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Spezifische Immuntherapie

Specific immunotherapy

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Zusammenfassung

Die subkutane Immuntherapie (SCIT) und sublinguale Immuntherapie (SLIT) sind zurzeit die einzigen routinemäßig verfügbaren Therapieoptionen, die allergische Erkrankungen nachhaltig beeinflussen können. Die dauerhafte Reduktion von Symptomen und der verminderte Bedarf an symptomatischer Medikation führen zu einer anhaltenden Verbesserung der Lebensqualität. Dennoch ist angesichts der relativ geringen Anwendungsquote eine Unterversorgung allergischer Patienten festzustellen. Nach adäquater Diagnostik sollte die Indikation zur spezifischen Immuntherapie (SIT) bei Patienten mit allergischer Rhinitis und eindeutig allergischem Asthma immer geprüft werden und ggf. als Standardtherapie angeboten werden. Aufgrund der derzeitigen Studienlage ist es nicht möglich, die Wirksamkeit der Extrakte unterschiedlicher Hersteller direkt zu vergleichen, auch der Vergleich der Wirksamkeit zwischen SLIT und SCIT ist nicht möglich. Prinzipiell sollten Präparate mit dokumentierter Wirksamkeit und Sicherheit vorgezogen werden. Für Allergene, die nach der aktuellen Therapie-Allergene-Verordnung zugelassen sind, ist die Wirksamkeit sicher belegt. Unabhängig von den Applikationsrouten müssen Bemühungen dahingehend verstärkt werden, Patienten über 3 Jahre in der Behandlung zu halten. Die SIT überzeugt auch sozioökonomisch gesehen bereits kurze Zeit nach Therapiebeginn.

Abstract

SCIT (subcutaneous immunotherapy) and SLIT (sublingual immunotherapy) are the only routinely available therapies, which modify allergic diseases sustainably. The ongoing reduction of symptoms and the lower need of symptomatic medication are able to improve the quality of life over a long period of time. However, allergic patients are underprovided due to low use of SIT (specific immunotherapy). After thorough diagnostic workup, the indication has to be checked carefully especially in patients with allergic rhinitis and allergic asthma, to insure that SIT is standard therapy. Allergen extracts are manufacturer-specific preparations, therefore their effects cannot be compared directly, just as SCIT and SLIT efficacy cannot be compared directly. In general, preparations with proven efficacy and safety profile should be preferred. Allergens listed in the TAV (Therapeutic Allergen Regulation) fulfill these requirements. However, it is important to ensure adherence for 3 years of therapy, independent of the route of application. SIT has proven socioeconomic benefit already after a short time of therapy.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. S. Grundmann erhielt Erstattung für Kongressgebühren von Bencard, ALK und Novartis. Reise- und Übernachtungskosten wurden erstattet von Bencard, ALK und Novartis. Sie bekam Honorare für die Vorbereitung von wissenschaftlichen Fortbildungsveranstaltungen von Novartis und ALK. P. Mosters erhielt Erstattung für Kongressgebühren von Allergopharma und Honorare für die Vorbereitung von wissenschaftlichen Fortbildungsveranstaltungen von Allergopharma. R. Brehler erhielt Honorare für Beratertätigkeiten von Allergopharma, Novartis und Stallergenes. Des Weiteren erhielt er Erstattung für Kongressgebühren von Allergopharma, Novartis und Stallergenes. Reise- und Übernachtungskosten wurden ihm erstattet von Allergopharma, Novartis, Stallergenes und ALK. Er bekam Honorare für die Vorbereitung von wissenschaftlichen Fortbildungsveranstaltungen von Allergopharma, Novartis, Stallergenes, Bencard und HAL. Für die Durchführung von klinischen Auftragsstudien erhielt er Honorare von Allergopharma, Novartis, Leti, HAL, Stallergenes und ALK (Annahme auf ein Drittmittelkonto der Klinik). Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Klinik und Poliklinik für Dermatologie, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland

    S.A. Grundmann, P. Mosters & R. Brehler

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  1. S.A. Grundmann
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Correspondence to S.A. Grundmann.

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Grundmann, S., Mosters, P. & Brehler, R. Spezifische Immuntherapie. Hautarzt 65, 633–647 (2014). https://doi.org/10.1007/s00105-014-2817-0

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