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Kinder- und Jugendmedizin 2020; 20(05): 298-304
DOI: 10.1055/a-1237-0822
Schwerpunkt
© Georg Thieme Verlag KG Stuttgart · New York

Schwere Nahrungsmittelallergien – ist eine Toleranzinduktion möglich?

Severe food allergy – is there a way to induce tolerance?
Jochen Meister
1   HELIOS-Klinikum Aue, Klinik für Kinder- und Jugendmedizin
3   Universitäts AllergieCentrum (UAC), Universitätsklinikum der TU Dresden
,
Katja Nemat
2   Kinderpneumologie/Allergologie am Kinderzentrum Dresden-Friedrichstadt (Kid)
3   Universitäts AllergieCentrum (UAC), Universitätsklinikum der TU Dresden
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Publikationsverlauf

eingereicht 22. April 2020

akzeptiert 28. April 2020

Publikationsdatum:
21. Oktober 2020 (online)

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ZUSAMMENFASSUNG

Die Standardtherapie bei schweren Nahrungsmittelallergien (NMA) umfasst Karenzdiät, Ernährungsberatung sowie Ausstattung mit Notfallmedikamenten und Schulung in den Notfallplan. Aufgrund der starken Einschränkung der Lebensqualität von Patienten mit schwerer Nahrungsmittelallergie sind kausale Therapieansätze wünschenswert, die eine orale Toleranz aktiv induzieren. In den letzten zwei Jahrzehnten wurden verschiedene Applikations-Routen (sublingual, oral, epikutan) einer spezifischen Immuntherapie bei Patienten mit Hühnerei-, Kuhmilch- und Erdnussallergie untersucht. Aktuelle Studien konzentrierten sich vor allem auf die orale Immuntherapie (OIT) mit Erdnuss und zeigten, dass die klinische Reaktionsschwelle durch eine wiederholte Zuführung definierter Allergenmengen tatsächlich angehoben werden konnte. Kürzlich hat die US-amerikanische Arzneimittelbehörde das Erdnuss-Pulver Palforzia als erstes Therapeutikum für Nahrungsmittelallergien bei Kindern und Jugendlichen zugelassen. Jedoch ist die Erdnuss-OIT auch mit systemischen Nebenwirkungen assoziiert. Eine Niedrigdosis-OIT zeigte ein besseres Sicherheitsprofil. Zusätzliche Studien mit direktem Vergleich verschiedener Allergendosen und Dosissteigerungs-Protokolle sind notwendig. Weiterhin müssen Langzeit-Wirksamkeit und Kosteneffektivität verschiedener Ansätze zur Induktion oraler Toleranz bewertet werden.

ABSTRACT

Current standard management of food allergy comprises a strict elimination diet, nutritional support and immediate recognition and treatment of allergic reactions. Due to the constantly necessary vigilance and fear of life-threatening symptoms, this strategy results in significant impairment of patients’ quality of life. Accordingly, an interventional treatment for severe food allergy with active induction of oral tolerance is highly desirable. In the last two decades different routes (sublingual, oral and epicutaneous) of food immunotherapy have been examined in patients with hen`s egg, milk and peanut allergy. Most recent studies focused on oral immunotherapy (OIT) with peanut and demonstrated, that the reactivity threshold could be raised effectively through repeated administration of a defined allergen dose at regular intervals. Recently, the US Food and Drug Administration (FDA) approved the peanut powder Palforzia as the first drug for food allergy treatment in children and adolescents. However, peanut OIT was shown to be associated with systemic side effects. Using a low maintenance dose in peanut OIT had a better safety profile. Additional studies that directly compare different doses and dosing schedules are needed. Further research should also assess long-term efficacy and cost-effectiveness of different approaches of food tolerance induction.

Schlüsselwörter

Nahrungsmittelallergie - Anaphylaxie - Orale Toleranzinduktion - Orale Immuntherapie (OIT) - Epikutane Immuntherapie (EPIT) - Sublinguale Immuntherapie (SLIT) - Allergen-spezifische Immuntherapie (AIT)

Keywords

Food allergy - IgE-mediated food allergy - anaphylaxis - oral tolerance - oral immunotherapy (OIT) - sublingual immunotherapy (SLIT) - epicutaneous immunotherapy (EPIT) - allergen immunotherapy (AIT)
 

  • Literatur

  • 1 Gupta RS, Springston EE, Warrier M. et al The prevalence, severity, and distribution of childhood food allergy in the United States. Pediatrics 2011; 128 (01) e-17
    CrossrefPubMedGoogle Scholar
  • 2 Nwaru BI, Hickstein L, Panesar SS. et al Prevalence of common food allergies in Europe: a systematic review and meta-analysis. Allergy 2014; 69 (08) 99-1007
    CrossrefPubMedGoogle Scholar
  • 3 Roehr CC, Edenharter G, Reimann S. et al Food allergy and non-allergic food hypersensitivity in children and adolescents. Clin Exp Allergy 2004; 34 (10) 1534-1541
    CrossrefPubMedGoogle Scholar
  • 4 Berin MC. Mechanisms that define transient versus persistent food allergy. J Allergy Clin Immunol 2019; 143 (02) 45-457
    CrossrefPubMedGoogle Scholar
  • 5 Grabenhenrich LB, Dolle S, Moneret-Vautrin A. et al Anaphylaxis in children and adolescents: The European Anaphylaxis Registry. J Allergy Clin Immunol 2016; 137 (04) 1128-37 e1
    CrossrefPubMedGoogle Scholar
  • 6 Beyer K. Die Rolle der Ernährung in der Prävention allergischer Erkrankungen. Pädiatrische Allergologie 2018; 2018: 8-12
    Google Scholar
  • 7 Du Toit G, Roberts G, Sayre PH. et al Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med 2015; 372 (09) 803-813
    CrossrefPubMedGoogle Scholar
  • 8 Schoemaker AA, Sprikkelman AB, Grimshaw KE. et al Incidence and natural history of challenge-proven cow’s milk allergy in European children – uroPrevall birth cohort. Allergy 2015; 70 (08) 963-972
    CrossrefPubMedGoogle Scholar
  • 9 Xepapadaki P, Fiocchi A, Grabenhenrich L. et al Incidence and natural history of hen’s egg allergy in the first 2 years of life-the EuroPrevall birth cohort study. Allergy 2016; 71 (03) 350-357
    CrossrefPubMedGoogle Scholar
  • 10 Peters RL, Allen KJ, Dharmage SC. et al Natural history of peanut allergy and predictors of resolution in the first 4 years of life: A population-based assessment. J Allergy Clin Immunol 2015; 135 (05) 1257-1266 e1-2
    CrossrefPubMedGoogle Scholar
  • 11 Fleischer DM. The natural history of peanut and tree nut allergy. Curr Allergy Asthma Rep 2007; 7 (03) 175-181
    CrossrefPubMedGoogle Scholar
  • 12 Martin PE, Eckert JK, Koplin JJ. et al Which infants with eczema are at risk of food allergy? Results from a population-based cohort. Clin Exp Allergy 2015; 45 (01) 255-264
    CrossrefPubMedGoogle Scholar
  • 13 Robison RG, Singh AM. Controversies in Allergy: Food Testing and Dietary Avoidance in Atopic Dermatitis. J Allergy Clin Immunol Pract 2019; 7 (01) 35-39
    CrossrefPubMedGoogle Scholar
  • 14 Meister J, Nemat K. Nahrungsmittelallergie bei Atopischer Dermatitis: Praktisches Vorgehen. Pädiatrische Praxis 2018; 89: 1-13
    Google Scholar
  • 15 Togias A, Cooper SF, Acebal ML. et al Addendum Guidelines for the Prevention of Peanut Allergy in the United States: Summary of the National Institute of Allergy and Infectious Diseases-Sponsored Expert Panel. J Acad Nutr Diet 2017; 117 (05) 788-793
    CrossrefPubMedGoogle Scholar
  • 16 Du Toit G, Sampson HA, Plaut M. et al Food allergy: Update on prevention and tolerance. J Allergy Clin Immunol 2018; 141 (01) 30-40
    CrossrefPubMedGoogle Scholar
  • 17 Kim JS, Nowak-Wegrzyn A, Sicherer SH. et al Dietary baked milk accelerates the resolution of cow’s milk allergy in children. J Allergy Clin Immunol 2011; 128 (01) 125-131 e2
    CrossrefPubMedGoogle Scholar
  • 18 Berni Canani R, Di Costanzo M, Bedogni G. et al Extensively hydrolyzed casein formula containing Lactobacillus rhamnosus GG reduces the occurrence of other allergic manifestations in children with cow’s milk allergy: 3-year randomized controlled trial. J Allergy Clin Immunol 2017; 139 (06) 1906-1913 e4
    CrossrefPubMedGoogle Scholar
  • 19 Adelsberger L. Was ist Allergie und wie heilt man sie?. DMW 1936: 733-737
    PubMedGoogle Scholar
  • 20 Brewe F. Spezifische orale Toleranzinduktion bei Nahrungsmittelallergie im Kindesalter. Wirksamkeit und Reaktionsmuster Berlin: Universitätsmedizin Berlin; 2008
    Google Scholar
  • 21 Nurmatov U, Dhami S, Arasi S. et al Allergen immunotherapy for IgE-mediated food allergy: a systematic review and meta-analysis. Allergy 2017; 72 (08) 1133-1147
    CrossrefPubMedGoogle Scholar
  • 22 Zhang W, Sindher SB, Sampath V, Nadeau K. Comparison of sublingual immunotherapy and oral immunotherapy in peanut allergy. Allergo J Int 2018; 27 (06) 153-161
    CrossrefPubMedGoogle Scholar
  • 23 Trendelenburg VB. Zukünftige Therapieoptionen für Erdnussallergiker: Fakt oder Fiktion?. Pädiatrische Allergologie 2019 Sonderheft „Nahrungsmittelallergie“ 53-58
    PubMedGoogle Scholar
  • 24 FDA (US Food and Drug Administration) Media FDA News Release: FDA approves first drug for treatment of peanut allergy for children. www.fda.gov/news-events/press-announcements/fda-approves-first-drug-treatment-peanut-allergy-children accessed 31.01.2020
    Google Scholar
  • 25 Investigators PGoC, Vickery BP, Vereda A. et al AR101 Oral Immunotherapy for Peanut Allergy. N Engl J Med 2018; 379 (21) 1991-2001
    CrossrefPubMedGoogle Scholar
  • 26 Vickery BP, Hourihane JO, Adelman DC. Oral Immunotherapy for Peanut Allergy. N Engl J Med 2019; 380 (07) 691-669
    PubMedGoogle Scholar
  • 27 MacGinnitie AJ, Rachid R, Gragg H. et al Omalizumab facilitates rapid oral desensitization for peanut allergy. J Allergy Clin Immunol 2017; 139 (03) 873-881 e8
    CrossrefPubMedGoogle Scholar
  • 28 Burks AW, Sampson HA, Plaut M. et al Treatment for food allergy. J Allergy Clin Immunol 2018; 141 (01) 1-9
    CrossrefPubMedGoogle Scholar
  • 29 Bluemchen K, Trendelenburg V, Ahrens F. et al Efficacy, Safety, and Quality of Life in a Multicenter, Randomized, Placebo-Controlled Trial of Low-Dose Peanut Oral Immunotherapy in Children with Peanut Allergy. J Allergy Clin Immunol Pract 2019; 7 (02) 479-491 e10
    CrossrefPubMedGoogle Scholar
  • 30 Bluemchen K, Beder A, Beschorner J. et al Modified oral food challenge used with sensitization biomarkers provides more real-life clinical thresholds for peanut allergy. J Allergy Clin Immunol 2014; 134 (02) 390-398
    CrossrefPubMedGoogle Scholar
  • 31 Fleischer DM, Conover-Walker MK, Matsui EC, Wood RA. The natural history of tree nut allergy. J Allergy Clin Immunol 2005; 116 (05) 1087-1093
    CrossrefPubMedGoogle Scholar
  • 32 Fleischer DM, Greenhawt M, Sussman G. et al Effect of Epicutaneous Immunotherapy vs Placebo on Reaction to Peanut Protein Ingestion Among Children With Peanut Allergy: The PEPITES Randomized Clinical Trial. JAMA 2019; 321 (10) 946-955
    CrossrefPubMedGoogle Scholar
  • 33 Remington BC, Krone T, Kim EH. et al Estimated risk reduction to packaged food reactions by epicutaneous immunotherapy (EPIT) for peanut allergy. Ann Allergy Asthma Immunol 2019; 123 (05) 488-493 e2
    CrossrefPubMedGoogle Scholar
  • 34 DBV Media Contact DBV Technologies Provides Update on Viaskin Peanut BLA for Children Ages 4–11 Years. www.globenewswire.com/news-release/2020/03/16/2001453/0/en/DBV-Technologies-Provides-Update-on-Viaskin-Peanut-BLA-for-Children-Ages-4-11-Years.html accessed 16.03.2020
    Google Scholar
  • 35 Romantsik O, Tosca MA, Zappettini S, Calevo MG. Oral and sublingual immunotherapy for egg allergy. Cochrane Database Syst Rev 2018; 4: CD010638
    PubMedGoogle Scholar
  • 36 Nowak-Wegrzyn A, Sato S, Fiocchi A, Ebisawa M. Oral and sublingual immunotherapy for food allergy. Curr Opin Allergy Clin Immunol 2019; 19 (06) 60-613
    CrossrefPubMedGoogle Scholar
  • 37 Pajno GB, Fernandez-Rivas M, Arasi S. et al EAACI Guidelines on allergen immunotherapy: IgE-mediated food allergy. Allergy 2018; 73 (04) 799-815
    CrossrefPubMedGoogle Scholar
  • 38 Bluemchen K, Eiwegger T. Oral peanut immunotherapy How much is too much? How much is enough?. Allergy 2019; 74 (02) 220-222
    CrossrefPubMedGoogle Scholar