Aktuelle Therapiekonzepte bei allergischen und hyperergischen Erkrankungen der oberen Luftwege

Zusammenfassung

Die allergische Rhinitis (AR) und hyperergische Erkrankungen der oberen Luftwege sind durch die nasale Hyperreaktivität charakterisiert, die je nach Art der auslösenden Reize als spezifische nasale Hyperreaktivität, z. B. bei der AR, oder als unspezifische nasale Hyperreaktivität als idiopathische Rhinitis (IR) (früher gebräuchliche Synonyme: unspezifische nasale Hyperreaktivität; vasomotorische Rhinitis) bei nicht näher charakterisierten Reizen bezeichnet wird.

Die frühe und fachgerechte Therapie von allergischen Erkrankungen der oberen Luftwege ist von immenser Bedeutung, da die allergische Rhinitis mit Komorbiditäten wie etwa Asthma und Rhinosinusitis vergesellschaftet ist. Das therapeutische Konzept ist durch Neu- und Weiterentwicklung pharmakologischer Substanzklassen wie etwa Antihistaminika und Glukokortikosteroide geprägt. Auch die spezifische Immuntherapie, die einzig kausale Therapie der AR, ist in den letzten Jahren hinsichtlich Applikationsart und -schema reformiert worden. Allerdings lässt sich aus den bisherigen Untersuchungen zu diesen Modifikationen noch keine gesicherte Empfehlung zur oralen, sublingualen und/oder nasalen Immuntherapie ableiten.

Das Konzept der Behandlung der IR zielt auf eine symptombezogene Therapie der nasalen Hyperreaktivität ab, da ätiologische Faktoren zu dieser Form der Rhinitis noch nicht hinreichend bekannt sind. Arzneimittelgruppen wie Mastzellstabilisatoren, systemische und topische Antihistaminika, topische und systemische Glukokortikosteroide, Ipatropiumbromid und alpha-Sympathomimetika gehören zum Spektrum der verwendeten Therapeutika.

Schlüsselwörter

Allergische Rhinitis - idiopathische Rhinitis - Glukokortikosteroide - Antihistaminika - Anticholinergika - Immuntherapie - sublingual

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