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DOI: 10.1055/s-0030-1248625
© Georg Thieme Verlag KG Stuttgart · New York
Allergieprävention – Paradigmenwechsel bei den Empfehlungen für die Ernährung
Allergy Prevention – Paradigm Change in the Recommendations for NutritionPublication History
Publication Date:
01 December 2010 (online)
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Zusammenfassung
Empfehlungen zur Verhinderung allergischer Erkrankungen waren bis vor wenigen Jahren von dem therapeutischen Ansatz der Meidung potenter bzw. häufiger Allergene bestimmt. Diese – therapeutisch sinnvolle – Maßnahme hat sich in der Prävention nicht bewährt. Im Gegenteil, heute wird davon ausgegangen, dass die Konfrontation für die Entwicklung einer Toleranz notwendig ist. Dem Stillen wird dabei weiterhin eine wichtige Rolle zugesprochen – allerdings ohne Karenzempfehlungen für die Stillende. Ein regelmäßiger Verzehr von Fisch in der Stillzeit wird ausdrücklich empfohlen. Im Unterschied zu früheren Empfehlungen wird der Zeitraum für ein ausschließliches Stillen auf die ersten 4 Monate begrenzt. Danach sollte – idealerweise parallel zum Stillen – der Aufbau der Beikost erfolgen. Eine verzögerte Einführung potenter Allergene wie Kuhmilch, Hühnerei, Weizen etc. – wie sie jahrelang für allergiegefährdete Säuglinge empfohlen wurde – erscheint aus heutiger Sicht im Hinblick auf eine Allergieprophylaxe nicht nur wirkungslos, sondern möglicherweise sogar kontraproduktiv. Für Fisch wird vielmehr ein gezielter Verzehr – sowohl für die Schwangere / Stillende als auch für den Nachwuchs – empfohlen. Damit differenzieren die Empfehlungen zur Beikosteinführung im Hinblick auf Beginn und Lebensmittelauswahl nicht mehr zwischen Risiko- und Nichtrisikokindern.
Abstract
In the past, recommendations for protection against allergic diseases were based on the belief that allergy could be prevented by the therapeutic approach to avoid potent and major allergens. This assumption resulted in restricted diets for pregnant / breast feeding mothers and infants at risk. However, with this practice prevalence of allergic diseases did not decrease but rather increased, reflecting a failure of immune tolerance mechanisms. There is mounting evidence that exposure is necessary for development of immune tolerance. Therefore, recommendations changed completely: there is no reason for pregnant breast feeding mothers to avoid common allergens in view of allergy prevention. On the contrary, regular fish consumption seems to have a protective effect. Complementary feeding can be started after 4 months of exclusive breastfeeding, ideally maintaining breastfeeding during early feeding. A delay of potent allergens such as cow’s milk, hen’s egg, wheat etc. is not recommended. Early fish consumption is regarded as protective, also in the infant. In summary, weaning practice does not differ any more between infants at risk and infants without risk of allergy in view of timing and choice of foods.
Schlüsselwörter
Allergieprävention - Allergieprophylaxe - Allergierisiko - Ernährungsempfehlungen - Schwangerschaft - Stillen
Keywords
allergy prevention - allergy prophylaxis - risk of allergy - nutritional advices - pregnancy - breast feeding
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