Skip to main content

Allergische Rhinitis

Immunologische und neurogene Mechanismen

Allergic rhinitis

Immunological and neurogenic mechanisms

HNO volume 59, pages 1191–1197 (2011)Cite this article

Zusammenfassung

Die allergische Rhinitis ist eine der häufigsten Erkrankungen der Menschheit. Wichtig ist, dass es sich hierbei um eine immunologische Erkrankung handelt, die mit weitreichenden Veränderungen in den Atemwegsschleimhäuten verbunden ist. Zu den Kardinalsymptomen der Rhinitis allergica zählen die nasale Obstruktion, die Rhinorrhö sowie Juckreiz und Niesreiz. Die hierzu führenden Mechanismen sind sehr komplex und beinhalten die Aktivierung und Einwanderung von Entzündungszellen, Weitstellung von Gefäßen, Steigerung und Änderung der Drüsentätigkeit, Aktivierung von Nervenendigungen, Auslösung einer neurogenen Entzündung und morphologisch nachweisbare Umbauvorgänge der Schleimhaut – letztlich auch eine systemische Aktivierung von Immunprozessen. All dies macht deutlich, dass die allergische Rhinitis eine ernstzunehmende und frühzeitig und konsequent zu behandelnde Erkrankung darstellt, die bislang – wohl nicht zuletzt aufgrund ihrer großen Häufigkeit – allzu oft unberechtigterweise bagatellisiert wird.

Abstract

Allergic rhinitis is one of the most common diseases to affect humans. It is important to note that it is an immunological disease which is associated with significant changes in the mucous membrane of the respiratory tract. Clinical symptoms of allergic rhinitis include sneezing, rhinorrhea, nasal itching, and nasal congestion. The mechanism underlying the development of symptoms associated with allergic rhinitis are complex, including activation and infiltration of inflammatory cells, edema, increased and altered gland activity, nerve terminal activation, triggering of neurogenic inflammation and morphologically detectable remodelling processes in the mucous membrane. Finally, a systematic activation of immune processes also takes place. Thus, allergic rhinitis is clearly a serious disease requiring prompt and effective treatment; moreover, it has been unjustly trivialized to date, not least because of its high incidence.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Abb. 1
Abb. 2

Literatur

  1. Leitlinie der DGAI zur Behandlung der allergsichen Rhinokonjunktivitis (2003) Interdisziplinäre Arbeitsgruppe „Allergische Rhinitis“ der Sektion HNO der DGAI. Allergo J 12:182–194

    Google Scholar 

  2. Ader R, Cohen N, Felten D (1995) Psychoneuroimmunology: interactions between the nervous system and the immune system. Lancet 345:99–103

    PubMed  Article  CAS  Google Scholar 

  3. Bachert C, Hormann K, Mosges R et al (2003) An update on the diagnosis and treatment of sinusitis and nasal polyposis. Allergy 58:176–191

    PubMed  Article  CAS  Google Scholar 

  4. Barnes PJ (1986) Neural control of human airways in health and disease. Am Rev Respir Dis 134:1289–1314

    PubMed  CAS  Google Scholar 

  5. Bevilacqua MP (1993) Endothelial-leukocyte adhesion molecules. Annu Rev Immunol 11:767–804

    PubMed  Article  CAS  Google Scholar 

  6. Bousquet J, Chanez P, Campbell AM, Vignola AM (1997) Cellular inflammation in asthma. Arb Paul Ehrlich Inst Bundesamt Sera Impfstoffe Frankf A M 1997(91):22–28

    Google Scholar 

  7. Brozek JL, Bousquet J, Baena-Cagnani CE et al (2010) Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol 126(3):466–476

    PubMed  Article  Google Scholar 

  8. Church MK, el-Lati S, Caulfield JP (1991) Neuropeptide-induced secretion from human skin mast cells. Int Arch Allergy Appl Immunol 94:310–318

    PubMed  Article  CAS  Google Scholar 

  9. Ciprandi G, Buscaglia S, Pesce G, et al (1995) Minimal persistent inflammation is present at mucosal level in patients with asymptomatic rhinitis and mite allergy. J Allergy Clin Immunol 96:971–979

    PubMed  Article  CAS  Google Scholar 

  10. Connell JT (1969) Quantitative intranasal pollen challenges. 3. The priming effect in allergic rhinitis. J Allergy 43:33–44

    PubMed  Article  CAS  Google Scholar 

  11. Coombs RR, Gell PGH (1963) The classification of allergic reactions underlying disease. Clin Aspects Immunol 317

  12. Corey JP, Adham RE, Abbass AH, Seligman I (1994) The role of IgE-mediated hypersensitivity in otitis media with effusion. Am J Otolaryngol 15:138–144

    PubMed  Article  CAS  Google Scholar 

  13. Craig TJ, Teets S, Lehman EB et al (1998) Nasal congestion secondary to allergic rhinitis as a cause of sleep disturbance and daytime fatigue and the response to topical nasal corticosteroids. J Allergy Clin Immunol 101:633–637

    PubMed  Article  CAS  Google Scholar 

  14. Cross SA (1994) Pathophysiology of pain. Mayo Clin Proc 69:375–383

    PubMed  CAS  Google Scholar 

  15. Enk AH, Katz SI (1992) Identification and induction of keratinocyte-derived IL-10. J Immunol 149:92–95

    PubMed  CAS  Google Scholar 

  16. Felten DL (1991) Neurotransmitter signaling of cells of the immune system: important progress, major gaps. Brain Behav Immun 5:2–8

    PubMed  Article  CAS  Google Scholar 

  17. Girard JP, Springer TA (1995) High endothelial venules (HEVs): specialized endothelium for lymphocyte migration. Immunol Today 16:449–57

    PubMed  Article  CAS  Google Scholar 

  18. Gleich GJ (2000) Mechanisms of eosinophil-associated inflammation. J Allergy Clin Immunol 105:651–663

    PubMed  Article  CAS  Google Scholar 

  19. Doerfler H, Hummel T, Klimek L, Kobal G (2006) Intranasal trigeminal sensitivity in subjects with allergic rhinitis. Eur Arch Otorhinolaryngol 263:86–90

    PubMed  Article  CAS  Google Scholar 

  20. Johansson SG, Hourihane JO, Bousquet J et al (2001) A revised nomenclature for allergy. An EAACI position statement from the EAACI nomenclature task force. Allergy 56:813–24

    PubMed  Article  CAS  Google Scholar 

  21. Johnson JG, Jenkins MK (1992) Co-stimulatory functions of antigen-presenting cells. J Invest Dermatol 99:62S–65S

    PubMed  Article  CAS  Google Scholar 

  22. Jones HE, Inouye JC, McGerity JL, Lewis CW (1975) Atopic disease and serum immunoglobulin-E. Br J Dermatol 92:17–25

    PubMed  Article  CAS  Google Scholar 

  23. Kashiba H, Fukui H, Morikawa Y, Senba E (1999) Gene expression of histamine H1 receptor in guinea pig primary sensory neurons: a relationship between H1 receptor mRNA-expressing neurons and peptidergic neurons. Brain Res Mol Brain Res 66:24–34

    PubMed  Article  CAS  Google Scholar 

  24. Kay AB, Ying S, Varney V et al (1991) Messenger RNA expression of the cytokine gene cluster, interleukin 3 (IL-3), IL-4, IL-5, and granulocyte/macrophage colony-stimulating factor, in allergen-induced late-phase cutaneous reactions in atopic subjects. J Exp Med 173:775–778

    PubMed  Article  CAS  Google Scholar 

  25. Klimek L, Reichenbach M, Mewes T, Mann W (1997) Untersuchungen zur Reproduzierbarkeit und jahreszeitlichen Abhängigkeit von spezifischen intranasalen Provokationstests bei Birkenpollenallergikern. Laryngorhinootologie 76:475–479

    PubMed  Article  CAS  Google Scholar 

  26. Klimek L, Schäfer D (1996) Wirkungen von Substanz-P an der Nasenschleimhaut. Allergologie 19:524

    Google Scholar 

  27. Kobal G, Hummel T (1991) Schmerzmessung nach Reizung der Nasenschleimhaut mit Kohlendioxid. Eur J Pain 12: 31-38

    Google Scholar 

  28. Kripke ML, Munn CG, Jeevan A et al (1990) Evidence that cutaneous antigen-presenting cells migrate to regional lymph nodes during contact sensitization. J Immunol 145:2833–2838

    PubMed  CAS  Google Scholar 

  29. Kummer W, Fischer A (1991) Tissue distribution of neutral endopeptidase 24.11 (‚enkephalinase‘) activity in guinea pig trachea. Neuropeptides 18:181–186

    PubMed  Article  CAS  Google Scholar 

  30. Kunkel G, Klimek L (2005) Die neurogene Entzündungsreaktion bei allergischen Erkrankungen. In: Saloga J, Klimek L, Buhl J (Hrsg) Handbuch der Allergologie. Schattauer, Stuttgart

  31. Lack G (2001) Pediatric allergic rhinitis and comorbid disorders. J Allergy Clin Immunol 108:S9–S15

    PubMed  Article  CAS  Google Scholar 

  32. Leynaert B, Bousquet J, Neukirch C et al (1999) Perennial rhinitis: An independent risk factor for asthma in nonatopic subjects: results from the European Community Respiratory Health Survey. J Allergy Clin Immunol 104:301–304

    PubMed  Article  CAS  Google Scholar 

  33. Lundblad L, Lundberg JM, Brodin E, Anggard A (1983) Origin and distribution of capsaicin-sensitive substance P-immunoreactive nerves in the nasal mucosa. Acta Otolaryngol 96:485–493

    PubMed  Article  CAS  Google Scholar 

  34. Maggi E, Parronchi P, Manetti R et al (1992) Reciprocal regulatory effects of IFN-gamma and IL-4 on the in vitro development of human Th1 and Th2 clones. J Immunol 148:2142–2147

    PubMed  CAS  Google Scholar 

  35. McColley SA, Carroll JL, Curtis S et al (1997) High prevalence of allergic sensitization in children with habitual snoring and obstructive sleep apnea. Chest 111:170–173

    PubMed  Article  CAS  Google Scholar 

  36. McGillis JP, Organist ML, Payan DG (1987) Substance P and immunoregulation. Fed Proc 46:196–199

    PubMed  CAS  Google Scholar 

  37. Modlin RL (1994) Th1-Th2 paradigm: insights from leprosy. J Invest Dermatol 102:828–832

    PubMed  Article  CAS  Google Scholar 

  38. Mosmann TR, Cherwinski H, Bond MW et al (2005) Two types of murine helper T cell clone. I. Definition according to profiles of lymphokine activities and secreted proteins. 1986. J Immunol 175:5–14

    PubMed  CAS  Google Scholar 

  39. Pariente PD, LePen C, Los F, Bousquet J (1997) Quality-of-life outcomes and the use of antihistamines in a French national population-based sample of patients with perennial rhinitis. Pharmacoeconomics 12:585–595

    PubMed  Article  CAS  Google Scholar 

  40. Philip G, Baroody FM, Proud D et al (1994) The human nasal response to capsaicin. J Allergy Clin Immunol 94:1035–1045

    PubMed  Article  CAS  Google Scholar 

  41. Picker LJ (1994) Control of lymphocyte homing. Curr Opin Immunol 6:394–406

    PubMed  Article  CAS  Google Scholar 

  42. Price DD (1972) Characteristics of second pain and flexion reflexes indicative of prolonged central summation. Exp Neurol 37:371–387

    PubMed  Article  CAS  Google Scholar 

  43. Ring J, Bachert C, Bauer CP, Czech W (2010) Weißbuch: Allergie in Deutschland 2010. Urban & Vogel, München

  44. Schartz L, Huff T (1993) Biology of mast cells and Basophils. In: Middleton EJ, Reed CE, Ellis EF (Hrsg) Allergy, principles and practice, 4. Aufl. Mosby-Year-Book, St. Louis

  45. Schleimer RP, Sterbinsky SA, Kaiser J et al (1992) IL-4 induces adherence of human eosinophils and basophils but not neutrophils to endothelium. Association with expression of VCAM-1. J Immunol 148:1086–1092

    PubMed  CAS  Google Scholar 

  46. Statistisches Bundesamt (2000) Gesundheitsbericht für Deutschland. Spezialbericht Allergien. Metzler-Poeschel, Stuttgart

  47. Takeda N, Kalubi B, Abe Y et al (1993) Neurogenic inflammation in nasal allergy: histochemical and pharmacological studies in guinea pigs. A review. Acta Otolaryngol Suppl 501:21–24

    PubMed  Article  CAS  Google Scholar 

  48. Torebjork HE, Hallin RG (1973) Perceptual changes accompanying controlled preferential blocking of A and C fibre responses in intact human skin nerves. Exp Brain Res 16:321–332

    PubMed  Article  CAS  Google Scholar 

  49. Uddman R, Malm L, Sundler F (1983) Substance-P-containing nerve fibers in the nasal mucosa. Arch Otorhinolaryngol 238:9–16

    PubMed  Article  CAS  Google Scholar 

  50. Reijsen FC van, Bruijnzeel-Koomen CA, Kalthoff FS et al (1992) Skin-derived aeroallergen-specific T-cell clones of Th2 phenotype in patients with atopic dermatitis. J Allergy Clin Immunol 90:184–193

    PubMed  Article  Google Scholar 

  51. Vercelli D (1993) Regulation of IgE synthesis. Allergy Proc 14:413–416

    PubMed  Article  CAS  Google Scholar 

  52. Vuurman EF, Veggel LM van, Uiterwijk MM et al (1993) Seasonal allergic rhinitis and antihistamine effects on children’s learning. Ann Allergy 71:121–126

    PubMed  CAS  Google Scholar 

  53. Wang JM, Rambaldi A, Biondi A et al (1989) Recombinant human interleukin 5 is a selective eosinophil chemoattractant. Eur J Immunol 19:701–705

    PubMed  Article  CAS  Google Scholar 

  54. Wardlaw AJ, Moqbel R, Cromwell O, Kay AB (1986) Platelet-activating factor. A potent chemotactic and chemokinetic factor for human eosinophils. J Clin Invest 78:1701–1706

    PubMed  Article  CAS  Google Scholar 

  55. Widdicombe JG (1990) Nasal pathophysiology. Respir Med 84(Suppl A):3–9

    PubMed  Article  Google Scholar 

  56. Wright AL, Holberg CJ, Martinez FD et al (1994) Epidemiology of physician-diagnosed allergic rhinitis in childhood. Pediatrics 94:895–901

    PubMed  CAS  Google Scholar 

  57. Wright RJ, Cohen RT, Cohen S (2005) The impact of stress on the development and expression of atopy. Curr Opin Allergy Clin Immunol 5:23–29

    PubMed  Article  Google Scholar 

  58. Yosipovitch G, Greaves MW, Schmelz M (2003) Itch. Lancet 361:690–694

    PubMed  Article  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Affiliations

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

    L. Klimek & O. Pfaar

Authors
  1. L. Klimek
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. O. Pfaar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L. Klimek.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Klimek, L., Pfaar, O. Allergische Rhinitis. HNO 59, 1191–1197 (2011). https://doi.org/10.1007/s00106-011-2294-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00106-011-2294-z

Stichwörter

  • Allergische Rhinitis
  • Immunologie
  • T-Zellen
  • Persistierende Entzündung
  • Neurogene Entzündung

Keywords

  • Allergic rhinitis
  • Immunology
  • T-cells
  • Persistent inflammation
  • Neurogenic inflammation