{"id":3908,"date":"2024-12-10T17:24:06","date_gmt":"2024-12-10T14:24:06","guid":{"rendered":"https:\/\/pharmaworlddergi.com\/?p=3908"},"modified":"2024-12-13T14:00:46","modified_gmt":"2024-12-13T11:00:46","slug":"besin-alerjileri-inek-sutu-protein-alerjisi-ve-mikrobiyota","status":"publish","type":"post","link":"https:\/\/pharmaworlddergi.com\/?p=3908","title":{"rendered":"Besin Alerjileri, \u0130nek S\u00fct\u00fc Protein Alerjisi ve Mikrobiyota"},"content":{"rendered":"\n

Besin alerjileri belirli bir g\u0131daya maruz kal\u0131nd\u0131\u011f\u0131nda ortaya \u00e7\u0131kan ve tekrarlanan bir ba\u011f\u0131\u015f\u0131kl\u0131k tepkisi sonucu geli\u015fen olumsuz sa\u011fl\u0131k etkileri olarak tan\u0131mlan\u0131r. Bu t\u00fcr alerjiler, cilt, solunum, sindirim ve\/veya kardiyovask\u00fcler sistemlerde ani veya s\u00fcregelen semptomlara yol a\u00e7abilir.  Besin alerjisinin geli\u015fiminde, antijen maruziyeti, kommensal mikrobiyota ve bunlar\u0131n etkile\u015fimlerinin etkisiyle olu\u015fan ba\u011f\u0131\u015f\u0131kl\u0131k tolerans\u0131n\u0131n bozulmas\u0131 \u00f6nemli bir rol oynar.1-3 <\/sup>Prof. Dr. Co\u015fkun \u00c7eltik besin alerjileri hakk\u0131nda \u00f6nemli bilgiler payla\u015ft\u0131. <\/em><\/strong><\/p>\n\n\n\n

 \u201cBesin alerjilerinin prevalans\u0131 giderek art\u0131yor\u201d<\/em><\/strong><\/p>\n\n\n

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\"\"<\/figure><\/div>\n\n\n

Son y\u00fcz y\u0131lda, sanayile\u015fme ve \u015fehirle\u015fmenin getirdi\u011fi bir sonu\u00e7 olarak besin alerjilerinin s\u0131kl\u0131\u011f\u0131 d\u00fcnya \u00e7ap\u0131nda artm\u0131\u015ft\u0131r ve giderek artmaktad\u0131r. Besin alerjileri IgE arac\u0131l\u0131kl\u0131 olabildi\u011fi gibi non-IgE arac\u0131l\u0131kl\u0131 veya miks tipte olabilir. IgE arac\u0131l\u0131kl\u0131 olanlarda IgE ve ili\u015fkili direkt testler y\u00fcksek saptand\u0131\u011f\u0131 i\u00e7in tan\u0131s\u0131 daha kolay iken, di\u011fer tiplerin tan\u0131s\u0131nda bu testlerin \u00e7o\u011fu negatif olaca\u011f\u0131 i\u00e7in tan\u0131s\u0131 daha zordur. Bununla birlikte baz\u0131 semptomatik bulgular ve endoskopik biopsiler veya g\u0131da eliminasyon-provakasyon testleri e\u015fli\u011finde do\u011fru tan\u0131 konulabilir.1<\/sup><\/p>\n\n\n\n

IgE arac\u0131l\u0131 besin alerjisi s\u0131kl\u0131\u011f\u0131 \u00e7ocuklarda eri\u015fkinlerden daha y\u00fcksektir. Bu s\u0131kl\u0131k %2-8 aras\u0131nda de\u011fi\u015firken, di\u011fer non-IgE ve miks tip besin alerjilerinin ger\u00e7ek s\u0131kl\u0131\u011f\u0131 net bilinmemektedir ve hepsi birlikte de\u011ferlendirildi\u011finde bu oran\u0131n \u00e7ok daha y\u00fcksek oldu\u011fu tahmin edilir.1,2<\/sup><\/p>\n\n\n\n

Besin alerjilerinden en \u00e7ok etkilenen ya\u015f grubu be\u015f ya\u015f alt\u0131 ve \u00f6zellikle s\u00fct\u00e7ocu\u011fu grubudur. Hayat\u0131n ilk y\u0131llar\u0131nda intestinal bariyer yeterince g\u00fc\u00e7l\u00fc de\u011fildir, mikrobiota tam \u015feklini almam\u0131\u015ft\u0131r, ayr\u0131ca ba\u011f\u0131\u015f\u0131kl\u0131k ve alerjen tolerabilite yetene\u011fi de g\u00f6receli olarak daha d\u00fc\u015f\u00fckt\u00fcr. Bu nedenlerle k\u00fc\u00e7\u00fck ya\u015f gruplar\u0131nda besin alerjisi prevalans\u0131 daha y\u00fcksek saptan\u0131r. Ya\u015f ilerledik\u00e7e prevelans oranlar\u0131 giderek giderek azal\u0131r ve daha ileri \u00e7ocukluk d\u00f6neminde ve eri\u015fkinlerde besin alerji s\u0131kl\u0131\u011f\u0131n\u0131n %0,5-1\u2019in alt\u0131nda oldu\u011fu raporlan\u0131r.1-3<\/sup><\/p>\n\n\n\n

\u00c7ocuklarda en s\u0131k g\u00f6r\u00fclen besin alerjileri inek s\u00fct\u00fc, yumurta, soya, yer f\u0131st\u0131\u011f\u0131, kabuklu kuruyemi\u015fler, kabuklu deniz mahs\u00fclleri, bu\u011fday ve bal\u0131kt\u0131r. Ayr\u0131ca \u00e7apraz alerjiler de mevcuttur. \u00d6rne\u011fin inek s\u00fct\u00fc alerjisi saptanan bir \u00e7ocukta y\u00fcksek oranda ke\u00e7i, koyun ve manda s\u00fct\u00fcne ve hatta dana etine de alerji saptanabilir.1-3<\/sup><\/p>\n\n\n\n

\u00c7ocuklarda besin alerjilerinin yakla\u015f\u0131k %60\u2019\u0131n\u0131 inek s\u00fct\u00fc protein alerjisi (ISPA) olu\u015fturur ve ISPA en s\u0131k infant ya\u015f grubunda g\u00f6r\u00fcl\u00fcr. \u0130nfantlarda ISPA prevalans\u0131 yakla\u015f\u0131k %2\u2019dir.1-3<\/sup><\/p>\n\n\n\n

\u201c<\/sup>\u00c7e\u015fitli genetik, \u00e7evresel ve beslenme fakt\u00f6rleri, ba\u011f\u0131rsak mikrobiyomu ile ba\u011f\u0131\u015f\u0131kl\u0131k sistemi aras\u0131ndaki ili\u015fkiyi etkileyerek besin alerjilerinin ortaya \u00e7\u0131kmas\u0131nda rol oynayabilir\u201d<\/em><\/strong><\/p>\n\n\n\n

Son y\u0131llardaki ekonomik geli\u015fmeler, beslenme al\u0131\u015fkanl\u0131klar\u0131n\u0131n ve ya\u015fam tarz\u0131n\u0131n de\u011fi\u015fmesi ba\u011f\u0131rsak mikrobiyotas\u0131n\u0131 do\u011frudan etkilemi\u015ftir. Ba\u011f\u0131rsak mikrobiyotas\u0131 ile alerji aras\u0131nda  yak\u0131ndan bir ili\u015fki mevcuttur. Probiyotikler, ba\u011f\u0131rsaklarda adeta bir bek\u00e7i gibi g\u00f6rev g\u00f6r\u00fcr ve ba\u011f\u0131rsak ge\u00e7irgenli\u011fini kontrol eder. Ba\u011f\u0131rsak mikrobiyotas\u0131ndaki probiyotiklerle patojen mikroplar aras\u0131ndaki dengenin bozulmas\u0131 anlam\u0131na gelen disbiyozis durumunda besin alerjileri daha s\u0131k g\u00f6r\u00fcl\u00fcr. Yap\u0131lan \u00e7al\u0131\u015fmalarda \u0130SPA’l\u0131 \u00e7ocuklarda da disbiosisin \u00f6nemli bir bozukluk oldu\u011fu vurgulanm\u0131\u015ft\u0131r.3<\/sup><\/p>\n\n\n\n

\u201cAnne s\u00fct\u00fc t\u00fcm bebekler i\u00e7in alt\u0131n standartt\u0131r\u201d<\/em><\/strong><\/p>\n\n\n\n

Anne s\u00fct\u00fc, ya\u015fam\u0131n erken d\u00f6neminde bebek beslenmesi i\u00e7in alt\u0131n standart olarak kabul edilir. Anne s\u00fct\u00fc sinbiyotik yani probiyotik ve prebiyotikleri birlikte bar\u0131nd\u0131ran bir besindir. Bu sayede anne s\u00fct\u00fc probiyotiklerin sa\u011flad\u0131\u011f\u0131 t\u00fcm faydal\u0131 \u00f6zellikleri g\u00f6sterir, dolay\u0131s\u0131yla alerji de bask\u0131lar.<\/p>\n\n\n\n

Anne s\u00fct\u00fcn\u00fcn \u00f6zellikle atopik kal\u0131t\u0131m\u0131 olan bebeklerde, atopik hastal\u0131k geli\u015fimine kar\u015f\u0131 koruma sa\u011flamadaki faydalar\u0131n\u0131 g\u00f6steren bir\u00e7ok \u00e7al\u0131\u015fma bulunmaktad\u0131r. Anne s\u00fct\u00fcnde bulunan prebiyotik \u00f6zellikli anne s\u00fct\u00fc oligosakkaritleri (HMO’lar), probiyotiklerin b\u00fcy\u00fcmesini te\u015fvik eder ve patojenlerin ba\u011f\u0131rsak epiteline yap\u0131\u015fmas\u0131n\u0131 engeller. Bu sayede intestinal mikrobiyotay\u0131 d\u00fczenler.4,5 <\/sup>Anne s\u00fct\u00fc alamayan bebeklerde kullan\u0131lan formulalara sinbiyotik eklenmesinin faydas\u0131 \u00fczerinde bir\u00e7ok yay\u0131n bulunmaktad\u0131r.4-6 <\/sup>Ayr\u0131ca ISPA\u2019l\u0131 bebeklerde de aminoasid bazl\u0131 tam hidrolize form\u00fcla (AAF) veya ileri derece hidrolize form\u00fcla (eHF) i\u00e7ine sinbiyotik eklenmesi avantaj sa\u011flar.7-10<\/sup>\u00a0<\/p>\n\n\n\n

\u201c\u0130SPA y\u00f6netiminde birinci basamak tedavi: Sinbiyotik i\u00e7eren ileri derece hidrolize form\u00fcla\u201d<\/em><\/strong><\/p>\n\n\n\n

\u0130SPA y\u00f6netimine ili\u015fkin t\u00fcm k\u0131lavuzlar, alerjik bebekler i\u00e7in ideal beslenme olarak s\u00fcrekli emzirmeyi \u00f6nermektedir. Anne s\u00fct\u00fc mevcut olmad\u0131\u011f\u0131nda veya yetersiz oldu\u011funda \u00e7o\u011fu k\u0131lavuz, hafif ila orta dereceli \u0130SPA i\u00e7in ilk tercih olarak eHF \u00f6nermektedir ve eHF ba\u015far\u0131s\u0131z olursa AAF’ye ge\u00e7ilmektedir.4<\/sup><\/p>\n\n\n\n

\u0130SPA\u2019l\u0131 bebeklerde sinbiyotik i\u00e7eren eHF, bebeklerin gastrointestinal sa\u011fl\u0131\u011f\u0131n\u0131 destekleyerek atopik semptomlarda belirgin iyile\u015fmeler sa\u011flamaktad\u0131r. Bu form\u00fclalar, d\u0131\u015fk\u0131 say\u0131s\u0131, k\u0131vam\u0131 ve  g\u00fcnl\u00fck reg\u00fcrjitasyon say\u0131s\u0131 gibi \u00f6nemli parametrelerde anlaml\u0131 iyile\u015fmeler g\u00f6sterirken; bebeklerin b\u00fcy\u00fcme s\u00fcre\u00e7lerinin de sa\u011fl\u0131kl\u0131 olmas\u0131n\u0131 sa\u011flamaktad\u0131r. Ayr\u0131ca, sinbiyotik eHF\u2019ler, di\u011fer hipoalerjenik form\u00fclalara g\u00f6re tad\u0131 a\u00e7\u0131s\u0131ndan da avantaj sunarak tedaviye uyumu art\u0131rmakta, ebeveyn ve bak\u0131c\u0131lar\u0131n ya\u015fam kalitesini y\u00fckseltmektedir. Tolerans geli\u015fimi a\u00e7\u0131s\u0131ndan bak\u0131ld\u0131\u011f\u0131nda ise, \u00f6zellikle non-IgE arac\u0131l\u0131 inek s\u00fct\u00fc proteinine duyarl\u0131l\u0131\u011f\u0131 olan bebeklerde, sinbiyotik i\u00e7eren form\u00fclalar\u0131n daha avantajl\u0131 oldu\u011fu, tolerans geli\u015fmini h\u0131zland\u0131rd\u0131\u011f\u0131 ve ailelerin ya\u015fam kalitesine olumlu katk\u0131 sa\u011flad\u0131\u011f\u0131 belirlenmi\u015ftir. 4-10<\/sup><\/p>\n\n\n\n

Sonu\u00e7 olarak \u0130SPA tedavisinde sinbiyotik i\u00e7eren alerji formulalar\u0131n\u0131n kullan\u0131m\u0131 hem tat, hem alerjik reaksiyonlar hem de sa\u011fl\u0131kl\u0131 intestinal mikrobiyota geli\u015fimi a\u00e7\u0131s\u0131ndan \u00f6ncelikli olarak kullan\u0131labilir.<\/p>\n\n\n\n

Referanslar:<\/strong><\/p>\n\n\n\n

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  2. Zhao W, Ho HE, Bunyavanich S. The gut microbiome in food allergy. Ann Allergy Asthma Immunol. 2019 Mar;122(3):276-282.<\/li>\n\n\n\n
  3. Qian, M.,et al. Alterations in the gut microbiota of toddlers with cow milk protein allergy treated with a partially hydrolyzed formula containing synbiotics: A nonrandomized controlled interventional study. Food Science & Nutrition, 2024;12(2):765-775.<\/li>\n\n\n\n
  4. Vandenplas Y, et al. Current Guidelines and Future Strategies for the Management of Cow’s Milk Allergy. J Asthma Allergy. 2021 Oct;14:1243-1256.<\/li>\n\n\n\n
  5. Mosca F, Giann\u00ec ML. Human milk: composition and health benefits. Pediatr Med Chir. 2017 Jun 28;39(2):155. doi: 10.4081\/pmc.2017.155. PMID: 28673076.7650147.<\/li>\n\n\n\n
  6. Hubbard GP, et al. Synbiotic containing extensively hydrolyzed formula improves gastrointestinal and atopic symptom severity, growth, caregiver quality of life, and hospital-related healthcare use in infants with cow’s milk allergy. Immun Inflamm Dis. 2022;10(6):e636.<\/li>\n\n\n\n
  7. Van der Aa, et al. Synbiotics prevent asthma-like symptoms in infants with atopic dermatitis. Allergy, 2011;66(2):170\u2013177.<\/li>\n\n\n\n
  8. Chatchatee P, Nowak-Wegrzyn A, Lange L, Benjaponpitak S, Chong KW, Sangsupawanich P, Eussen SRBM, van Ampting MTJ, Oude Nijhuis MM, Langford JE, Trendelenburg V, Pesek R, Davis CM, Muraro A, Erlewyn-Lajeunesse M, Fox AT, Michaelis LJ, Beyer K; PRESTO study team. Tolerance development in cow’s milk-allergic children receiving amino acid-based formula with synbiotics: 36-Months follow-up of a randomized controlled trial (PRESTO Study). J Pediatr Gastroenterol Nutr. 2024 Mar;78(3):699-703<\/li>\n\n\n\n
  9. Soria R, Del Compare M, Sallaberry M, et al. Efficacy of an extensively hydrolyzed formula with the addition of synbiotics in infants with cow’s milk protein allergy: a real-world evidence study. Front Allergy. 2023 Oct 9;4:1265083.<\/li>\n\n\n\n
  10. Sa\u00e7kesen C. et al. \u0130nek S\u00fct\u00fc Proteini Alerjisi Tan\u0131, Tedavi ve \u0130zlem Rehberi. Nobel T\u0131p Kitabevi, 2023.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Besin alerjileri belirli bir g\u0131daya maruz kal\u0131nd\u0131\u011f\u0131nda ortaya \u00e7\u0131kan ve tekrarlanan bir ba\u011f\u0131\u015f\u0131kl\u0131k tepkisi sonucu geli\u015fen olumsuz sa\u011fl\u0131k etkileri olarak tan\u0131mlan\u0131r. Bu t\u00fcr alerjiler, cilt, solunum, sindirim ve\/veya kardiyovask\u00fcler sistemlerde ani veya s\u00fcregelen semptomlara yol a\u00e7abilir.\u00a0 Besin alerjisinin geli\u015fiminde, antijen maruziyeti, kommensal mikrobiyota ve bunlar\u0131n etkile\u015fimlerinin etkisiyle olu\u015fan ba\u011f\u0131\u015f\u0131kl\u0131k tolerans\u0131n\u0131n bozulmas\u0131 \u00f6nemli bir rol oynar.1-3 Prof. Dr. Co\u015fkun \u00c7eltik besin alerjileri hakk\u0131nda \u00f6nemli bilgiler payla\u015ft\u0131. <\/p>\n","protected":false},"author":1,"featured_media":3912,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[48,2],"tags":[],"_links":{"self":[{"href":"https:\/\/pharmaworlddergi.com\/index.php?rest_route=\/wp\/v2\/posts\/3908"}],"collection":[{"href":"https:\/\/pharmaworlddergi.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/pharmaworlddergi.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/pharmaworlddergi.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/pharmaworlddergi.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3908"}],"version-history":[{"count":9,"href":"https:\/\/pharmaworlddergi.com\/index.php?rest_route=\/wp\/v2\/posts\/3908\/revisions"}],"predecessor-version":[{"id":3930,"href":"https:\/\/pharmaworlddergi.com\/index.php?rest_route=\/wp\/v2\/posts\/3908\/revisions\/3930"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/pharmaworlddergi.com\/index.php?rest_route=\/wp\/v2\/media\/3912"}],"wp:attachment":[{"href":"https:\/\/pharmaworlddergi.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3908"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/pharmaworlddergi.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=3908"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/pharmaworlddergi.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=3908"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}