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Prävention von Asthma im Kindesalter. Was bedeutet der Bauernhofeffekt für die Praxis?

Prevention of childhood asthma—What does the farm effect mean in clinical practice?

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Zusammenfassung

Asthma im Kindesalter tritt weltweit mit zunehmender Prävalenz auf. Insbesondere die Industrienationen sind von dieser Entwicklung betroffen. Die Komplexität der Erkrankung, deren Genese von zahlreichen endogenen und exogenen Faktoren abhängt, erschwert die Entschlüsselung der Ursachen dieser beunruhigenden Entwicklung. Seit Entstehung der Hygienehypothese vor etwa 30 Jahren, die den Rückgang der mikrobiellen Stimulation durch Infektionen als Risikofaktor postulierte, wurden zahlreiche Einflussfaktoren untersucht. In groß angelegten Bauernhofstudien konnten Stallhaltung von Tieren und Konsum von unbehandelten Milchprodukten als präventive Faktoren identifiziert werden. Als zugrunde liegender Pathomechanismus wurden eine Stimulation und Regulation des Immunsystems in seiner prä- und postnatalen Entwicklung durch mikrobielle Vielfalt, Allergen- und Endotoxinexposition sowie durch die besondere Zusammensetzung der unbehandelten Kuhmilch beschrieben. Während die Exposition gegenüber protektiven Substanzen in der Umwelt aufgrund der zahlreichen Komponenten und der schwierigen Umsetzbarkeit noch keinen Einzug in den klinischen Alltag gefunden hat, spielen die Erkenntnisse zu un- oder teilbehandelten Milchprodukten eine zunehmende Rolle als mögliche Strategien in der Prävention des Asthmas im Kindesalter.

Abstract

The prevalence of childhood asthma is increasing worldwide. Industrial nations are particularly affected by this development. The complexity of the disease, the genesis of which depends on numerous endogenous and exogenous factors, makes it difficult to decipher the causes of this worrying development. With the emergence of the hygiene hypothesis some 30 years ago, which postulated the decline in microbial stimulation by infections as a risk factor, numerous influencing factors were examined. In large-scale farm studies, animal husbandry and consumption of untreated dairy products could be identified as preventive factors. The underlying pathomechanism was described as stimulation and regulation of the immune system in its prenatal and postnatal development through microbial diversity, allergen and endotoxin exposure as well as the special composition of untreated cow’s milk. While exposure to protective substances in the environment has not yet found its way into everyday clinical practice due to the numerous influencing components and the difficult feasibility, the findings on untreated or partially treated dairy products play an increasing role as possible strategies in the prevention of childhood asthma.

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Authors and Affiliations

  1. Abteilung für Asthma und Allergien, Dr. von Haunersches Kinderspital, LMU Klinikum, Lindwurmstr. 4, 80337, München, Deutschland

    N. Maison &  E. von Mutius

  2. Helmholtz Zentrum München, Institut für Asthma und Allergie Prävention, Neuherberg, Deutschland

    N. Maison, S. Pechlivanis &  E. von Mutius

  3. Comprehensive Pneumology Center (CPC-M), Deutsches Zentrum für Lungenforschung (DZL), München, Deutschland

    N. Maison &  E. von Mutius

Authors
  1. N. Maison
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  2. S. Pechlivanis
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  3. E. von Mutius
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Correspondence to N. Maison.

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Interessenkonflikt

E. von Mutius: During the 36 months prior to publication, Dr. Erika von Mutius reports to have received personal fees from Pharmaventures, from OM Pharma S. A., from Springer-Verlag GmbH, from Elsevier GmbH and Elsevier Ltd., from Peptinnovate Ltd., from Turun Yliopisto, from Tampereen Yliopisto, from Helsingin Yliopisto, from European Respiratory Society, from Deutsche Pharmazeutische Gesellschaft e. V., from Massachusetts Medical Society, from Chinese University of Hongkong, from European Commission, from Böhringer Ingelheim International GmbH, from Universiteit Utrecht, Faculteit Diergeneeskunde, from Universität Salzburg, from Georg Thieme Verlag, from Japanese Society of Pediatric Allergy and Clinical Immunology (JSPACI), outside the submitted work; In addition, Dr. von Mutius has a patent LU101064 – Barn dust extract for the prevention and treatment of diseases pending, a patent EP2361632: Specific environmental bacteria for the protection from and/or the treatment of allergic, chronic inflammatory and/or autoimmune disorders with royalties paid to ProtectImmun GmbH, a patent Publication number EP 1411977: Composition containing bacterial antigens used for the prophylaxis and the treatment of allergic diseases. licensed to ProtectImmun GmbH, a patent Publication number EP1637147: Stable dust extract for allergy protection licensed to ProtectImmun GmbH, and a patent Publication number EP 1964570: Pharmaceutical compound to protect against allergies and inflammatory diseases licensed to ProtectImmun GmbH. N. Maison und S. Pechlivanis geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Maison, N., Pechlivanis, S. & von Mutius, E. Prävention von Asthma im Kindesalter. Was bedeutet der Bauernhofeffekt für die Praxis?. Monatsschr Kinderheilkd 168, 988–994 (2020). https://doi.org/10.1007/s00112-020-00992-y

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  • DOI: https://doi.org/10.1007/s00112-020-00992-y

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