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ARIA-Leitlinie 2019: Behandlung der allergischen Rhinitis im deutschen Gesundheitssystem

An Erratum to this article was published on 25 March 2020

This article has been updated

Zusammenfassung

Hintergrund

Die Anzahl der von Allergien betroffenen Patienten nimmt weltweit zu. Hiermit gehen erhebliche Kosten für die Gesundheits- und Sozialsysteme durch allergische Erkrankungen einher. Integrierte Versorgungskonzepte sind erforderlich, die innerhalb der nationalen Gesundheitssysteme eine umfassende Versorgung ermöglichen. Die ARIA-Initiative entwickelt international gültige Leitlinien für allergische Atemwegserkrankungen.

Methoden

ARIA dient der verbesserten Versorgung von Patienten mit Allergien und chronischen Atemwegserkrankungen. In Zusammenarbeit mit anderen internationalen Initiativen, nationalen Fachgesellschaften und Patientenorganisationen im Bereich Allergien und Atemwegserkrankungen wurde eine realitätsnahe, integrative Versorgungsleitlinie („integrated care pathways“, ICPs) für eine digital unterstützte, integrative, individualisierte Behandlung von allergischer Rhinitis (AR) mit komorbidem Asthma entwickelt, die in der vorliegenden Arbeit auf das deutsche Gesundheitssystem übertragen wird.

Ergebnisse

Die vorliegende ICP-Versorgungsleitlinie umfasst wesentliche Bereiche der Versorgung von Patienten mit AR mit und ohne Asthma einschließlich der Sicht von Patienten und weiterer versorgungsnaher Gesundheitsdienstleister.

Diskussion

Eine umfassende ICP-Leitlinie kann die Versorgungsrealität wesentlich besser abbilden als herkömmliche Leitlinienmodelle.

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Change history

  • 25 March 2020

    Affiliation und Disclaimer von Vera Mahler wurden fehlerhaft dargestellt und werden hiermit korrigiert: Medizinische Fakultät, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Deutschland Die in diesem Review geäußerten Inhalte und Positionen geben die persönliche Expertenmeinung der Auto...

Abbreviations

AEC:

Allergen exposure chamber

AeDA:

Ärzteverband deutscher Allergologen

AIRWAYS-ICPs’:

Integrated care pathways for airway diseases

AIT:

Allergenspezifische Immuntherapie

AMG:

Arzneimittelgesetz

AMR:

Arzneimittelrichtlinie

AR:

Allergische Rhinitis

ARIA:

Allergic rhinitis and its impact on asthma

CP:

Centralized procedure

CRD:

Chronic respiratory disease

DAAB:

Deutscher Allergie- und Asthmabund

DBPCRCT:

Double-blind placebo-controlled randomized clinical trial

DCP:

Decentralized procedure

EAACI:

European Academy for Allergy and Clinical Immunology

EG:

Europäische Gemeinschaft

EIP on AHA:

European Innovation Partnership on Active and Healthy Ageing

EIT:

European Institute for Innovation and Technology

EMA:

European Medicines Agency

EU:

Europäische Union

G-BA:

Gemeinsamer Bundesausschuss

GKV:

Gesetzliche Krankenversicherung

GRADE:

Grading of Recommendations Assessment, Development and Evaluation

ICER:

Incremental cost effectiveness ratio

ICP:

Integrated care pathway

INAH:

Intranasale Antihistaminika

INCS:

Intranasale Kortikosteroide

JA-CHRODIS:

Joint Action on chronic diseases and promoting healthy ageing across the life cycle

KV:

Krankenversicherung

LTRA:

Leukotrienrezeptor-Antagonist

MACVIA:

MAladies Chroniques pour un VIeillissement Actif (Fighting chronic diseases for active and healthy ageing)

MASK:

Mobile Airways Sentinel Network

MASK-air:

Formerly Allergy Diary

MPAzeFlu:

Nasale Fixkombination aus Azelastin und Fluticason

MRP:

Mutual recognition procedure

MS:

Mitgliedsstaaten

NICE:

National Institute for Health and Clinical Excellence (UK)

NIH:

National Institute of Health (USA)

NPP:

Named patients product

OAH:

Orale Antihistaminika

OTC:

Over the counter

PDC:

Proportion of days covered

PEI:

Paul-Ehrlich-Institut

POLLAR:

Impact of air POLLution on Asthma and Rhinitis

RCT:

Randomized controlled trials

RKI:

Robert Koch-Institut

RMS:

Reference Member State

RWE:

Real-world evidence

SCIT:

Subkutane Immuntherapie

SDM:

Shared decision making

SLIT:

Sublinguale Immuntherapie

TAV:

Therapieallergeneverordnung

UAW:

Unerwünschte Arzneimittelwirkung

VAS:

Visual analogue scale

WHO:

World Health Organization

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Interessenkonflikt

C. Bachert hat Honorare von Mylan, Stallergenes und ALK erhalten, außerhalb der vorliegenden Arbeit.

S. Becker hat Zuschüsse und/oder Honorare von ALK, Allergopharma, HAL Allergy, Bencard Allergy, Sanofi-Genzyme, Thermo Fisher Scientific, B.R.A.I.N AG und PARI GmbH erhalten, außerhalb der vorliegenden Arbeit.

T. Bieber hat Honorare von Sanofi, Novartis, AbbVIe, Galderma, Pfizer, Lilly und Kymab, außerhalb der vorliegenden Arbeit, erhalten.

J. Bousquet hat Honorare von Chiesi, Cipla, Hikma, Menarini, Mundipharma, Mylan, Novartis, Purina, Sanofi-Aventis, Takeda, Teva und Uriach erhalten, außerhalb der vorliegenden Arbeit. Außerdem war er beratend tätig für KYomed-Innov (advisory board, Vorträge).

R. Brehler hat Zuschüsse oder Honorare von Berufsgenossenschaften, Gerichten, ÄK Nordwürtemberg, ÄK Westfalen-Lippe, ALK, Allergopharma, Allmiral, Apothekerkammer, Astra Zeneca, Bencard, DPC, Gesellschaft zur Förderung der Dermatologischen Forschung und Fortbildung, GSK, HAL, HNO-Gesellschaft, Leti, Novartis, Pohl-Boskamp, Pfleger, Phadia, Update GmbH, Stallergenes, Biotechtools, Genentech, Novartis, Bencard, HAL, AstraZeneca und ALK erhalten, außerhalb der vorliegenden Arbeit.

V. Cardona hat Honorare von ALK, Allergopharma, Allergy Therapeutics, Diater, LETI, Thermofisher und Stallergenes erhalten, außerhalb der vorliegenden Arbeit.

J. Mullol hat Zuschüsse und/oder Honorare von ALK-Abelló, Sanofi-Genzyme & Regeneron, Menarini Group, MSD, Mitsubishi-Tanabe, Novartis, UCB Pharma, GENENTECH - Roche, URIACH Group und MYLAN-MEDA Pharma erhalten, außerhalb der vorliegenden Arbeit.

H. F. Merk hat Honorare von MEDA, Grünenthal und Coty erhalten, außerhalb der vorliegenden Arbeit.

T. Jakob hat Zuschüsse, Honorare oder nicht finanzielle Unterstützung von Novartis, ALK-Abelló, Bencard/Allergy Therapeutics, Allergopharma, Thermo Fisher Scientific und Celgene erhalten, außerhalb der vorliegenden Arbeit.

M. Jutel hat — während der Entstehung der Leitlinie — Honorare von ALK-Abelló, Allergopharma, Stallergenes, Anergis, Allergy Therapeutics, Circassia, Leti, Biomay und HAL erhalten. Zudem hat er Honorare von Astra-Zeneka, GSK, Novartis, Teva, Vectura, UCB, Takeda, Roche, Janssen, Medimmune und Chiesi erhalten, außerhalb der vorliegenden Arbeit.

L. Klimek hat Zuschüsse und/oder Honorare von ALK-Abelló, Novartis, Allergopharma, Bionorica, GSK, Lofarma, Boehringer Ingelheim, MEDA, Biomay, HAL, LETI, Roxall und Bencard erhalten, außerhalb der vorliegenden Arbeit.

P. Hellings hat während der Entstehung der Leitlinie Zuschüsse und Honorare von Mylan, erhalten sowie Honorare von Sanofi, Allergopharma und Stallergenes, außerhalb der vorliegenden Arbeit.

J. Saloga hat Honorare von ALK-Abelló, Novartis Pharma und Thermo Fisher erhalten, außerhalb der vorliegenden Arbeit.

C. Schmidt-Weber hat — während der Entstehung der Leitlinie — Zuschüsse von DFG und DZL erhalten. Zudem hat er Zuschüsse und/oder Honorare von Bencard, Allergopharma, Leti Pharma erhalten, außerhalb der vorliegenden Arbeit. Außerdem hat er ein Patent auf AIT biomarker.

S. Strieth hat Zuschüsse und/oder Honorare von der Deutschen Forschungsgemeinschaft (DFG), Stiftung Tumorforschung Kopf-Hals, Andreas Fahl Medizintechnik-Vertrieb, Atos Medical, Tracoe Medical, Heimomed Heinze, Bromepithetik, Fresenius Kabi, Auris Medical, Merck Serono, Otonomy, Inc., Nordmark Arzneimittel, Sanofi Genzyme und ALK-Abelló sowie nicht finanzielle Unterstützung von MED-EL AG erhalten, außerhalb der vorliegenden Arbeit.

R. Treudler hat Zuschüsse oder Honorare von Sanofi-Genzyme, ALK-Abello, Takeda, Novartis und Hautnetz Leipzig, erhalten. Außerdem gab es eine wissenschaftliche Zusammenarbeit mit Fraunhofer-IZI Leipzig, außerhalb der vorliegenden Arbeit.

S. Toppila-Salmi war beratend tätig für Mylan Laboratories Ltd, ERT Ltd und Roche Products Ltd, außerhalb der vorliegenden Arbeit.

C. Vogelberg hat Zuschüsse und/oder Honorare von ALK-Abelló, Allergopharma, AstraZeneca, Boehringer Ingelheim, Bencard Allergy, DBV Technologies, Novartis Pharma und Sanofi Avensis erhalten, außerhalb der vorliegenden Arbeit.

A. Bedbrook, R. Buhl, G. W. Canonica, T. B. Casale, I. Casper, A. Chaker, W. Czarlewski, W. Czech, J. Fischer, W. Fokkens, T. Fuchs, M. Gerstlauer, E. Hamelmann, K. Hörmann, K. Jung, M. Kopp, D. Larenas-Linnemann, V. Mahler, N. Mülleneisen, K. Nemat, N. G. Papadopoulos, O. Pfaar, U. Rabe, J. Ring, W. Schlenter, H. Seyfarth, A. Sperl, T. Spindler, P. Staubach, A. Wallrafen, W. Wehrmann, T. Werfel, H. Wrede und T. Zuberbier erklären, dass keine Interessenkonflikte bestehen.

Der Verlag erklärt, dass die inhaltliche Qualität des Beitrags von zwei unabhängigen Gutachtern geprüft wurde. Werbung in dieser Zeitschriftenausgabe hat keinen Bezug zur CME-Fortbildung. Der Verlag garantiert, dass die CME-Fragen frei sind von werblichen Aussagen und keinerlei Produktempfehlungen enthalten. Dies gilt insbesondere für Präparate, die zur Therapie des dargestellten Krankheitsbildes geeignet sind.

Zitierweise

Klimek L, Bachert C, Pfaar O, Becker S, Bieber T, Brehler R, Buhl R, Casper I, Chaker A, Czech W, Fischer J, Fuchs T, Gerstlauer M, Hörmann K, Jakob T, Jung K, Kopp MV, Mahler V, Merk H, Mülleneisen N, Nemat K, Rabe U, Ring J, Saloga J, Schlenter W, Schmidt-Weber C, Seyfarth H, Sperl A, Spindler T, Staubach P, Strieth S, Treudler R, Vogelberg C, Wallrafen A, Wehrmann W, Wrede H, Zuberbier T, Bedbrook A, Canonica GW, Cardona V, Casale TB, Czarlewski W, Fokkens WJ, Hamelmann E, Hellings PW, Jutel M, Larenas-Linnemann D, Mullol J, Papadopoulos NG, Toppila-Salmi S, Werfel T, Bousquet J et al. ARIA guideline 2019: treatment of allergic rhinitis in the German healthcare system. ARIA guideline 2019: treatment of allergic rhinitis in the German health system. Allergo J Int 2019;28:255–76

https://doi.org/10.1007/s40629-019-00110-9

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Klimek, L., Bachert, C., Pfaar, O. et al. ARIA-Leitlinie 2019: Behandlung der allergischen Rhinitis im deutschen Gesundheitssystem. Allergo J 28, 20–46 (2019). https://doi.org/10.1007/s15007-019-1938-2

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Schlüsselwörter

  • allergische Erkrankungen
  • allergisches Asthma
  • integrated care pathway
  • allergenspezifische Immuntherapie, Gesundheitssystem