Grundlagen allergischer Erkrankungen der Augenoberfläche und aktuelle medikamentöse Therapiekonzepte

Zusammenfassung

Hintergrund: Die okuläre Allergie gehört zu den häufigsten Augenerkrankungen weltweit. Dem klinischen Phänotyp und der Pathogenese nach werden verschiedene Allergieformen unterschieden, die unterschiedliche Behandlungsstrategien erfordern. Der Übersichtsartikel stellt die zentralen immunologischen Pathomechanismen sowie aktuelle Behandlungsmöglichkeiten dar. Methoden: Literatursuche in PubMed und eigene klinische und experimentelle Daten. Ergebnisse: An der Pathogenese der okulären Allergie sind unterschiedliche Immunzellen wie dendritische Zellen, B-Zellen, T-Zellen, Mastzellen, Eosinophile und regulatorische T-Zellen beteiligt. Therapeutische Ansätze fokussieren auf eine Symptomverbesserung mittels Antihistaminika, Mastzellstabilisatoren und Kombinationswirkstoffen. In schweren Fällen werden Steroide und Calcineurin-Inhibitoren eingesetzt. Schlussfolgerungen: Obwohl in der Erforschung der Pathogenese der okulären Allergie in den vergangenen Jahren große Fortschritte gemacht wurden, sind noch Fragen z. B. zum Zusammenhang zwischen Trockenem Auge und okulärer Allergie ungeklärt. Zukünftige Therapieverfahren werden auf kürzlich beschriebene Mechanismen wie die Lymphangiogenese aufbauen und zunehmend kausalere Behandlungsmethoden ermöglichen.

Abstract

Background: Ocular allergy belongs to the most common ocular diseases globally. Following clinical phenotype and immunopathogenesis different forms of allergy are distinguished, which require different forms of therapeutic approach. This manuscript reviews the basic immunological processes involved in the development of ocular allergies and current and future therapeutic approaches. Methods: Results of a literature search in PubMed and our own clinical and experimental experience are presented. Results: In the immunopathogenesis of ocular allergy different immune cells such as dendritic cells, B-cells, T-cells, mast cells, eosinophils and regulatory T-cells are involved. Therapeutic approaches focus on either relief of symptoms using antihistamins or mast cell stabilisers or combinations of both. In severe cases steroids or calcineurin inhibitors are used. Discussion: Despite great progress in the investigation of ocular allergy in the past decade several open questions remain, such as the relation of ocular allergy with dry eye disease. Future therapeutic approaches will likely be based on recently identified new aspects such as lymphangiogenesis and will allow better and potentially causal treatment of ocular allergy.

Schlüsselwörter

Bindehaut - Kornea - Lider

Key words

conjunctiva - cornea - lids

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