Zusammenfassung
Die allergische Rhinitis (AR) ist mit einer globalen Prävalenz von ca. 20 % die häufigste Immunerkrankung überhaupt und stellt eine der häufigsten chronischen Erkrankungen im Kindes- und Jugendalter dar. Typische Symptome sind Rhinorrhö, Niesreiz, Pruritus, nasale Obstruktion und okulare Symptome. Typische Komorbiditäten sind andere Erkrankungen des atopischen Formenkreises, wie Asthma bronchiale, atopische Dermatitis, und Nahrungsmittelallergien, einschließlich orales Allergiesyndrom (OAS), sowie die chronische Rhinosinusitis, die Otitis media mit Ausfluss („otitis media with effusion“, OME) und hyperplastische Adenoide.
Die Behandlung beruht auf 4 Eckpfeilern: Aufklärung des Patienten, Allergenkarenz, Pharmakotherapie und spezifische Immuntherapie. Die medikamentösen Therapieoptionen der AR sind vielfältig und beinhalten derzeit v. a. den Einsatz von topischen Glukokortikosteroiden, Antihistaminika und Leukotrienrezeptorantagonisten. Die aktuellen Leitlinien empfehlen intranasale Glukokortikoide und systemische Antihistaminika als effektive und sichere Primärtherapie. Nicht alle Patienten erreichen damit eine gute Symptomkontrolle, sodass neue Behandlungswege und -strategien gefunden werden müssen. Aktuelle Weiterentwicklungen beinhalten Substanzen wie neuartige Antihistaminika nicht nur gegen den H1-Rezeptor, nasale Glukokortikosteroide in Form von Pro-Drugs sowie ein Kombinationsnasenspray, das die Gabe von Antihistaminikum und Glukokortikoid vereint. Auch bei der allergenspezifischen Immuntherapie (AIT), dem einzigen kausalen Therapieansatz, konnten in den letzten Jahren große Fortschritte erzielt werden.
Neben der AR können sich Allergien im Hals-Nasen-Ohren(HNO)-Bereich auch in Form von Paukenergüssen, Ekzem und oralem Allergiesyndrom (OAS) manifestieren.
Abstract
Allergic rhinitis (AR) is the most common immune-mediated disease that affects approximately 20% of the global population and is one of the leading chronic diseases in children and adolescents. An AR strongly impacts the quality of life as well as work and school productivity. Associated diseases include other atopic diseases, such as allergic (extrinsic) bronchial asthma, atopic dermatitis, food allergies including oral allergy syndrome, and chronic rhinosinusitis, otitis media with effusion (OME) with Eustachian tube dysfunction (tubal dysfunction), and hyperplastic adenoids.
Current therapeutic options are based on four columns and include patient education, allergen avoidance, pharmacotherapy, and allergen immunotherapy. Pharmacotherapy includes intranasal glucocorticoids, antihistamines and leukotriene receptor antagonists. The current guidelines recommend intranasal glucocorticoids and systemic antihistamines as effective and safe first-line therapies; however, not all patients achieve symptom control with the current treatment options. Therefore, it is necessary to develop new treatment strategies and/or improve current therapeutic options. Over the last years some new agents were developed which may have an impact on the way allergic rhinitis is treated in the near future. These include new compounds such as SYK inhibitors, which inhibit the signaling pathway of the allergic reaction, new antihistamines targeting not only the H1-receptor but also the H3-receptor, new improved glucocorticoids in the form of prodrugs as well as a novel formulations combining the administration of a nasal antihistamine and glucocorticoids. Also for allergen-specific immunotherapy, new promising approaches were achieved over the last years.
Besides AR, allergic diseases in the ear nose and throat (ENT) tract can be manifested as otitis media with effusion, atopic dermatitis and oral allergy syndrome.
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Hamelmann, E., Klimek, L. Allergien im Hals-Nasen-Ohren-Bereich. Monatsschr Kinderheilkd 166, 192–200 (2018). https://doi.org/10.1007/s00112-018-0441-2
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DOI: https://doi.org/10.1007/s00112-018-0441-2