Zusammenfassung
Allergische Reaktionen nach Insektenstichen werden in Deutschland hauptsächlich durch Honigbienen (Apis mellifera) oder bestimmte Faltenwespen (z. B. Vespula vulgaris, Vespula germanica) verursacht. Die Therapieerfolge durch eine spezifische Immuntherapie sind hoch, trotzdem ist mit Therapieversagern zu rechnen. Im Hinblick auf die vitale Bedrohung, die von Insektengiftallergien ausgeht, müssen gerade Therapieversager in einem frühen Therapiestadium identifiziert und die Therapiedosis für eine erfolgreiche Behandlung angepasst werden. Prick-Test und aktuelle in-vitro Verfahren lassen bisher keine verlässlichen Rückschlüsse zu, ob ein Patient eine Schutzwirkung entwickelt bzw. ein Therapieversager ist oder nicht. Die Stichprovokation bietet derzeit als einziges Verfahren die Möglichkeit Therapieversager in einem frühen Stadium der Therapie zu identifizieren und somit durch Anpassung der Therapiedosis eine erfolgreiche Hyposensibilisierung zu ermöglichen.
Abstract
Therapy Control of Specific Hymenoptera Venom Allergy
In Germany anaphylactic reactions after insect stings are mostly caused by honey bee (Apis mellifera) and wasp (Vespula vulgaris, Vespula germanica). In the majority of cases venom immunotherapy is a successful therapy and protects patients from recurrent systemic anaphylactic reaction. In some patients persistent severe reactions after insect sting can even occur in spite of venom therapy, as a sign of therapy failure. It is important to identify these patients, who do not benefit from venom immunotherapy, in an early stage of therapy. In this case dose rate of venom immunotherapy must be adjusted for a successful therapy outcome. Up to now skin prick tests, specific IgE-antibodies and in vitro diagnostics are not suitable for detecting therapy failure. Patients with treatment failure can be diagnosed by insect sting test and almost all of them will become fully protected by increasing the maintenance dose.
Schlüsselwörter
Insektengiftallergie - Stichprovokation - Therapiekontrolle
Key words
hymenoptera venom allergy - insect sting test - treatment efficacy
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Korrespondenzadresse
Dr. Wolfram Aust
Liebigstraße 10–14
04158 Leipzig
eMail: wolfram.aust@medizin.uni-leipzig.de
