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Epidemiologische Daten zur Nahrungsmittelallergie in Europa

  • Linus B. Grabenhenrich
Leitthema

Zusammenfassung

Die Interpretation epidemiologischer Daten zu Nahrungsmittelunverträglichkeiten sollte 2 Aspekte klar trennen: Die Disposition eines Individuums, bei Verzehr bestimmter Nahrungsmittel symptomatisch zu reagieren und die tatsächlich stattfindenden Reaktionen, welche nur bei ausreichendem Verzehr oder gezielter Exposition/Provokation beobachtet werden können.

Die genaue Angabe der verwendeten Falldefinition ist für den Bericht und die Interpretation der Häufigkeit von Nahrungsmittelunverträglichkeiten unverzichtbar. In Europa werden Prävalenzschätzer für selbst berichtete Reaktionen von 5,7–61,6 % und für ärztlich diagnostizierte Unverträglichkeiten von 0,2–4,2 % berichtet. Werden nur doppelblind nachgewiesene Soforttypreaktionen berücksichtigt, so ergeben sich Prävalenzen von 0–2,2 %. Die Disposition, mit schweren Symptomen zu reagieren, ist vermutlich seltener, kann aber aus bisher veröffentlichten Daten nicht solide angegeben werden. Die einzigen für Deutschland vorliegenden Daten ergeben eine Prävalenz IgE-vermittelter Reaktionen von 2,5% für Berlin.

Die häufigsten Auslöser im Kleinkindalter sind Kuhmilch und Hühnerei, welche in der Regel milde, auf die Haut beschränkte Symptome bewirken. Die frühkindlich erworbenen Nahrungsmittelallergien verschwinden meist bis zum Schuleintritt. Es gibt bisher keine veröffentlichten Daten zum langfristigen Verlauf der Disposition zur allergischen Reaktion.

Das Europäische Anaphylaxie-Register dokumentiert das Spektrum schwerer allergischer Reaktionen. Für tödlich verlaufende Reaktionen gibt es eine größere Fallserie aus England. Aus beiden Ansätzen lässt sich jedoch keine Inzidenz schätzen, da die Meldungen freiwillig sind. Auch über die Relevanz von schweren allergischen Reaktionen auf Lebensmittel lässt sich aus diesen Daten keine Aussage treffen.

Um differenzierte Aussagen zu Häufigkeit und Verlauf zu erhalten, sind weitere systematische Untersuchungen an ausreichend großen Personengruppen unter Einsatz möglichst objektiver diagnostischer Kriterien erforderlich.

Schlüsselwörter

Nahrungsmittelallergie Nahrungsmittelunverträglichkeit Nahrungsmittelprovokation Anaphylaxie Prävalenz 

The epidemiology of food allergy in Europe

Abstract

The interpretation of epidemiological data on food hypersensitivities should clearly separate two issues: the disposition to respond symptomatically to certain foods and the actual reactions occurring, which can be observed only when there is sufficient consumption or targeted exposure/provocation.

The exact specification of the case definition is essential for reporting and interpreting food hypersensitivity frequencies. In Europe, prevalence estimates of self-reported reactions are reported from 5.7 to 61.6 %, and physician-diagnosed hypersensitivities from 0.2 to 4.2 %. Consideration of only double-blind proven immediate-type reactions gave estimates ranging from 0.0 to 2.2 %. The disposition for severe reactions against food might be less frequent, but cannot be estimated robustly from published data. The only data available for Germany estimates a prevalence of IgE-mediated reactions of 2,5% for Berlin.

The most common triggers of early childhood food allergy are cow’s milk and hen’s egg, which usually cause mild symptoms, limited to the skin. Food allergy aquired in infancy usually disappears by early school age.

The European Anaphylaxis Registry documents the spectrum of severe allergic reactions. England has a larger case series for fatal reactions. No incidence can be estimated from either approach, because reporting is voluntary. Additionally, the discussed data does not inform about the clinical relevance of severe allergic reactions against foods.

Future systematic studies about the incidence and course of food hypersensitivity should examine sufficiently large groups of people using objective diagnostic criteria.

Keywords

Food allergy Food hypersensitivity Oral food challenge Anaphylaxis Prevalence 

Notes

Danksagung

Besonderer Dank gilt meinem Kollegen Andreas Reich für die vielen Gespräche über Methodik in der Allergieforschung und allen Kolleginnen und Kollegen für die lehrreiche Arbeit an realen Forschungsprojekten, insbesondere in MAS-90, EuroPrevall/iFAAM und dem Europäischen Anaphylaxie-Register.

Einhaltung ethischer Richtlinien

Interessenkonflikt

L. Grabenhenrich steht aktuell in einem Beschäftigungsverhältnis, welches durch das von der Europäischen Union geförderte iFAAM-Projekt zur Untersuchung von Nahrungsmittelallergien (EU grant agreement number 312147) finanziert wird.

Dieser Beitrag beinhaltet keine vom Autor durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Institut für Sozialmedizin, Epidemiologie und GesundheitsökonomieCharité - Universitätsmedizin BerlinBerlinDeutschland

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