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Atopisches Ekzem

Provokationsfaktoren und Möglichkeiten ihrer wirkungsvollen Reduktion bzw. Elimination

Zusammenfassung

Das atopische Ekzem gehört mit dem Asthma bronchiale und der Rhinoconjunctivitis allergica zu der Trias der atopischen Erkrankungen. Grundlegender pathogenetischer Faktor ist die genetische Disposition. Erst das Vorliegen von Provokationsfaktoren führt jedoch zur Realisation der Erkrankung, das heißt zum Auftreten von Hauterscheinungen. Neben der stadiengerechten Therapie der Erkrankung spielt im modernen Krankheitsmanagement die Beachtung von Auslösern eine wesentliche Rolle, deren konsequente Aufdeckung und Vermeidung Krankheitsschübe mildern oder sogar ganz verhindern kann. Das Spektrum der in Frage kommenden Provokationsfaktoren erstreckt sich hierbei von im Alltag einfach umzusetzenden Ratschlägen, wie z. B. der richtigen Auswahl der Kleidung, bis hin zu spezifischen Maßnahmen wie der Aeroallergenreduktion in Innenräumen und Diätempfehlungen.

Abstract

Atopic eczema forms together with extrinsic bronchial asthma and allergic rhinoconjunctivitis the classical atopic triad. Genetic predisposition is the crucial pathogenetic factor. The combination of genetic disposition and provocation factors leads to the clinical appearance of skin disease. In addition to therapy adjusted to the stage of the disease, modern management should include a search for relevant trigger factors and then their avoidance to reduce or even prevent flares of the disease. The spectrum of provocation factors ranges from simple measures such as appropriate clothing up to specific measures such as indoor aeroallergen reduction measures.

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Literatur

  1. Abeck D, Brockow K, Mempel M et al. (1999) Behandlung des akut exazerbierten atopischen Ekzems mit fett-feuchten Verbänden und topischem Chlorhexidin. Hautarzt 50:418–421

    Article  CAS  PubMed  Google Scholar 

  2. Abeck D, Ring J (2002) Atopisches Ekzem im Kindesalter—Neurodermitis. Steinkopff, Darmstadt

  3. Abeck D, Strom K (2000) Optimal management of atopic dermatitis. Am J Clin Dermatol 1:41–46

    CAS  PubMed  Google Scholar 

  4. Arlian LG, Neal JS, Morgan MS et al. (2001) Reducing relative humidity is a practical way to control dust mites and their allergens in homes in temperate climates. J Allergy Clin Immunol 107:99–104

    Article  CAS  PubMed  Google Scholar 

  5. Atherton D (1995) Atopic eczema in childhood. The facts. Oxford University Press

  6. Augustin M, Zschoke I (2001) Lebensqualität und Ökonomie bei allergischen Hauterkrankungen. Allergologie 24:433–442

    Google Scholar 

  7. Bahceciler NN, Isik U, Barlan IB, Basaran MM (2001) Efficacy of sublingual immunotherapy in children with asthma and rhinitis: a double-blind, placebo-controlled study. Pediatr Pulmonol 32:49–55

    Article  CAS  Google Scholar 

  8. Bartels VT (2002) Mess- und Beurteilungsverfahren für die physiologische Funktion von allergendichten Matratzenbezügen (Encasings). Allergo J 11:452–457

    Google Scholar 

  9. Bauer CP (1998) Hausstaubmilbenallergie-Aspekte zur Sensibilisierung und Allergenreduktion. Pädiatr Allergologie Klin Prax 1:6–13

  10. Behr-Völtzer C, Hamm M, Vieluf D, Ring J (2002) Diät bei Nahrungsmittelallergien und -intoleranzen, 2. Aufl., Urban und Vogel, München

  11. Bendsoe N, Bjornberg A, Asnes H (1987) Itching from wool fibres in atopic dermatitis. Contact Derm 17:21–22

    CAS  PubMed  Google Scholar 

  12. Bieber T, Fried J (2000) Aktuelle Studie zur Wirkung von Weichspülern auf die Haut von Atopikern. Deutsche Haut- und Allergiehilfe e.V.

  13. Breum R (2000) Staubsauger—Die Luft ist rein. Ökotest, ÖKO-TEST Verlag GmbH, Frankfurt

  14. Brockow K, Hautmann C, Fötisch K et al. (in press) Orange-induced skin lesions in patients with atopic eczema—evidence for a non IgE-mediated Pathomechanism. Acta Dermato Venereol

  15. Clausen K, Ciesla R, Köhnlein B et al. (1998) Methodik und Didaktik der Neurodermitisschulung. Präv Rehab 10:198–202

  16. Cremer H (1993) Children with "sensitive skin". The role of skin irritation in the development of "atopic eczema". Eur J Pediat Dermatol 3:13–20

    Google Scholar 

  17. Darsow U, Forer I, Ring J (in press) Specific hyposensitization in atopic eczema. In: Lotti T, Hercogova J (eds) Inflammation models in skin diseases

  18. Darsow U, Ring J (2000) Airborne and dietary allergens in atopic eczema: a comprehensive review of diagnostic tests. Clin Exp Dermatol 25:544–551

    Article  CAS  PubMed  Google Scholar 

  19. Darsow U, Vieluf D, Ring J (1999) Evaluating the relevance of aeroallergen sensitization in atopic eczema with the atopy patch test: a randomized, double-blind multicenter study. Atopy Patch Test Study Group. J Am Acad Dermatol 40:187–193

    CAS  PubMed  Google Scholar 

  20. Ehlers I, Binder C, Constien A et al. (2000) Eliminationsdiäten bei Nahrungsmittelallergie und anderen Unverträglichkeitsreaktionen aus der Sicht des Arbeitskreises Diätetik in der Allergologie. Allergologie 23:512–563

    Google Scholar 

  21. Ehlers I, Forschner K, Zuberbier T et al. (2002) Ernährungsstatus bei erwachsenen Patienten mit atopischer Dermatitis. Hautarzt 53:183–188

    Article  Google Scholar 

  22. Ehlers A, Stangier U, Gieler U (1995) Treatment of atopic dermatitis: a comparison of psychological and dermatological approaches to relapse prevention. J Consult Clin Psychol 63:624–635

    Article  PubMed  Google Scholar 

  23. Elsner P (1994) Allergic and irritative textile dermatitis. Schweiz Med Wochenschr 124:111–118

    CAS  PubMed  Google Scholar 

  24. Emerson RM, Williams HC, Allen BR (1998) Severity distribution of atopic dermatitis in the community and its relationship to secondary referal. Br J Dermatol 139:73–76

    Article  CAS  PubMed  Google Scholar 

  25. Ewers U, Kainka E, Umbach KH, Diebschlag W (2000) Methoden zur Überprüfung der Qualitätsanforderungen an milbenallergendichte Matratzen- und Bettbezüge (Encasings). Allergo J 9:261–270

    Google Scholar 

  26. Fartasch M, Abeck D, Werfel T et al. (2000) Aktueller Stand des interdisziplinären Modellprojektes "Neurodermitis-Schulung für Kinder und Jugendliche". Hautarzt 51:299–301

    Article  CAS  PubMed  Google Scholar 

  27. Fisher AA (1996) Nonallergic "itch" and "prickly" sensation to wool fibers in atopic and nonatopic persons. Cutis 58:323–324

    CAS  PubMed  Google Scholar 

  28. Garnsworthy RK, Gully RL, Kenins P et al. (1988) Physical nature of wool fiber. J Neurophysiol 59:1083–1097

    CAS  PubMed  Google Scholar 

  29. Gauger A, Mempel M, Schekatz A et al. (in press) Silver-coated textiles reduce Staphylococcus aureus-colonization in patients with atopic eczema. Dermatology

  30. Glover MT, Atherton DJ (1992) A double-blind controlled trial of hyposensitization to Dermatophagoides pteronyssinus in children with atopic eczema. Clin Exp Allergy 22:440–446

    CAS  PubMed  Google Scholar 

  31. Gotzsche PC, Johansen HK, Hammarquist C, Burr ML (2001) House dust mite control measures for asthma (Cochrane Review). Cochrane Database Syst Rev 2:CD001187

    PubMed  Google Scholar 

  32. Gutgesell C, Heise S, Seubert S et al. (2001) Double-blind placebo-controlled house dust mite control measures in adult patients with atopic dermatitis. Br J Dermatol 145:70–74

    Article  CAS  PubMed  Google Scholar 

  33. Hermanns JF, Goffin V, Arrese JE et al. (2001) Beneficial effects of softened fabrics on atopic skin. Dermatology 202:167–170

    Article  CAS  Google Scholar 

  34. Hosche BN (1982) Some comfort aspects of wool textiles. Prickliness and warmth. Textile Machining Society, Japan, pp 375–391

  35. Isolauri E, Arvola T, Sutas Y et al. (2000) Probiotics in the management of atopic eczema. Clin Exp Allergy 30:1604–1610

    Article  CAS  PubMed  Google Scholar 

  36. Jirapongsananuruk O, Malainual N, Sangsupawanich P et al. (2000) Partial mattress encasing significantly reduces house dust mite antigen on bed sheet surface: a controlled trial. Ann Allergy Asthma Immunol 84:305–310

    CAS  PubMed  Google Scholar 

  37. Kalliomäki M, Salminen S, Arvilommi H et al. (2001) Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial. Lancet 357:1076–1079

    PubMed  Google Scholar 

  38. Kankaanpaa PE, Yang B, Kallio HP et al. (2002) Influence of probiotic supplemented infant formula on composition of plasma lipids in atopic infants. J Nutr Biochem 13:364–369

    Article  CAS  PubMed  Google Scholar 

  39. Kilpeläinen M, Koskenvuo M, Helenius H, Terho EO (2002) Stressful life events promote the manifestation of asthma and atopic diseases. Clin Exp Allergy 32:256–263

    Article  PubMed  Google Scholar 

  40. Leung DYM (2000) Atopic dermatitis: new insights and opportunities for therapeutic intervention. J Allergy Clin Immunol 105:860–876

    Article  CAS  PubMed  Google Scholar 

  41. Leung DYM (2001) Atopic dermatitis and the immune system: the role of superantigens and bacteria. J Am Acad Dermatol 45 [1. Suppl]:13–16

  42. Linde YW (1992) "Dry" skin in atopic dermatitis. A clinical study. Acta Derm Venereol 177:9–13

    CAS  Google Scholar 

  43. Majamaa H, Isolauri E (1997) Probiotics: a novel approach in the management of food allergy. J Allergy Clin Immunol 99:179–185

    CAS  PubMed  Google Scholar 

  44. McNally NJ, Williams HC, Phillips DR et al. (1998) Atopic eczema and domestic water hardness. Lancet 352:527–531

    Article  CAS  PubMed  Google Scholar 

  45. Moira CY, Ferguson A, Dimich-Ward H et al. (2002) Effectiveness of and compliance to intervention measures in reducing house dust and cat allergen levels. Ann Allergy Asthma Immunol 88:52–58

    PubMed  Google Scholar 

  46. Niebel G, Wieborg G, Zietlow J (1997) Diagnose: Neurodermitis. Lern- und Übungshilfen für Eltern und Kinder. Hansisches Verlagskontor, Lübeck

  47. Oosting AJ, de Bruin-Weller MS, Terreehorst I et al. (2002) Effect of mattress encasings on atopic dermatitis outcome measures in a double-blind, placebo-controlled study: the Dutch mite avoidance study. J Allergy Clin Immunol 110:500–506

    Article  PubMed  Google Scholar 

  48. Pacor ML, Biasi D, Maleknia T (1994) The efficacy of long-term specific immunotherapy for dermatophagoides pteronyssinus in patients with atopic dermatitis. Recenti Prog Med 85:273–277

    CAS  PubMed  Google Scholar 

  49. Pajno GB, Barberio G, De Luca F et al. (2001) Prevention of new sensitizations in asthmatic children monosensitized to house dust mite by specific immunotherapy. A six-year follow-up study. Clin Exp Allergy 31:1392–1397

    Article  CAS  PubMed  Google Scholar 

  50. Pajno GB, Morabito L, Barberio G, Parmiani S (2000) Clinical and immunologic effects of long-term sublingual immunotherapy in asthmatic children sensitized to mites: a double-blind, placebo-controlled study. Allergy 55:842–849

    Article  CAS  PubMed  Google Scholar 

  51. Palma-Carlos AG, Spinola-Santos A, Ferreira MB et al. (2001) Immunotherapy in allergic rhinitis. Allerg Immunol 33:323–326

    CAS  Google Scholar 

  52. Perzanowski MS, Rönmark E, Nold B et al. (1999) Relevance of allergens from cats and dogs to asthma in the northern-most province of Sweden: schools as a major site of exposure. J Allergy Clin Immunology 103:1018-1024

    CAS  Google Scholar 

  53. Pessi T, Sutas Y, Hurme M, Isolauri E (2000) Interleukin-10 generation in atopic children following oral Lactobacillus rhamnosus GG. Clin Exp Allergy 30:1804–1808

    Article  CAS  PubMed  Google Scholar 

  54. Pichler CE, Helbling A, Pichler WJ (2001) Three years of specific immunotherapy with house-dust-mite extracts in patients with rhinitis and asthma: significant improvement of allergen-specific parameters and of nonspecific bronchial hyperreactivity. Allergy 56:301–306

    Article  CAS  PubMed  Google Scholar 

  55. Pitten FA, Kalveram CM, Kruger U et al. (2000) Reduktion der Besiedelung neuwertiger Matratzen mit Bakterien, Schimmelpilzen und Hausstaubmilben durch Matratzenganzbezüge. Hautarzt 51:655–660

    Article  CAS  PubMed  Google Scholar 

  56. Przybilla B, Ring J (1990) Food allergy and atopic eczema. Seminar Dermatol 9:220–225

    CAS  Google Scholar 

  57. Rautava S, Kalliomaki M, Isolauri E (2002) Probiotics during pregnancy and breast-feeding might confer immunomodulatory protection against atopic disease in the infant. J Allergy Clin Immunol 109:119–121

    Article  PubMed  Google Scholar 

  58. Reekers R, Busche M, Wittmann M et al. (1999) Birch pollen-related foods trigger atopic dermatitis in patients with specific cutaneous T-cell responses to birch pollen antigens. J Allergy Clin Immunol 104:466–472

    CAS  PubMed  Google Scholar 

  59. Ricci G, Patrizi A, Specchia F et al. (2000) Effect of house dust mite avoidance measures in children with atopic dermatitis. Br J Dermatol 143:379–384

    Article  CAS  PubMed  Google Scholar 

  60. Ring J (1998) Neurodermitis. Expertise zur gesundheitlichen Versorgung und Vorsorge bei Kindern mit atopischem Ekzem. ecomed, Landsberg.

  61. Ring J, Brockow K, Abeck D (1996) The therapeutic concept of "patient management" in atopic eczema. Allergy:206–215

  62. Ring J, Brockow K, Behrendt H (2001) Adverse reactions to foods. J Chromatogr B Biomed Sci Appl 756:3–10

    Article  CAS  PubMed  Google Scholar 

  63. Ring J, Darsow U, Behrendt H (2001) Atopic eczema and allergy. Curr Allergy Rep 1:39–43

    CAS  PubMed  Google Scholar 

  64. Ring J, Palos E (1986) Psychosomatische Aspekte der Eltern-Kind-Beziehung bei atopischem Ekzem im Kindesalter. II. Erziehungsstil, Familiensituation im Zeichentest und strukturierten Interview. Hautarzt 37:609–617

    CAS  PubMed  Google Scholar 

  65. Ring J, Palos E, Zimmermann F (1986) Psychosomatische Aspekte der Eltern-Kind-Beziehung bei atopischem Ekzem im Kindesalter. I. Psychodiagnostische Testverfahren bei Eltern und Kindern im Vergleich zu körperlichen Befunden. Hautarzt 37:560–567

    CAS  PubMed  Google Scholar 

  66. Rodriguez C, Daskaleros PA, Sauers LJ et al. (1994) Effects of fabric softeners on the skin. Derm Beruf Umw 42:58–61

    Google Scholar 

  67. Ruzicka T, Ring J, Przybilla B (1991) Handbook of atopic eczema. Springer, Berlin Heidelberg New York Tokyo

  68. Salminen S, Bouley C, Boutron-Ruault MC et al. (1998) Functional food science and gastrointestinal physiology and function. Br J Nutr 80:147–171

    Google Scholar 

  69. Schäfer T, Heinrich J, Wjst M et al. (1999) Association between severity of atopic eczema and degree of sensitization to aeroallergens in schoolchildren. J Allergy Clin Immunol 104:1280–1284

    PubMed  Google Scholar 

  70. Schäfer T, Ring J (1995) Epidemiologie atopischer Erkrankungen. Dt Derm 43:142–146

    Google Scholar 

  71. Schneider G, Gieler U (2001) Psychosomatic dermatology—state of the art. Z Psychosom Med Psychother 47:307–331

    CAS  PubMed  Google Scholar 

  72. Schumacher B (2002) Milbenvernichtungsmittel—Da lacht die Milbe. Ökotest, ÖKO-TEST Verlag GmbH, Frankfurt

  73. Sheikh A, Hurwitz B (2001) House dust mite avoidance measures for perennial allergic rhinitis (Cochrane Review). Cochrane Database Syst Rev 4:CD001563

    PubMed  Google Scholar 

  74. Sullivan PB (1999) Food allergy and food intolerance in childhood. Indian J Pediatr 66:S37–S45

    CAS  PubMed  Google Scholar 

  75. Szucs T (1996) Sozioökonomische Aspekte der Neurodermitis in Deutschland. In: Riedl-Seifert R (Hrsg) , München, S 49–65

  76. Tan BB, Weald D, Strickland I, Friedmann PS (1996) Double-blind controlled trial of effect of housedust-mite allergen avoidance on atopic dermatitis. Lancet 347:15–18

    CAS  PubMed  Google Scholar 

  77. Van Bever HP, Docx M, Stevens WJ (1989) Food and food additives in severe atopic dermatitis. Allergy 44:588–594

    PubMed  Google Scholar 

  78. Vanlaar CH, Peat JK, Marks GB et al. (2000) Domestic control of house dust mite allergen in children's beds. J Allergy Clin Immunol 105:1130–1133

    Article  CAS  PubMed  Google Scholar 

  79. Vocks E, Busch R, Frohlich C et al. (2001) Influence of weather and climate on subjective symptom intensity in atopic eczema. Int J Biometeorol 45:27–33

    Article  CAS  PubMed  Google Scholar 

  80. Werfel T, Kapp A (1998) Environmental and other major provocation factors in atopic dermatitis. Allergy 53:731–739

    CAS  PubMed  Google Scholar 

  81. Wolkersdorfer A, Wahn U, Kjellman NI et al. (2002) Natural course of sensitization to cow's milk and hen's egg in childhood atopic dermatitis: ETAC study group. Clin Exp Allergy 32:70–73

    Article  CAS  PubMed  Google Scholar 

  82. Worm M, Ehlers I, Sterry W, Zuberbier T (2000) Clinical relevance of food additives in adult patients with atopic dermatitis. Clin Exp Allergy 30:407–414

    Article  CAS  PubMed  Google Scholar 

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Fischer, S., Ring, J. & Abeck, D. Atopisches Ekzem. Hautarzt 54, 914–924 (2003). https://doi.org/10.1007/s00105-003-0557-7

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Schlüsselwörter

  • Atopisches Ekzem
  • Provokationsfaktoren
  • Rezidiv
  • Aeroallergene
  • Nahrungsmittelallergene

Keywords

  • Atopic eczema
  • Provokation
  • Recurrence
  • Aeroallergens
  • Nutritionallergens