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Allergo Journal
Erschienen in: Allergo Journal 8/2019

04.12.2019 | Arzneimittelallergien und Intoleranzreaktionen | Übersicht

Schwere Hautreaktionen: klinisches Bild, Epidemiologie, Ätiologie, Pathogenese und Therapie

verfasst von: Maren Paulmann, Prof. Dr. Maja Mockenhaupt

Erschienen in: Allergo Journal | Ausgabe 8/2019

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Zusammenfassung

Hintergrund

Schwere Hautreaktionen, meist infolge von Medikamenteneinnahme, sind sehr selten und können mit einer hohen Letalität einhergehen. Eine geeignete Therapie, um die Letalität zu senken, ist erstrebenswert.

Methoden

Die aktuellen Veröffentlichungen zu dieser Thematik wurden gesichtet und bewertet.

Ergebnisse

Bei den selbstlimitierenden Erkrankungen akute generalisierte exanthematische Pustulose (AGEP) und generalisiertes bullöses fixes Arzneiexanthem (GBFDE) gibt es keine klare Indikation für eine systemische immunmodulierende Therapie, der Goldstandard ist die supportive Therapie. Bei „drug reaction with eosinophilia and systemic symptoms“ (DRESS) ist die Situation weniger eindeutig, doch werden systemische Glukokortikosteroide vor allem bei ausgeprägter Organbeteiligung empfohlen. Diese geht mit Komplikationen und häufig auch einer Virusreaktivierung einher, welche die Abheilung verzögern kann. Die Datenlage bei Stevens-Johnson-Syndrom (SJS)/Toxisch epidermaler Nekrolyse (TEN) ist kontrovers für verschiedene immunmodulierende Therapien. Aktuelle Publikationen präferieren eine Steroid-Pulstherapie, den Tumornekrosefaktor(TNF)-α-Inhibitor Etanercept sowie den Calcineurin-Inhibitor Cyclosporin A, wobei letztgenannter den vielversprechendsten Ansatz darstellt.

Schlussfolgerung

Die Seltenheit und Unvorhersehbarkeit der Reaktionen machen eine randomisierte doppelblinde Therapiestudie extrem schwierig. Mithilfe von Metaanalysen kann eine Tendenz in der Anwendung von systemischen Therapieoptionen herausgearbeitet werden. Für alle Krankheitsbilder stellt die supportive Therapie immer noch die wichtigste Behandlungsstrategie dar.
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Metadaten
Titel
Schwere Hautreaktionen: klinisches Bild, Epidemiologie, Ätiologie, Pathogenese und Therapie
verfasst von
Maren Paulmann
Prof. Dr. Maja Mockenhaupt
Publikationsdatum
04.12.2019
Verlag
Springer Medizin
Erschienen in
Allergo Journal / Ausgabe 8/2019
Print ISSN: 0941-8849
Elektronische ISSN: 2195-6405
DOI
https://doi.org/10.1007/s15007-019-1973-z

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