Caroline Beutner

Background: European guidelines recommend using a standardized baseline series of skin prick test (SPT) allergens for the diagnosis of airway allergies. In addition, local adaptation and/or extension of test panels according to regional exposure and sensitization patterns are increasingly being discussed. Methods: Regional sensitization rates according to SPTs based on the most recent GA ² LEN baseline series in Central Germany were retrospectively analyzed for 960 consecutive patients with respiratory symptoms at our university outpatient clinic. Additional SPT allergens of interest were further analyzed. Results: High sensitization rates to the baseline SPT series were observed in our highly selected study cohort. The positivity rates were particularly high for olive pollen (30.8%) and plantain pollen (33.4%). Positive olive and birch pollen SPTs were found in 98.5% of olive‐ash‐birch pollen tested patients. High SPT positivity rates (98.1%) for plane tree and olive tree pollen were found, whereas only six patients (1.9%) were diagnosed with exclusive cypress pollen sensitization. Subgroup analysis of SPTs for palm tree pollen revealed that 92% of patients with palm tree positivity showed polysensitization, and all but one patient had concomitant grass pollen sensitization. Conclusion: Regular evaluations of SPT series may be necessary because of climate change, extract production, and increasing population mobility. Ash and cypress pollen extracts could currently be removed from the baseline SPT panel without significantly decreasing diagnostic accuracy. Positive SPTs to non‐native palm tree pollen may indicate the presence of IgE to cross‐reacting panallergens, which may help to differentiate primary sensitization from cross‐reactivity directly. Limitations include the retrospective monocentric design and lack of molecular IgE confirmation.

Introduction: Skin prick tests (SPTs) are the gold standard for diagnosis of allergic rhinitis (AR). A decrease in the number of allergens included in standard SPT panels has recently been debated – particularly regarding the cross-reacting homologous pollen from birch, alder, and hazel trees – but has not yet been implemented in clinical guidelines. Methods: A subgroup of patients with AR (n = 69) who showed inconsistent SPT results among birch, alder, and hazel was investigated in detail. Beyond SPT, patient workup included assessment of clinical relevance and various serological parameters (total IgE, and specific IgE to birch, alder, and hazel and to Bet v 1, Bet v 2, and Bet v 4). Results: More than half the study group had negative SPT results for birch but positive results for alder and/or hazel, and 87% of the study group was polysensitized, showing at least one more positive SPT result for other plants. Whereas 30.4% of patients showed serological sensitization to birch pollen extract, only 18.8% displayed positive specific IgE to Bet v 1. Clinical assessment revealed that most patients with AR were polysensitized and had perennial symptoms or symptoms also occurring during times other than tree flowering times. If the SPT panel is limited to testing birch only, 52.2% of patients in this subgroup would have been overlooked. Conclusion: Inconsistent SPT results in the birch homologous group may result from cross-reacting allergens or technical errors. If patients report convincing clinical symptoms despite negative results from a reduced SPT panel or inconsistent results for homologous allergens, SPT should be repeated, and molecular markers should be added to achieve a correct diagnosis.

The measures taken to cope with the COVID-19 pandemic by governments worldwide have vast consequences on all areas of life. To assess the impact of the COVID-19 pandemic on long-term career development, we evaluated the work-family balance of medical doctors at nine German university clinics. The results indicate a severely disturbed work-family balance, which was mostly due to insufficient childcare, based on restrictions in school operations and childcare. Despite the newly created emergency childcare options, aiming to ensure the functioning of the “systematically important” professional groups, medical doctors feel that they are not sufficiently supported by the measures taken by local governments. Women, in particular, see their professional development at risk. Our results underline that proper and flexible childcare is essential for the career advancement of female medical doctors and is particularly important in times of crises such as the current COVID-19 pandemic. At university medicine clinics, increased work time flexibility and optimized schooling and childcare are needed to promote the career development of female as well as male medical doctors in the early stage of their careers.

Zusammenfassung: Hintergrund: Die Sensibilisierungsraten für Aeroallergene steigen weltweit. Die Prävalenz nimmt insbesondere in den westlichen Ländern zu. Ziel dieser Arbeit war es, (1) Sensibilisierungsraten und (2) Kreuzsensibilisierungsmuster in Haut‐Prick‐Tests (HPTs) für die wichtigsten Inhalationsallergene in Mitteldeutschland, angepasst an den regionalen Pollenflug, über 20 Jahre hinweg zu untersuchen.Patienten und Methodik: In dieser monozentrischen Studie wurden HPTs für Baumpollen, Gräserpollen und Hausstaubmilben (HDM) bei 4315 Patienten, darunter auch Kinder, mit Verdacht auf Atemwegsallergien von 1998–2017 ausgewertet.Ergebnisse: Die Sensibilisierungsraten für fast alle Aeroallergene zeigten einen signifikanten Anstieg über die Jahre, ohne relevante Veränderungen der regionalen Pollenzahlen. Die aktuellen Sensibilisierungsraten bei allen symptomatischen Patienten waren am höchsten für Gräser‐ (55,3 %) und Roggenpollen (59,6 %), wobei die HDM‐Sensibilisierung im Laufe der Zeit am stärksten zunahm (von 37,8 % auf aktuell 50,1 %). Ein geringer, aber konsistenter Anteil der Baumpollen‐sensibilisierten Patienten (3,6–7,8 %) zeigte jedoch isolierte positive HPTs auf Erlen‐ und/oder Haselpollen ohne Sensibilisierung auf Birkenpollen.Schlussfolgerungen: Wir zeigen einen signifikanten Anstieg der Gesamtzahl der sensibilisierten Patienten sowie eine Zunahme der Kreuzsensibilisierung gegen eng verwandte Allergene. Patienten mit ungewöhnlichen Monosensibilisierungsprofilen gegenüber häufigen Inhalationsallergenen müssen genauer untersucht werden, da diese Patienten derzeit von klinischen Studien zur Allergen‐Immuntherapie ausgeschlossen sind.