Allergieprävention heute

Zusammenfassung

Atopische Erkrankungen wie das atopische Ekzem, die Nahrungsmittelallergie, das allergische Asthma und die allergische Rhinokonjunktivitis sind häufig im Kindesalter. Allergieprävention wird von vielen Eltern und behandelnden Ärzten angestrebt, auch gibt es seit 2009 eine neue S3-Leitlinie zur Allergieprävention, aber es gibt letztendlich nach wie vor keine 100-prozentige Vorbeugung. Die epidemiologischen Studien der letzten beiden Jahrzehnte suggerieren, dass genetische und epigentische Faktoren die Hauptrolle bei der Entwicklung allergischer Erkrankungen spielen. Hierbei modulieren veränderte Umweltfaktoren wie z. B. die Ernährung oder der Kontakt zu Mikroorganismen das An- und Abschalten von proentzündlichen oder entzündungshemmenden Genen, sodass trotz gleichbleibender DNA in einer veränderten Umwelt bestimmte Gene mehr oder weniger zum Tragen kommen und die Prävalenz von inflammatorischen Erkrankungen zunimmt.

Im folgenden Artikel wird ein Überblick über die Datenlage hinsichtlich Allergieprävention und Risiko- bzw. protektiver Faktoren gegeben.

Summary

Atopic diseases like atopic eczema, food allergy, atopic asthma and allergic rhinitis are frequent in childhood and adolescence. Parents and doctors like to have clear prevention guidelines, however, a successful allergy prevention is still not possible, although a new guideline (S3-Leitlinie Allergieprävention) has been published in 2009. Epidemiological studies have been conducted during the last 2 decades and they suggested that genetic and epigenetic factors play a role in the development of allergic disease and in the increase of prevalence. Environmental factors like nutrition, microbiota, exposure to microorganisms can turn on and off pro- and anti-inflammatory genes, thus influencing the prevalence of inflammatory diseases although the DNA is not changed in sequence. The following article tries to give an overview on the current status of scientific knowledge about allergy prevention.

Schlüsselwörter

Allergieprävention - atopische Erkrankungen - atopisches Ekzem - Nahrungsmittelallergien - allergisches Asthma - allergische Rhinokonjunktivitis

Keywords

Allergy prevention - atopic diseases - atopic eczema - food allergy - atopic asthma - allergic rhinitis

• Literatur

• 1 Alm J. Atopy in children of families with an anthroposophic lifestyle.. Lancet 1999; 353: 1485-1488.
• 2 Alm JS. et al An anthroposophic lifestyle and intestinal microflora in infancy.. Pediatr Allergy Immunol 2002; 13: 402-411.
• 3 Asher MI, Montefort S, Björkstén B. et al Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys.. Lancet 2006; 368: 733-743.
• 4 Bäck O, Blomquist HKS, Hernell O, Stenberg B. Does vitamin D intake during infancy promote the development of atopic allergy?. Acta Derm Venereol 2009; 89: 28-32.
• 5 Braun-Fahrländer C, von Mutius E. Can farm milk consumption prevent allergic diseases?. Clin Exp Allergy 2011; 41: 29-35.
• 6 Breton CV, Byun H-M, Wenten M. et al Prenatal tobacco smoke exposure affects global and gene-specific DNA methylation.. Am J Respir Crit Care Med 2009; 180: 462-467.
• 7 Caudri D, Wijga A, Scholtens S. et al Early daycare is associated with an increase in airway symptoms in early childhood bit is no protection against asthma or atopy at 8 years.. Am J Respir Crit Care Med 2009; 180: 491-498.
• 8 Chatzi L, Kogevinas M. Prenatal and childhhod Mediterranean diet and the development of asthma and allergies in children.. Public Health Nutrition 2009; 12: 1629-1634.
• 9 Custovic A, Rothers J, Stern D. et al Effect of day care attendance on sensitization and atopic wheezing differs by Toll-like receptor 2 genotype in 2 population- based birth cohort studies.. J Allergy Clin Immunol 2011; 127: 390-397.
• 10 Debarry J, Hanuszkiewicz A, Stein K. et al The allergy- protective properties of Acinetobacter Iwoffii F78 are imparted by its lipopolysaccharide.. Allergy 2010; 65: 690-697.
• 11 Ege M. et al Exposure to environmental microorganismes and childhood asthma.. N Engl J Med 2011; 364: 701-709.
• 12 Flöistrup H. et al Allergic disease and sensitization in Steiner school children.. J Allergy Clin Immunol 2006; 117: 59-66.
• 13 Giwercman C, Halkjaer LB, Jensen SM. et al Increased risk of eczema but reduced risk of early wheezey disorder from exclusive breast-feeding in high-risk infants.. J Allergy Clin Immunol 2010; 125: 866-871.
• 14 Greenough A, Shaheen SO, Shennan A. et al Respiratory outcomes in early childhood following antenatal vitamin C and E supplementation.. Thorax 2010; 65: 998-1003.
• 15 Grüber C, Warner J, Hill D. et al Transient suppression of atopy in early childhood is associated with high vaccination coverage.. Pediatrics 2003; 111: e282-288.
• 16 Grüber C, Illi S, Plieth A. et al Cultrural adaptation is associated with atopy and wheezing among children of Turkish origin living in Germany.. Clin Exp Allergy 2002; 32: 526-531.
• 17 Grüber C, van Stuijvenberg M, Mosca F. et al Reduced occurrence of early atopic dermatitis because of immunoactive prebiotocs among low-atopy risk.. J Allergy Clin Immunol 2010; 126: 791-797.
• 18 Hamelmann E, Beyer K, Grüber C. et al Primary prevention of allergy: avoiding risk or providing protection?. Clin Exp Allergy 2008; 38: 233-245.
• 19 Hviid A, Melbye M. Measles-Mumps-Rubellavaccination and asthma-like disease in early childhood.. Am J Epidemiol 2008; 168: 1277-1283.
• 20 Illi S, von Mutius E, Lau S. et al Perennial sensitisation early in life and chronic asthma in children.. Lancet 2006; 368: 763-770.
• 21 Johannsen H, Prescott SL. Practical prebiotics, probiotics, synbiotics for allergists: how useful are they?. Clin Exper Allergy Clin Immunol 2009; 39: 1801-1814.
• 22 Kalliomäki M, Salminen S, Arvilommi H. et al Probiotics in primary prevention of atopic disease: a randomized placebo-controlled trial.. Lancet 2001; 357: 1076-1079.
• 23 Kalliomäki M, Salminen S, Poussa T. et al Probiotics and prevention of atopic disease: 4 year follow-up of a randomized placebo-controlled trial.. Lancet 2003; 361: 1869-1871.
• 24 Keil T, Lau S, Roll S. et al Maternal smoking increases the risk of allergic sensitization and wheezing only in children with allergic predisposition: longitudinal analysis from birth to 10 years.. Allergy 2009; 64: 445-451.
• 25 Koplin JJ, Osborne NJ, Wake M, Martin PE. et al Can early introduction of egge prevent egg allergy in infants?. J Allergy Clin Immunol 2010; 126: 807-813.
• 26 Kopp MV, Hennemuth I, Dietschek A. et al A randomized placebo-controlled trial of probiotics for primary prevention: no clinical or immunological effects of Lactobacillus GG supplementation.. Pediatrics 2008; 121: e850-856.
• 27 Kucharski R, Maleszka J, Foret S, Maleszka R. Nutritional control of reproductive status in honeybees via DNA methylation.. Science 2008; 319: 1827-1830.
• 28 Kull I, Melen E, Alm J. et al Breast-feeding in relation to asthma, ling function, and sensitization in young schoolchildren.. J Allergy Clin Immunol 2010; 125: 1013-1019.
• 29 Kumar RK, Hitchins M, Foster PS. Epigenetic changes in childhood asthma.. Disease models and mechanisms 2009; 2: 549-553.
• 30 Lau S, Illi S, Sommerfeld C. et al Early exposure to house dust mite and cat allergens and the development of childhood asthma.. Lancet 2000; 356: 1392-1397.
• 31 Lee J, Seto D, Bielory L. Meta-analysis of clinical trials of probiotics for prevention and treatment of pediatric atopic dermatitis.. J Allergy Clin Immunol 2008; 121: 116-121.
• 32 Litonjua AA. Childhood asthma may be a consequence of vitamin D deficiency.. Curr Opin Allergy Clin Immunol 2009; 9: 202-207.
• 33 Liu J, Ballaney M, Al-Alem U. et al Combined inhaled diesel exhaust particles and allergen exposure alter methylation of T-helper gens and IgE production in vivo.. Toxicol Sci 2008; 102: 76-81.
• 34 Matricardi P, Grüber C, Wahn U, Lau S. The asthmaobesity link in childhood: open questions, complex evidence, a few answers only.. Clin Exp Allergy 2007; 37: 476-484.
• 35 Mohapatra SS, Boyapalle S. Epidemilogic, experimental and clinical links between respiratory syncytial virus infection and asthma.. Clin Microbiology Reviews 2008; 21: 495-504.
• 36 Muche-Borowski C, Kopp M, Reese I. et al S3-Leitlinie Allergieprävention - update 2009. Leitlinie der Gesellschaft für Pädiatrische Allergologie und Umweltmedizin e. V. 2009. (Pädiatrische Allergologie in Klinik und Praxis).. J Dtsch Dermatol Ges 2010; 8: 718-724.
• 37 Nagel G, Weinmayr G, Kleiner A. et al Effect of diet on asthma and allergic sensitisation in the International Study on Allergies and Asthma in Childhood (ISAAC) Phase Two.. Thorax 2010; 65: 516-522.
• 38 Oien T, Storro O, Johnsen R. Do early intake of fish and fish oil protect against eczema and doctor-diagnosed asthma at 2 years of age? A cohort study.. J Epidemiol Community Health 2010; 64: 124-129.
• 39 Patel S, Murray CS, Woodcock A. et al Dietary antioxidant intake, allergic sensitization and allergic diseases in young children.. Allergy 2009; 64: 1766-1772.
• 40 Peters M, Kauth M, Scherner O. et al Arabinogalactan isolated from cowshed dust extract protects mice from allergic airway inflammation and sensitization.. J Allergy Clin Immunol 2010; 126: 648-656.
• 41 Puthothen B, Bierbaum S, Kopp MV. et al Association of TNF-alpha with severe respiratory syncytial virus infection and bronchial asthma.. Pediatr Allergy Immunol 2009; 20: 157-163.
• 42 Roduit C, Scholtens S, de Jongste JC. et al Asthma at 8 years of age in children born by Caesarean section.. Thorax 2009; 64: 107-113.
• 43 Saarinen UM. et al Prolonged breast feeding as prophylaxis for atopic disease.. Lancet 1979; 28: 163-166.
• 44 Saarinen UM. Dietary antigen avoidance: postponement of food allergy.. Lancet 1980; 17: 1093
• 45 Salfeld P, Kopp MV. Probiotics cannot be generally recommended for primary prevention of AD.. J Allergy Clin Immunol 2009; 124: 170
• 46 Sariachvili M, Droste J, Dom S. et al Early exposure to solid foods and the development of eczema in children up to 4 years of age.. Pediatr Allergy Immunol 2010; 21: 74-81.
• 47 Sithole F, Douwes J, Burstyn I, Veugelers P. Body mass inde and childhood asthma: a linear association?. J Asthma 2008; 45: 473-477.
• 48 Sordillo JE, Hoffmann EB, Celedon JC. et al Multiple microbial exposures in the home may protect against asthma or allergy in childhood.. Clin Exp Allergy 2010; 40: 902-910.
• 49 Storro O, Oien T, Dotterud CK. et al A primary health-care intervention on pre and postnatal risk factor behavior to prevent childhood allergy. The Prevention of Allergy among Children in Trindheim (PACT) study.. BMC Public Health 2010; 10: 443
• 50 Su RC, Becker AB, Kozyrskyj AL, Hayglass KT. Epigenetic regulation of established human type 1 versus type 2 cytokine responses.. J Allergy Clin Immunol 2008; 121: 57-63.
• 51 Svanes C, Sunyer J, Plana E. et al Early life origins of chronic obstructive pulmonary disease.. Thorax 2010; 65: 14-20.
• 52 Taylor AL, Dunstan JA, Prescott SL. Probiotics supplementation for the first 6 months of life fails to reduce the risk of atopic dermatitis and increases the risk of allergen sensitization in high-risk children: a randomized controlled trial.. J Allergy Clin Immunol 2007; 119: 184-191.
• 53 von Berg A, Filipiak-Pittroff B, Krämer U. et al Preventive effect of hydrolyzed infant formulas persists until age 6 years:long-term results from the German Infant Nutritional Intervention Study (GINI).. J Allergy Clin Immunol 2008; 121: 1442-1447.
• 54 Weiss ST, Shore S. Obesity and asthma. Directions for research.. Am J Resp Crit Care Med 2004; 169: 963-968.
• 55 Woodcock A, Lowe LA, Murray CS. et al Early life environmental control: effect on symptoms, sensitization, and lung function at age 3 years.. Am J Respir Crit Care Med 2004; 170: 433-439.
• 56 Wu P, Dupont WD, Griffin MR. et al Evidence of a causal role of winter virus infection during infancy in early childhood asthma.. Am J Respir Crit Care Med 2008; 178: 1123-1129.
• 57 Xu X, Dailey AB, Freeman NC. et al The effects of birthweight and breastfeeding on asthma among children aged 1-5 years.. J Pediatr and Child Health 2009; 45: 646-651.
• 58 Bergmann RL, Diepgen TL, Kuss O. et al MASstudy group. Breastfeeding duration is a risk factor for atopic eczema.. Clin Exp Allergy 2002; 32: 205-209.
• 59 Niers L, Martin R, Rijkers G, Sengers F. et al The effect of selected probiotic strains on the development of eczema (the PandA study).. Allergy 2009; 64: 1349-1358.