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Cluster-Immuntherapie bei allergischer Rhinokonjunktivitis

Übersicht über ein neues Therapiekonzept

Cluster immunotherapy in allergic rhinoconjunctivitis

Review of a new therapeutic approach

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Zusammenfassung

Bei Patienten mit allergischer Rhinokonjunktivitis ist neben Karenzmaßnahmen die Hyposensibilisierungstherapie oder spezifische Immuntherapie (SIT) die einzige kausale Behandlungsmöglichkeit. Die Wirksamkeit der Therapie ist umfangreich belegt und abhängig vom spezifischen Allergen, der Qualität und Gesamtdosis der verabreichten Allergenextrakte und dem Applikationsschema. Bei der konventionellen SIT wird ein Allergenextrakt repetitiv in ansteigenden Dosen subkutan injiziert (Dosissteigerungsphase), bis eine individuelle Maximaldosis erreicht ist (Beginn der Erhaltungsphase). Es existieren unterschiedliche Therapieschemata für die subkutane SIT. Bei der Cluster-Therapie werden während der Dosissteigerung 2–3 Injektionen je Behandlungstag in wöchentlichen Abständen verabreicht, wodurch das rasche Erreichen der Maximaldosis gewährleistet wird. Verschiedene Cluster-Protokolle sind in der Literatur beschrieben. Zusammenfassend zeigen die Daten der Cluster-Studien, dass Art und Anzahl der unerwünschten Reaktionen den konventionellen Schemata entsprechen. Unter Sicherheitsaspekten könnte daher die Cluster-SIT zu einer interessanten Alternative herkömmlicher Therapieschemata für die Dosissteigerungsphase werden. Neuere Studien der schnellen Cluster-Aufdosierung belegen zudem, dass eine klinische Wirksamkeit rascher eintritt als bei der konventionellen Therapie.

Abstract

Apart from allergen avoidance, specific immunotherapy (SIT) represents the only potentially curative treatment available to patients with allergic rhinoconjunctivitis. Evidence for its clinical efficacy has been clearly demonstrated in several controlled clinical trials and depends on the allergen to which the patient is sensitive, the quality and total amount of allergen administered, and the SIT schedule. In classic SIT, gradually ascending dosages of the allergen extract are injected subcutaneously (dose-increase period) until the individual maximum dose is reached (dose-maintenance period). Several dosage schedules have been worked out. In cluster immunotherapy, 2–3 injections per day of treatment are given once a week to rapidly reach the maintenance dose. Several cluster schedules have been described. Recent data demonstrate that the frequency and severity of adverse effects in cluster immunotherapy correspond to those in other dosage schedules. As far as safety goes, cluster immunotherapy is an interesting alternative for the dose-increase period. In addition, recent studies reveal that clinical benefits appear sooner with cluster immunotherapy.

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Authors and Affiliations

  1. Zentrum für Rhinologie und Allergologie, Wiesbaden

    L. Klimek

  2. Zentrum für Rhinologie und Allergologie, An den Quellen 10, 65183 , Wiesbaden

    O. Pfaar

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  1. O. Pfaar
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  2. L. Klimek
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Correspondence to O. Pfaar.

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Pfaar, O., Klimek, L. Cluster-Immuntherapie bei allergischer Rhinokonjunktivitis. Hautarzt 57, 875–880 (2006). https://doi.org/10.1007/s00105-006-1205-9

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