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Stellenwert und Indikation der SLIT im Vergleich zur SCIT

Status and indications for SLIT in comparison to SCIT

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Zusammenfassung

Der Erfolg einer spezifischen Immuntherapie ist wesentlich abhängig von der korrekten Diagnose, Indikationsstellung, Identifizierung der klinisch relevanten Allergene sowie Abwägung des Risikos. Grundsätzlich sind für beide Applikationsarten, SCIT und SLIT, standardisierte bzw. qualitativ hochwertige Präparate mit eindeutigem Effektivitätsnachweis in randomisierten, kontrollierten Studien sowie möglichst bekanntem Majorallergengehalt zu bevorzugen. Da sich SCIT- und SLIT-Präparate und ihre Anwendung auch untereinander erheblich unterscheiden, ist eine allergen- und produktspezifische Bewertung für die jeweilige Indikation erforderlich. Die deutschen allergologischen Fachgesellschaften bewerten die SLIT im Vergleich zur SCIT kritischer als die europäische Fachgesellschaft: Den bisherigen Kenntnisstand – in Ermangelung qualitativ hochwertiger direkter Vergleichsstudien – zusammenfassend, sollte eine qualitativ hochwertige SCIT einer SLIT vorgezogen werden, da für die SLIT im Vergleich zur SCIT insbesondere Langzeiteffekte und präventive Wirkung noch nicht ausreichend belegt sind. Kommt eine SCIT nicht infrage, kann eine qualitativ hochwertige SLIT bei Erwachsenen mit allergischer Rhinokonjunktivitis sinnvoll sein.

Abstract

Appropriate specific immunotherapy depends on the correct diagnosis, identification of the clinically relevant allergens and consideration of risks. Standardized high-quality allergen extracts preferably of known major allergen content and with clear-cut proven efficacy in randomized controlled studies should be used for both SCIT and SLIT. The various SCIT and SLIT extracts differ considerably, so an allergen and product specific evaluation is recommended for the respective choice and indication. The German allergy society’s comparison of SLIT to SCIT is much less favorable than that of the European society. In the absence of high-quality direct comparisons between the two therapies, a high-quality SCIT should be preferred to SLIT because long-term and preventive effects (development of asthma and new sensitizations) have been demonstrated more satisfactorily for SCIT. If SCIT is out of the question (refusal of injections, systemic side effects of SCIT) a high-quality SLIT may be indicated in adults with rhinoconjunctivitis.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Referententätigkeiten für ALK-Scherax, HAL, Stallergenes.

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  1. Klinik für Dermatologie, Venerologie und Allergologie, Medizinische Hochschule Hannover, Ricklinger Straße 5, 30449, Hannover, Deutschland

    B. Wedi

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Wedi, B. Stellenwert und Indikation der SLIT im Vergleich zur SCIT. Hautarzt 59, 537–543 (2008). https://doi.org/10.1007/s00105-008-1491-5

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