Food allergies are a relatively new phenomenon

Prevention: Gladly more allergens in the house

The urban lifestyle promotes the development of asthma and allergies. In the absence of specific prevention concepts, effective therapies are needed.

Allergies often begin in early childhood or adolescence, but older people are also increasingly developing allergies or asthma. This trend may be related to the increasing exposure to aggressive pollen, which leads to sensitization more quickly. Relatively new is the realization that allergies have “potential for contagion”: If the partner is allergic, the risk of illness increases - the more so, the longer the relationship lasts. For healthy people who have been married to a partner afflicted by hay fever for twelve to 20 years, the risk is almost doubled; increased almost 14-fold for relationships of more than 36 years. "This phenomenon is possibly related to the adjustment of the microbiome of partners over time," says Prof. Dr. med. Mattias Kopp, Clinic for Pediatric and Adolescent Medicine at the University of Lübeck.

Microbial colonization plays a key role in formation

As far as we know today, disturbed microbial colonization of the skin, the respiratory tract and, above all, the intestines play a key role in the development of asthma and allergies. Apparently the western lifestyle is changing the microbiome. Children who grew up in large families or in contact with stable animals are less likely to suffer from allergies. In addition, cesarean section children have a 20 percent increased risk of asthma. The increased use of antibiotics should also be viewed critically.

In the past, the focus was on avoiding allergens, today the focus is on developing tolerance: "We need contact with microbial components in order to train the immune system and educate it to be tolerant," summed up Kopp. Pets are no longer taboo in families with increased allergies. New data show that dogs and hamsters protect against allergic sensitization.

Children of parents who sucked the pacifier instead of disinfecting it also had fewer asthma, eczema and allergic sensitizations at the age of 18 months. Since germs from the mouth and throat are also responsible for tooth decay, this recommendation cannot be given uncritically. Taking prebiotics and probiotics or bacterial lysates cannot reduce the risk of asthma and allergies.

Despite the better understanding of how allergies develop, there are currently hardly any concrete concepts for primary prevention. It is all the more important to prevent the floor change from hay fever to asthma or the progression from mild to severe asthma. Treatment with inhaled steroids plays a key role in this. It enables most patients to carry out normal everyday activities and exercise resilience without asthma symptoms.

In addition to allergic asthma, there are a number of other asthma endotypes. "The patients differ significantly in their symptoms, the level of suffering and the need for therapy," said Dr. med. Mark Voss-Dirks, resident pulmonologist from Hanover. The current GINA guideline 2015 (Global Initiative for Asthma) generally recommends a five-stage scheme for achieving asthma control. Each stage provides for the use of a rapidly acting beta-2 sympathomimetic if necessary. Levels 2 to 5 use an inhaled corticosteroid (ICS) as an anti-inflammatory therapy for basic control, from level 3 additional medication for bronchodilation is required; maintenance therapy then includes a combination of ICS and a long-acting beta-2 symphatomimetic (LABA). The management is constantly checked: Does the medication have to be intensified or can it be de-escalated?

Difficult fine adjustment due to fixed combinations

Fine adjustments have not always been ideal in the past: the ICS / LABA fixed combinations available up to now have the disadvantage that both components are increased when the dose is increased. However, some patients only need intensified anti-inflammatory therapy, while bronchodilation is sufficient with the low LABA dosage. "For better asthma control, these patients previously had to accept LABA-mediated side effects, such as palpitations, insomnia and tremors," says Voss-Dirks.

A new therapy option has been available since January: For the first time, an extra-fine high-dose fixed combination is available in which the ICS dose (beclometasone) was doubled, while the LABA (formoterol) portion remained constant. This benefits asthma patients with more severe and more frequent asthma symptoms who need a therapy adjustment with a higher-dose ICS.

Dipl. Oec. troph. Dorothee Hahne

Source: Press conference on the occasion of the 57.
DGP Congress: The changing prevalence of allergies -
A challenge for asthma therapy?
Leizpig. Organizer: Chiesi GmbH