HNO

, Volume 53, Issue 12, pp 1099–1115 | Cite as

Diagnostik und Therapie der Insektengiftallergie

Eine wichtige Aufgabe auch für den allergologisch tätigen HNO-Arzt
  • O. Pfaar
  • L. Klimek
  • I. Hansen
  • B. A. Stuck
  • K. Hörmann
Weiterbildung · Zertifizierte Fortbildung

Zusammenfassung

Aufgrund der zunehmenden Häufigkeit von Bienen- und Wespengiftallergien (Hymenopterengiftallergien) und der potenziell lebensbedrohenden Reaktionen ist es auch für den allergologisch tätigen HNO-Arzt von großer Bedeutung, sich mit modernen Standards in Diagnostik und Therapie dieser allergischen Erkrankung auseinander zu setzen. In der Diagnostik sind Hauttests wie der Titrations-Prick-Test und die Bestimmung der spezifischen IgE-Antikörper im Serum von Bedeutung. Bei einer entsprechenden Anamnese sowie Testbefunden wird der Patient zunächst mit einem „Notfall-Set“ ausgestattet. Ferner ist die Indikation zur spezifischen Hyposensibilisierung (SIT) gegeben. Grundsätzlich lassen sich für die Steigerungsphase die Schnellhyposensibilisierung und die konventionelle Hyposensibilisierung unterscheiden, wobei als Initialtherapie die in der Klinik durchgeführte Schnellhyposensibilisierung (Rush-SIT) besonders geeignet scheint. Bei der richtig durchgeführten SIT finden sich nur selten systemische anaphylaktische Nebenwirkungen. Durch eine 3–5 Jahre lang durchgeführte SIT kann bei 90 bis nahezu 100% der Patienten ein vollständiger Schutz erreicht werden.

Schlüsselwörter

Insektengiftallergie Spezifische Immuntherapie Hyposensibilisierung Hauttest Schnellhyposensibilisierung 

Diagnosis and treatment of insect venom allergy

An important allergological problem also to be dealt with by the ear, nose and throat specialist

Abstract

The increasing incidence and the potentially life-threatening reactions to venom stings indicate the necessity for otolaryngologists to have a basic knowledge of the diagnosis and treatment of venom allergy. The diagnosis of insect venom allergy is based on the history, skin prick testing (ideally performed as a titration series), and in vitro analysis of specific IgE antibodies to venoms. An emergency medication kit should be prescribed for the patient in case of future venom stings, comprising an H1-blocking antihistamine, a steroid and an adrenaline pen for self-injection. Subcutaneous allergen-specific immunotherapy (sSIT) is the standard treatment to avoid allergic reactions following venom stings in the future. SIT is indicated following all immediate-type reactions to venom stings; contraindications relate to the general recommendations of allergen-specific immunotherapy. Aqueous as well as alum-adsorbed depot allergen preparations can be used for subcutaneous injections. The important dose-increase phase can be performed using conventional, cluster, rush or ultra-rush schedules. Specific immunotherapy is successful in nearly 90% to 100% of patients after 3–5 years of treatment.

Keywords

Venom allergy Specific immunotherapy Hyposensitization Skin prick test Rush schedule 

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Copyright information

© Springer Medizin Verlag 2005

Authors and Affiliations

  • O. Pfaar
    • 1
    • 2
    • 3
  • L. Klimek
    • 1
    • 2
  • I. Hansen
    • 1
  • B. A. Stuck
    • 2
  • K. Hörmann
    • 2
  1. 1.Zentrum für Rhinologie und Allergologie Wiesbaden
  2. 2.Universitäts-HNO-Klinik Mannheim
  3. 3.Zentrum für Rhinologie und AllergologieWiesbaden

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