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Prophylaxe von Angioödemen

Angioedema prophylaxis

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Zusammenfassung

Das Angioödem ist eine spontan auftretende, ödematöse Schwellung der tieferen Schichten der Haut oder der Schleimhaut. Angioödeme im Bereich der Atemwege sind potenziell lebensbedrohlich. Die Zuordnung von Angioödemen in Mastzell-vermittelt (z. B. Urtikaria) oder Bradykinin-vermittelt (z. B. hereditäres Angioödem) ist wichtig für die richtige und rationale Behandlung. Grundsätzlich stehen dafür 2 therapeutische Strategien zur Verfügung: Zum einen die bedarfsweise Behandlung von bereits aufgetretenen Angioödemen mit dem Ziel, die Weiterentwicklung der Attacke zu beenden und damit die Schwere und Dauer der Attacke zu begrenzen. Diese Strategie ist in der Versorgung von Patienten mit hereditärem Angioödem fest verankert, bei der chronischen spontanen Urtikaria hingegen findet die Bedarfstherapie keine Anwendung. Demgegenüber hat die Strategie der Prophylaxe zum Ziel, das Auftreten von spontanen und induzierten Attacken möglichst zu verhindern. Die Prophylaxe ist alleinige Therapiestrategie bei der chronischen Urtikaria und zieht sich durch alle Stufen des Behandlungsalgorithmus. Beim hereditären Angioödem kann die Bedarfstherapie nach sorgfältiger und individueller Indikationsstellung durch eine Prophylaxe komplementiert werden. In dieser Indikation gewinnt sie aktuell durch verbesserte Behandlungsoptionen zunehmend an Bedeutung. Patienten, die ein prophylaktisches Regime anwenden, sind viel seltener gezwungen, auf das unvorhersehbare Auftreten einer Attacke zu warten und dann zu reagieren. Die prophylaktische Behandlung findet – im Gegensatz zur bedarfsweisen Therapie – zu von dem Patienten selbst bestimmten Zeiten statt. Der Wegfall der Unvorhersehbarkeit ist ein entscheidendes Moment der Lebensqualitätsverbesserung.

Abstract

Angioedema is a spontaneous, edematous swelling of the deep layers of the skin or mucous membrane. Angioedema in the respiratory tract is potentially life-threatening. The classification of angioedema into mast-cell-mediated (e. g. urticaria) or bradykinin-mediated (e. g. hereditary angioedema) is important for correct and rational treatment. Generally, two therapeutic strategies are available for angioedema treatment. On-demand treatment of angioedema symptoms that already have emerged aims to stop the further development of the attack and, thus, limits the severity and duration of the attack. This strategy is well established in the treatment of patients with hereditary angioedema, whereas in chronic spontaneous urticaria on-demand therapy plays no role in the guideline recommendations. In contrast, the therapeutic strategy of prophylaxis aims to prevent the occurrence of spontaneous and induced attacks as far as possible. Prophylaxis is the sole therapy strategy for chronic urticaria and is applied at all stages of the treatment algorithm. In the case of hereditary angioedema, on-demand therapy can be complemented by prophylaxis after careful and individual indication. In hereditary angioedema, prophylaxis is currently gaining in importance due to improved treatment options. Patients who use a prophylactic regime are much less likely to be forced to wait for the unpredictable occurrence of an attack and then to react with an on-demand treatment. Prophylactic treatment takes place at times determined by the patient himself, in contrast to treatment on an as-needed basis. The loss of unpredictability is a decisive moment in improving the quality of life.

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Correspondence to M. Magerl MD.

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V. Zampeli hat persönliche Honorare von Shire, CSL Behring und Pharming erhalten. M. Magerl hat persönliche Honorare und nichtfinanzielle Unterstützung von BioCryst, CSL Behring, KalVista, Pharming und Shire erhalten.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Zampeli, V., Magerl, M. Prophylaxe von Angioödemen. Hautarzt 70, 107–115 (2019). https://doi.org/10.1007/s00105-018-4345-9

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  • DOI: https://doi.org/10.1007/s00105-018-4345-9

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