Zusammenfassung
Die Kuhmilchallergie ist die häufigste Nahrungsmittelallergie in der frühen Kindheit, mit Auftreten in den ersten Lebensmonaten. Trotz ihres gutartigen spontanen Verlaufs bleibt die Kuhmilchallergie problematisch, da die Diagnose unsicher und die Vorhersage von Verlauf und Erlangen oraler Toleranz schwierig ist. Orale Toleranz ist zu 45–56% mit 1 Jahr, zu 60–77% mit 2 Jahren und ca. 90–95% mit 5–10 Jahren zu erwarten. Orale Toleranz bedeutet eine Modulation der systemischen Immunreaktion auf orale Proteine, wobei Antigene, Darmmukosa, antigenpräsentierende Zellen und T-Lymphozyten die Hauptbeteiligte darstellen. Die relevanten Nahrungsmittelallergene sind Kuhmilch, Soja und Hühnereiweiß, ebenso Fisch, Meeresprodukte und Erdnüsse. Man unterscheidet 2 Formen der oralen Toleranz: die primäre bedeutet die Induktion von Toleranz gegenüber einem bisher unbekannten Antigen, die sekundäre entspricht einer erneuten Induktion von Toleranz gegen ein Antigen. Die Rolle von Antigenkarenz und partiell hydrolysierten Formuladiäten wurde besonders bei der primären Toleranz untersucht. Für die sekundäre Toleranz erhalten Patienten eine kuchmilchfreie Diät und stark hydrolysierte Formulanahrung, die spontane Entwicklung der Toleranz scheint schneller durch Zugabe von Oligopeptiden als durch Aminosäuren zu erreichen.
Abstract
Cow's milk allergy (CMA) is the most frequent food allergy in early childhood, occurring during the first months of life. Despite its spontaneous benign evolution, CMA is still problematic, since diagnosis remains unsafe and the prediction of clinical outcome and time of appearance of oral tolerance (OT) is difficult. The acquisition of OT is of 45–56% at 1 year, 60–77% at2 years and about 90–95% after 5 to 10 years. The concept of OT is a mechanism of immunological regulation, which consists of a modulation of the systemic immune response to oral proteins. The main actors of OT are: antigens, digestive mucosal, antigen-presenting cells and T-lymphocytes. The most common food allergens are cow's milk, soy and egg proteins, as well as fish and seafood products and peanuts. Two types of oral tolerance exist: primary, which is the induction of tolerance to a formerly unknown antigen; and secondary, which is a re-induction of OT to an antigen. The role of eviction of antigens and of partially hydrolyzed formulae was largely studied for primary tolerance. For secondary OT, patients must receive a cow's milk-free diet and extensively hydrolyzed formulae until its spontaneous appearance, which, as shown in a recent study, seems to be quicker with the use of oligopeptides rather than amino acids.
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Belli, C.D., Eigenmann, P.A. Induktion der oralen Toleranz bei Kindern mit Kuhmilchallergie. Monatsschr Kinderheilkd 151 (Suppl 1), S31–S33 (2003). https://doi.org/10.1007/s00112-003-0788-9
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DOI: https://doi.org/10.1007/s00112-003-0788-9