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2016 | OriginalPaper | Buchkapitel

55. Prinzip der temporären Toleranzinduktion

verfasst von : U. Darsow, Prof. Dr. med., J. Ring, Prof. Dr. med. Dr. phil.

Erschienen in: Allergologie

Verlag: Springer Berlin Heidelberg

Zusammenfassung

Die temporäre Toleranzinduktion bei Medikamentenunverträglichkeit und Nahrungsmittelallergie ist nicht als Routineverfahren zu betrachten, die Indikation wird jeweils im Einzelfall nach Risiko-Nutzen-Abwägung gestellt. Wiederholte Applikation von zunehmenden Mengen des relevanten Allergens bis hin zur Symptomfreiheit ist für zahlreiche Arzneistoffe gelungen. Im Unterschied zur klassischen allergenspezifischen Immuntherapie ist allerdings hier der Mechanismus nicht geklärt, und es wird in der Regel keine echte langanhaltende immunologische Toleranz erreicht. Auch für Nahrungsmittelallergien ist die wiederholte Aufnahme von zunehmenden Mengen des relevanten Nahrungsmittels bis hin zur temporären Verträglichkeit der zuletzt verabreichten Menge beschrieben. Unter Beachtung einer Reihe von Vorsichtsmaßnahmen ist das Prinzip der temporären Toleranzinduktion in spezialisierten Zentren ein erfolgreiches Verfahren. Unterschiedliche Ansprechraten bei der Toleranzinduktion sind u. a. auf Unterschiede in Methoden und Schemata sowie auch auf die individuelle Reaktionsbereitschaft der Patienten zurückführbar.
Literatur
Zurück zum Zitat Beyer K (2012) A European perspective on immunotherapy for food allergies. J Allergy Clin Immunol 129: 1179–1184 Beyer K (2012) A European perspective on immunotherapy for food allergies. J Allergy Clin Immunol 129: 1179–1184
Zurück zum Zitat Beyer K, Wahn U (2008) Oral immunotherapy for food allergy in children. Curr Opin Allergy Clin Immunol 8: 553–556 Beyer K, Wahn U (2008) Oral immunotherapy for food allergy in children. Curr Opin Allergy Clin Immunol 8: 553–556
Zurück zum Zitat Bircher AJ (2000) Hyposensibilisierung bei Arzneimittelallergie. In: Ring J, Darsow U (Hrsg) Allergie 2000. Dustri, München, S 219–228 Bircher AJ (2000) Hyposensibilisierung bei Arzneimittelallergie. In: Ring J, Darsow U (Hrsg) Allergie 2000. Dustri, München, S 219–228
Zurück zum Zitat de Boissieu D, Dupont C (2006) Sublingual immunotherapy for cow’s milk protein allergy: a preliminary report. Allergy 61: 1238–9 de Boissieu D, Dupont C (2006) Sublingual immunotherapy for cow’s milk protein allergy: a preliminary report. Allergy 61: 1238–9
Zurück zum Zitat Brozek JL, Terracciano L, Hsu J, Kreis J, Compalati E, Santesso N et al. (2012) Oral immunotherapy for IgE-mediated cow’s milk allergy: a systematic review and metaanalysis. Clin Exp Allergy 42: 363–374 Brozek JL, Terracciano L, Hsu J, Kreis J, Compalati E, Santesso N et al. (2012) Oral immunotherapy for IgE-mediated cow’s milk allergy: a systematic review and metaanalysis. Clin Exp Allergy 42: 363–374
Zurück zum Zitat Buchanan AD, Green TD, Jones SM et al. (2007) Egg oral immunotherapy in nonanaphylactic children with egg allergy. J Allergy Clin Immunol 119: 199–205 Buchanan AD, Green TD, Jones SM et al. (2007) Egg oral immunotherapy in nonanaphylactic children with egg allergy. J Allergy Clin Immunol 119: 199–205
Zurück zum Zitat Calvani M, Giorgio V, Miceli Sopo S (2010) Specific oral tolerance induction for food. A systematic review. Eur Ann Allergy Clin Immunol 42: 11–19 Calvani M, Giorgio V, Miceli Sopo S (2010) Specific oral tolerance induction for food. A systematic review. Eur Ann Allergy Clin Immunol 42: 11–19
Zurück zum Zitat Castells M (2007) Drug Hypersensitivity. In: Pichler W (Hrsg) Drug desensitization in oncology: chemotherapy agents and monoclonal antibodies. Karger Verlag, Bern, S 413–425 Castells M (2007) Drug Hypersensitivity. In: Pichler W (Hrsg) Drug desensitization in oncology: chemotherapy agents and monoclonal antibodies. Karger Verlag, Bern, S 413–425
Zurück zum Zitat Castells M, Tennant NM, Sloane DE, Hsu FI, Barrett NA, Hong DI et al. (2008) Hypersensitivity reactions to chemotherapy: outcomes and safety of rapid desensitization in 413 cases. J Allergy Clin Immunol 122: 574–580 Castells M, Tennant NM, Sloane DE, Hsu FI, Barrett NA, Hong DI et al. (2008) Hypersensitivity reactions to chemotherapy: outcomes and safety of rapid desensitization in 413 cases. J Allergy Clin Immunol 122: 574–580
Zurück zum Zitat Castells M, Sancho-Serra Mdel C, Simarro M (2012) Hypersensitivity to antineoplastic agents: mechanisms and treatment with rapid desensitization. Cancer Immunol Immunother 61: 1575–1584 Castells M, Sancho-Serra Mdel C, Simarro M (2012) Hypersensitivity to antineoplastic agents: mechanisms and treatment with rapid desensitization. Cancer Immunol Immunother 61: 1575–1584
Zurück zum Zitat Cernadas JR, Brockow K, Romano A, Aberer W, Torres MJ, Bircher A, Campi P, Sanz ML, Castells M, Demoly P, Pichler WJ (2010) for the European Network of Drug Allergy and the EAACI interest group on drug hypersensitivity. General considerations on rapid desensitization for drug hypersensitivity – a consensus statement. Allergy 65: 1357–1366 Cernadas JR, Brockow K, Romano A, Aberer W, Torres MJ, Bircher A, Campi P, Sanz ML, Castells M, Demoly P, Pichler WJ (2010) for the European Network of Drug Allergy and the EAACI interest group on drug hypersensitivity. General considerations on rapid desensitization for drug hypersensitivity – a consensus statement. Allergy 65: 1357–1366
Zurück zum Zitat Cox L, Li JT, Nelson H, Lockey R (2007) Allergen immunotherapy: a practice parameter second update. J Allergy Clin Immunol 120: S25–85 Cox L, Li JT, Nelson H, Lockey R (2007) Allergen immunotherapy: a practice parameter second update. J Allergy Clin Immunol 120: S25–85
Zurück zum Zitat Cox L, Nelson H, Lockey R, Calabria C, Chacko T, Finegold I, Nelson M, Weber R, Bernstein DI, Blessing-Moore J, Khan DA, Lang DM, Nicklas RA, Oppenheimer J, Portnoy JM, Randolph C, Schuller DE, Spector SL, Tilles S, Wallace D (2011) Allergen immunotherapy: a practice parameter third update. J Allergy Clin Immunol 127(1 Suppl): S1–55 Cox L, Nelson H, Lockey R, Calabria C, Chacko T, Finegold I, Nelson M, Weber R, Bernstein DI, Blessing-Moore J, Khan DA, Lang DM, Nicklas RA, Oppenheimer J, Portnoy JM, Randolph C, Schuller DE, Spector SL, Tilles S, Wallace D (2011) Allergen immunotherapy: a practice parameter third update. J Allergy Clin Immunol 127(1 Suppl): S1–55
Zurück zum Zitat Demoly P, Pichler W, Pirmohamed M, Romano A (2008) Important questions in Allergy: 1–drug allergy/hypersensitivity. Allergy 63: 616–619 Demoly P, Pichler W, Pirmohamed M, Romano A (2008) Important questions in Allergy: 1–drug allergy/hypersensitivity. Allergy 63: 616–619
Zurück zum Zitat Dupont C, Kalach N, Soulaines P, Legoue-Morillon S, Piloquet H, Benhamou PH (2010) Cow’s milk epicutaneous immunotherapy in children: a pilot trial of safety, acceptability, and impact on allergic reactivity. J Allergy Clin Immunol 125: 1165–1167 Dupont C, Kalach N, Soulaines P, Legoue-Morillon S, Piloquet H, Benhamou PH (2010) Cow’s milk epicutaneous immunotherapy in children: a pilot trial of safety, acceptability, and impact on allergic reactivity. J Allergy Clin Immunol 125: 1165–1167
Zurück zum Zitat Du Toit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF, Brough HA, Phippard D, Basting M, Feeney M, Turcanu V, Sever ML, Gomez Lorenzo M, Plaut M, Lack G (2015) LEAP Study Team. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med 372: 803–13 Du Toit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF, Brough HA, Phippard D, Basting M, Feeney M, Turcanu V, Sever ML, Gomez Lorenzo M, Plaut M, Lack G (2015) LEAP Study Team. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med 372: 803–13
Zurück zum Zitat Enrique E, Malek T, Pineda F et al. (2008) Sublingual immunotherapy for hazelnut food allergy: a follow-up study. Ann Allergy Asthma Immunol 100: 283–284 Enrique E, Malek T, Pineda F et al. (2008) Sublingual immunotherapy for hazelnut food allergy: a follow-up study. Ann Allergy Asthma Immunol 100: 283–284
Zurück zum Zitat Enrique E, Pineda F, Malek T et al. (2005) Sublingual immunotherapy for hazelnut food allergy: a randomized, double-blind, placebo-controlled study with a standardized hazelnut extract. J Allergy Clin Immunol 116: 1073–1079 Enrique E, Pineda F, Malek T et al. (2005) Sublingual immunotherapy for hazelnut food allergy: a randomized, double-blind, placebo-controlled study with a standardized hazelnut extract. J Allergy Clin Immunol 116: 1073–1079
Zurück zum Zitat Fisher HR, Du TG, Lack G (2011) Specific oral tolerance induction in food allergic children: is oral desensitisation more effective than allergen avoidance?: a metaanalysis of published RCTs. Arch Dis Child 96: 259–264 Fisher HR, Du TG, Lack G (2011) Specific oral tolerance induction in food allergic children: is oral desensitisation more effective than allergen avoidance?: a metaanalysis of published RCTs. Arch Dis Child 96: 259–264
Zurück zum Zitat Hofmann AM, Scurlock AM, Jones SM et al. (2009) Safety of a peanut oral immunotherapy protocol in children with peanut allergy. J Allergy Clin Immunol 124: 286–291 Hofmann AM, Scurlock AM, Jones SM et al. (2009) Safety of a peanut oral immunotherapy protocol in children with peanut allergy. J Allergy Clin Immunol 124: 286–291
Zurück zum Zitat Johansson SGO, Bieber T, Dahl R, Friedmann PS, Lanier BQ, Lockey RF et al. (2004) Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. J Allergy Clin Immunol 113: 832–836 Johansson SGO, Bieber T, Dahl R, Friedmann PS, Lanier BQ, Lockey RF et al. (2004) Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. J Allergy Clin Immunol 113: 832–836
Zurück zum Zitat Jones SM, Pons L, Roberts JL et al. (2009) Clinical efficacy and immune regulation with peanut oral immunotherapy. J Allergy Clin Immunol 124: 292–300 Jones SM, Pons L, Roberts JL et al. (2009) Clinical efficacy and immune regulation with peanut oral immunotherapy. J Allergy Clin Immunol 124: 292–300
Zurück zum Zitat Karl S, Ring J (1999) Pro and contra of specific hyposensitization. Eur J Dermatol 9: 325–331 Karl S, Ring J (1999) Pro and contra of specific hyposensitization. Eur J Dermatol 9: 325–331
Zurück zum Zitat Keet CA, Frischmeyer-Guerrerio PA, Thyagarajan A, Schroeder JT, Hamilton RG, Boden S et al. (2012) The safety and efficacy of sublingual and oral immunotherapy for milk allergy. J Allergy Clin Immunol 129: 448–455 Keet CA, Frischmeyer-Guerrerio PA, Thyagarajan A, Schroeder JT, Hamilton RG, Boden S et al. (2012) The safety and efficacy of sublingual and oral immunotherapy for milk allergy. J Allergy Clin Immunol 129: 448–455
Zurück zum Zitat Kerzl R, Simonowa A, Ring J, Ollert M, Mempel M (2007) Life-threatening anaphylaxis to kiwi fruit: protective sublingual allergen immunotherapy effect persists even after discontinuation. J Allergy Clin Immunol 119: 507–508 Kerzl R, Simonowa A, Ring J, Ollert M, Mempel M (2007) Life-threatening anaphylaxis to kiwi fruit: protective sublingual allergen immunotherapy effect persists even after discontinuation. J Allergy Clin Immunol 119: 507–508
Zurück zum Zitat Kim EH, Bird JA, Kulis M, Laubach S, Pons L, Shreffler W et al. (2011) Sublingual immunotherapy for peanut allergy: clinical and immunologic evidence of desensitization. J Allergy Clin Immunol 127: 640–646 Kim EH, Bird JA, Kulis M, Laubach S, Pons L, Shreffler W et al. (2011) Sublingual immunotherapy for peanut allergy: clinical and immunologic evidence of desensitization. J Allergy Clin Immunol 127: 640–646
Zurück zum Zitat Kulis M, Saba K, Kim EH, Bird JA, Kamilaris N, Vickery BP et al. (2012) Increased peanut-specific IgA levels in saliva correlate with food challenge outcomes after peanut sublingual immunotherapy. J Allergy Clin Immunol 129: 1159–1162 Kulis M, Saba K, Kim EH, Bird JA, Kamilaris N, Vickery BP et al. (2012) Increased peanut-specific IgA levels in saliva correlate with food challenge outcomes after peanut sublingual immunotherapy. J Allergy Clin Immunol 129: 1159–1162
Zurück zum Zitat Mempel M, Rakoski J, Ring J, Ollert M (2003) Severe anaphylaxis to kiwi fruit: immunologic changes related to successful sublingual allergen immunotherapy. J Allergy Clin Immunol 111: 1406–1409 Mempel M, Rakoski J, Ring J, Ollert M (2003) Severe anaphylaxis to kiwi fruit: immunologic changes related to successful sublingual allergen immunotherapy. J Allergy Clin Immunol 111: 1406–1409
Zurück zum Zitat Nadeau KC, Schneider LC, Hoyte L, Borras I, Umetsu DT (2011) Rapid oral desensitization in combination with omalizumab therapy in patients with cow’s milk allergy. J Allergy Clin Immunol 127: 1622–1624 Nadeau KC, Schneider LC, Hoyte L, Borras I, Umetsu DT (2011) Rapid oral desensitization in combination with omalizumab therapy in patients with cow’s milk allergy. J Allergy Clin Immunol 127: 1622–1624
Zurück zum Zitat Narisety SD, Skripak JM, Steele P et al. (2009) Open-label maintenance after milk oral immunotherapy for IgE-mediated cow’s milk allergy. J Allergy Clin Immunol 124: 610–612 Narisety SD, Skripak JM, Steele P et al. (2009) Open-label maintenance after milk oral immunotherapy for IgE-mediated cow’s milk allergy. J Allergy Clin Immunol 124: 610–612
Zurück zum Zitat Nelson HS, Lahr J, Rule R, Bock A, Leung D (1997) Treatment of anaphylactic sensitivity to peanuts by immunotherapy with injections of aqueous peanut extract. J Allergy Clin Immunol 99: 744–751 Nelson HS, Lahr J, Rule R, Bock A, Leung D (1997) Treatment of anaphylactic sensitivity to peanuts by immunotherapy with injections of aqueous peanut extract. J Allergy Clin Immunol 99: 744–751
Zurück zum Zitat Nowak-Wegrzyn A, Sampson HA (2011) Future therapies for food allergies. J Allergy Clin Immunol 127: 558–573 Nowak-Wegrzyn A, Sampson HA (2011) Future therapies for food allergies. J Allergy Clin Immunol 127: 558–573
Zurück zum Zitat Nurmatov U, Venderbosch I, Devereux G, Simons FER, Sheikh A (2012) Allergen-specific oral immunotherapy for peanut allergy. Cochrane Database Syst Rev 9: CD009014 Nurmatov U, Venderbosch I, Devereux G, Simons FER, Sheikh A (2012) Allergen-specific oral immunotherapy for peanut allergy. Cochrane Database Syst Rev 9: CD009014
Zurück zum Zitat Oppenheimer JJ, Nelson HS, Bock SA, Christensen F, Leung DY (1992) Treatment of peanut allergy with rush immunotherapy. J Allergy Clin Immunol 90: 256–262 Oppenheimer JJ, Nelson HS, Bock SA, Christensen F, Leung DY (1992) Treatment of peanut allergy with rush immunotherapy. J Allergy Clin Immunol 90: 256–262
Zurück zum Zitat Patriarca G, Nucera E, Roncallo C et al. (2003) Oral desensitizing treatment in food allergy: clinical and immunological results. Aliment Pharmacol Ther 17: 459–465 Patriarca G, Nucera E, Roncallo C et al. (2003) Oral desensitizing treatment in food allergy: clinical and immunological results. Aliment Pharmacol Ther 17: 459–465
Zurück zum Zitat Ring J (2004) Angewandte Allergologie. 3. Aufl. Urban & Vogel, München, S 254–259, 322 Ring J (2004) Angewandte Allergologie. 3. Aufl. Urban & Vogel, München, S 254–259, 322
Zurück zum Zitat Ruggiero A, Triarico S, Trombatore G, Battista A, Dell’acqua F, Rizzari C, Riccardi R (2013) Incidence, clinical features and management of hypersensitivity reactions to chemotherapeutic drugs in children with cancer. Eur J Clin Pharmacol 69(10): 1739–1746 Ruggiero A, Triarico S, Trombatore G, Battista A, Dell’acqua F, Rizzari C, Riccardi R (2013) Incidence, clinical features and management of hypersensitivity reactions to chemotherapeutic drugs in children with cancer. Eur J Clin Pharmacol 69(10): 1739–1746
Zurück zum Zitat Sanchez-Garcia S, Rodriguez DR, Escudero C, Martinez-Gomez MJ, Ibanez MD (2012) Possible eosinophilic esophagitis induced by milk oral immunotherapy. J Allergy Clin Immunol 129: 1155–1157 Sanchez-Garcia S, Rodriguez DR, Escudero C, Martinez-Gomez MJ, Ibanez MD (2012) Possible eosinophilic esophagitis induced by milk oral immunotherapy. J Allergy Clin Immunol 129: 1155–1157
Zurück zum Zitat Scherer K, Brockow K, Aberer W, Gooi JH, Demoly P, Romano A, Schnyder B, Whitaker P, Cernadas JS, Bircher AJ; ENDA, the European Network on Drug Allergy and the EAACI Drug Allergy Interest Group (2013) Desensitization in delayed drug hypersensitivity reactions – an EAACI position paper of the Drug Allergy Interest Group. Allergy 68(7): 844–852 Scherer K, Brockow K, Aberer W, Gooi JH, Demoly P, Romano A, Schnyder B, Whitaker P, Cernadas JS, Bircher AJ; ENDA, the European Network on Drug Allergy and the EAACI Drug Allergy Interest Group (2013) Desensitization in delayed drug hypersensitivity reactions – an EAACI position paper of the Drug Allergy Interest Group. Allergy 68(7): 844–852
Zurück zum Zitat Sheikh A, Nurmatov U, Venderbosch I, Bischoff E (2012) Oral immunotherapy for the treatment of peanut allergy: systematic review of six case series studies. Prim Care Respir J 21: 41–49 Sheikh A, Nurmatov U, Venderbosch I, Bischoff E (2012) Oral immunotherapy for the treatment of peanut allergy: systematic review of six case series studies. Prim Care Respir J 21: 41–49
Zurück zum Zitat Staden U, Rolinck-Werninghaus C, Brewe F, Wahn U, Niggemann B, Beyer K (2007) Specific oral tolerance induction in food allergy in children: efficacy and clinical patterns of reaction. Allergy 62: 1261–9 Staden U, Rolinck-Werninghaus C, Brewe F, Wahn U, Niggemann B, Beyer K (2007) Specific oral tolerance induction in food allergy in children: efficacy and clinical patterns of reaction. Allergy 62: 1261–9
Zurück zum Zitat Sullivan TJ (1982) Antigen-specific desensitization of patients allergic to penicillin. J Allergy Clin Immunol 69: 500–508 Sullivan TJ (1982) Antigen-specific desensitization of patients allergic to penicillin. J Allergy Clin Immunol 69: 500–508
Zurück zum Zitat Szczeklik A, Sanak M, Nizankowska-Mogilnicka E, Kiełbasa B (2004) Aspirin intolerance and the cyclooxygenase-leukotriene pathways. Curr Opin Pulm Med 10: 51–56 Szczeklik A, Sanak M, Nizankowska-Mogilnicka E, Kiełbasa B (2004) Aspirin intolerance and the cyclooxygenase-leukotriene pathways. Curr Opin Pulm Med 10: 51–56
Zurück zum Zitat Teraki Y, Shiohara T (2004) Successful desensitization to fixed drug eruption: the presence of CD25+ CD4+ T cells in the epidermis of fixed drug eruption lesions may be involved in the induction of desensitization. Dermatology 209: 29–32 Teraki Y, Shiohara T (2004) Successful desensitization to fixed drug eruption: the presence of CD25+ CD4+ T cells in the epidermis of fixed drug eruption lesions may be involved in the induction of desensitization. Dermatology 209: 29–32
Zurück zum Zitat Veien NK (2011) Systemic contact dermatitis. Int J Dermatol 50: 1445–1456 Veien NK (2011) Systemic contact dermatitis. Int J Dermatol 50: 1445–1456
Zurück zum Zitat Wüthrich B (1996) Oral desensitization with cow’s milk in cow’s milk allergy. Pro! Monogr Allergy 32: 236–240 Wüthrich B (1996) Oral desensitization with cow’s milk in cow’s milk allergy. Pro! Monogr Allergy 32: 236–240
Metadaten
Titel
Prinzip der temporären Toleranzinduktion
verfasst von
U. Darsow, Prof. Dr. med.
J. Ring, Prof. Dr. med. Dr. phil.
Copyright-Jahr
2016
Verlag
Springer Berlin Heidelberg
DOI
https://doi.org/10.1007/978-3-642-37203-2_55

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