Die saisonale und perenniale allergische Rhinokonjunktivitis

 

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Zusammenfassung

Sowohl bei der saisonalen allergischen Konjunktivitis (seasonal allergic conjunctivitis, SAC) und ganzjährigen allergischen Konjunktivitis (perennial allergic conjunctivitis, PAC) als auch bei der intermittierenden und persistierenden Rhinitis handelt es sich umweit verbreitete Krankheitsbilder, die in der Mehrzahl der Fälle gemeinsam auftreten und daher zumeist unter dem Oberbegriff der allergischen Rhinokonjunktivitis zusammengefasst werden. SAC und PAC zusammen machen als die 2 akuten Formen mehr als 90% der Gesamtzahl aller Fälle von allergischer Konjunktivitis aus. Verglichen mit den chronischen Formen verlaufen sie harmloser, bekommen jedoch aufgrund der Häufigkeit und sowie des nachgewiesenen Einflusses auf die Lebensqualität der Patienten klinische und sozioökonomische Relevanz. Auslöser der der allergischen Rhinokonjunktivitis zugrunde liegenden IgE-vermittelten Typ-1-Hypersensitivitätsreaktion sind zumeist Aeroallergene. Pathognomonisches Symptom ist Juckreiz. Okulär zeigen sich zudem Chemosis, Bindehautinjektion, wässrige Sekretion sowie Lidschwellungen. HNO-ärztlich finden sich zumeist gesteigerte Nasensekretion, retronasaler Schleimfluss und Niesen. Durch Behinderung der Nasenatmung können Schlaf- und Konzentrationsstörungen auftreten. Therapeutisch können neben der Vermeidung der Allergenexposition durch Modifikation von Umweltfaktoren bei milden Formen von SAC und PAC Tränenersatzmittel eingesetzt werden. Topische Antihistaminika eignen sich insbesondere zur Linderung der akuten Symptomatik. Topische Mastzellstabilisatoren hingegen zeigen einen längerfristigen Effekt. Dual wirksame Kombinationen aus Antihistaminikum und Mastzellstabilisator vereinen gute Wirksamkeit und Anwenderfreundlichkeit. Lokale Steroide sollten bei SAC und PAC zurückhaltend und zeitlich begrenzt angewendet werden. Im Falle einer langfristigen Anwendung antiallergischer Lokalmedikation wird die Verwendung unkonservierter Präparate empfohlen. Die HNO-ärztlich häufig in Kombination mit Antihistaminika angewendeten intranasalen Steroide zeigen bei Verwendung moderner Präparate ein günstiges Nebenwirkungsprofil. Zusammenfassend stellt die allergische Rhinokonjunktivitis ein häufiges und nach korrekter Diagnosestellung gut therapierbares Krankheitsbild dar. Durch gezielte Behandlung kann innerhalb kurzer Zeit eine deutliche Verbesserung der Lebensqualität der betroffenen Patienten erreicht werden.

Abstract

Seasonsal allergic conjunctivitis (SAC) and perennial allergic conjunctivitis (PAC) as well as intermittent and persistent allergic rhinitis are widespread diseases. Because a combined occurrence of ocular and nasal symptoms is very common the summarising term allergic rhinoconjunctivitis is frequently used. SAC and PAC representing the two acute forms of allergic conjunctivitis account for more than 90% of all cases of allergic conjunctivitis. Compared to the chronic forms of allergic conjunctivitis their course of disease is milder. Nevertheless because of their high prevalence and the proven influence on patientsʼ quality of life they possess clinical and socioeconomic relevance. Allergic rhinoconjunctivitis is caused by a type 1 IgE-mediated hypersensitivitity reaction that is provoked by aeroallergens in the majority of cases. The pathognomonic sign is itching. Besides, typical ocular findings are chemosis, conjunctival injection,watery secretion and lid swelling. Otorhinolaryngologistsʼ findings include rhinorrhea, postnasal drip and sneezing. Problems in breathing through the nose resulting from nasal obstruction can cause impaired nighttime sleep and daytime somnolence. In addition to a reduction of allergen exposure by modification of environment and life style factors, in mild forms of SAC and PAC artificial tears are recommended. Topical antihistamines can generate rapid relief from acute symptoms and itching. Topical mast cell stabilisers however provide long-term effects. Dual action drugs that combine antihistamines and mast cell stabilisers show increased patient compliance due to reduced application frequency. Use of topical steroids should be cautious and only temporary. For prolonged treatment periods unpreserved anti-allergic eye-drops should be preferred. Combined topical antihistamines and new-generation topical nasal steroids often used by otorhinolaryngologists demonstrate a good safety profile without systemic side effects. In summary, allergic rhinoconjunctivitis represents a common disease pattern that can be treated effectively. Once it is diagnosed correctly targeted treatment results in improved patientsʼ quality of life quickly.

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