Analyse der Effektivität der subkutanen Immuntherapie mit Hausstaubmilbenextrakten bei Erwachsenen mit allergischer Rhinitis und/oder Asthma bronchiale

 

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Zusammenfassung

Einleitung: Die spezifische subkutane Immuntherapie und die Allergenelimination sind die einzigen kausalen Therapieoptionen bei perennialen Allergien. Die spezifische Immuntherapie hat das Potenzial, die Symptome und den Medikamentenbedarf zu reduzieren und kann darüber hinaus das Fortschreiten der Erkrankung, z. B. die Entwicklung eines Asthma bronchiale, aufhalten.

Methoden: Um die Gültigkeit dieser Aussagen für die spezifische Immuntherapie mit Der p und Der f zu untersuchen, wurde eine Analyse aller in der Literatur ab 1970 verfügbaren randomisierten Doppelblind-, plazebokontrollierten Studien an Erwachsenen mit allergischer Rhinitis und/oder Asthma hinsichtlich der Effektivität der Immuntherapie durchgeführt.

Ergebnisse: Es fanden sich 13 Studien, die den Kriterien entsprachen. Die Effektivität wurde anhand des Symptomscore, des Medicationscore, der Lungenfunktion und der Ergebnisse der spezifischen Organprovokation gemessen. Die Organprovokation fand in Form des titrierten spezifischen nasalen, konjunktivalen oder bronchialen Provokationstests Anwendung. Aufgrund der bei den Provokationstests zur Verfügung stehenden absoluten Patientendaten konnte die Effektivität in Form der Odd's Ratio und des 95 %-Konfidenzintervalls berechnet werden. Bezogen auf die Studien nach 1980 zeigte sich eine signifikante Besserung des Symptomscores und des Medikationsscores nach spezifischer Immuntherapie mit Der p oder Der f, die Lungenfunktion wurde nicht signifikant beeinflusst. Gemessen an der spezifischen Organprovokation zeigte sich eine signifikante Reduktion der Hyperreagibilität der Schleimhaut nach Allergenexposition.

Diskussion: Die spezifische Organprovokation erweist sich damit als nützlicher und sensitiver Verlaufsparameter bei der Immuntherapie. Betrachtet man die Nebenwirkungsrate der analysierten Studien, so zeigt sich, dass lokale Hautreaktionen häufiger zu beobachten waren und das Risiko von lebensbedrohlichen Nebenwirkungen gering ist. Die spezifische Immuntherapie mit Hausstaubmilbenextrakt bei Erwachsenen mit allergischer Rhinitis und/oder Asthma ist effektiv und sicher, wenn sie unter kontrollierten Bedingungen durchgeführt wird.

Abstract

Background: Allergen specific immunotherapy and allergen reduction are the only therapies in perennial allergic diseases to reduce symptoms in the long term. Specific immunotherapy has the potential to reduce symptoms and the need for medication significantly and furthermore to prevent progression into more severe disease e. g. asthma.

Methods: The clinical value of specific immunotherapy has been studied for the last 30 years. We undertook an analysis of clinical trials of subcutaneous specific immunotherapy with Der p or Der f in adults to assess the efficacy of this controversial form of allergy treatment.

Results: A computerized bibliographic search revealed 13 randomised double-blind, placebo-controlled trials of specific immunotherapy with Der p/Der f for rhinitis and/or asthma in adults since 1970. The results extracted included patients symptoms, medication requirements, lung function, specific challenge-tests as titrated nasal, conjunctival or bronchial challenge test and side effects. For studies with continuous outcomes as symptomscore and medicationscore the effect size was obtained by the difference in the scores between the active therapy and the placebo groups. For studies with categorical outcomes as increase or decrease in challenge-tests the results were expressed as odds ratios for improvement against no change and 95 % confidence intervals were calculated.

Discussion: Focused on the studies after 1980 there was a significant improvement on symptomscore and medicationscore in the actively treated group compared to the placebo group, while the lung function was not significantly altered. Allergen provocation tests reflect the sensitivity of the shock organ. As the documentation of the clinical effects measured by challenge tests shows a highly significant improvement in the actively treated group, we recommend allergen provocation tests as a useful and sensitive parameter during specific immunotherapy. The risk of life-threatening side effects is low, although severe anaphylactic reactions may be induced. Specific immunotherapy using a standardized house-dust mite extract is effective and safe in adults when administered under optimal conditions.

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Dr. Doreen Polzehl

Universitätsklinik für HNO-Heilkunde

Prittwitzstraße 43 · 89075 Ulm ·

Email: doreen.polzehl@medizin.uni-ulm.de