Brehler Randolf, Stöcker Benedikt, Grundmann Sonja
Clinic for Allergology, Occupational Dermatology, and Environmental Medicine, Department of Dermatology, University Medical Center Münster, Münster, Germany.
J Dtsch Dermatol Ges. 2015 Aug;13(8):747-62; quiz 763-4. doi: 10.1111/ddg.12782.
In recent decades, the incidence of allergic diseases has dramatically increased, by now affecting a large percentage of the population. For a long time, allergen avoidance was considered the most crucial measure in primary allergy prevention. However, studies have increasingly shown that exposure to allergens is an essential prerequisite for the development of immunological tolerance. Diagnostic workup is based on patient history, skin tests, and measurement of specific IgE antibodies. The introduction of component-based diagnostic workup offer an option to differentiate between primary sensitization and cross-reactivity caused by sensitization to panallergens or sensitization to cross-reactive carbohydrate epitopes. Symptomatic treatment only leads to temporary relief of allergic symptoms. By contrast, specific immunotherapy (SIT) may have long-lasting therapeutic effects and potentially even result in a complete cure. The selection of allergens for SIT is guided by the principle of major allergens. It is recommended to use those preparations that have been proven safe and effective in controlled clinical studies. With respect to subcutaneous immunotherapy, a host of tested and approved extracts are available for a wide range of different allergens. Large clinical trials have also confirmed the efficacy of sublingual immunotherapy with grass and also birch pollen extracts, which has led to the official approval of some preparations containing these allergens.
近几十年来，过敏性疾病的发病率急剧上升，目前影响着很大一部分人口。长期以来，避免接触过敏原被认为是原发性过敏预防中最关键的措施。然而，越来越多的研究表明，接触过敏原是免疫耐受发展的必要前提。诊断检查基于患者病史、皮肤试验和特异性IgE抗体的检测。基于组分的诊断检查方法的引入为区分原发性致敏与由泛过敏原致敏或对交叉反应性碳水化合物表位致敏引起的交叉反应提供了一种选择。对症治疗只能暂时缓解过敏症状。相比之下，特异性免疫疗法（SIT）可能具有持久的治疗效果，甚至有可能实现完全治愈。SIT中过敏原的选择以主要过敏原原则为指导。建议使用在对照临床研究中已被证明安全有效的制剂。关于皮下免疫疗法，有一系列经过测试和批准的提取物可用于多种不同的过敏原。大型临床试验也证实了舌下免疫疗法对草花粉和桦树花粉提取物的疗效，这导致了一些含有这些过敏原的制剂获得官方批准。
