Entstehung und Prävention von Allergien im Kindes- und Jugendalter

Zusammenfassung

Die Prävalenz allergischer Erkrankungen ist nicht nur in der »westlichen« Welt in den letzten Jahrzehnten deutlich angestiegen. Warum jedoch das Immunsystem bei manchen Allergenen mit Toleranz bzw. mit einer allergischen Erkrankung reagiert, ist nur teilweise verstanden. Postnatal aber auch pränatal wirken Allergene auf das sich entwickelnde Immunsystem. Im Bereich des erworbenen Immunsystems hat sich auf Zell- und Proteinebene das TH-1/TH-2-Modell etabliert. Aber auch dem angeborenen Immunsystem bzw. der Interaktion von angeborenem und erworbenem Immunsystem kommt eine entscheidende Rolle auf die Entwicklung allergischer Erkrankungen zu. Hierbei können neben genetischen Ursachen weitere Faktoren wie zum Beispiel die Exposition von mikrobiellen Substanzen zur Entstehung und Vermeidung von allergischen Erkrankungen beitragen. Ziel dieses Artikels ist es, neben neuen Aspekten zur Entstehung auch Ansätze und Strategien zur Prävention von Allergien im Kindes- und Jugendalter aufzuzeigen.

Summary

Asthma is the most common chronic disease in childhood in western countries, with an increasing prevalence over the last decades. However the mechanism driving the immune system to tolerance or an allergic disease is not well determined to date. On the cellular or protein level the TH-/TH-2 model was established for the adaptive immune system. More recently, the role of the innate immune system and the interaction between the adaptive and innate immune systems have gained importance in the development of allergic diseases. Besides genetic influences, epidemiological as well as immunological studies were able to identify additional factors, such as the role of microbial substances in the induction or protection against allergic diseases. The aim of this article is to present new aspects of the offspring and furthermore strategies for prevention from allergic diseases in childhood.

Schlüsselwörter

Allergie - Asthma bronchiale - angeborenes und erworbenes Immunsystem

Keywords

Allergic disease - asthma - innate - adaptive immune system

• Literatur

• 1 von Mutius E. et al. Prevalence of asthma and atopy in two areas of West and East Germany. Am J Resp Crit Care Med 1994; 149 (01) 358-64.
• 2 Heinrich J. et al. Age-dependent differences in the prevalence of allergic rhinitis and atopic sensitization between a eastern and a western German city. Allergy 1998; 53: 89-93.
• 3 von Mutius E. et al. Increasing prevalence of hay fever and atopy among children in Leipzig, East Germany. Lancet 1998; 351: 862-6.
• 4 Burr ML. et al. Changes in asthma prevalence: two surveys 15 years apart. Arch Dis Child 64 1998; 1452-6.
• 5 Kuehni CE. et al. Are all wheezing disorders in very young (preschool) children increasing in prevalence?. Lancet 2001; 357: 1821-5.
• 6 Measuring childhood asthma prevalence before and after the 1997 redesign of the National Health Interview Survey _ United States. Morb Mortal Wkly Rep 2000; 49: 908-11.
• 7 Ronchetti R. et al. Is the increase in childhood asthma coming to an end? Findings from three surveys of schoolchildren in Rome, Italy. Eur Respir J 2001; 17: 881-6.
• 8 Schroeter CH. et al. Development of the early immune system: Impact on allergic diseases. Immunol Allergy Clin N Am 2002; 22: 713-36.
• 9 Mosmann TR. et al. Two types of murine helper T cell clone. Definition according to profiles of lymphokine activities and secreted proteins. J Immunol 1986; 136: 2348-57.
• 10 Yssel H. et al. Regulatory T cells and allergic asthma. Microbes and Infection 2001; 3: 899-904.
• 11 Weiner HL. Induction and mechnism of action of transforming growth factor-beta-secreting Th3 regulatory cells. Immun Rev 2001; 182: 207-14.
• 12 Braun-Fahrlander et al. Prevalence of hay fever and allergic sensitization in farmer’s children and their peers living in the same rural community. SCARPOL team. Swiss Study on Childhood Allergy and Respiratory Symptoms with Respect to Air Pollution. Clin Exp Allergy 1999; 29: 28-34.
• 13 Von Ehrenstein OS. et al. Reduced risk of hay fever and asthma among children of farmers. Clin Exp Allergy 2000; 30: 187-93.
• 14 Riedler J. et al. Austrian children living on a farm have less hay fever, asthma and allergic sensitization. Clin Exp Allergy 2000; 30: 194-200.
• 15 Bellou A. et al. Toll receptors modulate allergic responses: interaction with dendritic cells, T cells and mast cells. Curr Opin Allergy Clin Immunol 2003; 3: 487-94.
• 16 Braun Fahrländer C. et al. Environmental exposure to endotoxin and its relation to asthma in school-age children. N Engl J Med 2002; 347: 869-77.
• 17 Warner JA. et al. Prenatal origins of allergic disease. J Allerg Clin Immunol 2000; 105: S493-8.
• 18 Kondo N. et al. Cord blood lymphocyte responses to food antigens for the prediction of allergic disorders. Arch Dis Child 1992; 67: 1003-7.
• 19 Szepfalusi Z. et al. Transplacental priming of the human immune system with environmental allergens can occur early in gestation. J Allergy Clin Immunol 2000; 106: 530-6.
• 20 Warner JA. et al. Is deficiency of interferon gamma production by allergen triggered cord blood cells a predictor of atopic eczema?. Clin Exp Allergy 1994; 24: 423-30.
• 21 Kondo N. et al. Reduced interferon gamma production by antigen-stimulated cord blood mononuclear cells is a risk factor of allergic disorders – 6-year follow-up study. Clin Exp Allerg 1998; 28: 1340-4.
• 22 Finn PW. et al. Children at risk for asthma: home allergen levels, lymphocyte proliferation, and wheeze. J Allergy Clin Immunol 2000; 105: 933-42.
• 23 Strachan DP. et al. Incidence and prognosis of asthma and wheezing illness from early childhood to age 33 in a national British cohort. Bmj 1996; 312: 1195-99.
• 24 Wickens K. et al. The magnitude of the effect of smaller family sizes on the increase in the prevalence of asthma and hay fever in the United Kingdom and New Zealand. J Allergy Clin Immunol 1999; 104: 554-8.
• 25 Kramer U. et al. Age of entry to day nursery and allergy in later childhood. Lancet 1999; 353: 450-4.
• 26 Ball TM. et al. Siblings, day-care attendance, and the risk of asthma and wheezing during childhood. N Engl J Med 2000; 343: 538-43.
• 27 Roost HP. et al. Role of current and childhood exposure to cat and atopic sensitization. European Community Respiratory Health Survey. J Allergy Clin Immunol 1999; 104: 941-7.
• 28 Svanes C. et al. Childhood environment and adult atopy: results from the European Community Respiratory Health Survey. J Allergy Clin Immunol 1999; 103: 415-20.
• 29 Hesselmar B. et al. Does early exposure to cat or dog protect against later allergy development?. Clin Exp Allergy 1999; 611-7.
• 30 Martinez FD. et al. Asthma and wheezing in the first six years of life. New Engl J Med 1995; 332: 133-8.
• 31 Businco L. et al. Hydrolysed cow´s milk formulae. Allergenicity and use in treatment and prevention. An ESPACI position paper. Pediatr Allergy Immunol 1993; 4: 101-11.
• 32 ETAC Study Group. Allergic factors associated with the development of asthma and the influence of ceterizine in a double-blind randomised, placebo-controlled trial: First results of ETAC. Pediatr Allergy Clin Immunol 1992; 4: 116-24.
• 33 Boquete M. et al. Preventive immunotherapy. Allergol Immunopathol 2000; 28: 89-93.