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Nahrungsmittelanaphylaxie im Kindesalter

Food-induced anaphylaxis in childhood

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Zusammenfassung

Anaphylaxien können als schwere, systemische und potenziell lebensbedrohliche allergische Reaktionen mit raschem Beginn definiert werden. Im Kindesalter sind sie am häufigsten auf Nahrungsmittelallergene zurückzuführen. Als Hauptauslöser gelten in dieser Altersgruppe Erdnuss, Kuhmilch, Haselnuss, Hühnerei und Fisch. Betroffene Kinder können neben der klassischen Akutsymptomatik auch verzögerte Reaktionen oder nahrungsmittelabhängige, anstrengungsassoziierte Anaphylaxien entwickeln. Letztere werden häufig durch Weizenproteine ausgelöst, während verzögerte Anaphylaxien auf einer Sensibilisierung gegen das Oligosaccharid Galaktose-α-1,3-Galaktose beruhen können. Aufgrund des Risikos biphasischer Verläufe sollten Kinder mit schwerer Nahrungsmittelanaphylaxie bis zur sicheren Remission überwacht werden. Nahrungsmittelanaphylaxien führen häufig zu einer reduzierten Lebensqualität der Kinder und ihrer Familien. Um dies zu verhindern, sind ein sorgfältiges Entlassungsmanagement und eine strukturierte ambulante Weiterbetreuung unerlässlich. Diese wird durch allergologisch versierte Ernährungsfachkräfte, Kinderärzte, Kinderallergologen und Kinderpsychologen sichergestellt. Zusätzlich sollten Patienten und Eltern nach schwerer Nahrungsmittelanaphylaxie eine strukturierte Anaphylaxieschulung erhalten.

Abstract

Anaphylaxis can be defined as a severe, potentially life-threatening, systemic hypersensitivity reaction of sudden onset. In childhood, anaphylactic reactions are most frequently triggered by food allergens. Peanut, cow’s milk, hazelnut, hen’s egg and fish represent the most common culprit foods in the pediatric age group. Besides classical immediate symptoms, affected children may also develop delayed reactions or food-dependent, exercise-induced anaphylaxis. The latter is often based on sensitization against wheat proteins, whereas delayed anaphylaxis may be triggered by the oligosaccharide galactose-α-1,3-galactose. Due to the risk of biphasic reactions, children with severe food-induced anaphylaxis should be closely monitored until complete remission. Food-induced anaphylaxis may lead to quality of life impairment in affected children and their caregivers. To prevent this a careful discharge management and structured outpatient follow-up visits are indispensable. This care is best provided by allergy-trained dieticians, pediatricians, pediatric allergologists and child psychologists. Additionally, patients with severe food-induced anaphylaxis and their caregivers should be provided with a structured anaphylaxis training program.

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Literatur

  1. Berg EA, Platts-Mills TA, Commins SP (2014) Drug allergens and food – the cetuximab and galactose-α-1,3-galactose story. Ann Allergy Asthma Immunol 112(2):97–101

    Article  PubMed  CAS  Google Scholar 

  2. Chipps BE (2013) Update in pediatric anaphylaxis: a systematic review. Clin Pediatr (Phila) 52(5):451–461

    Google Scholar 

  3. Commins SP, Satinover SM, Hosen J et al (2009) Delayed anaphylaxis, angioedema, or urticaria after consumption of red meat in patients with IgE antibodies specific for galactose-alpha-1,3-galactose. J Allergy Clin Immunol 123(2):426–433

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  4. Dinakar C (2012) Anaphylaxis in children: current understanding and key issues in diagnosis and treatment. Curr Allergy Asthma Rep 12(6):641–649

    Article  PubMed  PubMed Central  Google Scholar 

  5. Du Toit G (2007) Food-dependent exercise-induced anaphylaxis in childhood. Pediatr Allergy Immunol 18(5):455–463

    Article  Google Scholar 

  6. Gupta R, Sheikh A, Strachan DP et al (2007) Time trends in allergic disorders in the UK. Thorax 62(1):91–96

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  7. Inoue N, Yamamoto A (2013) Clinical evaluation of pediatric anaphylaxis and the necessity for multiple doses of epinephrine. Asia Pac Allergy 3(2):106–114

    Article  PubMed  PubMed Central  Google Scholar 

  8. Järvinen KM (2011) Food-induced anaphylaxis. Curr Opin Allergy Clin Immunol 11(3):255–261

    Article  PubMed  Google Scholar 

  9. Järvinen KM, Amalanayagam S, Shreffler WG et al (2009) Epinephrine treatment is infrequent and biphasic reactions are rare in food-induced reactions during oral food challenges in children. J Allergy Clin Immunol 124(6):1267–1272

    Article  PubMed  PubMed Central  Google Scholar 

  10. Jappe U (2012) Update on meat allergy. α-Gal: a new epitope, a new entity? Hautarzt 63(4):299–306

    Article  PubMed  CAS  Google Scholar 

  11. Kennedy JL, Stallings AP, Platts-Mills TA et al (2013) Galactose-α-1,3-galactose and delayed anaphylaxis, angioedema, and urticaria in children. Pediatrics 131(5):e1545–e1552

    Article  PubMed  PubMed Central  Google Scholar 

  12. Landsman-Blumberg PB et al (2014) Concordance with recommended postdischarge care guidelines among children with food-induced anaphylaxis. J Pediatr 164(6):1444–1448

    Article  PubMed  Google Scholar 

  13. Lau GY, Patel N, Umasunthar T et al (2014) Anxiety and stress in mothers of food-allergic children. Pediatr Allergy Immunol 25(3):236–242

    Article  PubMed  Google Scholar 

  14. Lee JM, Greenes DS (2000) Biphasic anaphylactic reactions in pediatrics. Pediatrics 106(4):762–766

    Article  PubMed  CAS  Google Scholar 

  15. Lee J, Garrett JP, Brown-Whitehorn T et al (2013) Biphasic reactions in children undergoing oral food challenges. Allergy Asthma Proc 34(3):220–226

    Article  PubMed  Google Scholar 

  16. Lemon-Mule H, Sampson HA, Sicherer SH et al (2008) Immunologic changes in children with egg allergy ingesting extensively heated egg. J Allergy Clin Immunol 122:977–983

    Article  PubMed  CAS  Google Scholar 

  17. Leonardi S, Pecoraro R, Filippelli M et al (2014) Allergic reactions to foods by inhalation in children. Allergy Asthma Proc 35(4):288–294

    Article  PubMed  Google Scholar 

  18. Libbers L, Flokstra-de Blok BM, Vlieg-Boerstra BJ et al (2013) No matrix effect in double-blind, placebo-controlled egg challenges in egg allergic children. Clin Exp Allergy 43(9):1067–1070

    Article  PubMed  CAS  Google Scholar 

  19. Maulitz RM, Pratt DS, Schocket AL (1979) Exercise-induced anaphylactic reaction to shellfish. J Allergy Clin Immunol 63(6):433–434

    Article  PubMed  CAS  Google Scholar 

  20. McClain S, Bannon GA (2006) Animal models of food allergy: opportunities and barriers. Curr Allergy Asthma Rep 6(2):141–144

    Article  PubMed  Google Scholar 

  21. Mehr S, Liew WK, Tey D, Tang ML (2009) Clinical predictors for biphasic reactions in children presenting with anaphylaxis. Clin Exp Allergy 39(9):1390–1396

    Article  PubMed  CAS  Google Scholar 

  22. Monga S, Manassis K (2006) Treating anxiety in children with life-threatening anaphylactic conditions. J Am Acad Child Adolesc Psychiatry 45:1007–1010

    Article  PubMed  Google Scholar 

  23. Morita E, Chinuki Y, Takahashi H (2013) Recent advances of in vitro tests for the diagnosis of food-dependent exercise-induced anaphylaxis. J Dermatol Sci 71(3):155–159

    Article  PubMed  CAS  Google Scholar 

  24. Mueller GA, Maleki SJ, Johnson K et al (2013) Identification of Maillard reaction products on peanut allergens that influence binding to the receptor for advanced glycation end products. Allergy 68(12):1546–1554

    Article  PubMed  CAS  Google Scholar 

  25. Muraro A, Roberts G, Worm M et al (2014) Anaphylaxis: guidelines from the European Academy of Allergy and Clinical Immunology. Allergy. DOI 10.1111/all.12437

  26. Nguyen-Luu NU, Ben-Shoshan M, Alizadehfar R et al (2012) Inadvertent exposures in children with peanut allergy. Pediatr Allergy Immunol 23(2):133–139

    Article  PubMed  Google Scholar 

  27. Nowak-Wegrzyn A, Bloom KA, Sicherer SH et al (2008) Tolerance to extensively heated milk in children with cow’s milk allergy. J Allergy Clin Immunol 122:342–347

    Article  PubMed  Google Scholar 

  28. Panesar SS, Javad S, Silva D de et al (2013) The epidemiology of anaphylaxis in Europe: a systematic review. Allergy 68(11):1353–1361

    Article  PubMed  CAS  Google Scholar 

  29. Povesi Dascola C, Caffarelli C (2012) Exercise-induced anaphylaxis: a clinical view. Ital J Pediatr 38:43

    Article  Google Scholar 

  30. Ring J, Beyer K, Biedermann T et al (2014) Guideline for acute therapy and management of anaphylaxis. S2 guideline of DGAKI, AeDA, GPA, DAAU, BVKJ, ÖGAI, SGAI, DGAI, DGP, DGPM, AGATE and DAAB. Allergo J Int 23:96–112

    Article  Google Scholar 

  31. Ring J, Beyer K, Dorsch A et al (2012) Anaphylaxieschulung – ein neues Behandlungsprogramm zur tertiären Krankheitsprävention nach Anaphylaxie. Allergo J 21:96–102

    Article  Google Scholar 

  32. Romano A, Scala E, Rumi G et al (2012) Lipid transfer proteins: the most frequent sensitizer in Italian subjects with food-dependent exercise-induced anaphylaxis. Clin Exp Allergy 42(11):1643–1653

    Article  PubMed  CAS  Google Scholar 

  33. Russell S, Monroe K, Losek JD (2010) Anaphylaxis management in the pediatric emergency department: opportunities for improvement. Pediatr Emerg Care 26(2):71–76

    Article  PubMed  Google Scholar 

  34. Sczepanksi R, Brockow K, Worm M (o J) Qualitätsmanagement in der Anaphylaxie-Schulung von Kindern/Jugendlichen und ihren Eltern sowie Erwachsenen. http://www.anaphylaxieschulung.de/Sites/QM%20AGATE%2029%203%2012.pdf. Zugegriffen: 13. Juli 2014

  35. Shemesh E, Annunziato RA, Ambrose MA et al (2013) Child and parental reports of bullying in a consecutive sample of children with food allergy. Pediatrics 131(1):e10–e17

    Article  PubMed  PubMed Central  Google Scholar 

  36. Umasunthar T, Leonardi-Bee J, Hodes M et al (2013) Incidence of fatal food anaphylaxis in people with food allergy: a systematic review and meta-analysis. Clin Exp Allergy 43(12):1333–1341

    Article  PubMed  CAS  Google Scholar 

  37. Velde JL van der, Flokstra-de Blok BM, Dunngalvin A et al (2011) Parents report better health-related quality of life for their food-allergic children than children themselves. Clin Exp Allergy 41(10):1431–1439

    Article  PubMed  Google Scholar 

  38. Velde JL van der, Flokstra-de Blok BM, Hamp A et al (2011) Adolescent-parent disagreement on health-related quality of life of food-allergic adolescents: who makes the difference? Allergy 66(12):1580–1589

    Article  PubMed  Google Scholar 

  39. Williams JG (2013) Identification of Maillard reaction products on peanut allergens that influence binding to the receptor for advanced glycation end products. Allergy 68(12):1546–1554

    Article  PubMed  Google Scholar 

  40. Wölbing F et al (2013) About the role and underlying mechanisms of cofactors in anaphylaxis. Allergy 68:1085–1092

    Article  PubMed  Google Scholar 

  41. Wong GK, Krishna MT (2013) Food-dependent exercise-induced anaphylaxis: is wheat unique? Curr Allergy Asthma Rep 13(6):639–644

    Article  PubMed  CAS  Google Scholar 

  42. Worm M, Eckermann O, Dölle S et al (2014) Triggers and treatment of anaphylaxis: an analysis of 4000 cases from Germany, Austria and Switzerland. Dtsch Arztebl Int 111(21):367–375

    PubMed  PubMed Central  Google Scholar 

  43. Worm M, Moneret-Vautrin A, Scherer K et al (2014) First European data from the network of severe allergic reactions (NORA). Allergy. DOI 10.1111/all.12475

  44. Wylon K, Hompes S, Worm M (2013) Exercise-induced anaphylaxis. Hautarzt 64(2):97–101

    Article  PubMed  CAS  Google Scholar 

  45. Ott H, Kopp MV, Lange L (2014) Kinderallergologie in Klinik und Praxis. Springer, Berlin Heidelberg New York Tokio

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Danksagung

Der Autor dankt Frau Prof. M. Worm und Frau Dr. rer. medic. S. Dölle (Klinik für Dermatologie, Venerologie und Allergologie, Charité Universitätsmedizin Berlin) für die Übermittlung der in Abb. 1 verwendeten Daten aus dem Anaphylaxieregister.

Einhaltung ethischer Richtlinien

Interessenkonflikt. H. Ott gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Fachbereich Pädiatrische Dermatologie, Kinderkrankenhaus Auf der Bult, Janusz-Korczak-Allee 12, 30173, Hannover, Deutschland

    H. Ott

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Correspondence to H. Ott.

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Dieser Beitrag ist Herrn Professor Dr. med. G. Heimann in dankbarer Erinnerung gewidmet.

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Ott, H. Nahrungsmittelanaphylaxie im Kindesalter. Monatsschr Kinderheilkd 162, 883–891 (2014). https://doi.org/10.1007/s00112-014-3133-6

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