Allergenspezifische Immuntherapie: Aktueller Stand sowie neue Erkenntnisse und Entwicklungen

Zusammenfassung

IgE-vermittelte Allergien haben in den letzten Jahrzehnten deutlich zugenommen. Die allergenspezifische Immuntherapie (AIT) stellt die einzige kausale Behandlungsoption dar. Zudem kann sie der Ausweitung der allergischen Reaktionslage (Entwicklung eines allergischen Asthma bronchiale [AAB], Sensibilisierungsspektrum) vorbeugen. Im Fokus neuer Entwicklungen stehen die Erschließung neuer Behandlungsindikationen sowie Bestrebungen, über neue Allergenpräparate und innovative Anwendungsverfahren die Effektivität und Sicherheit der AIT weiter zu optimieren. Wesentliche Voraussetzungen hierfür sind sowohl vertiefte Kenntnisse über die immunologischen Mechanismen, die der AIT zugrunde liegen, als auch das Wissen um Kontraindikationen und mögliche Risiken. Es ist davon auszugehen, dass die Bedeutung der AIT für die Behandlung allergischer Erkrankungen in Zukunft weiter zunehmen wird.

Abstract

IgE-mediated allergies have significantly increased during the last decades. Allergen-specific immunotherapy (AIT) is the only causal treatment, which in addition can prevent the development of allergic asthma and new sensitizations. Recent progress focuses on the broadening of potential treatment options and the optimization of efficiency and safety through the development of new allergen products and innovative applications. Essential preconditions are both the profound knowledge about the immunological mechanisms underlying tolerance induction by AIT and the recognition of contraindications and potential risks. It is anticipated that the impact of AIT on the treatment of allergic diseases will further increase in the years to come.

Kernaussagen/Fazit für die Praxis

AIT

• ist die einzige kausale Behandlungsoption IgE-mediierter Allergien.

• indiziert für IgE-vermittelte Atemwegs- und HG-Allergien und ist ggf. off-label einsetzbar bei atopischem Ekzem und HG-induzierter gesteigerter LK.

• ist mit nativen Allergenen und Allergoiden durchführbar, wobei Präparate mit geprüfter Wirksamkeit (www.pei.de/DE/arzneimittel/allergene/allergene-node.html) eingesetzt werden sollten.

• führt zur Bildung allergenblockierender IgG-Ak und Verlust allergenspezifischer T-Zellreaktivität.

• kann als SCIT oder SLIT bei respiratorischen und SCIT bei HG-Allergien mit unterschiedlichen Applikationsschemata durchgeführt werden.

• kann mit LR und SR einhergehen, die applikationsabhängig (SCIT, SLIT) unterschiedlich gewichtet auftreten und durch Präventionsmaßnahmen behandelt werden können.

• kann in naher Zukunft durch Einführung modifizierter Allergenpräparate (z. B. hypoallergene Varianten, Allergenpeptide) und Applikationsformen (epidermal, intradermal, intralymphatisch) möglicherweise weiter optimiert werden.

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