, NRW) to 72% (prick test reactivity to birch, NRW). Sensitization to non-frequent pollen allergens ranged from 0% (sIgE to Amb a 1/ragweed, NRW) to 41% (prick test reactivity to olive, Bavaria). Sensitization data partly correlated with each other and in connection with symptom periods showed a partly similar seasonal pattern as pollen data.
Sensitization to non-frequent pollen allergens have to be considered when examining patients with respective seasonal symptoms, and test (and respective therapy) allergens for non-frequent pollen allergies need to be available. Further prerequisites for adequate patient management would be a nationwide pollen monitoring system giving continuous pollen data and a systematic sensitization monitoring at patient level.
花粉过敏的诊断主要基于用于皮肤点刺试验的测试变应原。在全球过敏和哮喘欧洲网络推荐的最低限度吸入性变应原测试组合中，包含了10种花粉变应原。可能需要考虑补充其他花粉变应原；然而，人们对此的认识可能并不总是足够。此外，至少在德国，由于测试变应原需要监管批准，情况可能会更加复杂。市售测试变应原的减少可能导致非常见过敏患者出现诊断空白。有多少非常见花粉过敏患者会受到这一空白的影响？本文给出的数据部分回答了这个问题。
该研究包括描述性和分析性两部分。在描述性部分，采用皮肤点刺试验和/或ISAC技术，对来自德国两个联邦州（北莱茵-威斯特法伦州，n = 360；巴伐利亚州，n = 339）的成年医师诊断为过敏性鼻炎的患者，检测其对常见花粉变应原（桤木、榛子、桦树、甜草；根据德国治疗变应原条例）和相应非常见花粉变应原（柏树、日本柳杉、白蜡树、悬铃木、橄榄、百慕大草、墙草、车前草、藜、艾蒿、豚草和碱蓬）的致敏情况。此外，评估了相应的区域花粉数据。在分析性部分，将致敏数据相互关联，并与症状期的问诊数据相关联。
对常见花粉变应原的致敏率范围为45%（北莱茵-威斯特法伦州对桤木属1/桤木的特异性IgE）至72%（北莱茵-威斯特法伦州对桦树的点刺试验反应性）。对非常见花粉变应原的致敏率范围为0%（北莱茵-威斯特法伦州对豚草属1/豚草的特异性IgE）至41%（巴伐利亚州对橄榄的点刺试验反应性）。致敏数据部分相互关联，并且与症状期相关联时显示出与花粉数据部分相似的季节性模式。
在检查有相应季节性症状的患者时，必须考虑对非常见花粉变应原的致敏情况，并且需要有针对非常见花粉过敏的测试（和相应治疗）变应原。对患者进行充分管理的其他先决条件包括一个能提供持续花粉数据的全国性花粉监测系统以及在患者层面进行系统性致敏监测。
