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Urtikaria … und die Therapie versagt!

Urticaria … and treatment fails

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Zusammenfassung

In den Leitlinien wird Beschwerdefreiheit, also komplettes Ansprechen auf die Therapie, als Behandlungsziel definiert. In dieser Übersicht wurde daher die verfügbare Literatur gezielt auf das Nichterreichen dieses Ziels (Therapieversagen) hin untersucht. Systematische Untersuchungen hierzu liegen nicht vor. H1-Antihistaminika in der Standarddosis sind bislang die einzig zugelassene Therapieoption. Die Durchsicht der wenigen verfügbaren Daten mit Angabe der komplett beschwerdefrei gewordenen Patienten zeigt ein Versagen des H1-Antihistaminikums in Standarddosis bei den meisten Behandelten mit Urtikaria. Selbst mit Dosiserhöhung bis zum 4-Fachen liegt die Versagerquote erstaunlich hoch. Auch bei Add-on-Therapie mit Montelukast, Dapson und Ciclosporin A wird das Ziel komplette Beschwerdefreiheit häufig nicht erreicht. Studien, in denen die Versagerquote über längere Zeiträume (≥ 12 Wochen) niedrig liegt, finden sich für die chronische spontane Urtikaria mit Omalizumab, wobei bislang nicht systematisch untersucht wurde, ob die Rate der Therapieversager mittels einer Dosiserhöhung von Omalizumab bzw. Intervallverkürzung weiter reduzierbar wäre. Insgesamt ist erstaunlich, wie gering die verfügbare Anzahl an Studien mit Angabe der Rate beschwerdefrei gewordener Probanden ist. Auch die untersuchten Probandenzahlen sind verhältnismäßig gering. Die Studien sind außerdem aufgrund unterschiedlicher Einschlusskriterien (Schweregrad der Urtikaria, erlaubte Basistherapie) und evaluierter Parameter schwer zu vergleichen. Zusammenfassend besteht noch erheblicher Handlungsbedarf, um Patienten mit Urtikaria mit dem Ziel komplette Beschwerdefreiheit behandeln zu können.

Abstract

According to the guidelines the treatment goal for all types of urticaria is to achieve complete symptom relief. Therefore the available literature for urticaria treatment was reviewed regarding this aim and treatment failure, respectively. Systematic studies are not available. Standard doses of H1-antihistamines are the only approved therapy. Review of the limited data where statements are made about complete alleviation of symptoms shows that standard doses of H1-antihistamines rarely achieve this. Even when the dosage is increased up to four-fold, the failure rate is high. Additional therapy with montelukast, dapsone, and cyclosporine A also often fails to produce complete control. For severe chronic spontaneous urticaria, controlled studies using omalizumab have shown low failure rates over long time periods. It has not been investigated whether up-dosing or reduced injection intervals could further improve this rate. Taken together, the small amount of available data on complete symptom relief in urticaria treatment is astonishing. Moreover, the studies can not be compared due to different inclusion criteria (severity of urticaria, allowed basic treatment) and evaluated parameters. Further controlled studies are vitally needed to achieve the goal of complete symptom relief in urticaria.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. B. Wedi erhielt Vortragshonorare bzw. Honorare für Beratungstätigkeiten der Firmen Novartis, Dr. Pfleger, ALK-Abéllo, Stallergenes, Viropharma. U. Raap erhielt Honorare für Beratertätigkeiten und eine Forschungsförderung der Firma Novartis. A. Kapp erhielt Vortragshonorare der Firma ALK-Abéllo. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    B. Wedi, D. Wieczorek, U. Raap & A. Kapp

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  1. B. Wedi
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  2. D. Wieczorek
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  3. U. Raap
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  4. A. Kapp
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Correspondence to B. Wedi.

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Wedi, B., Wieczorek, D., Raap, U. et al. Urtikaria … und die Therapie versagt!. Hautarzt 64, 656–663 (2013). https://doi.org/10.1007/s00105-013-2568-3

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