Schwere Nahrungsmittelallergien – ist eine Toleranzinduktion möglich?

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)

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