Paradigmenwechsel in der Allergieprävention

Allergy is a hypersensitivity reaction, which occurs when an immune response is directed against an innocuous antigen from the environment. In children, allergies most often affect the airways (e.g. bronchial asthma, allergic rhinitis), the gut (e.g. nutritional allergies) or the skin (e.g. atopic eczema). A look back over the last 10 years shows that most allergy prevalences have reached a maximum and contact allergies even decrease. With one exception: the prevalence of allergic asthma in boys is still increasing. The current recommendations for allergy prevention are in the process of changing. The main principle of allergen avoidance is now increasingly replaced by strategies focusing primarily on active tolerance induction. Clinical and experimental data suggest that tolerance might be achieved by an early contact with environmental antigens and allergens. In light of this concept, a critical review of current guidelines is necessary, i. e., updated clinical findings do not support the use of hydrolyzed formula to prevent allergic disease in high-risk infants. Similarly, the observation that early introduction of peanuts might significantly decrease the development of subsequent peanut allergy among British children will change our recommendations about introduction of supplementary food. The recommendations on breast feeding over 4 months, avoiding environmental tobacco smoke and avoidance of overweight will remain unchanged.