Besin Alerjilerine Yönelik Güncel Tedavi Yöntemleri

Yıl 2019, Cilt: 2 Sayı: 3, 103 - 108, 30.09.2019

Ümüş Özbey , Ayşe Özfer Özçelik

Öz

Besin ögelerine karşı IgE kaynaklı hiper-reaktivite olarak adlandırılan besin alerjileri yaşamı tehdit eden ve görülme sıklığı giderek artan bir sağlık sorunudur. Tedavi yöntemleri güncellenmekle birlikte bilinen en temel ve etkin tedavi yöntemi alerjen besinin diyetten elimine edilmesidir. Eliminasyon diyetleri belli alerjen besinin veya alerjenin neye olduğunun bilinmediği durumlarda muhtemel alerjen besinlerin diyetten çıkarılması esasına dayanmaktadır. Bu diyetlerin devamlılığı alerji semptomlarının azalmasında yüksek oranda etkinlik gösterebilmektedir. Ancak elimine edilen besin veya besin ögelerinin zamanla vücuttaki yetersizliği düşünüldüğünde bu diyetlerin devamlılığı çeşitli sağlık sorunlarına yol açabilmektedir. Bu nedenle alerjen besinlerin tüketim toleransını arttırmaya yönelik yeni tedavi yöntemleri geliştirilmektedir. Oral immünoterapi (OİT), sublingual immünoterapi (SLİT) ve yoğun ısıtılmış veya fırınlanmış ürünlerle OİT olarak adlandırılan bu güncel yöntemler besin alerjisi olan bireylerde zamanla alerjene karşı duyarsızlık sağlamayı amaçlamaktadır. Bu terapiler aracılığı ile alerjen besine karşı zamanla tolerans sağlanmakta ve alerjen besinin tüketimi arttırılabilmektedir. Bu derlemede ise bu güncel tedavi yöntemlerinin açıklanarak etkinliğinin gösterilmesi amaçlanmıştır.

Anahtar Kelimeler

Alerji, Beslenme, Tedavi

Current Treatment Methods for Food Allergies

Öz

Food allergies, called IgE-induced hyper-reactivity to nutrients, are a life-threatening and increasingly common health problem. Although the treatment methods are updated, the most basic and effective treatment method is to eliminate the allergen food from the diet. Elimination diets are based on the exclusion of possible allergen nutrients from the diet in cases where certain allergen food or allergen is unknown. Continuity of these diets can be highly effective in reducing allergy symptoms. However, when the foods or nutrients that are eliminated are considered to be insufficient in the body, the continuity of these diets can cause various health problems. Therefore, new treatment methods are being developed to increase consumption tolerance of allergen foods. These current methods, called oral immunotherapy (OIT), sublingual immunotherapy (SLIT) and OIT with intensely heated or baked products, aim to provide insensitivity to allergen over time in individuals with food allergy. Through these therapies, tolerance to allergen food can be achieved over time and consumption of allergen food can be increased. In this review, it is aimed to explain the effectiveness of these current treatment methods.

Anahtar Kelimeler

Allergy, Nutrition, Treatment

Kaynakça

• Berry MJ, Adams J, Voutilainen H, Feustel PJ, Celestin J, Järvinen KM. (2015). Impact of elimination diets on growth and nutritional status in children with multiple food allergies. Pediatric Allergy and Immunology 26(2), 133-138.
• Brożek JL, Terracciano L, Hsu J, Kreis J, Compalati E, Santesso N, Schünemann HJ. (2012). Oral immunotherapyfor IgE-mediated cow's milk allergy: a systematic review and meta-analysis. Clinical & Experimental Allergy 42(3), 363-374.
• Burks AW, Wood RA, Jones SM, Sicherer SH, Fleischer DM, Scurlock M, Dawson P. (2015). Sublingual immunotherapy for peanut allergy: long-term follow-up of a randomized multicenter trial. Journal of Allergy and Clinical Immunology. 135(5), 1240-1248.
• Burton OT, Rivas MN, Zhou JS, Logsdon SL, Darling AR, Koleoglou KJ, Oettgen HC. (2014). Immunoglobulin E signal inhibition during allergen ingestion leads to reversal of established food allergy and induction of regulatory T cells. Immunity 41(1), 141-151.
• Caminiti L, Pajno GB, Crisafulli G, Chiera F, Collura M, Panasci G, Passalacqua G. (2015). Oral immunotherapy for egg allergy: a double-blind placebo-controlled study, with postdesensitization follow-up. The Journal of Allergy and Clinical Immunology: In Practice 3(4), 532-539.
• Canonica GW, Cox L, Pawankar R, Baena-Cagnani CE, Blaiss M, Bonini S, van Wijk RG. (2014). Sublingual immunotherapy: World Allergy Organization position paper 2013 update. World Allergy Organization Journal 7(1), 1.
• Flammarion S, Santos C, Guimber D, Jouannic L, Thumerelle C, Gottrand F, Deschildre A. (2011). Diet and nutritional status of children with food allergies. Pediatric Allergy and Immunology 22(2), 161-165.
• Fleischer DM, Spergel JM, Assa’ad AH, Pongracic JA. (2013). Primary Prevention of Allergic Disease Through Nutritional Interventions. J Allergy Clin Immunol Pract 1:29-36.
• Fujimura T, Yonekura S, Horiguchi S, Taniguchi Y, Saito A, Yasueda H, Sakaguchi M. (2011). Increase of regulatory T cells and the ratio of specific IgE to total IgE are candidates for response monitoring or prognostic biomarkers in 2-year sublingual immunotherapy (SLIT) for Japanese cedar pollinosis. Clinical Immunology 139(1), 65-74.
• Goldberg MR, Nachshon L, Appel MY, Elizur A, Levy MB, Eisenberg E, Katz Y. (2016). Efficacy of baked milk oral immunotherapy in baked milk–reactive allergic patients. Journal of Allergy and Clinical Immunology 136(6), 1601-1606.
• Gonsalves N, Yang GY, Doerfler B, Ritz S, Ditto AM, Hirano I. (2012). Elimination diet effectively treats eosinophilic esophagitis in adults; food reintroduction identifies causative factors. Gastroenterology 142(7), 1451-1459.
• Gupta RS, Springston EE, Warrier MR, Smith B, Kumar R, Pongracic J, Holl JL. (2011). The prevalence, severity, and distribution of childhood food allergy in the United States. Pediatrics peds.
• Gübür S. (2012). Besin intoleransı saptanan kilolu ve obez kişilere uygulanan eliminasyon diyetinin, vücut kompozisyonu ve biyokimyasal parametrelere etkisinin belirlenmesi. İstanbul Bilim Üniversitesi Sağlık Bilimleri Enstitüsü Beslenme ve Diyetetik Yüksek Lisans Tezi, İstanbul.
• Hamad A, Kim EH, Burks AW, Hamilton DK, Herlihy L, Bennick, SA, Steele PH. (2018). A novel assessment of sustained unresponsiveness (SU) after long term sublingual immunotherapy (SLIT) in peanut allergic children: results of a 4 year phase II clinical trial. Journal of Allergy and Clinical Immunology, 141(2), AB200.
• Jones SM, Burks AW, Dupont C. (2014). State of the art on food allergen immunotherapy: oral, sublingual, and epicutaneous. Journal of Allergy and Clinical Immunology 133(2), 318-323.
• Kagalwalla AF, Wechsler JB, Amsden K, Schwartz S, Makhija M, Olive A, Sulkowski M. (2017). Efficacy of a 4-food elimination diet for children with eosinophilic esophagitis. Clinical Gastroenterology and Hepatology 15(11), 1698-1707.
• Khayatzadeh A, Gharaghozlou M, Ebisawa M, Shoormasti RS, Movahedi M. (2015). A safe and effective method for wheat oral immunotherapy. Iranian Journal of Allergy, Asthma and Immunology 15(6), 525-535.
• Kruszewski PG, Russo JM, Franciosi JP, Varni JW, Platts-Mills TAE, Erwin EA. (2016). Prospective, comparative effectiveness trial of cow's milk elimination and swallowed fluticasone for pediatric eosinophilic esophagitis. Diseases of the Esophagus. 29(4), 377-384.
• Leonard SA, Sampson HA, Sicherer SH, Noone S, Moshier EL,Godbold J, Nowak-Węgrzyn A. (2012). Dietary baked egg accelerates resolution of egg allergy in children. Journal of Allergy and Clinical Immunology 130(2), 473-480.
• Molina-Infante J, Arias Á, Alcedo J, Garcia-Romero R, Casabona-Frances S, Prieto-Garcia A, Guarner-Argente C. (2018). Step-up empiric elimination diet for pediatric and adult eosinophilic esophagitis: The 2-4-6 study. Journal of Allergy and Clinical Immunology, 141(4), 1365-1372.
• Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G, Beyer K, Bindslev-Jensen C, Fernandez Rivas M. (2014). EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. Allergy 69(8), 1008-1025.
• Nowak-Węgrzyn A, Albin S. (2015). Oral immunotherapy for food allergy: mechanisms and role in management. Clinical & Experimental Allergy 45(2), 368-383.
• Radulovic S, Wilson D, Calderon M, Durham S. (2011). Systematic reviews of sublingual immunotherapy (SLIT). Allergy 66(6), 740-752.
• Rienzo VD, Minelli M, Musarra A, Sambugaro R, Pecora S, Canonica WG, Passalacqua G. (2005). Post-marketing survey on the safety of sublingual immunotherapy in children below the age of 5 years. Clinical & Experimental Allergy 35(5), 560-564.
• Sánchez-García S, del Río PR, Escudero C, Martínez-Gómez MJ, Ibáñez MD. (2012). Possible eosinophilic esophagitis induced by milk oral immunotherapy. Journal of Allergy and Clinical Immunology 129(4), 1155-1157.
• Sicherer SH, Sampson HA. (2014). Food allergy: epidemiology, pathogenesis, diagnosis, and treatment. Journal of Allergy and Clinical Immunology 133(2), 291-307.
• Takahashi M, Taniuchi S, Soejima K, Hatano Y, Yamanouchi S, Kaneko K. (2016). Two-weeks-sustained unresponsiveness by oral immunotherapy using microwave heated cow’s milk for children with cow’s milk allergy. Allergy, Asthma & Clinical Immunology 12(1), 44.
• Thyagarajan A, Varshney P, Jones SM, Sicherer S, Wood R, Vickery BP, Burks AW. (2010). Peanut oral immunotherapy is not ready for clinical use. Journal of Allergy and Clinical Immunology 126(1), 31-32.
• Turnbull JL, Adams HN, Gorard DA. (2015). The diagnosis and management of food allergy and food intolerances. Alimentary Pharmacology & Therapeutics 41(1), 3-25.
• Varshney P, Jones SM, Scurlock AM, Perry TT, Kemper A, Steele P, Kulis M. (2011). A randomized controlled study of peanut oral immunotherapy: clinical desensitization and modulation of the allergic response. Journal of Allergy and Clinical Immunology 127(3), 654-660.
• Vickery BP, Berglund JP, Burk CM, Fine JP, Kim EH, Kim JI, Steele PH. (2017). Early oral immunotherapy in peanutallergic preschool children is safe and highly effective. Journal of Allergy and Clinical Immunology 139(1), 173-181.
• Waserman S, Watson W. (2011). Food allergy. Allergy, Asthma & Clinical Immunology 7(1), S7.
• Wood RA. (2016). Diagnostic elimination diets and oral food provocation. In Food Allergy: Molecular Basis and Clinical Practice 101, pp. 87-95.