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Spezifische Immuntherapie bei der Behandlung der atopischen Dermatitis

Specific immunotherapy in the treatment of atopic dermatitis

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Zusammenfassung

Die atopische Dermatitis (AD) ist eine chronisch inflammatorische Hauterkrankung aus dem atopischen Formenkreis, die mit charakteristischen ekzematösen Läsionen einhergeht. Neben vielfältigen befundadaptierten lokalen und systemischen Therapiemöglichkeiten der AD spielt das Erkennen und nach Möglichkeit auch die konsequente Meidung von Provokationsfaktoren eine herausragende Rolle im Krankheitsmanagement. Aeroallergene wie Hausstaubmilben, Pollen und Tierepithelien stellen bei entsprechend sensibilisierten Patienten wichtige Provokationsfaktoren dar. Während die klinische Wirksamkeit einer spezifischen Immuntherapie (SIT) bei Patienten mit allergischer Rhinitis, Asthma bronchiale und Insektengiftallergie gut belegt ist, wird der Stellenwert dieser Therapie bei der AD kontrovers diskutiert. Inzwischen gibt es doppelblinde, placebokontrollierte klinische Studien, die eine gute Wirksamkeit der SIT bei Patienten mit AD und einer Sensibilisierung gegenüber Hausstaub und Gräserpollen zeigen, sodass die SIT in ausgewählten Fällen einen Behandlungsansatz darstellen kann. Bis die SIT jedoch als Behandlungsoption in der Routineversorgung von Patienten mit AD angesehen werden kann, sind weitere klinische Studien an größeren Patientenkollektiven erforderlich.

Abstract

Atopic dermatitis (AD) is a common chronic inflammatory skin disease that is part of the atopic syndrome and is frequently associated with asthma and allergic rhinoconjunctilitis. Acute eczematous lesions are characterized by erythema, cozing and crusting, whereas chronic lesions show thickend skin and papules. In addition to local and systemic therapy adjusted to the stage of the disease, the search for relevant trigger factors and consecutively their avoidance plays a crucial role in disease management. Aeroallergens like house-dust-mites, pollen and animal epithelia represent important trigger factors in sensitized patients. While allergen-specific immunotherapy (SIT) is widely and most effective used in allergy to insect venoms and allergic rhinitis, its use in AD is still controversial. Double-blind, placebo-controlled clinical trials show that SIT is effective in patients with AD and clinically relevant sensitization to house dust mites and grass pollen and leads to clinical improvement of eczema. Despite these encouraging data, the use of SIT as a routine therapeutic approach in AD requires further evaluation.

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  1. Klinik und Poliklinik für Dermatologie und Allergologie der Medizinischen Hochschule Hannover, Ricklinger Straße 5, 30449, Hannover, Deutschland

    M. Niebuhr, A. Kapp & T. Werfel

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  1. M. Niebuhr
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  2. A. Kapp
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  3. T. Werfel
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Correspondence to M. Niebuhr.

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Niebuhr, M., Kapp, A. & Werfel, T. Spezifische Immuntherapie bei der Behandlung der atopischen Dermatitis. Hautarzt 58, 232–236 (2007). https://doi.org/10.1007/s00105-006-1220-x

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