Department of Pediatrics, Medical Faculty, Otto-von-Guericke-University, Magdeburg, Germany.
Front Immunol. 2021 Feb 25;12:617731. doi: 10.3389/fimmu.2021.617731. eCollection 2021.
Atopic diseases in childhood are a major burden worldwide and there is still a lack of knowledge about treatable causes. In industrialized countries such as Germany, almost every second child is sensitized to at least one common allergen. Recent studies show that although the predisposition to allergies is inherited, the adaptive immune system of neonates and infants follows a developmental trajectory and whether an allergy actually occurs depends also on timing of allergen exposure including diet as well as environmental factors. New recommendations are far from being rigid of allergen avoidance; it is rather moving toward conditions that stand for more biodiversity. The observation that introduction of peanuts or eggs early in life significantly reduced the development of a later allergy will change our recommendations for the introduction of complementary foods. This is consistent with the hygiene hypothesis that early provocation shapes the developing immune system so that it reacts appropriately. Therefore, promoting the development of tolerance is at the heart of sensible allergy prevention - and this begins with the last trimester of pregnancy. In light of this concept, actual recommendations are discussed.
儿童特应性疾病是全球范围内的一个主要负担,但对于可治疗的病因仍缺乏了解。在德国等工业化国家,几乎每两个孩子中就有一个对至少一种常见过敏原过敏。最近的研究表明,尽管过敏易感性是遗传的,但新生儿和婴儿的适应性免疫系统遵循发育轨迹,是否发生过敏还取决于过敏原暴露的时间,包括饮食和环境因素。新的建议远非严格的过敏原回避;而是转向代表更多生物多样性的条件。观察到在生命早期引入花生或鸡蛋会显著降低以后发生过敏的风险,这将改变我们对引入补充食品的建议。这与卫生假说一致,即早期刺激塑造了正在发育的免疫系统,使其做出适当的反应。因此,促进耐受的发展是合理过敏预防的核心——这从妊娠晚期就开始了。基于这一概念,讨论了实际的建议。