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Adaptive Desaktivierung bei ASS‑Hypersensitivität

Eine Erfolgsgeschichte?

Adaptive desensitization for acetylsalicylic acid hypersensitivity

A success story?

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Zusammenfassung

Hintergrund

Die adaptive Desaktivierung stellt noch immer die einzige kausale Therapie der Acetylsalicylsäure(ASS)-Hypersensitivität dar und wird nahezu weltweit durchgeführt. Bislang existieren jedoch kaum Daten zur Krankheitsentwicklung unter laufender Desaktivierungstherapie, insbesondere Langzeitdaten fehlen.

Studiendesign

Aus einem großen Patientenkollektiv mit nachgewiesener Hypersensitivität gegenüber ASS wurden 194 Patienten mit initiierter Desaktivierungstherapie über bis zu 5 Jahre (Mittelwert, MW: 32 Monate) nachbeobachtet.

Ergebnisse

Patienten mit einer Sofortreaktion in der systemischen Provokationsprüfung zeigten nach einem Jahr der Therapie Ansprechraten von 77 %. Im Beobachtungszeitraum wurde bei 12 % eine komplette Remission erreicht, bei 38 % zeigte sich eine deutlich rückläufige Symptomatik, in 32 % fand sich eine partielle Verbesserung, während 13 % unter persistierender und 5 % unter progredienter Symptomatik litten.

Schlussfolgerung

Die adaptive Desaktivierung stellt eine sehr effektive kausale Therapie zur Verbesserung sowohl der chronisch-hyperplastischen Sinusitis als auch des Asthma bronchiale dar. Zur Festlegung und Anpassung der Therapiedosierungen sowie zur Anwendungsdauer sollten weitere Daten gewonnen werden.

Abstract

Background

Adaptive desensitization still remains the only causative therapy for acetylsalicylic acid (ASA) hypersensitivity and is carried out nearly worldwide. To date there are hardly any data available on disease development under current desensitization therapy and longitudinal data in particular are missing.

Study design

Out of a large collective of patients with proven hypersensitivity to ASA, 194 patients with initiated desensitization treatment were observed for periods up to 5 years (average 32 months).

Results

Patients with immediate reactions to systemic challenge tests revealed a response rate of 77 % after 12 months of therapy. In this period 12 % reached complete remission, 38 % showed a clear reduction in symptoms, 32 % reached partial remission, 13 % remained unchanged and 5 % suffered from disease progression.

Conclusion

Adaptive desensitization therapy for hypersensitivity to ASA has been shown to be an effective causative therapy and chronic hyperplastic sinusitis as well as bronchial asthma could be improved. For the determination of maintenance dosages and required time periods more data are needed.

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Authors and Affiliations

  1. Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland

    G. Mühlmeier, R. Hausch & H. Maier

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  1. G. Mühlmeier
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  2. R. Hausch
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  3. H. Maier
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Correspondence to G. Mühlmeier.

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Interessenkonflikt

G. Mühlmeier, R. Hausch und H. Maier geben an, dass kein Interessenkonflikt besteht.

Alle beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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Mühlmeier, G., Hausch, R. & Maier, H. Adaptive Desaktivierung bei ASS‑Hypersensitivität. HNO 63, 707–714 (2015). https://doi.org/10.1007/s00106-015-0065-y

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