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Aktuelle Dermatologie 2013; 39(08/09): 347-362
DOI: 10.1055/s-0033-1344355
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© Georg Thieme Verlag KG Stuttgart · New York

Nahrungsmittelunverträglichkeiten[*]

Food Intolerance
S. C. Bischoff
Institut für Ernährungsmedizin, Universität Hohenheim, Stuttgart
› Author Affiliations
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Publication History

Publication Date:
11 September 2013 (online)

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Epidemiologie

  • Nahrungsmittelunverträglichkeiten betreffen ca. 20 – 30 % der Allgemeinbevölkerung in westlichen Ländern.

  • Bei etwa einem Viertel der betroffenen Kinder und einem Zehntel der betroffenen Erwachsenen liegt der Unverträglichkeit eine Allergie, d. h. eine immunologisch vermittelte Unverträglichkeitsreaktion zugrunde. In einem Drittel dieser Fälle treten gastrointestinale Symptome auf.

Pathophysiologie und klinisches Bild

  • Nahrungsmittelallergien (NMA) werden durch IgE-abhängige oder IgE-unabhängige immunologische Reaktionen ausgelöst, die zu einer Entzündungsreaktion führen, an der Mastzellen, eosinophile Granulozyten und andere Zellen beteiligt sind. Sowohl genetische als auch Umweltfaktoren werden ursächlich diskutiert.

  • Die NMA ist typischerweise eine Erkrankung der Haut, der Atemwege, des GI-Trakts oder einer Kombination hieraus.

  • Die NMA kann im Gegensatz zu Intoleranzen zu einer lebensbedrohlichen systemischen Anaphylaxie führen.

Diagnostik und Therapie

  • Neue Erkenntnisse zur Wechselwirkung zwischen angeborenem Immunsystem und intestinaler Mikrobiota haben innovative pathophysiologische Konzepte generiert, die epidemiologische Beobachtungen unterstützen, nach denen ländlicher Lebensstil protektiv wirkt gegen allergische und immunologische Erkrankungen.

  • Die Entwicklung rekombinanter Allergene und Allergenvarianten hat die Möglichkeiten der Diagnostik verbessert und bietet neue Therapieoptionen an, wie beispielsweise die Hyposensibilisierung und die Induktion von immunologischer Toleranz.

  • Nahrungsmittelintoleranzen, das sind nicht immunologisch vermittelte Nahrungsmittelunverträglichkeiten, die vielfach durch spezifische Enzymdefizienzen verursacht werden, sind differenzialdiagnostisch von Nahrungsmittelallergien abzugrenzen.

* Erstveröffentlichung in Gastroenterologie up2date 2012; 8: 143 – 161


 

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