IgE- und nicht IgE-vermittelte Nahrungsmittelallergien – ein Überblick

Nahrungsmittelallergien (NMA) sind komplexe immunologische Reaktionen auf Nahrungsbestandteile, die bei einem bedeutenden Anteil der Bevölkerung weltweit auftreten und zum Teil schwere Symptome verursachen. Grundsätzlich kann man die NMA in IgE-vermittelte und nicht IgE-vermittelte NMA unterteilen. Im Folgenden wird auf die Besonderheiten und Therapiemöglichkeiten der beiden Formen eingegangen.

Abstract

Food allergies are divided into 2 main categories: IgE-mediated and non-IgE-mediated food allergies. Both forms can have significant health effects but differ in mechanism, symptoms, and management. The manifestation of the 2 forms differs between children and adults. These differences can be observed in the prevalence and the type of most common allergens and clinical presentation. The prevalence of food allergies has increased worldwide in recent decades. IgE-mediated allergies are the best researched and documented. They are particularly common in children, while non-IgE-mediated allergies are less well understood and diagnosed, leading to uncertainty about their prevalence. They often manifest as gastrointestinal symptoms that can occur hours to days after ingestion and are often difficult to distinguish from other food intolerances. The occurrence of food allergies varies significantly geographically. Differences in dietary habits, food composition, and environmental factors can partly explain these differences. There are also indications that genetics may play a role. IgE-mediated and non-IgE-mediated food allergies represent a significant and growing challenge for the global healthcare system. This article provides an in-depth review of both types of food allergy, discussing their potential causes, diagnostic possibilities, and available therapeutic strategies. Some diseases represent a mixed form of IgE and non-IgE-mediated immunological adverse reactions. Eosinophilic oesophagitis is the most common eosinophilic disease, and the diagnosis and treatment options are explained in more detail below.

Kernaussagen

• Man unterscheidet IgE-vermittelte, nicht IgE-vermittelte und Mischformen der NMA. Eliminationsdiäten sind der Goldstandard zur Therapie von NMA.

• Die Hauptallergene bei der IgE-vermittelten NMA unterscheiden sich bei Kindern und Erwachsenen. Bei Kindern findet häufig eine Spontanremission statt.

• Die wichtigsten Nicht-IgE-NMA sind die FPIES, FPIAP und FPE, die vorwiegend im Säuglingsalter beschrieben sind, immer häufiger aber auch im Erwachsenenalter beobachtet und diagnostiziert werden.

• Die Diagnosestellung von FPIES, FPIAP und FPE gestaltet sich aufgrund fehlender Biomarker oft schwierig.

• Die häufigste IgE-/Nicht-IgE-Mischform ist die EoE. Neben einer Eliminationsdiät stellen Budesonid oder Protonenpumpeninhibitoren wichtige therapeutische Optionen dar.

Schlüsselwörter

Allergie - immunologisch unerwünschte Reaktion - IgE-vermittelt - nicht-IgE-vermittelt - eosinophile Ösophagitis

Keywords

allergy - immunological adverse reactions - IgE-mediated - non-IgE-mediated - eosinophilic esophagitis

Publication History

Article published online:
29 August 2024

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