Jappe Uta, Beckert Hendrik, Bergmann Karl-Christian, Gülsen Askin, Klimek Ludger, Philipp Sandra, Pickert Julia, Rauber-Ellinghaus Michèle M, Renz Harald, Taube Christian, Treudler Regina, Wagenmann Martin, Werfel Thomas, Worm Margita, Zuberbier Torsten
Research Group Clinical and Molecular Allergology of the Research Center Borstel, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL).
Interdisciplinary Allergy Outpatient Clinic, Medical Clinic III, University of Lübeck.
Allergol Select. 2021 Jan 5;5:1-25. doi: 10.5414/ALX02197E. eCollection 2021.
With the advent of biologicals, more and more therapeutics are available that specifically address specific switch points in the pathomechanism of immunologically dominated diseases. Thus, the focus of diagnostics and therapy (precision medicine) is more on the individual disease characteristics of the individual patient. Regarding the different phenotypes of atopic diseases, severe asthma was the first entity for which biologicals were approved, followed by urticaria, and finally atopic dermatitis and chronic rhinosinusitis with nasal polyps. Experience in the treatment of severe bronchial asthma has shown that the intensity of the response to biological therapy depends on the quality of clinical and immunological phenotyping of the patients. This also applies to different diseases of the atopic form, as patients can suffer from several atopic diseases at the same time, each with different characteristics. Biologics are already emerging that may represent a suitable therapy for allergic bronchial asthma, which often occurs together with severe neurodermatitis, and chronic rhinosinusitis with nasal polyps. In practice, however, the question of possible combinations of biologicals for the therapy of complex clinical pictures of individual patients is increasingly arising. In doing so, the side effect profile must be taken into account, including hypersensitivity reactions, whose diagnostic and logistical management must aim at a safe and efficient therapy of the underlying disease. Increased attention must also be paid to biological therapy in pregnancy and planned (predictable) vaccinations as well as existing infections, such as SARS-CoV-2 infection. Before starting a biological therapy, the immune status should be checked with regard to chronic viral and bacterial infections and, if necessary, the vaccination status should be refreshed or missing vaccinations should be made up for before starting therapy. Currently, reliable data on the effect of biologicals on the immunological situation of SARS-CoV-2 infection and COVID-19 are not available. Therefore, research and development of suitable diagnostic methods for detection of immunologically caused side effects as well as detection of potential therapy responders and non-responders is of great importance.
随着生物制剂的出现，越来越多的治疗方法可供使用，这些方法专门针对免疫主导疾病发病机制中的特定转换点。因此，诊断和治疗（精准医学）的重点更多地放在个体患者的个体疾病特征上。关于特应性疾病的不同表型，重度哮喘是首个生物制剂获批用于治疗的疾病实体，其次是荨麻疹，最后是特应性皮炎和伴有鼻息肉的慢性鼻-鼻窦炎。重度支气管哮喘的治疗经验表明，生物治疗的反应强度取决于患者临床和免疫表型分析的质量。这同样适用于不同形式的特应性疾病，因为患者可能同时患有多种特应性疾病，每种疾病都有不同的特征。生物制剂已经出现，它们可能是治疗常与重度神经性皮炎以及伴有鼻息肉的慢性鼻-鼻窦炎同时发生的过敏性支气管哮喘的合适疗法。然而，在实践中，针对个体患者复杂临床情况的生物制剂联合使用可能性的问题越来越突出。在此过程中，必须考虑副作用情况，包括超敏反应，其诊断和后勤管理必须以安全、有效地治疗基础疾病为目标。还必须更加关注孕期的生物治疗以及计划内（可预测的）疫苗接种和现有感染，如SARS-CoV-2感染。在开始生物治疗之前，应检查免疫状态，了解慢性病毒和细菌感染情况，如有必要，应在开始治疗前更新疫苗接种状态或补种漏种的疫苗。目前，尚无关于生物制剂对SARS-CoV-2感染和COVID-19免疫状况影响的可靠数据。因此，研发适用于检测免疫引起的副作用以及检测潜在治疗反应者和无反应者的诊断方法非常重要。
