Laryngorhinootologie 2020; 99(01): 56-66
DOI: 10.1055/a-0899-1202
CME-Fortbildung

Allergietherapie und Allergie-Immuntherapie im Kindesalter

Therapy of Allergies and Allergy Immunotherapy in Children
Ludger Klimek
,
Adam M. Chaker
,
Ingrid Casper
,
Annette Sperl
,
Sebastian Strieth
,
Ralph Mösges

Zusammenfassung

Inhalationsallergien bei Kindern erfordern eine umfassende Diagnostik und konsequente Therapie. Das Behandlungsspektrum umfasst neben der Allergenkarenz die symptomatische Pharmakotherapie und die kausale Allergie-Immuntherapie (AIT). Kinder sind eine wichtige Zielgruppe für eine AIT, da sie aufgrund ihrer Langzeiteffekte und sekundär-präventiven Eigenschaften den Verlauf der Erkrankung nachhaltig beeinflussen kann.

Abstract

Adequate diagnostical workup for respiratory allergies and consequent therapy in children determine the individual course of disease. Therapy consists first of symptomatic treatment and includes in the next step the important option of allergy immunotherapy (AIT) as a causative treatment of disease. Children are an important target group for AIT, since AIT offers a proven longterm effect including secondary preventive properties with not only transiently reduced symptoms but moreover longstanding and beneficial disease modification.

New strategies with AIT as primary and secondary preventive interventions are being evaluated with the aim to reduce clinical appearance and the amount and extent of sensitizations to allergens in high-risk children. Until implementation of such potentially preventive strategies the currently more attractive early intervention is the early adoption of AIT within the first 12 to 24 months of onset of symptoms as a first-line treatment of allergic rhinitis.

Simplified treatment protocols can improve the willingness to perform an AIT and the adherence and compliance of children and their parents. The overall goal is to make AIT as the most important treatment modality available to more affected children.



Publikationsverlauf

Artikel online veröffentlicht:
14. Januar 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 
  • Literatur

  • 1 Klimek L, Vogelberg C, Werfel T. Weißbuch Allergie in Deutschland. 4. Aufl.. Berlin: Springer; 2019
  • 2 Poethko-Müller C, Thamm M, Thamm R. Heuschnupfen und Asthma bei Kindern und Jugendlichen in Deutschland – Querschnittergebnisse aus KiGGS Welle 2 und Trends. 2018: Epidemiologie und Gesundheitsberichterstattung.
  • 3 Pfaar O, Bachert C, Bufe A. et al. Guideline on allergen-specific immunotherapy in IgE-mediated allergic diseases: S2k Guideline of the German Society for Allergology and Clinical Immunology (DGAKI), the Society for Pediatric Allergy and Environmental Medicine (GPA), the Medical Association of German Allergologists (AeDA), the Austrian Society for Allergy and Immunology (÷ GAI), the Swiss Society for Allergy and Immunology (SGAI), the German Society of Dermatology (DDG), the German Society of Oto- Rhino-Laryngology, Head and Neck Surgery (DGHNO-KHC), the German Society of Pediatrics and Adolescent Medicine (DGKJ), the Society for Pediatric Pneumology (GPP), the German Respiratory Society (DGP), the German Association of ENT Surgeons (BV-HNO), the Professional Federation of Paediatricians and Youth Doctors (BVKJ), the Federal Association of Pulmonologists (BDP) and the German Dermatologists Association (BVDD). Allergo Journal Int 2014; 23 (08) 282-319
  • 4 Des Roches A, Paradis L, Menardo JL. et al. Immunotherapy with a standardized Dermatophagoides pteronyssinus extract. VI. Specific immunotherapy prevents the onset of new sensitizations in children. J Allergy Clin Immunol 1997; 99 (04) 450-453
  • 5 Reha CM, Ebru A. Specific immunotherapy is effective in the prevention of new sensitivities. Allergol Immunopathol 2007; 35 (02) 44-51
  • 6 Pajno GB, Barberio G, De Luca F. et al. Prevention of new sensitizations in asthmatic children monosensitized to house dust mite by specific immunotherapy. A six-year follow-up study. Clin Exp Allergy 2001; 31 (09) 1392-1397
  • 7 Di Rienzo V, Marcucci F, Puccinelli P. et al. Long-lasting effect of sublingual immunotherapy in children with asthma due to house dust mite: a 10-year prospective study. Clin Exp Allergy 2003; 33 (02) 206-210
  • 8 Madonini E, Agostinis F, Barra R. et al. Long-term and preventive effects of sublingual allergen-specific immunotherapy: a retrospective, multicentric study. Int J Immunopathol Pharmacol 2003; 16 (01) 73-79
  • 9 Purello-D’Ambrosio F, Gangemi S, Merendino RA. et al. Prevention of new sensitizations in monosensitized subjects submitted to specific immunotherapy or not. A retrospective study. Clin Exp Allergy 2001; 31 (08) 1295-1302
  • 10 Eng PA, Borer-Reinhold M, Heijnen IAFM. et al. Twelve-year follow-up after discontinuation of preseasonal grass pollen immunotherapy in childhood. Allergy 2006; 61 (02) 198-201
  • 11 Inal A, Altintas DU, Yilmaz M. et al. Prevention of new sensitizations by specific immunotherapy in children with rhinitis and/or asthma monosensitized to house dust mite. J Investig Allergol Clin Immunol 2007; 17 (02) 85-91
  • 12 Jacobsen L, Niggemann B, Dreborg S. et al. Specific immunotherapy has long-term preventive effect of seasonal and perennial asthma: 10-year follow-up on the PAT study. Allergy 2007; 62 (08) 943-948
  • 13 Szépfalusi Z, Bannert C, Ronceray L. et al. Preventive sublingual immunotherapy in preschool children: first evidence for safety and pro-tolerogenic effects. Ped Allergy Immunology 2014; 25 (08) 788-795
  • 14 Holt PG, Rowe J, Kusel M. et al. Toward improved prediction of risk for atopy and asthma among preschoolers: a prospective cohort study. J Allergy Clin Immunol 2010; 125 (03) 653-659 659.e1–659.e7
  • 15 Asarnoj A, Ostblom E, Kull I. et al. Sensitization to inhalant allergens between 4 and 8 years of age is a dynamic process: results from the BAMSE birth cohort. Clin Exp Allergy 2008; 38 (09) 1507-1513
  • 16 Illi S, von Mutius E, Lau S. et al. Perennial allergen sensitisation early in life and chronic asthma in children: a birth cohort study. Lancet (London, England) 2006; 368 (9537): 763-770
  • 17 Simpson A, Soderstrom L, Ahlstedt S. et al. IgE antibody quantification and the probability of wheeze in preschool children. J Allergy Clin Immunol 2005; 116 (04) 744-749
  • 18 Hatzler L, Panetta V, Lau S. et al. Molecular spreading and predictive value of preclinical IgE response to Phleum pratense in children with hay fever. J Allergy Clin Immunol 2012; 130 (04) 894-901
  • 19 Stringari G, Tripodi S, Caffarelli C. et al. The effect of component-resolved diagnosis on specific immunotherapy prescription in children with hay fever. J Allergy Clin Immunol 2014; 134 (01) 75-81
  • 20 Holt PG. Immunoprophylaxis of atopy: light at the end of the tunnel?. Immunology today 1994; 15 (10) 484-989
  • 21 Holt PG, Sly PD, Sampson HA. et al. Prophylactic use of sublingual allergen immunotherapy in high-risk children: a pilot study. J Allergy Clin Immunol 2013; 132 (04) 991-993
  • 22 Zolkipli Z, Roberts G, Cornelius V. et al. Randomized controlled trial of primary prevention of atopy using house dust mite allergen oral immunotherapy in early childhood. J Allergy Clin Immunol 2015; 136 (06) 1541-1547
  • 23 Roberts G, Hurley C, Turcanu V. et al. Grass pollen immunotherapy as an effective therapy for childhood seasonal allergic asthma. J Allergy Clin Immunol 2006; 117 (02) 263-268
  • 24 Zielen S, Kardos P, Madonini E. Steroid-sparing effects with allergen-specific immunotherapy in children with asthma: a randomized controlled trial. J Allergy Clin Immunol 2010; 126 (05) 942-949
  • 25 EMA/PDCO. Standard Pediatric Investigation Plan for Allergen Products for Specific Allergen Immunotherapy. 2016
  • 26 Wahn U, Klimek L, Ploszczuk A. et al. High-dose sublingual immunotherapy with single-dose aqueous grass pollen extract in children is effective and safe: a double-blind, placebo-controlled study. J Allergy Clin Immunol 2012; 130 (04) 886-893
  • 27 Stelmach I, Kaluzińska-Parzyszek I, Jerzynska J. et al. Comparative effect of pre-coseasonal and continuous grass sublingual immunotherapy in children. Allergy 2012; 67 (03) 312-320
  • 28 Calderon MA, Gerth van Wijk R, Eichler I. et al. Perspectives on allergen-specific immunotherapy in childhood: an EAACI position statement. Ped Allergy Immunol 2012; 23 (04) 300-306
  • 29 Bufe A, Eberle P, Franke-Beckmann E. et al. Safety and efficacy in children of an SQ-standardized grass allergen tablet for sublingual immunotherapy. J Allergy Clin Immunol 2009; 123 (01) 167-173
  • 30 Nandy A, Höfner D, Klysner S. Rekombinante Allergene in der spezifischen Immuntherapie: Aktuelle Konzepte und Entwicklungen. Allergo-Journal 2015; 24 (05) 19