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Pneumologie 2006; 60(4): 241-247
DOI: 10.1055/s-2005-919117
Übersicht
© Georg Thieme Verlag Stuttgart · New York

Wirksamkeit und Sicherheit der sublingualen Immuntherapie (SLIT) - eine ausführliche Standortbestimmung

Efficacy and Safety of Sublingual Immunotherapy - a Detailed AnalysisK.-Ch.  Bergmann1
  • 1Allergie-Centrum-Charité, Standort: Klinik für Dermatologie, Venerologie und Allergologie (Direktor: Prof. Sterry), Berlin
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Publication History

Eingang: 5. August 2005

Akzeptiert: 23. Oktober 2005

Publication Date:
03 April 2006 (online)

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Zusammenfassung

Die sublinguale Immuntherapie wurde entwickelt, um das Risiko schwerer systemischer Nebenwirkungen zu vermeiden, wie sie bei der subkutanen Immuntherapie auftreten können. Auf der Grundlage von mehr als 20 kontrollierten Studien kann festgestellt werden, dass die Wirksamkeit und Sicherheit der SLIT zur Behandlung der allergischen Rhinokonjunktivitis bei Pollen- und Milbenallergie mittlerweile gut belegt ist. Die Daten für das allergische Asthma bedürfen noch der Überprüfung. Die sublinguale Immuntherapie stellt keinen Ersatz der subkutanen Immuntherapie dar, sondern ist eine relevante zusätzliche Option für definierte Patientengruppen. Von entscheidender Bedeutung für die Wirksamkeit ist die Applikation einer ausreichend hohen Dosis des Allergenextraktes. Für den klinischen Alltag kann die Empfehlung der ARIA-Working-Group zur Anwendung einer mindestens 50- bis 100-fachen kumulativen Dosis im Vergleich zur subkutanen IT verwendet werden. Die Therapie kann prä- oder cosaisonal sowie perennial erfolgen. Die Titration bei Behandlungsbeginn erfolgt heute üblicherweise mit täglich steigender Dosis über wenige Tage, bei ausgesuchten erwachsenen Patienten mit einer Pollenallergie gegebenenfalls auch innerhalb weniger Stunden. Die gut tolerierte Erhaltungsdosis wird im Allgemeinen während der gesamten Behandlungsdauer drei mal pro Woche oder täglich eingenommen. Nach endgültiger Validierung könnte die sublinguale saisonale Kurzzeit-Immuntherapie eine zusätzliche Option für bestimmte Patientengruppen, wie zum Beispiel Jugendliche, darstellen.

Abstract

Sublingual immunotherapy (SLIT) was developed to avoid the risk of severe systemic side effects which occur in subcutaneous immunotherapy. Data from more than 20 controlled studies clearly show the efficacy and safety of this type of immunotherapy in patients with allergic rhino-conjunctivitis due to pollen and mites. The data for allergic asthma still need confirmation. Sublingual immunotherapy is no substitute for subcutaneous immunotherapy but an additional option for defined groups of patients. The application of a sufficient amount of allergen is important for the efficacy of SLIT. According to the recommendation of the ARIA working group, a 50- to 100-fold cumulative dose should be applied as compared to subcutaneous immunotherapy. SLIT can be used preseasonally, during the saison or perennially. Therapy starts with a daily increase of the dose. In some cases, e. g., in adult patients with pollen allergy, doses can be increased within hours. The well-tolerated maintenance dose should be taken three times a week or daily. The sublingual seasonal short-time immunotherapy may become an additional option for subgroups of patients, e. g., for adolescents.

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Prof. Dr. med. Karl-Christian Bergmann

Charité-Universitätsmedizin Berlin · Klinik für Dermatologie, Venerologie und Allergologie · Allergie-Centrum-Charité

Schumannstr. 20/21

10117 Berlin