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Erschienen in: Allergo Journal 7/2012

22.03.2016 | Übersicht

Neues und Bewährtes zur Therapie des atopischen Ekzems

verfasst von: Prof. Dr. Regina Fölster-Holst

Erschienen in: Allergo Journal | Ausgabe 7/2012

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Zusammenfassung

Derzeit steht für das atopische Ekzem (AE) keine kausale Behandlung zur Verfügung. Neben der Meidung individueller Provokationsfaktoren umfasst die symptomatische Lokaltherapie eine stadiengerechte Anwendung pflegender und rückfettender sowie ggf. antiseptischer und antiinflammatorischer Externa. Die medikamentöse Therapie des schweren AE ist eine besondere Herausforderung. Als immunsuppressives Systemtherapeutikum ist in Deutschland derzeit nur Ciclosporin zugelassen; zur Unterbrechung des akuten Schubes können auch orale Glukokortikosteroide eingesetzt werden. Daneben stellen Methotrexat (MTX), Azathioprin, Mycophenolatmofetil und Leflunomid immunsuppressive Therapieoptionen im Einzelfall dar („off-label use“), die jedoch meist nur in kleineren Fallserien oder unkontrollierten Studien untersucht wurden.
Während in den letzten Jahren für die Behandlung der Psoriasis eine Reihe hochwirksamer Biologika entwickelt wurde, gibt es noch kein Medikament aus dieser Gruppe, welches für die Therapie des AE zugelassen ist. In offenen Anwendungsbeobachtungen ergaben sich jedoch Hinweise auf eine Wirksamkeit von Alefacept (Fusionsprotein, Inhibition der T-Zell-Aktivierung), Efalizumab (Anti-LFA-1-Antikörper), Rituximab (Anti-CD-20-Antikörper) und Omalizumab (Anti-IgE-Antikörper) zumindest bei Subgruppen von Patienten. Neben der extrakorporalen Photopherese könnte außerdem die Immunglobulin-Immunadsorption eine Option zur Behandlung des therapierefraktären AE darstellen.
Bei Patienten mit klinisch relevanter Sensibilisierung gegenüber Aeroallergenen ist die spezifische Immuntherapie, auch hinsichtlich des AE, durchaus eine Therapieoption.
Basierend auf zahlreichen neuen Erkenntnissen zur Pathogenese des AE werden derzeit eine Reihe neuer therapeutischer Ansätze verfolgt. Zielstrukturen sind unter anderem Filaggrinstoffwechsel und epidermale Proteasen, Tachykininrezeptoren, Histaminrezeptor 4, Interleukin-31 und Phosphodiesterase-4.
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Metadaten
Titel
Neues und Bewährtes zur Therapie des atopischen Ekzems
verfasst von
Prof. Dr. Regina Fölster-Holst
Publikationsdatum
22.03.2016
Verlag
Urban & Vogel
Erschienen in
Allergo Journal / Ausgabe 7/2012
Print ISSN: 0941-8849
Elektronische ISSN: 2195-6405
DOI
https://doi.org/10.1007/s15007-012-0391-2

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