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Immunglobulin-E-vermittelte Nahrungsmittelallergien im Kindesalter

Immunoglobulin E‑mediated food allergies in childhood

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Zusammenfassung

Immunglobulin-E(IgE)-vermittelte Nahrungsmittelallergien im Kindesalter sind häufig. Im Säuglings- und Kleinkindalter sind die primären Nahrungsmittelallergien vorrangig. Hühnerei ist der häufigste Auslöser, gefolgt von Kuhmilch, Erdnuss, Baumnüssen, Weizen, Soja und Fisch. Bei Schulkindern und Jugendlichen spielen pollenassoziierte Nahrungsmittelallergien ebenfalls eine wichtige Rolle. Am häufigsten finden sich Soforttypreaktionen. Die primäre Nahrungsmittelallergie kann sich u. a. in Urtikaria, Quincke-Ödem, Erbrechen, asthmatischen Symptomen, Stridor und Blutdruckabfall äußern. Bei der pollenassoziierten Nahrungsmittelallergie stehen v. a. die oralen Allergiesymptome im Vordergrund.

Ein wichtiger Risikofaktor für die Entwicklung einer primären Nahrungsmittelallergie ist die atopische Dermatitis mit ihrer Funktionsstörung der Hautbarriere und einer dadurch begünstigten Sensibilisierung. Präventionsmaßnahmen, die zur frühen oralen Toleranz führen, werden zurzeit intensiv untersucht. Neben der Anamnese sind der Nachweis einer Sensibilisierung und ggf. eine orale Nahrungsmittelprovokation diagnostische Bausteine.

Therapeutisch steht die Eliminationsdiät an erster Stelle. Patienten mit erhöhtem Risiko für anaphylaktische Reaktionen benötigen einen Adrenalinautoinjektor für akzidentelle Reaktionen. Instruktion in der Handhabung, schriftliche Anleitung in Form des Anaphylaxiepasses und ausführliche Schulung sollten selbstverständlich sein. Spezifische Immuntherapien sind zurzeit in der Entwicklung. Die Prognose der Nahrungsmittelallergie ist stark vom Allergen abhängig. Erdnuss- und Baumnussallergien bleiben häufig lebenslang bestehen; dagegen ist die Prognose der Hühnerei- und Kuhmilchallergie gut. Eine regelmäßige Reevaluation der Patienten ist notwendig.

Abstract

Immunoglobulin E (IgE)-mediated food allergies are common in childhood. In infants and toddlers primary food allergy is the most common. Most frequent triggers are hen’s egg, followed by cow’s milk, peanuts, tree nuts, wheat, soy and fish. Moreover, pollen-associated food allergy often develops in school children and teenagers. Immediate type reactions are most common in food allergies. Patients with primary food allergy often present with urticaria, angioedema, vomiting, asthmatic symptoms, stridor and drop in blood pressure. Patients with pollen-associated food allergies often develop oral or pharyngeal symptoms.

An important risk factor for the development of primary food allergy is the presence of atopic eczema with skin barrier dysfunction followed by sensitization. Prevention strategies through early oral tolerance induction are currently under evaluation. Patient history, determination of sensitization and oral food challenges are the most important diagnostic tools.

Elimination diets are currently the only therapeutic option. Patients at increased risk for anaphylaxis require an adrenalin autoinjector for the treatment of accidental reactions, instructions on usage, an anaphylaxis pass with written instructions and thorough schooling. Immunotherapeutic approaches for food allergies are currently under development. The long-term prognosis of food allergies depends on the allergen. Peanut and tree nut allergies tend to persist lifelong whereas hen’s egg and cow’s milk allergies are frequently outgrown. Regular re-evaluation is therefore necessary.

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Authors and Affiliations

  1. Klinik für Pädiatrie mit Schwerpunkt Pneumologie und Immunologie, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland

    K. Beyer &  B. Niggemann

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Correspondence to K. Beyer.

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Interessenkonflikt

K. Beyer und B. Niggemann stehen im Beschäftigungsverhältnis der Charité – Universitätsmedizin Berlin. K. Beyer erhielt Honorare für Beratertätigkeit oder Vorträge von Danone, Nestle, Meda Pharma, Bausch & Lomb, ALK, Novartis, Unilever, AllergoPharma, HAL, Aimmune und MedUpdate; B. Niggemann für Vorträge von Allergopharma, InfectoPharm, Meda Pharma und Nutricia. Sie erhielten Forschungsgelder von der Europäischen Union, der Deutschen Forschungsgemeinschaft, dem Food Allergy & Anaphylaxis Network, der Foundation for the Treatment of peanut allergy, Danone, Hipp, Hycor, ThermoFischer, DST Diagnostische Systeme & Technologien GmbH, Aimmune und DBV.

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Beyer, K., Niggemann, B. Immunglobulin-E-vermittelte Nahrungsmittelallergien im Kindesalter. Monatsschr Kinderheilkd 165, 108–116 (2017). https://doi.org/10.1007/s00112-016-0222-8

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