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Nahrungsmittelallergie bei atopischer Dermatitis

Food allergy in atopic dermatitis

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Zusammenfassung

Von Nahrungsmittelallergien sind deutlich mehr Kinder als erwachsene Patienten mit atopischer Dermatitis (AD) betroffen. Sensibilisierungen in frühester Kindheit sind signifikant häufiger mit einer AD assoziiert. Drei verschiedene klinische Reaktionsmuster sind bei Patienten mit AD zu unterscheiden: i. eine Soforttypreaktion, ii. eine isolierte Spättypreaktion, iii. kombinierte Reaktionen (i + ii). Während Kinder allergische Reaktionen v. a. gegen Grundnahrungsmittel sowie Erdnuss oder Baumnüsse aufweisen, scheinen bei erwachsenen Patienten aus Mittel- und Nordeuropa die birkenpollenassoziierten Nahrungsmittel eine größere Rolle zu spielen. Defekte der Hautbarrierefunktion scheinen die Entwicklung einer Sensibilisierung gegenüber Allergenen nach vorausgegangenem epikutanem Kontakt zu erleichtern. Zur klinischen Relevanz von Defekten der Darmbarriere ebenso zu genetischen Charakteristika, die mit einem erhöhten Risiko der Entstehung einer Nahrungsmittelallergie assoziiert sind, sind weitere Untersuchungen erforderlich. Etliche Studien legen den Schwerpunkt auf hinlängliche Präventionsstrategien, wie z. B. aktuell Stillen oder Ernährung mit hydrolysierter Milchersatznahrung in den ersten 4 Lebensmonaten.

Abstract

Food allergy predominantly affects children rather than adult patients with atopic dermatitis (AD). Early sensitization to foods has been found to be significantly associated with AD. Three different patterns of clinical reactions to food allergens in AD patients exist: i. immediate-type reaction, ii. isolated late-type reaction, iii. combined reaction (i. + ii.). While in children allergens from cow’s milk, hen’s egg, soy, wheat, fish, peanut or tree nuts are mostly responsible for allergic reactions, birch-pollen related food allergens seem to play a major role in adolescent and adults with AD in Central and Northern Europe. Defects of the epidermal barrier function seem to facilitate the development of sensitization to allergens following epicutaneous exposure. The relevance of defects of the gut barrier as well as genetic characteristics associated with an increased risk for food allergy remain to be further investigated. Numerous studies focus on prevention strategies which include breast-feeding or feeding with hydrolyzed milk substitute formula during the first 4 months of life.

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  1. Abteilung für Immundermatologie und experimentelle Allergologie, Klinik und Poliklinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover, Ricklinger Str. 5, 30449, Hannover, Deutschland

    K. Wichmann, A. Heratizadeh & T. Werfel

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  1. K. Wichmann
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  2. A. Heratizadeh
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  3. T. Werfel
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Correspondence to K. Wichmann.

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Grundlage dieses Artikels ist ein durch unsere Arbeitsgruppe 2011 zu diesem Thema veröffentlichter Artikel im Fachblatt Current Allergy and Asthma Reports, der durch aktuelle Literatur ergänzt wurde [Curr Allergy Asthma Rep 2011 Aug; 11(4):284–291].

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Wichmann, K., Heratizadeh, A. & Werfel, T. Nahrungsmittelallergie bei atopischer Dermatitis. Hautarzt 63, 315–324 (2012). https://doi.org/10.1007/s00105-011-2263-1

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