Bienen- und Wespengiftallergie in verschiedenen Lebensphasen

Zusammenfassung

Das individuelle Risiko für anaphylaktische Stichreaktionen bleibt im Laufe eines Menschenlebens nicht konstant, sondern ist von Lebensalter und Gesundheitszustand, von persönlichen Aktivitäten und Vorlieben abhängig. Lebensumstände und Begleiterkrankungen können darüber hinaus auch Entscheidungen hinsichtlich Diagnostik und Therapie beeinflussen. In der vorliegenden Arbeit werden Risiken und Besonderheiten von Patienten mit Bienen-/Wespengiftallergie in verschiedenen Lebensphasen erörtert. Schwere anaphylaktische Stichreaktionen sind im Kindes- und Jugendalter trotz verhältnismäßig häufiger Stiche durch Bienen und Wespen selten. Allergische Nebenwirkungen einer Immuntherapie mit Bienen-/Wespengift hingegen sind ebenso häufig wie bei Erwachsenen, aber i. d. R. sehr gut beherrschbar. Schwangeren unter bereits laufender Immuntherapie mit Bienen-/Wespengift sollte bei guter Verträglichkeit eine Therapiefortsetzung angeraten werden, da das Risiko von anaphylaktischen Therapiezwischenfällen als geringer eingeschätzt wird als die Gefahr einer schweren Stichreaktion im Falle eines vorzeitigen Abbruches. Die Wahrscheinlichkeit von Bienen oder Wespen gestochen zu werden und damit auch das Risiko anaphylaktischer Stichreaktionen werden durch Freizeitverhalten und Berufswahl entscheidend mitbestimmt. Das Risiko schwerer und möglicherweise tödlicher Stichreaktionen ist bei Patienten mit indolenter systemischer Mastozytose erheblich erhöht, steigt aber auch mit dem Lebensalter und möglicherweise im Rahmen bestimmter kardiovaskulärer Erkrankungen. Die Sicherheit einer Immuntherapie mit Bienen-/Wespengift wird durch antihypertensiv wirkende Medikamente, insbesondere auch durch β-Blocker und ACE-Hemmer, nicht beeinflusst. Bedenken bezüglich Sicherheit und Effektivität der Immuntherapie bei gleichzeitig bestehenden Autoimmun- oder Tumorerkrankungen konnten bislang nicht durch klinische Daten begründet werden. Eine Immuntherapie mit Bienen-/Wespengift kann auch bei Tumorerkrankungen in stabiler Remission oder behandelten Autoimmunerkrankungen durchaus sinnvoll sein.

Abstract

The individual risk of anaphylactic sting reactions does not remain constant over the course of human life, but is dependent on age and state of health, personal activities and preferences. Moreover, personal circumstances and comorbidities may impair the diagnosis and treatment of Hymenoptera venom allergy. This review article aims to give an overview on the risks and specific characteristics of venom allergic patients throughout the stages of life. Severe sting-induced reactions are uncommon in children and adolescents despite a frequent exposure to stinging insects. Anaphylactic side effects of venom immunotherapy in children are as frequent as in adults but usually respond well to anti-allergic treatment. A well-tolerated ongoing venom immunotherapy should be continued during pregnancy, because the risk of treatment-associated side effects is considered to be lower than the risk of a severe sting reaction following premature determination of treatment. Both occupational and recreational exposure to Hymenoptera stings may contribute to an increased frequency of anaphylactic sting reactions. The risk of severe and fatal reactions is increased in concurrent indolent systemic mastocytosis, but also in old age and possibly in coexistent cardiac comorbidities. Antihypertensive medication with beta-blockers and/or ACE inhibitors does not increase the risk of anaphylactic adverse effects during venom immunotherapy. Concerns regarding the safety and effectivity of venom immunotherapy in patients with coexisting malignancy or autoimmune diseases are not supported by clinical evidence. Treatment guidelines recommend venom immunotherapy for patients with sufficiently controlled autoimmune disorders or malignancies in stable remission.

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