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Allergenspezifische Immuntherapie von Nahrungsmittelallergien im Kindesalter. Aktueller Stand und Perspektiven

Allergen-specific immunotherapy for food allergies in childhood. Current options and future perspectives

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz volume 59, pages 855–864 (2016)Cite this article

Zusammenfassung

Seit mehreren Jahren wird zunehmend an kausalen Therapiemöglichkeiten für Nahrungsmittelallergien geforscht, besonderer Fokus lag dabei auf der oralen Immuntherapie (OIT) bei Hühnerei-, Kuhmilch- und Erdnussallergie im Kindesalter. Die Möglichkeit einer Desensibilisierung oder Steigerung der Reaktionsschwelle unter OIT konnte bislang in mehreren Studien gezeigt werden. Jedoch waren auch schwere Nebenwirkungen unter dieser Behandlungsmethode keine Seltenheit. Ob die OIT zu einer andauernden, „robusten“ Toleranzentwicklung bei den Patienten führen kann, ist noch nicht ausreichend untersucht. Neben der OIT wurden auch vereinzelt Studien zur sublingualen (SLIT) und epikutanen Immuntherapie (EPIT) durchgeführt, mit dem Ziel, ein verbessertes Nebenwirkungsprofil zu erreichen. Auch eine Kombination aus SLIT und OIT oder eine parallele Behandlung mit Anti-IgE oder Probiotika wurden in ersten Pilotstudien untersucht. Weitere placebokontrollierte Studien mit größerem Patientenkollektiv sind allerdings nötig, um standardisierte Protokolle entwickeln zu können, bevor die Immuntherapie in Zukunft als Behandlungskonzept bei Nahrungsmittelallergien im Kindesalter auch außerhalb der klinischen Forschung zum Einsatz kommen kann.

Abstract

During recent years increasing research has been conducted on casual treatment options for food allergy, with focus on oral immunotherapy (OIT) for hen’s egg, cow’s milk and peanut allergy. Several studies could show that OIT leads to desensitization or an increase of threshold. However, severe adverse events during this treatment are not uncommon. Whether OIT leads to a sustained, ‘robust’ development of tolerance in patients has not yet been thoroughly investigated. Besides OIT, some studies on sublingual (SLIT) and epicutaneous immunotherapy (EPIT) were performed, aiming to improve the safety profile. Furthermore, there are some pilot studies investigating a combined treatment of SLIT and OIT or a combined use of anti-IgE treatment or probiotic supplementation with OIT. Further placebo-controlled trials with larger sample size are needed in order to develop standardized protocols before immunotherapy may be used as a therapeutic option for food allergy outside of clinical trials.

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Affiliations

  1. Klinik für Pädiatrie mit Schwerpunkt Pneumologie/Immunologie, Universitätsmedizin Charité, Berlin, Deutschland

    Valérie Trendelenburg

  2. Klinik für Kinder- und Jugendmedizin, Pädiatrische Allergologie, Pneumologie und Mukoviszidose, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland

    Katharina Blümchen

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  1. Valérie Trendelenburg
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Correspondence to Katharina Blümchen.

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Interessenkonflikt

V. Trendelenburg gibt an, dass kein Interessenkonflikt besteht. K. Blümchen hat Referentenhonorare von MedaPharma, Novartis, Thermo Fischer Scientific, Nestle, Nutricia sowie Förderung durch die Nutricia Research Foundation, die Stiftung zur Behandlung von Erdnussallergie und die Berliner Sparkassenstiftung Medizin erhalten.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Trendelenburg, V., Blümchen, K. Allergenspezifische Immuntherapie von Nahrungsmittelallergien im Kindesalter. Aktueller Stand und Perspektiven. Bundesgesundheitsbl 59, 855–864 (2016). https://doi.org/10.1007/s00103-016-2372-1

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  • DOI: https://doi.org/10.1007/s00103-016-2372-1

Schlüsselwörter

  • Nahrungsmittelallergien
  • Orale Immuntherapie
  • Sublinguale Immuntherapie
  • Desensibilisierung
  • Toleranz

Keywords

  • Food allergy
  • Oral immunotherapy
  • Sublingual immunotherapy
  • Desensitization
  • Tolerance