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Allergieprävention durch Ernährung

Allergy prevention through nutrition

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Zusammenfassung

Allergische Erkrankungen betreffen in Deutschland mehr als 2 Mio. Kinder und Jugendliche. Kausale Therapien stehen nur eingeschränkt zur Verfügung. Umso wichtiger ist es, Möglichkeiten der Prävention zu nutzen. Ernährung kann einen Beitrag leisten und spielt v. a. sehr früh in der Entwicklung eine Rolle. Eine mediterrane Diät während der Schwangerschaft hat möglicherweise einen protektiven Effekt auf die Entstehung von Allergien beim Kind. Eine erhöhte Zufuhr von Omega-3-Fettsäuren, v. a. bei Schwangeren mit niedrigen Spiegeln von Omega-3-Fettsäuren, ist mit einem geringeren Auftreten allergischer Erkrankungen beim Kind assoziiert. Das Meiden möglicher Allergene während der Schwangerschaft hat sich dagegen als wirkungslos herausgestellt und wird nicht mehr empfohlen. Muttermilch ist ernährungsphysiologisch insgesamt die beste Säuglingsnahrung, wobei die Evidenz für eine allergiepräventive Wirkung gering ist. Trotz der Ergebnisse der GINI-Studie wird die Empfehlung zur Fütterung hydrolysierter Formulanahrung für Kinder mit familiärem Allergierisiko in letzter Zeit kontrovers diskutiert. Die verzögerte Einführung von Beikost hat keinen protektiven Effekt, und Studien zur frühen Gabe von Hühnerei und Erdnuss zeigten, dass eine frühe orale Allergenexposition im Hinblick auf die Prävention von Nahrungsmittelallergien zielführender ist als eine Allergenvermeidung.

Abstract

More than 2 million children and adolescents in Germany suffer from allergic diseases. Causal therapies are scarce and prevention is therefore essential. Nutrition is part of the game and its influence is particularly important in early life. A Mediterranean diet during pregnancy may be protective against the development of allergic diseases in the child. High omega‑3 fatty acid intake, especially in pregnant women with low serum levels of omega‑3 fatty acids, is associated with fewer allergic diseases in the child. Maternal avoidance of possible allergens during pregnancy has not been effective and is no longer recommended. Regarding nutritional aspects, breastmilk is the best infant food, while evidence for effects on allergy prevention is scarce. Despite the results of the GINI study, the recommendation of hydrolyzed formula for children with a familial risk has recently been controversially debated. The delayed initiation of solid foods does not protect against food allergies and studies on the early introduction of hen’s eggs and peanuts have shown that with respect to food allergies early oral allergen exposure is better than allergen avoidance.

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Abbreviations

AAF:

„Amino acid–based elemental formula“ (Säuglingsnahrung auf Aminosäurebasis)

BEAT:

Beating Egg Allergy

BF:

„Breastfeeding“ (Stillen)

DHA:

Docosahexaensäure

EAACI:

European Academy of Allergy and Clinical Immunology

EAT:

Enquiring About Tolerance

EHF:

„Extensively hydrolyzed formula“ (extensiv hydrolysierte Säuglingsnahrung)

EPA:

Eicosapentaensäure

FADS:

„Fatty acid desaturase“

GINI:

„German infant nutritional intervention“

HA:

Hypoallergen

HEAP:

Hen’s Egg Allergy Prevention

IgE:

Immunglobulin E

LEAP:

Learning Early About Peanut Allergy

PETIT:

Prevention of Egg Allergy with Tiny Amount Intake Trial

PHF:

„Partially hydrolyzed formula“ (partiell hydrolysierte Säuglingsnahrung)

RR:

„Relative risk“

SCORAD:

Scoring Atopic Dermatitis

STAR:

Solid Timing for Allergy Research

STEP:

Starting Time for Egg Protein

95 %-KI:

95 %-Konfidenzintervall

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Authors and Affiliations

  1. Abteilung für Pädiatrische Pneumologie und Allergologie, Kinderuniversitätsklinik Regensburg (KUNO), Universität Regensburg und Barmherzige Brüder, Klinik St. Hedwig Regensburg, Steinmetzstr. 1–3, 93049, Regensburg, Deutschland

    Susanne Harner &  Michael Kabesch

  2. Wissenschafts- und Entwicklungscampus Regensburg (WECARE), Barmherzige Brüder, Klinik St. Hedwig Regensburg, Steinmetzstr. 1–3, 93049, Regensburg, Deutschland

    Michael Kabesch

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  1. Susanne Harner
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Correspondence to Michael Kabesch.

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S. Harner und M. Kabesch haben in den letzten 5 Jahren Vortragshonorare von Nutricia erhalten.

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

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Harner, S., Kabesch, M. Allergieprävention durch Ernährung. Monatsschr Kinderheilkd 170, 513–519 (2022). https://doi.org/10.1007/s00112-022-01488-7

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