Skip to main content
SpringerLink
Log in

Pharmakoprophylaxe und Begleitmedikation bei spezifischer Immuntherapie

Pharmacoprophylaxis and co-medications in allergen-specific immunotherapy

  • Leitthema
  • Published:
Der Hautarzt Aims and scope Submit manuscript

Zusammenfassung

In Bezug auf die in zeitlichem Zusammenhang zur allergenspezifischen Immuntherapie (SIT) angewendeten Arzneistoffe wird unterschieden zwischen einer Pharmakoprophylaxe, die die Vermeidung oder Abschwächung unerwünschter lokaler und systemischer Nebenwirkungen der SIT bezweckt, und zum anderen einer Begleitmedikation, die zur Behandlung anderer Erkrankungen angewendet wird. Was eine Pharmakoprophylaxe anbetrifft, so können H1-blockierende Antihistaminika lokale und leichte systemische, nicht jedoch bedeutsame systemische Nebenwirkungen der SIT reduzieren. Die Effektivität der SIT wird durch H1-Antihistaminika nicht abgeschwächt. Schwerere systemische Nebenwirkungen konnten in einzelnen Fällen durch eine Pharmakoprophylaxe mit Omalizumab verhindert werden; ein Einsatz unter den Modalitäten des Off-Label-Use ist derzeit nur bei Insektengift-SIT zu rechtfertigen. Eine SIT bei Begleitmedikation mit immunmodulierenden Arzneistoffen kann im Einzelfall erwogen werden, wenn deren Wirkungs- und Nebenwirkungsprofil gut bekannt sind und ein negativer Effekt auf die SIT nicht wahrscheinlich ist. Sehr kritisch wird dagegen die gleichzeitige Gabe von erst seit Kurzem zugelassenen Immunsuppressiva und Biologika aufgrund der derzeit noch nicht abschätzbaren immunologischen Effekte gesehen. Obwohl für kardioselektive β-Blocker keine Daten zu ungünstigen Effekten in Hinblick auf eine SIT vorliegen, müssen sie grundsätzlich aus forensischen Gründen abgesetzt werden. Falls ein Absetzen nicht vertretbar ist und eine Insektengift-SIT dringlich indiziert ist, darf diese unter Behandlung mit β-Blockern vorgenommen werden. ACE-Hemmer sollen bei Patienten mit Insektengiftallergie dagegen stets abgesetzt werden.

Abstract

Drugs that are used in relation to allergen-specific immunotherapy (SIT) can be separated into pharmacoprophylaxis to avoid or decrease local and systemic adverse effects of SIT and in co-medications to treat other diseases. Regarding pharmacoprophylaxis, H1-antihistamines are able to reduce local and mild systemic, but not severe systemic side effects of SIT. H1-antihistamines do not attenuate the efficacy of SIT. Severe systemic side effects have been blocked in some cases with omalizumab; currently this agent can be used off-label during venom SIT. With regard to co-medication, the concomitant use of immunomodulating drugs during SIT must be individualized, if the effective profile and side effects of the immunomodulating drug are well-known and a negative effect on SIT is not likely. Recently approved immunosuppressive drugs and biologics are perceived critically due to their unpredictable immunologic effects. For forensic reasons cardioselective beta blockers should be discontinued although no data are available demonstrating adverse effects. If discontinuation is not justified and venom SIT is indicated, SIT can be performed while taking beta blockers. In contrast, ACE-inhibitors should always be stopped in patients with insect venom allergy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Averbeck M, Gebhardt C, Renner R et al (2008) Omalizumab helps to induce tolerability in a patient with wasp venom allergy and repeated adverse reactions during specific immunotherapy. Allergy 63:509

    Article  Google Scholar 

  2. Berchtold E, Maibach R, Müller U (1992) Reduction of side effects from rush-immunotherapy with honeybee venom by pretreatment with terfenadine. Clin Exp Allergy 22:59–65

    Article  PubMed  CAS  Google Scholar 

  3. Brockow K, Kiehn M, Riethmuller C et al (1997) Efficacy of antihistamine pretreatment in the prevention of adverse reactions to Hymenoptera immunotherapy: a prospective, randomized, placebo-controlled trial. J Allergy Clin Immunol 100:458–463

    Article  PubMed  CAS  Google Scholar 

  4. Calderon MA, Alves B, Jacobson M et al (2007) Allergen injection immunotherapy for seasonal allergic rhinitis. Cochrane Database Syst Rev CD001936

  5. Casale TB, Busse WW, Kline JN et al (2006) Omalizumab pretreatment decreases acute reactions after rush immunotherapy for ragweed-induced seasonal allergic rhinitis. J Allergy Clin Immunol 117:134–140

    Article  PubMed  CAS  Google Scholar 

  6. Cox L, Platts-Mills TA, Finegold I et al (2007) American Academy of Allergy, Asthma & Immunology/American College of Allergy, Asthma and Immunology Joint Task Force Report on omalizumab-associated anaphylaxis. J Allergy Clin Immunol 120:1373–1377

    Article  PubMed  CAS  Google Scholar 

  7. Eiwegger T, Gruber S, Geiger C et al (2009) Impact of systemic immuno-suppression after solid organ transplantation on allergen-specific responses. Allergy 66:271–278

    Article  Google Scholar 

  8. Galera C, Soohun N, Zankar N et al (2009) Severe anaphylaxis to bee venom immunotherapy: efficacy of pretreatment and concurrent treatment with omalizumab. J Investig Allergol Clin Immunol 19:225–229

    PubMed  CAS  Google Scholar 

  9. Golden DB, Moffitt J, Nicklas RA et al (2011) Stinging insect hypersensitivity: a practice parameter update 2011. J Allergy Clin Immunol 127:852–854

    Article  PubMed  Google Scholar 

  10. Hejjaoui A, Ferrando R, Dhivert H et al (1992) Systemic reactions occurring during immunotherapy with standardized pollen extracts. J Allergy Clin Immunol 89:925–933

    Article  PubMed  CAS  Google Scholar 

  11. Johansen P, Senti G, Martinez Gomez JM, Kündig TM (2007) Medication with antihistamines impairs allergen-specific immunotherapy in mice. Clin Exp Allergy 38:512–519

    Article  PubMed  Google Scholar 

  12. Kleine-Tebbe J, Bufe A, Ebner C et al (2009) Die spezifische Immuntherapie (Hyposensibilisierung) bei IgE-vermittelten allergischen Erkrankungen. Allergo J 18:508–537

    Google Scholar 

  13. Klunker S, Saggar LR, Seyfert-Margolis V et al (2007) Combination treatment with omalizumab and rush immunotherapy for ragweed-induced allergic rhinitis: Inhibition of IgE-facilitated allergen binding. J Allergy Clin Immunol 120:688–695

    Article  PubMed  CAS  Google Scholar 

  14. Koberlein J, Kothe AC, Schaffert C (2011) Determinants of patient compliance in allergic rhinoconjunctivitis. Curr Opin Allergy Clin Immunol 11:192–199

    Article  PubMed  Google Scholar 

  15. Kontou-Fili K (2008) High omalizumab dose controls recurrent reactions to venom immunotherapy in indolent systemic mastocytosis. Allergy 63:376–378

    Article  PubMed  CAS  Google Scholar 

  16. Kopp MV, Brauburger J, Riedinger F et al (2002) The effect of anti-IgE treatment on in vitro leukotriene release in children with seasonal allergic rhinitis. J Allergy Clin Immunol 110:728–735

    Article  PubMed  CAS  Google Scholar 

  17. Kopp MV, Stenglein S, Kamin W et al (2007) Omalizumab (Xolair) in children with seasonal allergic rhinitis: leukotriene release as a potential in vitro parameter to monitor therapeutic effects. Pediatr Allergy Immunol 18:523–527

    Article  PubMed  Google Scholar 

  18. Koschel D, Hoeffken G (2008) Hymenoptera venom immunotherapy and autoimmune diseases. Allergy 63(Suppl 88):81

    Article  Google Scholar 

  19. Kuehr J, Brauburger J, Zielen S et al (2002) Efficacy of combination treatment with anti-IgE plus specific immunotherapy in polysensitized children and adolescents with seasonal allergic rhinitis. J Allergy Clin Immunol 109:274–280

    Article  PubMed  CAS  Google Scholar 

  20. Lang DM, Alpern MB, Visintainer PF, Smith ST (1993) Elevated risk of anaphylactoid reaction from radiographic contrast media is associated with both beta-blocker exposure and cardiovascular disorders. Arch Intern Med 153:2033–2040

    Article  PubMed  CAS  Google Scholar 

  21. Massanari M, Nelson H, Casale T et al (2010) Effect of pretreatment with omalizumab on the tolerability of specific immunotherapy in allergic asthma. J Allergy Clin Immunol 125:383–389

    Article  PubMed  CAS  Google Scholar 

  22. Müller UR, Haeberli G (2005) Use of beta-blockers during immunotherapy for Hymenoptera venom allergy. J Allergy Clin Immunol 115:606–610

    Article  PubMed  Google Scholar 

  23. Müller U, Hari Y, Berchtold E (2001) Premedication with antihistamines may enhance efficacy of specific-allergen immunotherapy. J Allergy Clin Immunol 107:81–86

    Article  PubMed  Google Scholar 

  24. Müller UR, Jutel M, Reimers A et al (2008) Clinical and immunologic effects of H1 antihistamine preventive medication during honeybee venom immunotherapy. J Allergy Clin Immunol 122:1001–1007

    Article  PubMed  Google Scholar 

  25. Nielsen L, Johnsen CR, Mosbech H et al (1996) Antihistamine premedication in specific cluster immunotherapy: a double-blind, placebo-controlled study. J Allergy Clin Immunol 97:1207–1213

    Article  PubMed  CAS  Google Scholar 

  26. Ohashi Y, Nakai Y, Murata K (2006) Effect of pretreatment with fexofenadine on the safety of immunotherapy in patients with allergic rhinitis. Ann Allergy Asthma Immunol 96:600–605

    Article  PubMed  Google Scholar 

  27. Portnoy J, Bagstad K, Kanarek H et al (1994) Premedication reduces the incidence of systemic reactions during inhalant rush immunotherapy with mixtures of allergenic extracts. Allergy 73:409–418

    CAS  Google Scholar 

  28. Przybilla B, Ruëff F, Walker A et al (2011) Diagnose und Therapie der Bienen- und Wespengiftallergie. Allergo J (im Druck)

  29. Reimers A, Hari Y, Müller U (2000) Reduction of side-effects from ultrarush immunotherapy with honeybee venom by pretreatment with fexofenadine: a double-blind placebo-controlled trial. Allergy 55:484–488

    Article  PubMed  CAS  Google Scholar 

  30. Rerinck HC, Rueff F, Przybilla B (2008) Recurrent severe anaphylactic reactions to venom immunotherapy (VIT): omalizumab induces tolerance. J Allergy Clin Immunol 121:129

    Article  Google Scholar 

  31. Rolinck-Werninghaus C, Hamelmann E, Keil T et al (2004) The co-seasonal application of anti-IgE after preseasonal specific immunotherapy decreases ocular and nasal symptom scores and rescue medication use in grass pollen allergic children. Allergy 59:973–979

    Article  PubMed  CAS  Google Scholar 

  32. Ruëff F, Przybilla B, Biló M-B et al (2009) Predictors of severe systemic anaphylactic reactions in Hymenoptera venom allergy: the importance of baseline serum tryptase concentration and concurrent clinical variables. J Allergy Clin Immunol 124:1047–1054

    Article  PubMed  Google Scholar 

  33. Ruëff F, Räwer H-C, Eben R, Przybilla B (2009) Management von Nebenwirkungen bei subkutaner Hyposensibilisierung. Allergo J 18:618–624

    Google Scholar 

  34. Ruëff F, Przybilla B, Biló M-B et al (2010) Predictors of side effects during the build-up phase of venom immunotherapy for Hymenoptera venom allergy: the importance of baseline serum tryptase. J Allergy Clin Immunol 126:105–111

    Article  PubMed  Google Scholar 

  35. Schulze J, Rose M, Zielen S (2007) Beekeepers anaphylaxis: successful immunotherapy covered by omalizumab. Allergy 62:963–964

    Article  PubMed  CAS  Google Scholar 

  36. Soriano GV, Gonzalez DP, Niveiro HE (2008) Failure of omalizumab treatment after recurrent systemic reactions to bee-venom immunotherapy. J Investig Allergol Clin Immunol 18:225–226

    Google Scholar 

  37. Suzuki Y, Ra C (2009) Analysis of the mechanism for the development of allergic skin inflammation and the application for its treatment: aspirin modulation of IgE-dependent mast cell activation: role of aspirin-induced exacerbation of immediate allergy. J Pharmacol Sci 110:237–244

    Article  PubMed  CAS  Google Scholar 

  38. Tunon-Lara JM de, Villanueva P, Marcos M, Taytard A (1992) ACE inhibitors and anaphylactoid reactions during venom immunotherapy. Lancet 340:908

    Article  Google Scholar 

  39. Wantke MD, Demmer CC, Götz M, Jarisch R (1993) Reduction of side effects of specific immunotherapy. J Allergy Clin Immunol 92:497–498

    Article  PubMed  CAS  Google Scholar 

  40. Wedi B, Wieczorek D, Raap U, Kapp A (2008) Anti-IgE treatment overcomes intolerability of honeybee-venom ultra-rush immunotherapy in indolent systemic mastocytosis. In: Holgate ST, Marone G, Ring J (Hrsg) Cellular and molecular targets in allergy and clinical immunology. Hogrefe, Göttingen, S 182–183

  41. White KM, England RW (2008) Safety of angiotensin-converting enzyme inhibitors while receiving venom immunotherapy. Ann Allergy Asthma Immunol 101:426–430

    Article  PubMed  Google Scholar 

  42. Wieczorek D, Kapp A, Wedi B (2005) Omalizumab ermöglicht Einleitung einer Hyposensibilisierungsbehandlung mit Bienengift bei Risikopatient mit erhöhter Serumtryptase. Allergo J 14:515

    Google Scholar 

  43. Wöhrl S, Gamper S, Hemmer W et al (2007) Premedication with montelukast reduces local reactions of allergen immunotherapy. Int Arch Allergy Immunol 144:137–142

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover, Ricklinger Str. 5, 30449, Hannover, Deutschland

    B. Wedi

  2. AllergieZentrum, Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität, München, Deutschland

    F. Ruëff

Authors
  1. B. Wedi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Ruëff
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. Wedi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wedi, B., Ruëff, F. Pharmakoprophylaxe und Begleitmedikation bei spezifischer Immuntherapie. Hautarzt 62, 663–670 (2011). https://doi.org/10.1007/s00105-011-2157-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00105-011-2157-2

Schlüsselwörter

Keywords

Search

Navigation