Gemeinsamkeiten der allergischen Rhinitis und des allergischen Asthma bronchiale?
Die „One-Airway-One-Disease”-Hypothese

Zusammenfassung

Immunologische, genetische und epidemiologische Ergebnisse weisen auf eine sehr enge Beziehung zwischen der allergischen Rhinitis und dem allergischen Asthma bronchiale hin. Diese Aspekte wurden im Teil 1 dieser Übersicht dargestellt. Im Teil 2 werden die Klinik und Diagnostik insbesondere aber gemeinsame Therapieansätze vorgestellt. Die Allergenkarenz bildet bei allergologischen Erkrankungen das erste und wichtigste therapeutische Standbein. Die spezifische Immuntherapie (SIT), Leukotrien-modifizierende Medikamente (in Deutschland nur Montelukast), und Kortikosteroide sind Therapieoptionen, die bei beiden Entitäten der allergischen Erkrankung eingesetzt werden. Während die SIT in der Therapie der allergischen Rhinitis einen festen Stellenwert besitzt, wird sie beim Asthma nur unter bestimmten Bedingungen empfohlen. Montelukast ist mittlerweile zur Therapie des Asthma bronchiale als auch bei der Rhinitis allergica zugelassen. Kortikosteroide werden primär topisch angewendet, wobei aber die oberen und unteren Atemwege separat behandelt werden müssen. Eine systemische Applikation hemmt dagegen die immunologische Entzündung in beiden Kompartimenten, eine Wirkung, die auch dem allerdings in Deutschland noch nicht zugelassenen IgE-Inhibitor Omalizumab zugeschrieben wird. Somit stehen beim gemeinsamen Vorkommen einer allergischen Rhinitis und eines Asthma verschiedene Therapieoptionen zur Verfügung, mit der in einem einzigen gemeinsamen Therapieansatz beide allergische Entitäten behandelt werden können, womit die „One-Airway-One-Disease”-Hypothese zusätzlich unterstützt wird.

Abstract

As outlined in part 1, numerous data from immunologic, genetic and epidemiologic studies point to a systemic link between allergic asthma and rhinitis which can be seen as manifestations of a common atopic syndrome. In part 2 clinical manifestations, diagnostics and most importantly therapeutic options effecting on both nasal and bronchial symptoms will be discussed. Allergen avoidance is the first step in therapeutic management of allergic diseases. Specific immunotherapy (SIT), leukotriene modifying compounds (in Germany exclusively Montelukast), and corticosteroids inhibit inflammation in the epithelium of the upper and the lower airways. Although SIT has a widely accepted indication in the treatment of allergic rhinitis, it is just provisionally recommended for the treatment of asthmatic patients. Most recently Montelukast, a potent leukotriene receptor inhibitor, has been approved for the treatment of asthma as well as for allergic rhinitis. Local administration of corticosteroids requires that they be given both nasally and bronchially. Just on the i. v. or oral route corticosteroids may inhibit the allergic inflammation in both compartments. Newly developed IgE-inhibitor Omalizumab, which has no approval in Germany yet, has been reported to have similar effects. Thus, various therapeutic options are available to treat asthma and rhinitis at the same time. Furthermore, multilateral clinical efficacy of antiinflammatory drugs support the “One-Airway-One-Disease” hypothesis.

Literatur

• 1 Merget R, Schultze-Werninghaus G. Berufsasthma: Definition - Epidemiologie - ätiologische Substanzen - Prognose - Prävention - Diagnostik - gutachterliche Aspekte.  Pneumologie. 1996;  50 356-363
• 2 Baur X, Degens P O, Sander I. Baker's asthma: still among the most frequent occupational respiratory disorders.  J Allergy Clin Immunol. 1998;  102 984-997
• 3 Bousquet J. Allergic rhinitis and its impact on asthma (ARIA).  Clin Exp All Rev. 2003;  3 43-45
• 4 Demoly P, Allaert F A, Lecasble M. et al . Validation of the classification of ARIA (allergic rhinitis and impact on asthma).  Allergy. 2003;  58 672-675
• 5 Renz H. Fortschritte der allergologischen in-vitro-Diagnostik.  Klinikarzt. 2000;  5 126-131
• 6 Barnes P J, Chung K F, Page C P. Inflammatory mediators of asthma: an update.  Pharmacol Rev. 1998;  50 515-596
• 7 Sont J K, Willems L N, Bel E H. et al . Clinical control and histopathologic outcome of asthma when using airway hyperresponsiveness as an additional guide to long-term treatment. The AMPUL Study Group.  Am J Respir Crit Care Med. 1999;  159 1043-1051
• 8 Gillissen A, Bauer T, Richter F. et al . Diagnostik und Differenzialdiagnostik des Asthma bronchiale.  Z ärztl Fortbild Qual sich (ZaeFQ). 2001;  95 685-691
• 9 National Institutes of Health (Hrsg) .Global strategy for asthma management and prevention NHLBI/WHO Workshop report. Bethesda, USA: U.S. Department of Health and Human Services 2002
• 10 Wettengel R, Berdel D, Hofmann D. et al . Asthmatherapie bei Kindern und Erwachsenen. Empfehlungen der Deutschen Atemwegsliga in der Deutschen Gesellschaft für Pneumologie.  Med Klinik. 1998;  93 639-650
• 11 Dykewicz M S, Fineman S. Executive summary of joint task force practice parameters diagnosis and management of rhinitis.  Ann Allergy Asthma Immunol. 1998;  81 463-468
• 12 Worm M, Ehlers I, Sterry W. et al . Clinical relevance of food additives in adult patients with atopic dermatitis.  Clin Exp Allergy. 2000;  30 407-414
• 13 Slavin R G. Complications of allergic rhinitis: implications for sinusitis and asthma.  J Allergy Clin Immunol. 1998;  101 S357-S360
• 14 Cauwenberge P van, Bachert C, Passalacqua G. et al . Consensus statement on the treatment of allergic rhinitis.  Allergy. 2000;  55 116-134
• 15 Arzneimittelkommission der Deutschen Ärzteschaft (Hrsg) .Asthma bronchiale. Düsseldorf: nexus GmbH, 1. Ausg 2001
• 16 British Thoracic Society . The british guidelines on asthma management. Asthma in adults and schoolchildren.  Thorax. 2003;  58 1-94
• 17 Gillissen A, Bergmann K-C, Kleine-Tebbe J. et al . Die Bedeutung der spezifischen Immuntherapie bei allergischem Asthma bronchiale.  Dtsch Med Wschr. 2003;  5 204-209
• 18 Woodcock A, Forster L, Matthews E. et al . Control of exposure of mite allergen and allergen-impermeable bed covers for adults with asthma.  N Engl J Med. 2003;  349 225-236
• 19 Gotzsche P C, Hammarquist C, Burr M. House dust mite control measures in the management of asthma: meta-analysis.  BMJ. 1998;  317 1105-1110
• 20 Gotzsche P C, Johansen H K, Hammarquist C. et al . House dust mite control measures for asthma.  Cochrane Database Syst Rev. 2001;  (2) CD001187
• 21 Charous B L, Blanco C, Tarlo S. et al . Natural rubber latex allergy after 12 years: recommendations and perspectives.  J Allergy Clin Immunol. 2002;  109 31-34
• 22 Kampen V van, Merget R, Baur X. Occupational airway sensitizers: an overview on the respective literature.  Am J Ind Med. 2000;  38 164-218
• 23 Baur X. Baker's asthma: causes and prevention.  Int Arch Occup Environ Health. 1999;  72 292-296
• 24 Kilburn S, Lasserson T J, McKean M. Pet alllergen control measures for allergic asthma in children and adults.  Cochrane Database Syst Rev. 2003;  (1) CD002989
• 25 Subcommittee on occupational allergy of the EAACI . Guidelines for the diagnosis of occupational asthma.  Clin Exp Allergy. 1992;  22 103-108
• 26 Schultze-Werninghaus G, Merget R. Richtlinien für die gutachterliche Bewertung der Minderung der Erwerbsfähigkeit bei beruflichen obstruktiven Atemwegserkrankungen - ein Vorschlag.  Atemw.-Lungenkrkh. 1994;  20 146-148
• 27 Rowe B H, Spooner C H, Ducharme F M. et al . Corticosteroids for preventing relapse following acute exacerbations of asthma.  Cochrane Database Syst Rev. 2001;  (1) CD000195
• 28 Taramarcaz P, Gibson P. Intranasal corticosteroids for asthma control in people with coexisting asthma and rhinitis.  Cochrane Database Syst Rev. 2003;  4 CD003570
• 29 Barnes P J. Efficacy of inhaled corticosteroids in asthma.  J Allergy Clin Immunol. 1998;  102 531-538
• 30 Barnes P J. Molecular mechanisms of glucocorticosteroid action in asthma.  J Allergy Clin Immunol. 1996;  97 159-168
• 31 Fisher W G. Comparison of budesonide and disodium cromoglycate for the treatment of seasonal allergic rhinitis in children.  Ann Allergy. 1994;  73 515-520
• 32 Weiner J M, Abramson M J, Puy R M. Internasal corticosteroids versus oral H1 receptor antagonists in a allergic rhinitis: systematic review of randomised controlled trials.  BMJ. 1998;  317 1624-1629
• 33 Greiff L, Andersson M, Svensson C. et al . Effects of orally inhaled budesonide in seasonal allegic rhinitis.  Eur Respir J. 1998;  11 1268-1274
• 34 Suissa S, Ernst P, Benayoun S. et al . Low-dose inhaled corticosteroids and the prevention of death from asthma.  N Engl J Med. 2000;  343 332-336
• 35 Gillissen A, Welte T. State of the art der inhalativen Asthmatherapie.  Med Klinik. 2002;  97 12-14
• 36 Manser R, Reid D, Abramson M. Corticosteroids for acute severe asthma in hospitalised patients.  Cochrane Database Syst Rev. 2003;  (1) CD001740
• 37 Rowe B H, Spooner C, Ducharme F M. et al . Early emergency department treatment of acute asthma with systemic corticosteroids.  Cochrane Database Syst Rev. 2001;  (1) CD002160
• 38 Lockey R F. “ARIA”: global guidelines and new forms of allergen immunotherapy.  J Allergy Clin Immunol. 2001;  108 497-499
• 39 Mash B, Bheekie A, Jones P W. Inhaled vs. oral steroids for adults with chronic asthma.  Cochrane Database Syst Rev. 2001;  (1) CD002160
• 40 Juergens U R, Dethlefsen U, Steinkamp G. et al . Anti-inflammatory activity of 1.8-Cineol (eucalyptol) in bronchial asthma: a double-blind placebo-controlled trial.  Resp Med . 2003;  97 250-256
• 41 Kehrl W, Sonnemann U, Dethlefsen U. Therapy of acute nonpurulent rhinosinusitis with cineole: results of a double-blind, randomized, placebo-controlled trial.  Laryngoscope. 2004;  114 738-742
• 42 Bousquet J, Lockey R F, Malling H-J. Allergen immunotherapy: therapeutic vaccines for allergic diseases.  Allergy. 1998;  53 1-42
• 43 Malling H-J, Djurup R, Sondergaard I. et al . Immunotherapy. Position paper of the European Academy of Allergology and Clinical Immunology (EAACI).  Allergy. 1985;  40 702-709
• 44 Kleine-Tebbe J, Fuchs T, Klimek L. et al . Die spezifische Immuntherapie (Hyposensibilisierung) mit Allergenen.  Allergo Journal. 2000;  9 317-324
• 45 Sennekamp J, Kersten W, Hornung B. Empfehlungen zur Hyposensibilisierung mit Allergenextrakten.  Allergo J. 1995;  4 205-212
• 46 Durham S K, Walker S M, Varga E M. et al . Long-term clinical efficacy of grass-pollen immunotherapy.  N Engl J Med. 1999;  341 468-475
• 47 Durham S R, Ying S, Varney V A. et al . Grass pollen immunotherapy inhibits allergen-induced infiltration of CD4+ T lymphocytes and eosinophils in the nasal mucosa and increases the number of cells expressing messenger RNA for interferon-gamma.  J Allergy Clin Immunol. 1996;  97 1356-1365
• 48 Renz H. Immuntherapie bei breitem Allergiespektrum.  Dtsch Med Wschr. 2002;  127 1274-1275
• 49 Möller C h, Dreborg S, Ferdousi H A. et al . Pollen immunotherapy reduces the development of asthma in children with seasonal rhinoconjunctivitis (The PAT-Study).  J Allergy Clin Immunol. 2002;  109 251-256
• 50 Schultze-Werninghaus G. Wirksame Therapieoptionen bei Insektengiftallergien, Rhinokonjunktivitis und Asthma.  Klinikarzt. 2000;  5 132-136
• 51 Nelson H S. Advances in upper airway diseases and allergen immunotherapy.  J Allergy Clin Immunol. 2003;  111 S793-S798
• 52 Johnstone D E, Dutton A. The value of hyposensitization therapy for bronchial asthma in children - a 14-year study.  Pediatrics. 1968;  42 793-802
• 53 Pajno G B, 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 Allergol. 2001;  31 1392-1397
• 54 Walker S M, Pajno G B, Lima M T. et al . Grass pollen immunotherapy for seasonal rhinitis and asthma: a randomized, controlled trial.  J Allergy Clin Immunol. 2001;  107 87-93
• 55 Melen E, Wickman M, Nordvall S L. et al . Influence of early and current environmental exposure factors on sensitization and outcome of asthma in pre-school children.  Allergy. 2001;  56 646-652
• 56 Abramson M, Puy R, Weiner J. Immunotherapy in asthma: an updated systematic review.  Allergy. 1999;  54 1022-1041
• 57 Jarvis B, Markham A. Montelukast, a review of its therapeutic potential in persistent asthma.  Drugs. 2000;  59 891-928
• 58 Volovitz B, Duenas-Meza E, Chmielewska-Szewczyk D A. et al . Comparison of oral montelukast and inhaled cromolyn with respect to preference, satisfaction, and adherence: a multicenter, randomized, open-label, crossover study in children with mild to moderate persistent asthma.  Curr Ther Res. 2000;  61 490-506
• 59 Riccioni G, Vecchia R D, D'Orazio N D. et al . Comparison of montelukast and budesonide on bronchial reactivity in subjects with mild-moderate persistent asthma.  Pulm Pharmacol Therapeutics. 2003;  16 111-114
• 60 Diamant Z, Fokkens W J. Leukotriene receptor antagonists: clincial potential in allergic rhinitis.  Rhinology. 2001;  39 187-190
• 61 Lipworth B J. Emerging role of antileukotriene therapy in allergic rhinitis.  Clin Exp Allergy. 2001;  31 1813-1821
• 62 Pawankar R. Exploring the role of leukotriene receptor antagonists in the management of allergic rhinitis and comorbid asthma.  Clin Exp All Rev. 2003;  3 74-80
• 63 Philip G, Malmstrom K, Hampel Jr S F. et al . Montelukast for treating seasonal allergic rhinitis: a randomized, double-blind,placebo-controlled trial performed in the spring.  Clin Exp Allergy. 2002;  32 1020-1028
• 64 Adelsberg J von, Philip G, LaForce C F. et al . Randomized controlled trial evaluating the clinical benefit of montelukast for treating spring seasonal allergic rhinitis.  Ann Allergy Asthma Immunol. 2003;  90 214-222
• 65 Adelsberg J von, Philip G, Pedinoff A. et al . Montelukast improves symptoms of seasonal allergic rhinitis over a 4-week treatment period.  Allergy. 2003;  58 1268-1276
• 66 Hsieh J-C, Lue K-H, Lai D-S. et al . A comparison of cetirizine and montelukast for treating childhood perennial allergic rhinitis.  Pediatr Asthma Allergy Immunol. 2004;  17 59-69
• 67 Lee D KC, Jackson C M, Soutar P C. et al . Effects of single or combined histamine H₁-receptor and leukotriene CysLT1-receptor antagonism on nasal adenosine monophosphate challenge in persistent allergic rhinitis.  Br J Clin Pharmacol. 2003;  57 714-719
• 68 Meltzer E O, Malmstrom K, Lu S. et al . Concomitant montelukast and loratadine as treatment for seasonal allergic rhinitis: a randomized, placebo-controlled clinical trial.  J Allergy Clin Immunol. 2000;  105 917-922
• 69 Nayak A S, Philip G, Lu S. et al . Efficacy and tolerability of montelukast alone or in combination with loratadine in seasonal allergic rhinitis: a multicenter, randomized, double-blind, placebo-controlled trial performed in the fall.  Ann Allergy Asthma Immunol. 2002;  88 592-600
• 70 Wilson A. Antihistamines alone and in combination with leukotriene antagonists in nasal congestion.  Clin Exp All Rev. 2002;  2 95-100
• 71 Wilson A M, Dempsey O J, Sims E J. et al . A comparison of topical budesonide and oral montelukast in seasonal rhinitis and asthma.  Clin Exp Allergy. 2001;  31 616-624
• 72 Wilson A M, Orr L C, Sims E J. et al . Antiasthmatic effector of mediator blockade versus topical corticosteroids in allergic rhinitis and asthma.  Am J Respir Crit Care Med. 2000;  162 1297-1301
• 73 Pullerits T, Praks L, Ristioja V. et al . Comparison of a nasal glucocorticoid, antileukotriene, and a combination of antileukotriene and antihistamine in the treatment of seasonal allergic rhinitis.  J Allergy Clin Immunol. 2002;  109 949-955
• 74 Chervinsky P, Philip G, Malice M-P. et al . Montelukast for treating fall allergic rhinitis: effect of pollen exposure in 3 studies.  Ann Allergy Asthma Immunol. 2004;  92 367-373
• 75 Solér M, Matz J, Townley R. et al . The anti-IgE antibody omalizumab reduces exacerbations and steroid requirement in allergic asthmatics.  Eur Respir J. 2001;  18 254-261
• 76 Corren J, Casale T, Deniz Y. et al . Omalizumab, a recombinant humanized anti-IgE antibody, reduces asthma-related emergency room visits and hospitalizations in patients with allergic asthma.  J Allergy Clin Immunol. 2003;  111 87-90
• 77 Buhl R, Hanf G, Solér M. et al . The anti-IgE antibody omalizumab improves asthma-releated quality of life in patients with allergic asthma.  Eur Respir J. 2002;  20 1088-1094
• 78 Fahy J V, Fleming E, Wong H H. et al . The effect of an anti-IgE monoclonal antibody on the early- and late phase responses to allergen inhalation in asthmatic subjects.  Am J Respir Crit Care Med. 1997;  155 1828-1834
• 79 Noga O, Hanf G, Kunkel G. Immunological and clinical changes in allergic asthmatics following treatment with omalizumab.  Int Arch Allergy Appl Immunol. 2003;  131 46-52
• 80 Berger W, Gupta N, McAlary M. et al . Evaluation of long-term safety of the anti-IgE antibody, omalizumab, in children with allergic asthma.  Ann Allergy Asthma Immunol. 2003;  91 182-188
• 81 Lanier B Q, Corren J, Lumry W. et al . Omalizumab is effective in the long-term control of severe all asthma.  Ann Allergy Asthma Immunol. 2003;  91 154-159
• 82 D'Amato G. Therapy of allergic bronchial asthma with omalizumab - an IgE monoclonal antibody.  Expert Opin Biol Ther. 2003;  3 371-376
• 83 Chervinsky P, Casale T, Townley R. et al . Omalizumab, an anti-IgE antibody, in the treatment of adult adolescents with perennial allergic rhinitis.  Ann Allergy Asthma Immunol. 2003;  91 160-167
• 84 Casale T B, Condemi J J, Laforce C. et al . Effect of omalizumab on symptoms of seasonal allergic rhinitis, a randomized controlled trial.  JAMA. 2001;  286 2956-2967
• 85 Casale T B, Bernstein I L, Busse W W. et al . Use of an anti-IgE humanized monoclonal antibody in ragweed-induced allergic rhinitis.  J Allergy Clin Immunol. 1997;  100 110-121
• 86 Nayak A, Casale T, Miller S D. et al . Tolerability of retreatment with omalizumab, a recombinant humanized monoclonal anti-IgE antibody, during a second ragweed pollen season in patients with seasonal allergic rhinitis.  Allergy Asthma Proc. 2003;  24 323-329
• 87 Berkowitz R B, Roberson S, Zora J. et al . Mometasone furoate nasal spray is rapidly effective in the treatment of seasonal allergic rhinitis in an outdoor (park), acute exposure setting.  Allergy Asthma Proc. 1999;  20 167-172
• 88 Kanniess F, Richter K, Magnussen H. Effect of inhaled ciclesonide on hypersensitivity to AMP, induced sputum and exhaled nitric oxide in subjects with bronchial asthma.  Eur Respir J. 1999;  14 289s
• 89 Belvisi M G, Brown T J, Wicks S. et al . New glucocorticosteroids with an improved therapeutic ratio.  Pulm Pharmacol Therapeutics. 2001;  14 221-227
• 90 Drollmann A, Langdon C, Engelstätter R. et al . Ciclesonide is effective in the treatment of bronchial asthma.  Eur Respir J. 2001;  18 95s-95sk;
• 91 Nave R, Hummel R-P, Wohlsen A. et al . The active metabolite of ciclesonide, desisobutyryl-ciclesonide, forms highly lipophilic fatty acid conjugates in precision-cut rat lung slides.  Am J Respir Crit Care Med. 2004;  169 A91
• 92 Postma D S, Sevette C, Martinat Y. et al . Treatment of asthma by the inhaled corticosteroid ciclesonide given either in the morning or evening.  Eur Respir J. 2001;  17 1083-1088
• 93 Lee D KC, Haggart K, Currie G P. et al . Effects of hydrofluoroalkane formulations of ciclesonide 400 micro g once daily vs fluticasone 250 micro g twice daily on methacholine hyper-responsiveness in mild-to-moderate persistent asthma.  Br J Clin Pharmacol. 2004;  58 26-33
• 94 Larsen B B, Nielsen L P, Engelstätter R. et al . Effect of ciclesonide on allergen challenge in subjects with bronchial asthma.  Allergy. 2003;  58 207-212
• 95 Reynolds N A, Scott L J. Ciclesonide.  Drugs. 2004;  64 511-519