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Spezifische Immuntherapie (SIT) bei atopischer Dermatitis und Nahrungsmittelallergie

Specific immunotherapy (SIT) in atopic dermatitis and food allergy

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Zusammenfassung

Die atopische Dermatitis (AD) ist eine der häufigsten chronisch entzündlichen Hauterkrankungen mit zunehmender Prävalenz. Ungefähr 80% der erwachsenen Patienten mit AD haben Sensibilisierungen gegenüber saisonalen sowie perennialen Aeroallergenen und/oder Lebensmittelallergenen, die als Provokationsfaktoren für die Entstehung und Unterhaltung von Ekzemen dienen können. Neben vielfältigen befundadaptierten lokalen und systemischen Therapiemöglichkeiten der AD spielen das Erkennen und nach Möglichkeit auch die konsequente Meidung dieser Provokationsfaktoren eine herausragende Rolle im Krankheitsmanagement. Während die klinische Wirksamkeit einer SIT bei Patienten mit allergischer Rhinitis, Asthma bronchiale und Insektengiftallergie gut belegt ist, wird der Stellenwert dieser Therapie bei der AD nach wie vor kontrovers diskutiert. Inzwischen gibt es doppelblinde, placebokontrollierte klinische Studien, die eine gute Wirksamkeit der SIT bei Patienten mit AD zeigen. Bei der Nahrungsmittelallergie gibt es erste kasuistische Hinweise und klinische Studien mit kleinen Patientenzahlen für die Wirksamkeit einer SIT sowohl mit den Nahrungsmitteln selbst als auch mit kreuzreaktiven Aeroallergenen. Auch hier sind doppelblinde, placebokontrollierte Studien an größeren Patientenkollektiven notwendig, um die klinische Wirksamkeit und immunologische Wirkmechanismen der SIT bei Nahrungsmittelallergie näher zu untersuchen.

Abstract

Atopic dermatitis (AD) is one of the most frequent chronic inflammatory skin diseases with an increasing prevalence. About 80% of adult AD patients are sensitized against seasonal or perennial aeroallergens and/or food allergens which may play a pivotal role in triggering or maintaining eczema. In addition to local and systemic therapy adjusted to the stage of the disease, the search for relevant trigger factors and then their avoidance plays a crucial role in managing AD. While the effectiveness of SIT is best established in allergic rhinitis, bronchial asthma and insect venom allergy, its use in AD is still controversial. Double-blind, placebo-controlled clinical studies are now available showing good efficacy of SIT in patients with AD. For food allergies there are clues from case reports and small clinical studies suggesting effectiveness of SIT both for food allergies and associated aeroallergens. Double-blind, placebo-controlled studies involving larger numbers of patients are needed to establish the clinical effectiveness and immunologic mechanisms of SIT in food allergies.

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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 (SIT) bei atopischer Dermatitis und Nahrungsmittelallergie. Hautarzt 59, 544–550 (2008). https://doi.org/10.1007/s00105-008-1490-6

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